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Lung disease involving long-term poor airflow

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The Gary Null Show
The Gary Null Show - 10.07.21

The Gary Null Show

Play Episode Listen Later Oct 7, 2021 51:37


Natural compound in basil may protect against Alzheimer's disease pathology University of South Florida, October 5, 2021 Fenchol, a natural compound abundant in some plants including basil, can help protect the brain against Alzheimer's disease pathology, a preclinical study led by University of South Florida Health (USF Health) researchers suggests. The new study published Oct. 5 in the Frontiers in Aging Neuroscience, discovered a sensing mechanism associated with the gut microbiome that explains how fenchol reduces neurotoxicity in the Alzheimer's brain. Emerging evidence indicates that short-chain fatty acids (SCFAs)– metabolites produced by beneficial gut bacteria and the primary source of nutrition for cells in your colon—contribute to brain health. The abundance of SCFAs is often reduced in older patients with mild cognitive impairment and Alzheimer's disease, the most common form of dementia. However, how this decline in SCFAs contributes to Alzheimer's disease progression remains largely unknown. Gut-derived SCFAs that travel through the blood to the brain can bind to and activate free fatty acid receptor 2 (FFAR2), a cell signaling molecule expressed on brain cellscalled neurons. "Our study is the first to discover that stimulation of the FFAR2 sensing mechanism by these microbial metabolites (SCFAs) can be beneficial in protecting brain cells against toxic accumulation of the amyloid-beta (Aβ) protein associated with Alzheimer's disease," said principal investigator Hariom Yadav, Ph.D., professor of neurosurgery and brain repair at the USF Health Morsani College of Medicine, where he directs the USF Center for Microbiome Research. One of the two hallmark pathologies of Alzheimer's disease is hardened deposits of Aβ that clump together between nerve cells to form amyloid protein plaques in the brain. The other is neurofibrillary tangles of tau protein inside brain cells. These pathologies contribute to the neuron loss and death that ultimately cause the onset of Alzheimer's, a neurodegenerative disease characterized by loss of memory, thinking skills and other cognitive abilities. Dr. Yadav and his collaborators delve into molecular mechanisms to explain how interactions between the gut microbiome and the brain might influence brain health and age-related cognitive decline. In this study, Dr. Yadav said, the research team set out to uncover the "previously unknown" function of FFAR2 in the brain. The researchers first showed that inhibiting the FFAR2 receptor (thus blocking its ability to "sense" SCFAs in the environment outside the neuronal cell and transmit signaling inside the cell) contributes to the abnormal buildup of the Aβ protein causing neurotoxicity linked to Alzheimer's disease. Then, they performed large-scale virtual screening of more than 144,000 natural compounds to find potential candidates that could mimic the same beneficial effect of microbiota produced SCFAs in activating FFAR2 signaling. Identifying a natural compound alternative to SCFAs to optimally target the FFAR2 receptor on neurons is important, because cells in the gut and other organs consume most of these microbial metabolites before they reach the brain through blood circulation, Dr. Yadav noted. Dr. Yadav's team narrowed 15 leading compound candidates to the most potent one. Fenchol, a plant-derived compound that gives basil its aromatic scent, was best at binding to the FFAR's active site to stimulate its signaling. Further experiments in human neuronal cell cultures, as well as Caenorhabditis (C.) elegans (worm) and mouse models of Alzheimer's disease demonstrated that fenchol significantly reduced excess Aβ accumulation and death of neurons by stimulating FFAR2 signaling, the microbiome sensing mechanism. When the researchers more closely examined how fenchol modulates Aβ-induced neurotoxicity, they found that the compound decreased senescent neuronal cells, also known as "zombie" cells, commonly found in brains with Alzheimer's disease pathology. Zombie cells stop replicating and die a slow death. Meanwhile, Dr. Yadav said, they build up in diseased and aging organs, create a damaging inflammatory environment, and send stress or death signals to neighboring healthy cells, which eventually also change into harmful zombie cells or die. "Fenchol actually affects the two related mechanisms of senescence and proteolysis," Dr. Yadav said of the intriguing preclinical study finding. "It reduces the formation of half-dead zombie neuronal cells and also increases the degradation of (nonfunctioning) Aβ, so that amyloid protein is cleared from the brain much faster." Before you start throwing lots of extra basil in your spaghetti sauce or anything else you eat to help stave off dementia, more research is needed—including in humans. In exploring fenchol as a possible approach for treating or preventing Alzheimer's pathology, the USF Health team will seek answers to several questions. A key one is whether fenchol consumed in basil itself would be more or less bioactive (effective) than isolating and administering the compound in a pill, Dr. Yadav said. "We also want to know whether a potent dose of either basil or fenchol would be a quicker way to get the compound into the brain."   Researchers find sense of purpose associated with better memory Florida State University, October 6, 2021 Add an improved memory to the list of the many benefits that accompany having a sense of purpose in life. A new study led by Florida State University researchers showed a link between an individual's sense of purpose and their ability to recall vivid details. The researchers found that while both a sense of purpose and cognitive function made memories easier to recall, only a sense of purpose bestowed the benefits of vividness and coherence. The study, which focused on memories related to the COVID-19 pandemic, was published in the journal Memory. "Personal memories serve really important functions in everyday life," said Angelina Sutin, a professor in the College of Medicine and the paper's lead author. "They help us to set goals, control emotions and build intimacy with others. We also know people with a greater sense of purpose perform better on objective memory tests, like remembering a list of words. We were interested in whether purpose was also associated with the quality of memories of important personal experiences because such qualities may be one reason why purpose is associated with better mental and physical health." Nearly 800 study participants reported on their sense of purpose and completed tasks that measured their cognitive processing speed in January and February 2020, before the ongoing coronavirus pandemic took hold in the U.S. Researchers then measured participants' ability to retrieve and describe personal memories about the pandemic in July 2020, several months into the public health crisis. Participants with a stronger sense of purpose in life reported that their memories were more accessible, coherent and vivid than participants with less purpose. Those with a higher sense of purpose also reported many sensory details, spoke about their memories more from a first-person perspective and reported more positive feeling and less negative feeling when asked to retrieve a memory. The researchers also found that depressive symptoms had little effect on the ability to recall vivid details in memories, suggesting that the connection between life purpose and memory recall is not due to the fewer depressive symptoms among individuals higher in purpose. Purpose in life has been consistently associated with better episodic memory, such as the number of words retrieved correctly on a memory task. This latest research expands on those connections to memory by showing a correlation between purpose and the richness of personal memory. "We chose to measure the ability to recall memories associated with the COVID-19 pandemic because the pandemic is an event that touched everyone, but there has been a wide range of experiences and reactions to it that should be apparent in memories," said co-author Martina Luchetti, an assistant professor in the College of Medicine. Along with the association with better memory, previous research has found other numerous benefits connected with having a sense of purpose, from a lower risk of death to better physical and mental health. "Memories help people to sustain their well-being, social connections and cognitive health," said co-author Antonio Terracciano, a professor in the College of Medicine. "This research gives us more insight into the connections between a sense of purpose and the richness of personal memories. The vividness of those memories and how they fit into a coherent narrative may be one pathway through which purpose leads to these better outcomes.   Vitamin D protects against severe asthma attacks Queen Mary University of London, October 3, 2021 Taking oral vitamin D supplements in addition to standard asthma medication could halve the risk of asthma attacks requiring hospital attendance, according to research led by Queen Mary University of London (QMUL). Asthma affects more than 300 million people worldwide and is estimated to cause almost 400,000 deaths annually. Asthma deaths arise primarily during episodes of acute worsening of symptoms, known as attacks or 'exacerbations', which are commonly triggered by viral upper respiratory infections. Vitamin D is thought to protect against such attacks by boosting immune responses to respiratory viruses and dampening down harmful airway inflammation. The new study, funded by the National Institute for Health Research, and published in The Lancet Respiratory Medicine, collated and analysed the individual data from 955 participants in seven randomised controlled trials, which tested the use of vitamin D supplements. Overall, the researchers found that vitamin D supplementation resulted in: a 30 per cent reduction in the rate of asthma attacks requiring treatment with steroid tablets or injections - from 0.43 events per person per year to 0.30. a 50 per cent reduction in the risk of experiencing at least one asthma attack requiring Accident and Emergency Department attendance and/or hospitalisation - from 6 per cent of people experiencing such an event to 3 per cent. Vitamin D supplementation was found to be safe at the doses administered. No instances of excessively high calcium levels or renal stones were seen, and serious adverse events were evenly distributed between participants taking vitamin D and those on placebo. Lead researcher Professor Adrian Martineau said: "These results add to the ever growing body of evidence that vitamin D can support immune function as well as bone health. On average, three people in the UK die from asthma attacks every day. Vitamin D is safe to take and relatively inexpensive so supplementation represents a potentially cost-effective strategy to reduce this problem." The team's use of individual participant data also allowed them to query the extent to which different groups respond to vitamin D supplementation, in more detail than previous studies. In particular, vitamin D supplementation was found to have a strong and statistically-significant protective effect in participants who had low vitamin D levels to start with. These participants saw a 55 per cent reduction in the rate of asthma exacerbations requiring treatment with steroid tablets or injections - from 0.42 events per person per year to 0.19. However, due to relatively small numbers of patients within sub-groups, the researchers caution that they did not find definitive evidence to show that effects of vitamin D supplementation differ according to baseline vitamin D status. Professor Hywel Williams, Director of the NIHR Health Technology Assessment Programme, said: "The results of this NIHR-funded study brings together evidence from several other studies from over the world and is an important contribution to reducing uncertainties on whether Vitamin D is helpful for asthma - a common condition that impacts on many thousands of people worldwide." Dr David Jolliffe from QMUL, first author on the paper, added: "Our results are largely based on data from adults with mild to moderate asthma: children and adults with severe asthma were relatively under-represented in the dataset, so our findings cannot necessarily be generalised to these patient groups at this stage. Further clinical trials are on-going internationally, and we hope to include data from them in a future analysis to determine whether the promise of today's results is confirmed in an even larger and more diverse group of patients."     Study Shows Lifestyle Choices Have Significant Impact on Multiple Chronic Conditions, Significant Implications For Reducing Costs Yale University,  October 05, 2021 In a study published in the Journal of Preventive Medicine, Adams and colleagues showed a linear association between a number of modifiable risk factors and multiple chronic conditions, making those modifications a key to health care cost savings and to preventing a wide range of conditions. The data analyzed for the study, https://authors.elsevier.com/a/1VpFeKt2pmc9H, were from the publicly available 2013 Behavioral Risk Factor Surveillance System and included 483,865 non-institutionalized US adults ages 18 years old or older. Chronic conditions included asthma, arthritis, heart disease, stroke, chronic obstructive pulmonary disease (COPD), cognitive impairment, cancer other than skin, and kidney disease. Risk factors included obesity, current smoking, sedentary lifestyle, inadequate fruit and vegetable consumption and sleeping other than seven to eight hours, while depression, hypertension, high cholesterol, and diabetes were considered in each category. Previous research by Thorpe and colleagues had estimated that the care of adults with four or more chronic conditions (17.1% of all adults in the study) is responsible for 77.6% of all health care costs in the U.S. today. The potential savings by reducing just two risk factors (diabetes and hypertension) and their related comorbidity was estimated previously by Ormond and colleagues at $9 billion annually over one to two years and closer to $25 billion a year after 5 years or more, factoring in possible complications. True Health Initiative founder, at Yale University  Director and study co-author David L. Katz, MD, MPH, FACLM, pointed out that in addition to costs, another implication of the study results is an individual's access to healthcare if they have one or more of the chronic conditions. "Although insurers decide what qualifies as a pre-existing condition, all the chronic conditions used in this study except cognitive impairment are commonly included," he said. "Individuals with a pre-existing condition could be denied coverage or face higher premiums. While having a pre-existing condition might not affect coverage for adults eligible for Medicare, over half of all adults with multiple chronic conditions are ages 18 to 64 years." American College of Lifestyle Medicine President George Guthrie, MD, MPH, FACLM, said the study confirms the necessity for addressing the root cause of chronic conditions. "The evidence shows that the risks for chronic disease are rooted in lifestyle choices," he said. "More than ever, it is important to emphasize lifestyle medicine as the first treatment option for preventing, treating, and in some cases, reversing the cause of chronic conditions. If we can help people with chronic conditions, we can add years to their life and life to their years, as well as lower the ever-increasing costs of healthcare for everyone."     Physical athletes' visual skills prove sharper than action video game players University of Waterloo (Canada), October 7, 2021 Athletes still have the edge over action video gamers when it comes to dynamic visual skills, a new study from the University of Waterloo shows. For an athlete, having strong visual skills can be the difference between delivering a peak performance and achieving average results. "Athletes involved in sports with a high-level of movement—like soccer, football, or baseball—often score higher on dynamic visual acuity tests than non-athletes," said Dr. Kristine Dalton of Waterloo's School of Optometry & Vision Science. "Our research team wanted to investigate if action video gamers—who, like e-sport athletes, are regularly immersed in a dynamic, fast-paced 2D video environment for large periods of time—would also show superior levels of dynamic visual acuity on par with athletes competing in physical sport." While visual acuity (clarity or sharpness of vision) is most often measured under static conditions during annual check-ups with an optometrist, research shows that testing dynamic visual acuity is a more effective measure of a person's ability to see moving objects clearly—a baseline skill necessary for success in physical and e-sports alike.  Using a dynamic visual acuity skills-test designed and validated at the University of Waterloo, researchers discovered that while physical athletes score highly on dynamic visual acuity tests as expected, action video game players tested closer to non-athletes.  "Ultimately, athletes showed a stronger ability to identify smaller moving targets, which suggests visual processing differences exist between them and our video game players," said Alan Yee, a Ph.D. candidate in vision science. All participants were matched based on their level of static visual acuity and refractive error, distinguishing dynamic visual acuity as the varying factor on their test performance. These findings are also important for sports vision training centers that have been exploring the idea of developing video game-based training programs to help athletes elevate their performance. "Our findings show there is still a benefit to training in a 3D environment," said Dalton. "For athletes looking to develop stronger visual skills, the broader visual field and depth perception that come with physical training may be crucial to improving their dynamic visual acuity—and ultimately, their sport performance."  The study, Athletes demonstrate superior visual dynamic visual acuity, authored by Waterloo's School of Optometry & Vision Science's Dalton, Yee, Dr. Elizabeth Irving and Dr. Ben Thompson, was recently published in the journal Optometry and Vision Science.     Probiotic Akkermansia muciniphila and environmental enrichment reverse cognitive impairment associated with high-fat high-cholesterol consumption University of Oviedo (Spain), September 8, 2021 Nonalcoholic steatohepatitis (NASH) is one of the most prevalent diseases globally. A high-fat, high-cholesterol (HFHC) diet leads to an early NASH model. It has been suggested that gut microbiota mediates the effects of diet through the microbiota–gut–brain axis, modifying the host's brain metabolism and disrupting cognition. Here, we target NASH-induced cognitive damage by testing the impact of environmental enrichment (EE) and the administration of either Lacticaseibacillus rhamnosus GG (LGG) or Akkermansia muciniphila CIP107961 (AKK). EE and AKK, but not LGG, reverse the HFHC-induced cognitive dysfunction, including impaired spatial working memory and novel object recognition; however, whereas AKK restores brain metabolism, EE results in an overall decrease. Moreover, AKK and LGG did not induce major rearrangements in the intestinal microbiota, with only slight changes in bacterial composition and diversity, whereas EE led to an increase in Firmicutes and Verrucomicrobia members. Our findings illustrate the interplay between gut microbiota, the host's brain energy metabolism, and cognition. In addition, the findings suggest intervention strategies, such as the administration of AKK, for the management of the cognitive dysfunction related to NASH. In this study, we described cognitive, brain metabolism, and microbiota alterations associated with high-fat and high-cholesterol consumption. In addition, we clearly showed that environmental enrichment and A. muciniphila CIP107961 restore cognitive dysfunction. Furthermore, we revealed that cognitive improvement is associated with differential effects of environmental enrichment and this strain of A. muciniphila on brain metabolism and gut microbiota. Finally, we discovered that restored cognitive function was associated with the administration of A. muciniphila CIP107961, but not L. rhamnosus GG, which may be clinically relevant when selecting probiotics for treating HFHC-derived pathologies. In conclusion, the microbiota and cognition are intimately connected through the gut–brain axis, and in HFHC pathologies they can be influenced by environmental enrichment and A. muciniphila CIP107961 administration. Cognitive improvement was accompanied by changes in brain metabolic activity and gut microbial composition analysis, pointing to specific microbiota targets for intervention in diet-induced pathologies. However, some mechanisms other than major changes in microbiota composition and the combined effect of environmental enrichment and A. muciniphila administration, which we identified in this study, may also be biologically relevant and will need to be investigated in future studies due to their relative contributions to the selection of effective treatments for patients.           

JAMA Editors' Summary: On research in medicine, science, & clinical practice. For physicians, researchers, & clinicians.
Scopolamine Butylbromide for End-of-Life Death Rattle, Pulmonary Embolism Workups in COPD Exacerbation, Eosinophilic Esophagitis review, and more

JAMA Editors' Summary: On research in medicine, science, & clinical practice. For physicians, researchers, & clinicians.

Play Episode Listen Later Oct 5, 2021 9:23


Editor's Summary by Anne Cappola, MD, Associate Editor of JAMA, the Journal of the American Medical Association, for the October 5, 2021 issue.

Modern Mindset with Adam Cox
227 - Karen O'Hara on Alpha-1 Antitrypsin Deficiency

Modern Mindset with Adam Cox

Play Episode Listen Later Sep 28, 2021 10:24


Adam Cox is joined by Karen O'Hara, Chair of patient advocacy group, Alpha-1 UK Support Group, to discuss what Alpha-1 Antitrypsin Deficiency (AATD) is and the causes of the condition. They look at why is can be so difficult for sufferers to get a diagnosis, and Karen explains her own experience living with AATD.  https://alpha1.org.uk 

Back to Basics
Chronic Obstructive Pulmonary Disease - COPD

Back to Basics

Play Episode Listen Later Sep 28, 2021 30:52


Emphysema and Chronic Bronchitis together make up COPD. These are obstructive lung diseases like asthma, but what differentiates Emphysema from Chronic Bronchitis? Do your patients always have both? Find out in this episode of Back to Basics! We also have a big announcement! Soon we will be launching Guardian CME!! Guardian CME is a 100% FREE CAPCE platform so that you can get all your CAPCE credits by engaging our content as well as content from other great educators. And you heard that right....it's FREE! Head over to www.guardiancme.com and drop your email so we can let you know when we launch. --- Support this podcast: https://anchor.fm/guardianpodcast/support

Circulation on the Run
Circulation September 28, 2021 Issue

Circulation on the Run

Play Episode Listen Later Sep 27, 2021 29:39


This week's episode features a panel discussion. Please join author Harmony Reynolds, editorialist David Newby, and Associate Editors Nicholas Mills and Sandeep Das as they discuss the articles "Natural History of Patients with Ischemia and No Obstructive Coronary Artery Disease: The CIAO-ISCHEMIA Study, "Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity," and editorial "Forget ischemia, it's all about the plaque." Dr. Greg Hundley: Welcome listeners to this week's, September 28th, issue of Circulation on the Run. And I'm Dr. Greg Hundley, Director of the Poly Heart Center at VCU Health in Richmond, Virginia, and associate editor at Circulation. And this week, listeners, we have an outstanding feature discussion. It's actually forum where we're going to discuss from Dr. Reynolds two papers pertaining to the ischemia trial. One looking really at the functional importance of stress testing, the other looking at the anatomical importance of cardiac CT scanning. We're going to have two of the associate editors along with Dr. Reynolds, each that handled the two papers and also a guest editorialist that will help put the entire paper together. Well, before we get to that, we're going to start and review some of the other papers in this issue. And let's grab a cup of coffee and get started. Dr. Greg Hundley: The first comes to us from Dr. Maliheh Nazari-Jahantigh from Ludwig Maximilian University in Munich, Germany, and it pertains to atherosclerotic plaque rupture. So the necrotic core of an atherosclerotic plaque is partly formed by ineffective efferocytosis, which increases the risk of an atherosclerotic plaque rupture. And in cell biology, efferocytosis comes from the Latin word effero, which means to take to the grave or to bury. And it's really the process by which apoptotic cells are removed by phagocytic cells. And so therefore, it can be regarded as the burying of "dead cells." Now MicroRNAs contribute to necrotic core formation by regulating efferocytosis as well as macrophage apoptosis. We also know that atherosclerotic plaque rupture occurs at an increased frequency in the early morning, indicating that diurnal changes occur in plaque vulnerability. Now all those circadian rhythms play a role in atherosclerosis, the molecular clock output pathways that control plaque composition and rupture susceptibility are unclear. Dr. Greg Hundley: And so these authors investigated this phenomenon. And what they found, interestingly, their results suggest that the molecular clock in atherosclerotic lesions induces a diurnal rhythm of apoptosis regulated by circadian Mer 21 expression in macrophages that is not matched by efferocytosis, and thereby increasing the size of the necrotic core of these plaques. So clinically, the implications are that a macrophage death clock controlled by mer 21 may enhance lesion growth and susceptibility to plaque rupture indicating that the molecular clock can have detrimental effects under pathologic conditions. And additionally, the molecular clock in lesional macrophages may contribute to the circadian pattern of myocardial infarction, which could be a target for preventive measures to limit the mismatch between apoptosis and efferocytosis and thus reduce plaque vulnerability in the early morning. Dr. Greg Hundley: Well, our second paper comes to us also from the world of preclinical science, and it's from Professor Thomas Braun from the Max Planck Institute for heart and lung research. And this particular paper pertains to pulmonary hypertension. And as we know, pulmonary hypertension and chronic obstructive pulmonary disease, or COPD, originate from a complex interplay of environmental factors in genetic predispositions and little is known about developmental abnormalities or epigenetic dysregulation that might predisposed individuals to develop pulmonary hypertension or COPD in adults. So these authors screen a cohort of human pulmonary hypertension in COPD patients for changes of histone modifications by immunofluorescent staining. And also, they developed knockout mouse lines targeting cardiopulmonary progenitor cells and different heart and lung cell types. Dr. Greg Hundley: Now molecular, cellular and biochemical techniques were applied to analyze the function of SUV420H1-dependent epigenetic processes in cardiopulmonary progenitor cells and their derivatives. Well, what did they find? So the investigators found that loss of SUV420H1 in cardiopulmonary progenitor cells caused a COPD-like pulmonary hypertension phenotype in mice, including formation of perivascular tertiary lymphoid tissue, and goblet cell hyperplasia, hyperproliferation of smooth muscle cells and myofibroblast, impaired alveolarization and maturation of defects of the microvasculature leading to massive ripe ventricular dilation and premature death. Dr. Greg Hundley: Now mechanistically SUV420H1 bound directly to the five prime upstream in regulatory element of Superoxide Dismutase 3 gene to repress its expression and increased levels of the extracellular Superoxide Dismutase 3 enzyme in SUV420H1 mutants increased hydrogen peroxide concentration causing vascular defects and impairing alveolarization. So what can we take away, listeners, from this clinically? Well, the author's findings reveal a pivotal role of histone modifier SUV420H1 in cardiopulmonary co-development and uncover developmental origins of cardiopulmonary diseases. And now these results suggest that this study will facilitate the understanding of pathogenic events causing pulmonary hypertension in COPD and aid the development of epigenetic drugs for treatment of other cardiopulmonary diseases. Dr. Greg Hundley: Well, listeners, what else is in, we call it, the mail bag, but some of the other articles in the issue? Well, doctors Varricchi and Wang exchanged letters regarding the prior article, the role of IgE FcεRI in pathological cardiac remodeling and dysfunction. And our own Sara O'Brien highlights articles from our circulation family of journals. Professor Ross has a Research Letter regarding the effects of walnut consumption for two years on lipoprotein subclasses among healthy elders findings from the WAHA randomized controlled trial. And then finally, Dr. Maurer has a really nice On My Mind piece that raises concerns pertaining to the use of cardiac scintigraphy and screening for transthyretin cardiac amyloidosis. And now listeners, we're going to turn to that forum discussion where we have an author, our associate editors and an editorialist discussing two really important papers from the ischemia trial. Dr. Greg Hundley: Well, listeners, we are very excited today to discuss in sort of the forum feature, two papers pertaining to the ischemia trial. And with us this day, we have Dr. Harmony Reynolds from New York University Grossman School of Medicine in New York city; two of our associate editors, Dr. Nick Mills from university of Edinburgh in Scotland; and Dr. Sandeep Das from UT Southwestern; and then also an editorialist, Dr. David Newby, who's also University of Edinburgh in Scotland. Welcome to everyone. Dr. Greg Hundley: Harmony, we're going to start with you. And in the first paper, the natural history of ischemia and no obstructive coronary artery disease, can you describe for us a little bit of the context of what shaped this question for you, what hypothesis did you want to test? And then describe for us a little bit your study population and your study design. Dr. Harmony Reynolds: Sure. Thanks so much for having me here to discuss these papers. I'm really appreciative of the attention from circulation, and I'm excited for this discussion today. So in this first natural history paper, we were looking at ischemia with non-obstructive corona arteries, INOCA, the kind of thing that used to be called cardiac syndrome X. And we know this is an extremely common problem. It's defined by having signs or symptoms of ischemia and no 50% or greater lesion on coronary imaging. And we also know from prior invasive studies that the mechanisms of this are overwhelmingly microvascular coronary disease and provokable coronary spasm. Some patients prove to be normal and invasive testing, but most will have some objective abnormality. Dr. Harmony Reynolds: We know this problem is associated with a higher risk of cardiovascular events and with high costs, but what we didn't know was whether the symptoms and ischemia on stress testing are tracking together in these patients. So if we're trying to treat these patients, should we be doing serial stress testing and targeting the medical therapy to ischemia abrogation or should we just be making their symptoms go away? And would this provide any long range insights for us into when we can figure out the symptom are truly ischemic in nature? Dr. Harmony Reynolds: So we decided to use the ischemia trial, and we had a fantastic platform for that in ischemia because, as you know, patients were screened in part for randomization using coronary CT angiography. And even though these patients had moderate or severe ischemia, some had no obstructive coronary disease on that CT coronary angiogram. And those are the patients that we enrolled in CIAO-ISCHEMIA. They had an assessment of angina at baseline, and they had to be symptomatic at some point. They didn't have to be symptomatic at the moment. They were enrolled in CIAO, but they had their stress test generally to evaluate ischemic symptoms. And they had their stress echocardiogram read by a core lab. Importantly, that core lab did not know the result of that CT scan. So they read them like all the other ischemia stress echoes. And then these patients had an angina and ischemia assessment with a repeat stress echo at one year. Dr. Greg Hundley: And what did you find? Dr. Harmony Reynolds: There were a number of interesting findings from this study. The first thing was that the severity of ischemia in the CIAO patients with INOCA was very similar to the ischemia patients who had obstructive coronary disease. So that tells us that the INOCA problem can happen with quite a lot of ischemia, and that had not been as well delineated before. Another finding expected, but we did find that is that there were many more women in the INOCA group, two thirds of our child population was female. And in ischemia, overall, it was closer to a quarter. We found that the symptoms and the ischemia were quite changeable. So at one year, the stress echocardiogram was normal in half of the child participant and only 23% still had moderate or severe ischemia. Angina had improved in 43%, and it worsened in 14%. There was an awful lot of change over one year, but the change in angina and the change in ischemia did not track together. And that was a bit of a surprise to me. Dr. Greg Hundley: Very nice. Well, Nick, I know serving it as an associate editor, you see many papers come across your desk. What attracted you to pushing this paper forward for publication? Dr. Nicholas Mills: Thanks, Greg, and congratulations. Harmony, we love the papers you've been sending from ischemia trial, which genuinely is changing clinical practice all over the world. And it's been great to see the secondary analysis and follow-up papers. So this paper attracted me because it addresses an area where I still don't fully understand in clinical practice, what recommendations to make for my patients and what tests to arrange. As you say, INOCA is more common in women. I think these patients have largely been understudied over many decades, and there remains a lot of uncertainty. I liked it because you had a core lab, blinded core lab analysis with systematic follow up and it was a really well-done study. It reassured me in many ways because it told me that actually a lot of these patients, their symptoms get better, sort of irrespective of what we do. The treatments didn't seem to track within improvements of symptom, nor did the severity of ischemia, and that I think provides a lot of reassurance to our patients who are in this situation. Dr. Nicholas Mills: Of course, there is a group there who continue to have moderate to severe ischemia a year later. And I think this trial helps us understand maybe how we should study this group more, understand the heterogeneity that you've observed in this population in order to really try and resolve that and resolve their ongoing symptoms. But for the majority, four in five patients, they're going to do well and they're going to get better over time. And I think that's an important message from this study. Dr. Greg Hundley: Thank you so much, Nick. Well, Harmony, we're going to come back to you. You have a second paper, the outcomes in the ischemia trial really based on coronary artery disease and ischemia severity. Can you describe for us, again, working us back through, what were some of the constructs that you really wanted to address here? What was your hypothesis? And again, how did this study population maybe differ a little bit in this second paper? Dr. Harmony Reynolds: Thanks so much. So this paper tracked outcomes based on the severity of ischemia and the severity of coronary artery disease on the CT coronary angiogram now in randomized patients in the ischemia trial. So all of these had obstructive coronary disease and they were selected for randomization. And the premise of the ischemia trial was partly that we would be able to select patients who might benefit from revascularization and from an invasive strategy really based on how much ischemia they had on the stress test. Moderate or severe ischemia was required for randomization and for entry into the trial, but a core lab read those stress tests independently and independently assessed ischemia. And in some cases, when the site thought there was moderate or severe ischemia, the core lab did not agree. And the core lab independently decided whether it was moderate or severe. So we wanted to understand whether the ischemia severity at the time of trial entry influenced outcomes and influenced the outcomes by randomization treatment assignment. Dr. Harmony Reynolds: Similarly, about half of the patient had a CT that was interpretable for the number of vessels disease. And we wanted to understand in the context of all those prior stable ischemic heart disease trials, showing a lot of heterogeneity by the amount of coronary disease, whether in ischemia as well, there would be heterogeneity of the treatment effect based on how much coronary disease you started with. So the ischemia population, and this is almost the entire randomized cohort, but it's important to recognize for the CT analysis that only about three quarters of the patients had CT. They didn't get a CT, if your GFR was too low or if you had known coronary anatomy. And among those Cts, not every CT is perfectly interpretable for the number of vessels disease. These are sicker patients. These are not the super stable patients who have a low prevalence of disease. These were pretty sick, multi-vessel coronary disease patients, and they couldn't always hold their breast all that well. There was a lot of calcification in these. Dr. Harmony Reynolds: So for example, if there was motion artifact in the right coronary artery, we wouldn't be able to quantify the number of vessels disease. And that left us with a cohort of about half of our ischemia population, but that's still a giant cohort of several thousand patients. So that's how our study. Dr. Greg Hundley: Very good. And what did you find here? Dr. Harmony Reynolds: Here, we found that more severe ischemia was not associated with outcomes. Now that does go along with the COURAGE study in which after you adjust for clinical characteristics, ischemia was not associated with outcomes. But still it came as something of a surprise that even severe ischemia was not associated with a higher risk of outcomes than moderate or mild ischemia. We also found that in the coronary disease group, no matter how you measure the severity of coronary disease, the Duke prognostic index, the number of vessels disease, the segment involvement score, the segment stenosis score, all of these measures were very strongly associated with our outcomes, whether it was all cause mortality MI or our composite. Dr. Harmony Reynolds: When it came to treatment effect, we found that the ischemia severity were no relationship to treatment effect. There was no ischemia subgroup in which there appeared to be an advantage with an invasive strategy. But in the coronary disease group, and again taking into account the caveats of not everybody had a CT interpretable for the number of vessels disease, in those with the most severe coronary disease, that's the Duke 6 subgroup. And they had multi-vessel severe disease, either two vessel including the proximal LAD at 70% or three vessels with 70% stenosis. There was no benefit on mortality. But if we looked at the composite endpoint of cardiovascular death or MI, there appeared to be some advantage to the invasive strategy. Dr. Greg Hundley: Very good. Well, Sandeep, similar to Nick, working as an associate editor and meeting weekly, what attracted you to this particular paper? And why did you want to really see it come forward to be published? Dr. Sandeep Das: So first of all, I want to echo Nick's comments that these are great papers, and thanks very much for sending those our way and letting us have sort of first crack at them before they're released to the world. And I also want to comment on the side that Harmony and her team were just absolutely fantastic to work with in this process. From having been on the other side when you get 300 different comments from the editors and reviewers and you respond to them thoroughly and with grace, that's a feat in and of itself. So I want to shout out Harmony and her team for just being fantastic partners, because really we see ourselves as sort of the author's partners in kind of making the paper as good as it can be as the best it can be. Dr. Sandeep Das: So I'll admit upfront, I think it's kind of fashionable for people to say, well, I knew that this was going to show this, I knew this all from COURAGE, and this is not surprising to me. But I'll admit that I was surprised. And so this has been practice-changing for me, so this whole evolution post ischemia. And I really feel like a little bit of an existential crisis because I'm not sure I understand what ischemia means anymore. You ask me five years ago, I would've been very confident that I knew the answer to that. So you know what, really, as soon as this paper crossed our desk, I thought, wow, this is something we want to keep, this is something that's going to be really important to practice of cardiology. It's going to be really important to our readers. It's a great paper from a great group. This is something we want. So really it was never a question of, well, am I interested or am I not? I was interested from reading the abstract. Dr. Sandeep Das: So the question then became what are the real important questions that we need to sort of tease out and help elucidate for the clinician for the reader? And really for me, the question has always been, is there a subset of people where... So in my heart of hearts, I always kind of thought that burden of ischemia, if there was enough burden of ischemia, that it probably did help to revascularize that, right? I definitely practiced that way, right? There was some sort of number where I would start to say, that's a lot of ischemic myocardium and maybe we need to do something about that. Even though I know my intellectual brain says, no, there's no data that supports this, I really kind of thought it was true. And so Harmony and her team put another nail in that coffin here because it doesn't seem to be true, which to me was interesting and different and practice-changing. Dr. Sandeep Das: So the real questions here were sort of to tease out the interaction between anatomic severity, and we've all known that sort of anatomic burden of disease is proportional to adverse outcomes. That's not surprising. But the question then is, can we tease out a group where there may be benefit to revascularization? So there's a real interesting sort of interplay here between degree of ischemia and anatomic burden of disease. And is there a subset with enough of an anatomic burden of disease where you really may be interested in going after that to improve heart outcomes? So that's what I thought this was really fascinating paper. Dr. Greg Hundley: Very good. Well, David, we're going to turn to you next as the editorialist and asking you to sort of put the results of each of these two studies together. One, kind of highlighting for us how functional imaging might be useful to identify whether ischemia is present or not. And then the second study, really defining for us an association between anatomy and outcomes. So putting these all together, could you share your thoughts with us regarding these two papers? Dr. David Newby: Yes. Thank you. So I think that the CIAO-ISCHEMIA is very interesting, isn't it? And those clinicians were often challenged with symptoms versus our objective tests and trying to work out exactly what's going on, and it is. And such an important group as Harmony says, I can't agree more. We have a lot of morbidity here. As Nick said, I think the short term, a lot of the patients do seem to get better with just conservative management is good, but there's a core group that clearly are a problem. And as Harmony highlighted, you've got people with terrible regional wall-motion abnormalities on stress echo and yet no angina, others with no angina with no apparent difficulty on repeat testing. And then you've got a core group that has both, and it is fascinating to try and unpick that. And clearly, the symptoms are not correlating with our tests, and that's not the patient's fault. Dr. David Newby: And very often, no, no, you're wrong, can we say that to the patient? No, no, the patient is right and our tests are wrong, and we've got to work out how best to manage them. And I have a bit of analogy with Takotsubo cardiomyopathy as well, I think is at play here. I mean, here, you've got people with stable pain. We're not coming in as an acute emergency, but they're having regional wall motion abnormalities at times. They're getting a lot of symptoms. And we see similar things with Takotsubo, which is, I suppose, a much more flurry thing. I know that's something close to Harmony's his heart too. Excuse the pun. But this ischemia relationship, these regional wall motion abnormalities with chest pain, particularly in women, is something we really need to get our heads around and understand what's going on. It just reflects our ignorance, I think, of knowing exactly how to manage these patients. Dr. David Newby: And so for me, ischemia testing is about symptoms. It's about working out what's going on with the patient. It doesn't always give us the answer, but I certainly think that the role of ischemia testing is more about the symptoms. Dr. David Newby: And then when it comes to the second paper and outcomes with the ischemia trial, I absolutely was delighted to see those findings. I have to say place to what my prejudice is, I suppose, as someone that's been working with CT. And I suppose the slightly obvious thing is that the more disease you have, the more you will benefit from an intervention. And plaque and the burden of plaque is critical to that because how do you have a heart attack? Well, you have to have plaque, right? And it has to rupture. So the more plaque you have, the more likely you are. And I think that the analysis is again reinforcing what we've learned from some of the imaging trials with PROMIS and SCOT-HEART. Actually, the more plaque you have, the worse you are. Dr. David Newby: And yes, ischemia predicts risk, but ischemia predicts risk through its association with plaque burden, not through ischemia itself. And what I think we're seeing very nicely being played out in ischemia trial is the risk is definitely much stronger for CT than it is for imaging. And that's very clear, and that's exactly what PROMIS found exactly what SCOT-HEART found as well, and it's a rise robust finding. The interaction with the treatment effect that I find also fascinating and again plays to some of the bypass surgery trials that we've seen, bypass surgery tends to prevent spontaneous MIs and, even in some cases, mortality. And we're seeing trends in ischemia for mortality, can't over call them. I'd love to see what happens in 10 years. But I think in terms of the prevention of MIs, I'm putting all my money in one basket, which is the bypass surgery, 25% of course of patients revascularized that way. I don't believe that PCI is going to prevent the myocardial infarction. So I think all my money is in that box. Dr. David Newby: But it's absolutely fascinating data. It is all about the plaque if you're talking about prevention of clinical events downstream. And I think that's where the dichotomy is, scheme is about symptoms and understanding the patient's problems in terms of symptomatic improvement. If you want to improve their long term outcome, it's all about the plaque, understanding the burden of plaque and what you can do to hopefully prevent downstream event. Dr. Greg Hundley: Great. Thank you so much. And so listeners, we're going to ask each of our speakers today in really 20 or 30 seconds to go through and identify what do they think is the next study really to be performed in this space? So Harmony, we're going to start with you and then Nick, Sandeep and then finish up with David. Harmony? Dr. Harmony Reynolds: Thanks. Well, when it comes to INOCA, I would like to see more studies in the vein of CorMicA. So I'd like to see routine invasive testing to define the underlying pathophysiology problem and then targeted medical therapy interventions, and I'd like to see outcome trials. There's one outcome trial going on. It's a challenge because the event rate, though very important and higher than in the general population for sure, is low enough that these trials have to be quite large, and we look at ischemia with a relatively high event rate. And even so it's a stable population and that had to be large, this would have to be even larger. So we're going to need more mechanistic studies in order to lead to the treatment trials that will really influence practice. Dr. Harmony Reynolds: And in terms of the severity of coronary disease, this is a tough one. We felt like ischemia was a lift, and I'm not sure that there will be another huge stable ischemic heart disease trial. But sure, I'd love to see in people selected by CT for their advanced severity of coronary disease, whether an invasive management strategy makes a difference compared to medical therapy. I don't know that we'll see that one come to pass, but you never know. Dr. Greg Hundley: Nick? Dr. Nicholas Mills: Yeah. I agree. We need more mechanistic research, but I'd like to see more non-invasive methods to understand the mechanistic basis of this condition because CorMicA has caught an invasive protocol for a condition, which we know is benign and who most patients get better without any treatment. I would also like to see randomized blinded studies of treatment effects and because there are too many observational on blinded studies here. And I think the outcome has to be patient-focused and symptoms. Dr. Greg Hundley: Sandeep? Dr. Sandeep Das: Yeah. So everything that's been raised so far are fantastic comments and really on point. For me, I think if we can tease out the population that may benefit to get back to Dave's earlier comment that there's possibly not going to be a little humble here, there's possibly a population that has extensive, extensive CVD that could benefit from bypass surgery. And I think that that hasn't really been firmly demonstrated yet, although it's been suggested strongly. So that I think is an interesting study, and I hope that that gets done as a trial, but I can understand that it'd be a giant undertaking. And then the other thing I think is just algorithmic approaches that are driven by anatomical studies like SCOT-HEART and things like that, where we really try to make decisions based on the anatomical approach and pretend like the last 15 years never happened and that we kind are starting fresh with our best approach to how to treat these patients. Dr. Greg Hundley: And finally, David. Dr. David Newby: Yeah. I'm actually going to agree with everybody there, and I'm rooting for this trial actually because that's the one I want to do is look at advanced coronary disease on noninvasive imaging, irrespective of symptoms. And that's the big call actually if you've got no symptoms to put yourself through a bypass, because it's bypass, it's not standing. Bypass, we need. I'd also love to see some substudy coming out of ischemia. I think you're doing them. I hope you are looking at plaque burden and plaque characteristics because I think that's another level of complexity. We're so obsessed with stenosis, actually. And again, even anatomical and ischemia testing plays to that, it's not just about stenosis, stenotic arteries have big plaque burdens, et cetera. And it's not bypassing them, it's bypassing all the nonobstructive plaque and the obstructive plaque that has given you the benefit of revascularization with surgery. So I think you need to think about a really nice cool trial where we can do that trial even in the presence of nonobstructive disease, but big plaque burden, adverse plaque characteristics, and think about bypass. Dr. Greg Hundley: Very nice. Well, listeners, we want to thank Dr. Harmony Reynolds for bringing us these two really informative studies from the ischemia trial, and also our associate editors, Dr. Nick Mills and Dr. Sandeep Das for providing their perspective and our editorialist, Dr. David Newby, who really helped us organize our thoughts and put both of these two studies into great perspective highlighting in the first that functional testing can really help us identify the presence or absence of ischemia. And then our second study highlighting the association between CT coronary angiography and the identification of the anatomic severity of disease with cardiac outcomes. Dr. Greg Hundley: Well, on behalf of Carolyn and myself, we want to wish you a great week and we will catch you next week on the run. This program is copyright of the American Heart Association 2021. The opinions expressed by speaker in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit ahajournals.org.

Coffee Break HEMS Podcast
02.14 Avoiding the Vented COPD Death Spiral

Coffee Break HEMS Podcast

Play Episode Listen Later Sep 21, 2021 39:09


Hey guys, this week we're talking about intubated and vented COPDers and their annoying tendency to AutoPEEP on the vent.

biobalancehealth's podcast
Healthcast 563 - Viruses & Immunization: Who is at the Highest Risk of not Responding to Immunizations and getting COVID?

biobalancehealth's podcast

Play Episode Listen Later Sep 21, 2021 25:22


See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog/ There are known risks for individuals not responding to a vaccine e.g. Covid.   The factors that are key to responding to a vaccine hinge on the health and intact immune system of the patient.  The immune system is affected by your lifestyle, genetics, age and current medical conditions.  If your immune system is healthy, it will respond as predicted to make antibodies to kill the virus you are immunized against. In one sentence, healthy people respond to vaccines as they should and are protected against that virus from invading your body and causing disease. Immunized people with intact immune systems should not be able to transmit the disease either because they don't actually get infected by the virus! Sadly, the very people who need the vaccine the most, because they are at high risk, sick, old or have high risk genetics, are the very people who often do not develop an immune response to immunizations. The immune systems of these people do not respond with adequate immunity, or they only respond minimally, and it is not enough to prevent getting the virus.  These are the only people who should be told to get a booster shot! Because Immunizations are only as effective as your immune system, the factors that prevent a vaccine from working are the same as the factors that put you at risk for getting the virus, and a more severe form of the virus. So, what are the risks for having poor immune response to a virus or an immunization? Age, Lifestyle, and Genetic Risks: Age over 60 without Testosterone replacement—Testosterone stimulates your thymus gland to make more T killer and T helper cells as well as to increase antibody response to viruses. Age under 3 months is a time when babies are using up or losing the antibodies their mothers gave them through the placenta and they have not yet developed a fully competent immune system themselves. Babies 1-3 months should stay at home and limit visitors.  Breastfeeding improves their chances of being protected from viruses. Poor nutrition: Junk food, highly processed food, with high sugar content (viruses LOVE sugar!) suppress the activity of the immune system. Inadequate Vitamin D blood level. A level under 40 puts everyone at higher risk to get viruses.  In light-skinned people the sun can give them enough Vitamin D, but southern European, Polynesian, Hispanics and African Americans cannot absorb much vitamin D from the sun and must take it orally!  5,000 IU per day should be enough to supplement with. Smoking suppresses the immune system Alcohol consumption over 10 drinks a week lowers your immunity Obesity increases inflammation and lowers immunity Lack of exercise suppresses the immune response High stress lifestyle Lack of sleep (optimal sleep is 8-9 hours a night). Night shifts Meth, Cocaine and Heroin of course is going suppress your immunity. Your specific genetic makeup During the covid pandemic of 2020 scientists and geneticists have been studying the genetics of those people who have gotten severe covid infections and those people who have been exposed and didn't get it. They also have studied the genetics of people who don't respond to the vaccine. They have found a group of genetic snips (pieces) that are present in each of these groups.  They are publishing their findings in the Journal of Nature: Covid Host Genetics Initiative. Mapping the genetic architecture of Covid 19. Nature https:doi.org/10.1038/s41586-021-3767X(2021). Medical reasons for Getting viruses and not responding to vaccines. To treat disease doctors often must suppress the immune system of a patient to control the disease. This type of treatment decreases immunity in general and decreases the effectiveness of an immunization. Some drugs such as corticosteroids or Biologics, suppress the immune system and prevent the immune response necessary to develop antibodies to a virus from a vaccine. Those people who are chronically ill currently or in the past (heart disease, lung disease, Cancer, Diabetes, COPD, chronic infections etc.) have immune systems that have been overworked and are currently directed toward a different target, so a chronically ill patient may not develop immunity from a vaccine. If you are on one of these medications or have other chronic illnesses, you should prove that your immunization was successful by get a blood test for antibodies to the virus before you take your mask off. Medical reasons for non-response to vaccines and for increased risk for getting viruses: Autoimmune disease on immunosuppressant medication History of cancer treated with radiation and or chemotherapy can suppress your immune system for a lifetime. Organ Transplant on immune suppressants AIDS Chronic inflammation for any reason Diabetes and Pre-diabetes Heart Disease and High Blood Pressure Having a viral or bacterial infection when you get the immunization Chronic Medical Illness Pregnancy Low testosterone levels in old age Clearly your best chance of a successful immunization is having robust health, ideal weight, youth, good testosterone levels and lack of disease.  These are not reasons to avoid immunization, but they are good reasons to have a test to document that you are immune after you get a vaccine before you go out in public and expose yourself. You can't change the past, or your genetics, but you can change your habits and check your immunity if you are at high risk!

PBS NewsHour - Segments
Exposure related health conditions still trouble 9/11 first responders 20 years later

PBS NewsHour - Segments

Play Episode Listen Later Sep 13, 2021 9:11


Saturday marked the 20th anniversary of the Sept. 11 attacks. On that day and for weeks after, first responders at the World Trade Center worked to clear rubble and to search for remains. Many were stricken with debilitating illness, including chronic obstructive pulmonary disease (COPD). We hear from some of them, as Amna Nawaz reports on the challenges first responders are still facing. PBS NewsHour is supported by - https://www.pbs.org/newshour/about/funders

Charles Kwang's Podcast
Why you haven't found a cure for sinus congestion?

Charles Kwang's Podcast

Play Episode Listen Later Sep 7, 2021 31:32


Why are your sinus congested and everyone around you is fine?  Are you allergic to the air?  How are you ever going to be not allergic to air?  Why is everyone else not congested?  

The Nurse Practitioner - The Nurse Practitioner Podcast
Acute Care for COPD Exacerbations

The Nurse Practitioner - The Nurse Practitioner Podcast

Play Episode Listen Later Sep 4, 2021 26:45


In this episode of The Nurse Practitioner Podcast, Dr. Julia Rogers, DNP, RN, CNS, FNP-BC discusses acute care for COPD exacerbations.

Mayo Clinic Q&A
Breathing easier with COPD

Mayo Clinic Q&A

Play Episode Listen Later Sep 3, 2021 24:43


Chronic obstructive pulmonary disease, or COPD, is the third leading cause of death worldwide according to the World Health Organization. COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking or heating in poorly ventilated homes. People with COPD are at increased risk of other diseases too, such as heart disease, lung cancer and a variety of other conditions. Although COPD is a progressive disease, it is also treatable. "If you catch it at an early phase, treatment may consist of helping the patient to stop smoking or taking the patient away from the polluted environment that may be contributing to the disease," says Dr. John Costello, a consultant pulmonologist at Mayo Clinic Healthcare in London. "For those with more advanced disease, long term rehabilitation programs have been very successful in centers that specialize in pulmonary disease."As a part of rehabilitation, treatment for advanced COPD can include the use of medications, inhalers and oxygen therapy.On the Mayo Clinic Q&A podcast, Dr. Costello discusses how COPD is diagnosed and the treatment options for COPD.

EMiPcast
ROP Persian September 2021

EMiPcast

Play Episode Listen Later Sep 1, 2021 67:34


طب خانواده و مراقبت‌های اولیه، شهریور 1400 عوارض کاهش سریع گلوکز خون در بیماران دیابتی، خلاصه مقالات جدید، سایر درمانهای هایپرتیروییدی، گایدلاین جدید COPD و ... Telegram: t.me/Emipcast

Diabetes Connections with Stacey Simms Type 1 Diabetes
All About Afrezza Inhalable Insulin with CEO Mike Castagna

Diabetes Connections with Stacey Simms Type 1 Diabetes

Play Episode Listen Later Aug 31, 2021 38:33


How much do you really know about the only inhalable insulin? This week, Stacey interviews the CEO of MannKind, makers of Afrezza. Mike Castagna talks about how Afrezza works, misconceptions about the product, the worldwide market, pediatric studies and lots more. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. More about Afrezza Tim Street's blog Diabettech  Check out Stacey's book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Get the App and listen to Diabetes Connections wherever you go! Click here for iPhone      Click here for Android Episode transcription below: Stacey Simms  0:00 Diabetes Connections is brought to you by Dario health manage your blood glucose levels increase your possibilities by Gvoke Hypopen the first premixed auto injector for very low blood sugar and by Dexcom take control of your diabetes and live life to the fullest with Dexcom This is Diabetes Connections with Stacey Simms. This week all about Afrezza How much do you really know about the inhalable Insulet. I had a great conversation with the people who make it   Mike Castagna  0:34 For me, it's about using the right product to meet your needs to get you in control. And if you're doing well, great, we're going to avoid the long term complications. But if you're not doing your health, and you gotta really try to find the best set of tools, they're gonna make you successful and fit your lifestyle.   Stacey Simms  0:47 That's mankind CEO Mike Castagna. We talked about how Afrezza works misconceptions the worldwide market pediatric studies and lots more. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Welcome to another week of the show. We so glad to have you here we aim to educate and inspire about diabetes with a focus on people who use insulin. And this week, we're talking about the use of the only inhalable insulin, my son was diagnosed with type one right before he turned two, he is 16. My husband has type two diabetes, I don't have diabetes at all. But I have a background in broadcasting. And that is how you get the podcast, I have to say that personally, my family is very interested in Afrezza Benny really would like to try this seat. Of course, as I mentioned in that tease up there, they're looking at pediatrics, he is still under 18. So it's not proof for his age group. But we're watching it really closely. And I have a lot of friends. A lot of bloggers and people in the diabetes community have talked about this for years. And some things have changed. So I wanted to have them on the show and find out more. So a little bit of background for you. If you are brand new to all this, Afrezza was approved in the United States in 2014. And the company that makes it is mankind. For a while it was sold by Santa Fe, but then mankind took it back. It's one of those things where sometimes the business side seems to have gotten more attention than the product itself. So what is Afrezza it is a powder, it comes in cartridges, and you suck it in you inhale it with a special inhaler device. To me, it looks more like a whistle than a traditional inhaler like an asthma inhaler. It's not like a big tube. I'll link up some photos in the show notes. I'll also link up the Afrezza website so you can learn more and see their information. And my guest this week is Dr. Mike Castagna, the CEO of mankind now he has a Doctorate of pharmacy, he worked as a pharmacist behind the counter for CVS at the start of his career. But then he went back to school and he got an MBA from the Wharton School of Business. He's fun to talk to he doesn't mince words, and he truly believes in this product, I do have to tell you that Mike mentions monomeric insulin a couple of times, I'm going to come back after the interview and explain more about that give you a better definition. All you really need to know is that it's faster than how liquid insulin is made. And all of that in just a moment. But first Diabetes Connections is brought to you by Daario. And over the years I find we manage diabetes better when we're thinking less about all the stuff of diabetes tasks. That's why I love partnering with people who take the load off on things like ordering supplies, so I can really focus on Benny, the Dario diabetes success plan is all about you all the strips and lancets you need delivered to your door, one on one coaching so you can meet your milestones, weekly insights into your trends with suggestions on how to succeed, get the diabetes management plan that works with you and for you, Daria is published Studies demonstrate high impact clinical results, find out more go to my dario.com forward slash Diabetes Connections. Mike, thanks for joining me, I'm really excited to catch up. And look, I'm stuttering because I can't believe this is the first time we're talking to you. But thanks for coming on. Oh, thank you, Rodney. I'm super excited before we jump in and start talking about Afrezza Can you give us some perspective kind of dial back because mankind is not. It's not a name that came out of nowhere? There's really important history. Can you kind of talk about that a little bit first?   Mike Castagna  4:14 Sure. Mankind comes from our founder named after Al Mann and Al Mann was a true innovator. He started I think 17 companies and everything from the cochlear implant to the pacemaker to insulin pumps that many of us know today as Medtronic used to be called mini med. And Al Mann built the insulin pumps over the 80s and 90s and was very successful and sold that company to Medtronic. And then he took literally $1 billion of his own money and invested in mankind. And he had put this company together through three companies he owned the technology to make Afrezza was really a combination of companies and the reason he was so dedicated as he saw in the pump market, which we now see today on CGM was that the variability in mealtime control was so high and the fluctuations you see that the influence takes about an hour and a half to kick in. And it's hard to get real time control if you can't get a faster acting insulin. And so he set out to make a real time acting insulin, so phrases and hailed as monomeric. And that was really what the magic was in our technology making a dry powder was was free dryness, if you heard of dippin dots ice cream, we have basically large dipping machines in our factory, but we free dry the particles to make a freezer and under stabilize the monomeric form. So when you're inhaling, you're inhaling influenza, as soon as it's in your blood is active, or when you inject it has to hold hexamer and has to break down there were about 45 minutes. And that's how you can make it stabilize an injectable form. But it has to break down and then it starts working. And that's why there's always this lag effect between we see injectable and foam in and help us is very different products were categorized with real time rapid acting, but the name mankind comes from elmen and the guy who probably 60% of people on pumps have their own pumps that he created. So amazing gentlemen, huge contributions to diabetes and millions of people were alive today because of his work and his generosity and roven to take that forward here and kids and frozen inhaled insulin.   Stacey Simms  6:06 I mean, never look at dippin dots the same again.   Mike Castagna  6:10 I see a large factory of they don't like it, you know, we can always make different types of things don't go well.   Stacey Simms  6:15 I love it. Let me ask you to go into a little bit more detail about how someone who uses Afrezza would actually use it. Can you talk a little bit about like a daily routine?   Mike Castagna  6:25 Yeah, I mean, I know, you know, well, you're in this disease. I mean, people sometimes graze all day, and they just kind of ride their sugars and take a little bit some along the way or many boluses. And some people you know, eat once or twice a day, or some people, you know, carb restricted and everyone has a different way. And I think that you know, the big thing difference was for the patients that I see is, it's in the moment, meaning you don't have to time your meal and your insulin, when you're going to take it and where you're going to be. As soon as your food arrives. You take your first dose.   Stacey Simms  6:50 Most people I know who use Afrezza take a long acting insulin with it. Is that pretty standard for people with type one?   Mike Castagna  6:57 Yeah, I'll take one year, right? Yeah, you need a basal insulin of some sort, you know, and, and a meal time was held, we do have some patients on pumps where they will use their punches for their basil, for example, and use a phrase for real time corrections. So you know, the average patient is very different. We have some patients that are type twos, you know not not on any basil, you'll need to be on basil for if you're type two. But if you're type one, you need to basil, long acting insulin, and you need your meal time. And we know the biggest problem in this country is still mealtime control is the number one thing people with diabetes struggle with. And it's a big reason why, you know, six, or seven or eight, you know, eight out of 10 people basically are not a goal on insulin because of the mealtime control. So it's a daily challenge for everybody.   Stacey Simms  7:39 Can you talk a little bit about how Afrezza is kind of measured out? Because when we think of mealtime, insulin, everything's a carb ratios. And especially as I mentioned, if you're on an insulin pump, you're you're putting in the carbs that you eat. So how does that work?   Mike Castagna  7:51 Yeah, it's funny, I get into many debates with people because, you know, I'm a pharmacist by training, but I'm not the smartest guy. But I couldn't do all the work people do every day to influence sensitivity ratios and carb counting and timing. And all I can tell you is everyone's masks off by 50%, one direction or another. And so we have this false pretense that we're that accurate. And dosing are influenced by down to the half a unit or one unit. And the reality is your angle of injection can decrease, you know, change your absorption by 25%, your site of injection can change absorption, your your stress level can change your impact with your insulin, there's so many things that go into your daily dosing of insulin, that, you know, being that precise, down to the unit is not as accurate as we all think. And I think that's that's one of the misnomers of, you know, the timing is what you really struggle with when you're using injectable insulin, and you just don't know what's going to happen. You know, when people I guess doctors often you know, you don't have to carb count with Afrezza . And they give me funny looks. And the reality is, you know, we've never done a study where you're carb counting to get your dose of insulin, that's, you know, so becomes a four 812 dose linear all the way up to 48 units, it's additive, and you just got to be close enough. And so it's about a two to one ratio, you know, there's no direct pulmonary equivalent to injectable insulin, unfortunately, but, you know, people are taking five units of injectable insulin per meal, they're gonna need about eight units of Afrezza and maybe even 12. And you're gonna figure that out, it's your first meal or two what what the right dose is for you. But you just got to be close enough. And that's a big misunderstanding for people of how accurate the dose has to be. This is the sixth dose cartridge is a big problem. I know plenty of type one patients who take for a 1224 meal, especially they haven't Chinese food or sushi, they just they dose a lot. So I think that's something people have been comfortable, so dramatically different than anything they've ever been trained or taught in their history of living with diabetes.   Stacey Simms  9:36 I would assume that a prescription for Afrezza comes with a doctor's visit where someone whether it's someone who works for Afrezza, or the endocrinologist talks to you about how to do this dosing. You said you figure it out, but I've got to assume that you're not just sending people home with this inhalable and say, just test it, I mean, right somebody, you're at a ratio   Mike Castagna  9:59 and I think That's the key thing is, you know, having patients understand because it's odorless and tasteless. So you inhale, and you're like, what did I get it? And I'm like, yeah, if you inhaled, and I have the second, it's in your blood, it's in your lungs, it's breath activated. So you can't really, of course, you can try to mess up something. But we have something called Blue Hill, where we can show proper inhalation technique in the office on an iPhone app or an Android. And so you know, we hope that patients are being trained either by our trainers or the doctors offices, and will propagation technique looks like that's number one. And then number two is the right dosing. And as you know, individualized dosing is important and fun. And, again, that's why I say we take a lot of the math out because it's either gonna be a four or an eight, and all of a sudden, you're like, Oh my god, I'm gonna take an eight units, it's a lot it's really not when you're taking inhalation units versus injectable units and that's what people got to get comfortable with if their first or second dose so they really do figure out this meal did this or pizza is going to take longer so pick another dose and now our people do figure it out pretty much within the first week. And then there's one thing actually I want to mention because I often forget this is because injectable insulin is such a long tail it's in your body for four to six hours before it's out and that feeds into your basal rate your long acting and so when people switch over presence pretty much out of your body in a net roughly an hour and a half. Sometimes people need to adjust their basil and that's something to watch out for if you do switch to Afrezza enter you're struggling with with some of the basil rates. Some patients you know I hear people anecdotally you know, we don't want to study their the bump up their basil 10 15% on Lantus. And I've heard patients on to see that because it does have that long tail of down there in front sometimes on the basil. So there are the other metrics patients have to watch out for when they are switching to the product. It's not just the uptime, it's also something that basil where you look at   Stacey Simms  11:38 I have a question and I i apologize because it's a it's a bit ridiculous. I'm gonna ask it anyway. Right back to the interview in just a moment. But first Diabetes Connections is brought to you by Gvoke Hypopen. And our endo always told us that if you use insulin, you need to have emergency glucagon on hand as well. Low blood sugars are one thing we're usually able to treat those with fast acting glucose tabs or juice. But a very low blood sugar can be very frightening. Which is why I'm so glad there's a different option for emergency glucagon, it's Gvoke Hypopen. Gvoke Hypopen is pre mixed and ready to go with no visible needle, you pull off the red cap, push the yellow end onto bare skin and hold it for five seconds. That's it, find out more go to Diabetes connections.com and click on the Gvoke logo. Gvoke shouldn't be used in patients with pheochromocytoma or insulinoma. Visit Gvoke glucagon.com slash risk. Now back to my interview with Mike, where I will ask that ridiculous question.   You had mentioned it's tasteless, odorless, I recall hearing and I'll have to fact check this. But I recall hearing that years ago dandruff shampoo, they had to add like that tingly feeling because people didn't think it was working like it's totally fake. But people just didn't believe it was a medicated shampoo because it didn't have an unpleasant sensation. Have you thought or talked at all about adding like a flavor or a feeling to so people really know that they got it? Or is that just really bananas?   Mike Castagna  13:12 If somebody might company come and talk to you ahead of time? There's somebody internally who wants us to look at like cherry flavor Afrezza especially as they go into pediatrics? And the answer is, look, there's blueberry Metformin because the metformin smells awful and tastes awful, probably. So you know, those things are possible. We've never done them. And to my knowledge in this industry with dry powders, it is a question that came up recently. Is that should we be thinking about the cherry flavor Afrezza or some other flavor? And I think the answer is TBD. We I don't know what the date is on inhaling the food coloring dye or whatever. Yeah. But that's some of the stuff we have to justify that it's safe and effective. And along with FDA would want us to test but they come up recently and another internal discussion. And since you're asking, I think we'll look at it, even if maybe there's a way to even show a placebo, that's a cherry flavor or something right a one time dose to see what it's like. So I don't know. But now, but people like I said, it's sometimes you get a call, like you know, when you take a phrase of one out of four people will get a cough initially. And generally there were the first four weeks that cough goes away 97% of the people. So I always tell people, you're having a cough, like as long as not interrupting your life, it should slowly get to your first refill. And it should be mostly resolved by that your body's getting used to putting a powder in your lungs. But that's uh, you know, when people ask, what's the difference between injectable and inhaled in terms of safety, you know, you're putting a drug powder in for the first time in your body and your body could choose that. And the number one thing that's different, were injectable insulin. You know, you have other other things. You're dealing with injection sites and pump sites and scar tissue and things like that.   Stacey Simms  14:48 Does the body actually acclimate to the powder or is it just a question of someone gets better and used to the inhalation sensation?   Mike Castagna  14:55 You know, it's it's a good question. I don't know if I have a black and white answer here. bodies give. Yeah, my guess is the body's getting used to putting a dry powder in and just exit and you get used to like weed. You can drink a glass of water before and after and help you minimize it. But it's generally like that's what it feels like it's not a productive call frightening, there's not a call to happens 10 minutes later, it usually happens. We have to inhale.   Stacey Simms  15:17 You mentioned BlueHale , can you tell us a little bit more about what that is?   Mike Castagna  15:21 Yeah, so BlueHale  is to two different things. The first one that we're looking at is with the patient training device. So we can show you whether you had a good emulation or not a good emulation and show you that technique. The second version, actually, you can detect with those you put in the cartridge and hilar. So it has a proprietary software there that we can see what cartridge you put in for the adapter. And it'll tell you on your app, if you took a for a 12 or 16, how much you took in that session. And then we hooked integrate that with the CGM data. So now you can show those response curves on CGM one day and eventually I want to get into AI and predictive analytics. But we're not there yet. But we think that's the magic of what people really want, which is one that I use the thing when you live with diabetes, you just must remember and be that perfect to know exactly what those you did with them. You took it, what meal you were and then I simulated being a patient for a week. And I realized I could remember if I took a four and eight, I take a six or 620 is that 30 minutes or one hour like it was it was amazing. When you just think about life and people are human. They're there. They're human. So they're not keeping track. And they're not that accurate. They're just estimating. And that's when I talked about the dosing of insulin, like we're always estimating everything, we're estimating the time our food is going to come and how long it's going to work. You know, what the carbs are? How much am I gonna eat or drink? Like, it's all accurate? It's all off. None of it's that accurate. That to me is the thing I realized when I was thinking of doing one of those a disease, you don't you think they're perfect. They're not. They're human beings. And that's when I see one out of five doses of injectable insulin are intentionally missed. And the predominant one that's missed is actually lunchtime, which makes sense to wear out in a social environment. They don't want to inject. And by the time they get back, they forget it's probably too late. Or you're already high.   Stacey Simms  17:00 What do you mean by intentionally Miss? You mean? Like they people just forget?   Mike Castagna  17:03 No, no, they intentionally knew they should take a dose of insulin, but they're in a lunch conversation, or they forgot their insulin in the office. Or they'll have their CGM receiver on the bike, or they essentially don't they miss one of the five doses. So if you're missing 20% of your doses, it's really hard to get in control. And there's all kinds of reasons, but that's intentional omission versus unintentional. Which is I forgotten.   Stacey Simms  17:23 I'm curious what the sources on that that's, I mean, I don't doubt it. I'm just curious.   Mike Castagna  17:27 Yeah, I couldn't find it. follow up on that. I have your email, I'll look for it. Yeah, no, because I didn't believe it. And then there was a study done with one of the pens coming out that has digital connectivity. And I looked at it and I looked at the data and like, wait, if a person needs three times a day, seven days a week, that's at least 1721 doses, right? And I think the average person is taking like 1212 shots a week. And I'm like, Well, that doesn't make sense. But you realize, you know, again, we're human, people aren't always as compliant as we want, or they don't eat three times a day perfectly are the two big meals, you know, everyone does something different. So having insulin that meets your needs, and your lifestyle, I think is really important in the world. And you know, look, we like our products, obviously, we're here, we love the Afrezza. But But I also just for me, it's about using the right product that meets your needs to get you in control. And if you're doing well, great, you're gonna avoid the long term complications. But if you're not, you own your health, and you got to really try to find the best set of tools that are going to make you successful and fit your lifestyle. And, you know, obviously, we're not doing well when 80% of people on insulin on a boat. I mean, that's that, to me is the number one thing, I look at this country and say, well, despite all the adoption of pumps, and technology and CGM, we still have not made a meaningful difference in percent of people to go. And that's frustrating.   Stacey Simms  18:35 Way back in the beginning of this interview, we talked about Chinese food and pizza. And I'm just curious, you know, these are things that are hard to dos for, because they they kind of they come later, you know, what most people listening are very familiar with, and I think probably have their own system for dosing, whether it's an extended bolus or injecting more than once. How would you do something like that on a Friday? Is it a question of you would take what you think when you're eating, and then again, in a bit later, like, how do you account for those high fat foods?   Mike Castagna  19:02 Yeah, you know, I'm going to pick on Anthony Hightower, who I know you interviewed before. So I actually met Anthony on a bed over social media. And he had showed me your servers where he ate pizza. So I'll pick on him because I want the public discussion here, sir. He pizza and his sugars are basically flat over the two, three hours post meal. And I said, I'm like, shocked. He's like, this is something people cannot do naturally on the history of injectable insulin, they they always struggle. And when you eat pizza, you're going to struggle not just for hours, but potentially for the next day because just throws everything off. I think in his case, right? I've watched him he took a big dose up front, you know, let's say he's gonna take 12 units of injectable he took 24 units of Afrezza. And then he washed her wasn't an hour, and then an hour she was above where he started. He took another dose, maybe took a four and he has to tap it off. And then an hour later, just thought was too high or not right. But you can always keep your sugars in that kind of control. That's one of the studies we did back in 2018, called this test study was showing that you could do as soon as one hour with no more hyper risk. And that was a big concern of people, how can I do that one hour, well, pretty much hit its peak effect in one hour. So if your servers are still moving in the wrong direction, you can correct them at that point. And so that's where someone on pizza or Chinese food, like, yeah, it's a high dose up front and may manage it through the whole system. Or they may see an hour or two later, they're still high and to take another dose, that they can bring it down at some point.   Stacey Simms  20:20 Alright, let's talk about the big questions that people generally have. And that the one I hear the most is, Is it safe? Right? Is it? Is it okay to inhale this stuff into my lungs? Can you talk about the studies that you've done?   Mike Castagna  20:32 Yeah, I think if we were able to make inhaled insulin 100 years ago, we'd be scratching our heads those who would inject themselves three times a day. So I think it's just an unfortunate matter of 100 years of difference. But we studied a phrase that probably over 3000 patients 70, some trials $3 billion over 20 years, like, that's how much money time and energy is going into prove the safety and effectiveness of this product. And you know, and I tell people like you know, there is no data to say that it's not safe. We have all the rodent studies, all the CT scans that along looking for fibrosis looking for pulmonary issues, we found nothing. So it doesn't sit in the lung. There's an old product called exubera on the market years ago. And exubera was a sugar based manatal formulation which got absorbed over time into your lungs in a friend this case, the it's got water and human influence. So when we ask about what ingredients are you worried about the human influence, human influence, it's the whole AI base, but it's human influence characteristic, and water is purified. So we know that safe and the other only other carrier in our products SDK p which is a excluded product that is not metabolized in the body, it's just 100% extruded. So you know, there's three ingredients in our product. One is human insulin, one is water, and one is tkp. And SDK p comes out of the system. So I don't I don't think the body is afraid of human insulin. And what are so I think, you know, I always struggle with this topic. Because, you know, what happened is there was some lung cancer cases and Newser, were they there was a couple of our data. But you know, in the seven years since FDA approval, we've seen no safety signals come up in the postmarketing. We have almost 10,000 patients on the presidency. I know people in the drug for 1012 years. And so, you know, we don't see anything that gives us concern. And we're going into kids now, who would have to take the drug for 40 5060 years. So I think it's hard to prove something that you've never seen. But safety comes with time. And I think the good news is product has been approved by the FDA for seven years now. And we've not seeing any safety signals in our database, which we look every year, our rems program ended early by the FDA and and we've continued to show good data and all the studies we've done, we've not seen anything new come up in our anywhere safety issues. So if you're, you know, the populations, I would say if you have COPD, and asthma, this is not the right drug for you.   Stacey Simms  22:41 So a dumb question, though. If you have diabetes, and you smoke, can you get an Afrezza? prescription?   Mike Castagna  22:48 We would say you should not? Yes, we have a warning for that.   Stacey Simms  22:52 Well, I just wanted to be clear that there was an actual warning, it wasn't just a please don't because it's bad for   Mike Castagna  22:57 warning. Don't   Stacey Simms  23:00 tell me about the study with kids. Because I've got one, I've got a 16 year old who was quite interested in this product.   Mike Castagna  23:06 Yeah, no, I just found out Unfortunately, the dagga three year old cousin in the family have just come down with type one. And she will, she'll be four and our studies gonna go down to four years old to 17 years old, when we launch it. So I'm excited, we had to do a study to show that the pharmacokinetics and dynamics of inhaled insulin are similar in kids as it as adults. And so once that study was complete, we we wrote a protocol down to the FDA and said, We'd like to go into the next phase, and now run a larger study head to head against the standard of care. And the FDA has pretty much signed off on that protocol at this point. And we have contracted with a third party to now run that trial. And we'll be having our investigator meeting here in next month. And so hopefully, we'll see our first patient in the four to 17 year old range, probably here in September, October time frame. So super excited, long time to get here took too long from my perspective, but can't wait to help kids. But our founder Outman invested, he became very wealthy when he sold the insulin pump company. And he took $1 billion of his own money and made Afrezza inhaled insulin because he felt the problem with the injectable subcutaneous delivered insulin was it just took too long to work. And you know, somebody has an hour lag effects from food. That's real timing, it's always hard to catch those two even. And so he really wanted to make an inhaled insulin that really mimic a physiologic insulin that you see in the body. And he felt the only way you could get there was through a dry powder, lung delivered instantaneous insulin, you can also get there through an implantable pump. But that didn't work out when they tried that back in the 90s. I recall. So people got infections and things like that. So that would that didn't work. So they really were going to get a in my mind that physiologic inform that's gonna be monomeric stabilized is probably going to happen only through the inhaled route. So we have we have to get comfortable with this from overall efficacy and safety. Otherwise, you're not going to really ever get this control that people are looking for real time.   Stacey Simms  24:55 No man, he lived long enough to see Afrezza approved, didn't he?   Mike Castagna  24:59 He's All approved. And unfortunately, I'm here because he died on my daughter's birthday. So I was debating whether to come to mankind or not. And I'm very superstitious, the Al Mann pick the day he died. And he died February 25 2016. And then they made decision to join and help save the company and save a frozen kick on the market. Because I think, you know, I saw all these wonderful patients stories online. And I said, these patients like Anthony Hightower is one of them, what they did something that no one else did, they did something we never did in our clinical trials. And so I got to talk to them. And I realized we just didn't dose it properly. So you go back to the development of the product, a lot of the challenges were under dosing because everybody's trying to compare one to one to injectable insulin, and therefore one of underdosing patients, and therefore, they got equal outcomes didn't do any worse than injectable insulin per se. But could they have gotten better outcomes if we dosed improperly? Right? And I think that's, that's the state of we're now trying to generate to show that the kids buddy now be head to head, or if he knows him properly, what happens? Right, and that's we're really focused on right now.   Stacey Simms  26:01 Is there anything that you wanted to talk about that I haven't answered?   Mike Castagna  26:04 No. I mean, we're only available in the US, we're in the process of going to Europe. So I don't know if you have any. Yeah, we do. Though, so I know, we have patients on a name patient basis in Germany, and UK and Italy. So you know, their governments are actually important a president and pay for it. We're in the middle of filing for Australia. We were approved in Brazil, and we're going to India so so you'll see this more and more around the world. You have listeners in those markets. There's not gonna happen this year. And hopefully, the next year or the following year in some of these markets, we'll be looking at bringing it to more patients in those markets.   Stacey Simms  26:37 Well, and just got a big approval here in the United States for Medicare patients. Right.   Mike Castagna  26:42 Yeah. So that one, I, you know, we get a lot of questions on that one. And so you know, this market CGM patients were told you need to be injecting yourself, I think four times a day, we couldn't get your CGM. So then doctors were not getting patients Afrezza. And so we were able to ask CMS to change that, and they did to the year but rather haven't done they're not done. And so here we are a year later that that policy is now being updated. I want to thank CMS and all that you're helped make that happen. And I think it helps in people in CGN, because I understand that removes some of the other requirements to get CGM, even an injectable these patients so little mankind was the one who started that process. And then we're able to help a lot more people. So it's great. And we're trying to get Medicare $30 a month insulin. So we have Medicare listeners. And you know, we're trying to make sure we help get patients access that are on Medicare. I think that's important.   Stacey Simms  27:33 That doesn't stack up in terms of cost in the United States.   Mike Castagna  27:36 Yeah, I mean, you know, fortunately, the billion dollar debacle in this country is drug pricing, as we all know, and as a pharmacist, I know firsthand when people go through an LMS they're on how many co pays are on. And so we really have tried hard to make sure that no patients pay no more than $15. So we have copay card programs, we actually have a free drug programs, they really can't afford it, we'll give it to you for free. If you're going through the prior authorization process, we give it to you for free while you're going through that. So we all want payers and reimbursement to be the excuse of why a patient can't get access to our product, we think that people will do well on our product, we're willing to take that bet that they'll see good results. And if they see good results, the payers will usually pay for it. And it says you may or may not know that there's a monopoly in diabetes between two insulin players, and three payers, who are all working together to make sure there's no competition. You know, that's unfortunate, but they pay to make sure that patients have a difficult time getting Afrezza . And that's always one of my frustrations of competition or diseases. You know, 400 years, we've seen the precise the dispensing from 20 hours a while 95 and let's say miles, hundreds of dollars. You know, for me on the payer side, we want to make sure patients we try to bring it down to about $15 on commercial and Medicare, you know, they generally pay comparable to what they would and some Medicare plans a little bit higher I can you know, that's a hit or miss when you when you go to submit for reimbursement, but we try to do everything we can to make sure people will have access to our product   Stacey Simms  28:57 $15 for $15 for commercial patients, no, no, but what is it? What is it for? What do you get for $15? Is it a month? Is it a   Mike Castagna  29:05 my week? Yeah, whatever, whatever. You gave two boxes, three boxes, whatever is on that prescription for that month,   Stacey Simms  29:10 for the month. Okay, I didn't mean to interrupt you.   Mike Castagna  29:12 I don't think I know, I was gonna say I forgot we actually have a cash pay program. And people are paying cash for their insulin. And we do see several 1000 people a month paying cash for injectable insulin, we have influenced savings comm where it's $99 a month for frezza. And you know, can you a bigger box or more doses, you might pay 199 but we tried to make the cash price, you know, roughly $100 a month. If we if you had no insurance, for example.   Stacey Simms  29:37 I'm not sure you can answer this question. But I will ask it anyway, is the biggest challenge for you all the failure of exubera? Is it just people not knowing what this is? You know, as you move forward, you know, what is the big challenge to get more people to adopt us?   Mike Castagna  29:51 I mean, for me, the biggest challenge are the doctors. We created a program we basically gave it for free to patients for two years for 15 bucks. Like no no priority. Nothing, we just charge you $15. And that didn't change a lot of doctors from jumping on board. And doctors just don't know our data. And so they think this product doesn't have a lot of data behind it. And they don't know our data, they don't know. Like when I would ask a doctor, how fast from the time you inject your bolus, your pump to the time you look on a CGM, that your institute sugars are coming down, and I get in these endocrinologist, I'll get five minutes and mediate and 20 minutes an hour, the answers, I need 90 minutes, 220 minutes, that's the answer. And so they don't even know the pharmacokinetics and pharmacodynamics differences between injectable insulin inhaled, and then you have doctors, right, you know, calling some of these ultra acting drugs faster, we'll look at the package inserts, they're no faster than their old products. And there's a lot of misperceptions out there some of these newer launches of old tracking insulin, and to me they're, they're really not that much different than the predecessor and look at the data, you know, there's not a faster, there's not dramatically faster onset or offset or, you know, a one c lowering or weight gains on very much the same. So, no, I think it's just a matter of doctors trying to really understand the data.   Stacey Simms  31:02 Before I let you go, are there any plans in the future to change anything about the way it looks? or different colors? I mean, I know it sounds kind of silly, when you're just trying to get people to adopt the new technology, but from a user standpoint, and look, I know, you've heard all the jokes of my friends who use this will make you can't comment on designers. They don't say anything, they'll make comments like, you know, taking a hit or whatever, right? I mean, it's it's inhaling, it's this little thing that you're, you're inhaling, it looks a certain way. I'm curious if the cosmetics of it are anything that are on your radar, or needs to be improved even?   Mike Castagna  31:36 No, I mean, I think when you spend, you know, $3,000,000,000.20 years doing a new drug development or taking 100 year old product and reinventing it, you had to get that right in terms of device design and airflow dynamics and consistency. And those. And I think all that's really important because, you know, misperception that oh, my God, it's going to be less can be more variable than injectable insulin. And the data just doesn't support that statement. And so for us, we have one of the world's most unique installation platforms across the entire pharmaceutical industry, we deliver more power to the lung, the most technologies out there. So that's why you can get consistency, those two those, and you don't have a lot of variabilities, because our technology and our device is called a low velocity inhaler. And what that means is there's a resistor that helps slow the powders as they're coming out of the inhaler. So they get deep into the lungs. And that's why you get that nice absorption curves that we see. And we're most inhalers or high gloss inhalers. So it's just enough sucking air as hard as you can, and hoping you get you know, 20 30% of lung drug into your lungs, and mostly stuck in your teeth to device in the back of your throat. That's most dry powder inhaler technologies out there today. And so that's something unique to us and our technology and our device, they all work really well together, you couldn't just take our powder and put into another inhaler, and or just as well would not work. So yeah, we're pretty happy with the device I we are going to other diseases. So you know, we're we're going down to the FDA with our partner for an approval in October for pulmonary hypertension patients. And we have several other orphan lung areas we're going into to help more patients with lung disorders. So you know, I think that's important, like our, our technology, our inhaler, our platform is gonna be used in more and more patients over the next decade than just diabetes.   Stacey Simms  33:13 Well, that's what I was gonna ask is, if it works, so well, you know, will you partner with other medications? That's great to hear.   Mike Castagna  33:18 Yeah, you know, we're really busy, we probably have about 10 to 12 formulations of products working on this year and five marone products in the pipeline. And so it's it's a really good time of mankind, we're super excited to be here. And it was a turnaround, the company struggled for many, many years. And we're on our way to success. And I think, firstly, you'll be you'll be hearing more about it. So I know it's been a long time. And maybe you didn't talk to us yet. But hopefully you'll talk to us more and more as we continue to generate new data and more more patients start using it.   Stacey Simms  33:45 I'd love to, I'd love to, especially with the kids programs. And like I said, I've got a 16 year old who is very curious about this. And, you know, once once safe and effective. Once we get all that safety stuff in here. It's mom says, you know, I'll definitely I know, I would like to check it out. So I really appreciate you coming on and spending so much time with me and my listeners and explaining all this and we'll definitely talk again. Thanks, Mike.   You're listening to Diabetes Connections with Stacey Simms. More information at Diabetes connections.com. Always on the episode homepage. I also have a transcription as well, sometimes those podcast players don't display the show notes and the links. So if you have any trouble, just go back to Diabetes connections.com. And I just want to say that I did reach out to have Mike or somebody from Afrezza on the show. And you heard him say, you know, it's been a while, um, you know, it just took a while to connect to the right person. Let's just say that, and I will have them back on because lots of good stuff is happening. As you heard. I want to take a second and kind of explain Monomeric insulin and, you know, I'll be honest with you. The scientific points here are really not my strong suit. I'm a communications major, right. So I did what I always do, and I am People who know a lot more than I do to help me explain it. I went to the Facebook group Diabetes Connections as a group. And you know, I said, How do you explain monomeric insulin I know it's faster. And Tim Street, who is just wonderful and runs the diabettech.com page that's like diabetes tech diabetic, and I'll link that up as well. He provided this explanation, which really brought it home for me, and boy, I hope I'm pronouncing everything correctly. So Tim wrote, insulin naturally links its chains together to form stable molecules. Typically it connects two together and then links three of those two chains together. Additionally, to create six This is highly stable and described as hexameric. In order to use these chains, you have to break the molecules apart to single chains, which are monomers. Typically fast acting insulins are stored as dimers, two monomers connected, which are easier to split, then hexamers. by storing the insulin as a single chain, a monomer, the body doesn't have to break the chains to instantly use the insulin molecule it receives. And that is why Afreeza wraps the monomeric form in the capsules, to make it ultra fast. Thank you, Tim, that actually made a lot of sense. I gotta tell you, we have the smartest people and the kindest people in this Facebook group. If you're not there yet, and you want to join, come on in, I highly recommend it. You don't have to be a Tim Street. You don't have to be able to explain these concepts. You do have to be nice. And you do have to not post a lot of drama. I'm very tough on my diabetes groups. I run two of them. They're very nice and friendly places for a reason. But Tim, seriously, thank you so much. That was a great explanation. And I really appreciate it. Diabetes Connections is brought to you by Dexcom. If you're a veteran, the Dexcom g six continuous glucose monitoring system is now available at VA pharmacies in the United States. Qualified veterans with type one and type two diabetes may be covered. Picking up your Dexcom supplies at the pharmacy may save you a lot of time to connect with your doctor for more info Dexcom even has a discussion guide you can bring with you get that guide and find out more about eligibility. It's all@dexcom.com backslash veterans, and all the information is always at Diabetes connections.com. Before I let you go, just a quick note about back to school, I have never done less. I packed up a bag for Benny to bring to the nurse. He brings his daily supplies with him every day in his backpack. But of course, like most people, our nurse has backup supplies for him. So I put those together. He brought them in along with our plan or orders, you know from our endo. And that was it. I haven't set foot in the building. I'm not sure when I will go in or if I will go in probably when you forget something or they run out there. But I've never done less work. You know, I did a lot of work over the years to go to school and meet with people and he's got it. So not much to report. It feels very strange. All right. Please join me this Wednesday when we have our in the news live on Facebook every Wednesday at 430 and then we turn that into a podcast episode. I love doing that. It's been a lot of fun. I hope you're enjoying it. Give me your news tips. If you've got any from this week, just email me Stacey at Diabetes connections.com thanks as always to my editor John Bukenas from audio editing solutions. Thank you so much for listening. I'm Stacey Simms. I'll see you back here in a couple of days until then be kind to yourself.   Benny  38:27 Diabetes Connections is a production of Stacey Simms Media. All rights reserved. All wrongs avenged

Lady Bod Podcast
080: Fighting to breathe: The rise of COPD in women

Lady Bod Podcast

Play Episode Listen Later Aug 25, 2021 23:05


Are you interested in quitting or cutting back on your smoking, but don't know where to start? Maybe you're interested in quitting smoking, but are afraid you'll gain weight or have to deal with anxiety and uncomfortable emotions. Well, you're not alone. Hear from respiratory professionals about how you can take steps toward better lung health today, no matter how long you've been a smoker. This podcast will focus on real ways to help people who suffer from asthma and COPD, as well as those who need to quit smoking. Be a Quitter!! Listen as our guest Dr. Latonya Brown, Pulmonary and Critical Care Medicine Specialist at St. Elizabeth, sits down with Dr. Oakley and Holly to discuss how you can take steps toward better lung health today, no matter how long you've been a smoker. Be a quitter!! Thank you for listening. Please send in your comments, questions and suggestions for future topics at TheLadyBod@stelizabeth.com. The Lady Bod Podcast is presented by St. Elizabeth Healthcare and Physicians.

ReachMD CME
Recognizing & Treating Alpha-1 Antitrypsin Deficiency (AATD)

ReachMD CME

Play Episode Listen Later Aug 24, 2021


CME credits: 1.00 Valid until: 24-08-2022 Claim your CME credit at https://reachmd.com/programs/cme/recognizing-and-treating-alpha-1-antitrypsin-deficiency-aatd/12765/ Alpha-1 antitrypsin deficiency (AATD) is a common yet underdiagnosed genetic disorder. Led by 2 AATD experts, this activity will address the most current information on the screening, diagnosis, and treatment of this potentially fatal disorder. AATD primarily affects the lungs and liver and requires a multidisciplinary care approach. Faculty will review patients who are at risk for AATD, its clinical manifestations (including similarities with COPD), and possible consequences to the lung and liver. Current treatment involves augmentation therapy with IV administration of AAT; there are ongoing investigations into other potential treatments. Patient cases will help clinicians apply the foundational information to clinical practice.

HempShow
Christi Chapman | Chapman Health and Wellness

HempShow

Play Episode Listen Later Aug 16, 2021 15:39


Fed up with a lifetime of doctor's advice, side effects and general discomfort?  By using a metered dose inhalers, Christi Chapman, CEO and Founder of Chapman Health and Wellness found that patients with asthma, COPD, IBS and PTSD could benefit from how quickly it was delivered to the “blood stream.”  She  joins CannTrade's CEO Mark Restelli  to explain the revolutionary way that Emerald Daze Hemp CBD metered dose inhalers allows patients to discreetly, safely, and without heat or smoke enjoy the benefits Hemp CBD.   Produced by PodCONX HempShow - https://podconx.com/podcasts/hempshowCanntrade - https://canntrade.com/HempShow Registration -  https://app.canntrade.com/registerMark Restelli - https://podconx.com/guests/mark-restelliChristi Chapman - https://podconx.com/guests/christi-chapmanChapman Health & Wellness - https://chapmanhealthandwellness.com/

All Fired Up
Fat Kids Are Not Child Abuse With The Fat Doctor UK

All Fired Up

Play Episode Listen Later Aug 14, 2021 73:37


Imagine being 13 years old, standing in front of a judge, accused of the "crime" of being fat. Imagine the incredible pain you would feel as the judge announces that in the interests of your 'health', you will be removed from your family. But there's no need to imagine. During the height of the UK COVID-19 pandemic, two children were removed from their loving home and put into foster care. The ONLY reason was that both kids were fat. This harrowing story raised the ire of the fabulous Fat Doctor UK, who advocated and pleaded and offered to help educate the social workers, judge, and anyone who would listen, but her valiant attempts have so far been ignored. Two kids have lost their families, thanks to fatphobia. Join me and the fabulous Fat Doctor UK as we get UTTERLY fired up about this travesty of justice. This is a tough listen so please make sure you have adequate spoons. Show Transcript 0:00:12.7 Louise: Welcome to All Fired Up. I'm Louise, your host. And this is the podcast where we talk all things anti-diet. Has diet culture got you in a fit of rage? Is the injustice of the beauty ideal? Getting your knickers in a twist? Does fitspo, make you wanna spit spo? Are you ready to hurl if you hear one more weight loss tip? Are you ready to be mad, loud and proud? Well, you've come to the right place. Let's get all fired up. 0:00:40.3 Louise: Hello, diet culture drop-outs. I'm so pleased to be with you again and very excited about today's episode. Okay, so first of all, I wanna say a massive thank you to all of the listeners who are so faithful and loving. And I love all your messages and emails, so keep them coming. And if you love the show, don't forget to subscribe so you don't miss the episodes as they pop out on a roughly monthly basis. And if you love us, give us five stars because the more five star reviews we get, particularly on Apple Podcasts, the louder the message is, the more listeners we get and the quicker we can topple diet culture. And that's the objective here. 0:01:24.7 Louise: If you're looking for some free stuff to help you with your anti-diet journey, gosh I hate that word. Let's call it an adventure. Anti-Diet Adventure, 'cause that's what it is. It's rocking and rolling. It's up and down. It's not predictable. But if you're looking for a resource where you might be going to medical visit, you might be trying to explain just what you're doing to friends and family, look no further than the free e-book; Everything You've Been Told About Weightloss Is Bullshit, written by me and the Anti-Diet Advanced doctor dietician, Dr Fiona Willer. In it we're busting the top 10 myths that float around diet culture like poo in a swimming pool, about the relationship between health and weight, and we're busting myths left, right and centre. 0:02:06.8 Louise: It's a really awesome resource. It's crammed full of science and facts and it will really help steel you and give you the armour that you need to push back against diet culture. So if you wanna grab a copy, it's absolutely free. Like I said, you can go to Instagram which is untrapped_ au and click on the link in the bio and grab a copy there. Or you can go to the website untrapped.com.au and a little pop-up will come and you will grab it there. More free stuff, if you are struggling with relationship with your body during the last couple of years in particular, Befriending Your Body is my free e-course. All about self-compassion, this amazing skill of being kind and befriending your body. And it's like a super power, self-compassion, because we're all taught from the moment we're born, practically, to disconnect and dislike and judge and body police ourselves. Not exactly a recipe for happiness and satisfaction. 0:03:05.9 Louise: So, this little e-course will help build the skill of self-compassion, which is absolutely awesome because if we can learn to connect with our imperfect bodies, we can learn to inhabit them, to look after them and to push back against the forces that are still trying to get us separate from them. You can find the Befriending Your Body e-course from Instagram. So, untrapped_au. Click on the link, Befriending Your Body, it's all free, it's beautiful. It's just so lovely to practice self-compassion meditations. Self-compassion is built for difficult times. And my friends, we're in a difficult time. So, get hold of that if you haven't already. 0:03:47.6 Louise: Big shout out and hello to all of the Untrapped community, the Master Class and online community, who we meet every week. We push back against diet culture together. We share our stories, we've been supporting each other through the various challenges of lockdown and it's just a wonderful community of awesome human beings. So, if you're struggling and you want to join a community, as well as learning all of the skills of how to do things like intuitive eating, returning to a relationship with moving your body that doesn't feel like hard work. Understanding weight stigma and weight prejudice, relationship with body, all of that kind of stuff is covered in this comprehensive course, Untrapped, which I co-created in 2017 with 11 other amazing anti-diet health professionals. 0:04:39.9 Louise: So if you wanna grab a hold of this program and join our online community, please do and now's the time. We're meeting weekly. So every Saturday, I meet with the whole community and we have an awesome chinwag about everything that's going on. You also get all of the material. And there's other things that happened throughout the year like events and retreats. Well, if they're not scuppered by COVID. [chuckle] In usual times, we are able to do that. Well, if that's not being scuppered by COVID, of course. But in ordinary times, we do extra stuff. So find out more about Untrapped on the website, untrapped.com.au. You can also find a link from Insta. So, I think that's a run through all of the preamble. 0:05:23.5 Louise: Now, we arrive at the exciting time. I am so excited to bring you today's episode. You would have heard of the Fat Doctor UK by now, because she burst onto the internet a few months ago. And it seems like she's everywhere and she is loud and she is angry and she's a GP. So, here we have a very fierce, fat-positive voice, straight out of the UK medical profession, which is sorely needed. And I've just got so much admiration for Natasha and everything that she's doing. And I was actually listening to the Mindful Dietician podcast when I first heard Natasha being interviewed by the wonderful, Fi Sutherland. And during that conversation, she mentioned an awful situation in the UK where two kids were removed from their family for being fat. 0:06:13.9 Louise: And I'd actually seen that story and was so horrified that I kind of shelved it a way. But hearing Natasha talk about it and what she decided to do about it herself, it just inspired me. I just knew I had to talk to her. So this episode is everything. It's a long one, and it's a bloody rollercoaster. We go a lot of places during this epic, fantastic conversation. So you are going to laugh, you are going to cry. You're gonna cry more than once, because I know I did. You're gonna be absolutely furious, because just what we're talking about is just so horrific. We are in the 21st century and kids are being removed from loving homes simply because of BMI and a failure to do the impossible, which is lose weight and keep it off via the epic fail of dieting. 0:07:06.8 Louise: So look, this is really a challenging episode to listen to. It's a horrible story but the conversation with The Fat Doctor, Natasha herself is nothing short of inspiring. This woman is on a crusade. She has got heaps of other people involved in changing the landscape in a meaningful way. She is a real champion in the UK and across the planet, and I know you're gonna enjoy this conversation, but have some tissues close by and keep your slow breathing going to help contain the rage 'cause it's real. So without further ado, I give you me and The Fat Doctor herself, Natasha Larmie. So Tash, thank you so much for coming on the show. 0:07:49.0 Natasha Larmie: Thank you so much for having me, I am so excited. Due to the time difference, it's past midnight now and I've never been this awake past midnight before, so I'm really looking forward to this talk. 0:07:58.8 Louise: Oh my god, I am so impressed with your fired up-ness. [laughter] [laughter] 0:08:04.6 Louise: Tell me what is firing you up. 0:08:07.3 NL: Just in general or specifically about this case? 'Cause obviously a lot of things are firing me up, but I mean, obviously... 0:08:11.7 Louise: Yes. 0:08:12.5 NL: We wanna talk about this particular case that's firing me up. 0:08:16.3 Louise: Yes, what is this case? 0:08:17.9 NL: Yeah, what's going on with this case. So I think it was back in September, October last year that it happened, but I became aware of it a few months later, where two young people, one was actually over the age of 16 and his sibling, his younger sibling is under the age of 16, had been removed from a very loving home, for all intents and purposes, a very loving, happy home and placed into foster care by a judge simply because they were fat, and there is really no other reason at all. There was no other signs of child abuse, neglect, physical abuse, emotional abuse, nothing. It's just because they were fat and they failed to lose weight, a judge removed them from a loving home and placed them in foster care, and the older sibling, I think he's 16, 17, didn't actually have to go in because he was too old and the younger girl, she's 13, and she was removed from her home. 0:09:11.5 NL: And when I read about it I think I was so disgusted, it sort of broke... One newspaper reports on it in the UK, and it was several weeks later I guess, because the court transcript had come out, and I read it, I read the article, and I just thought, "Well, this is just the press over-exaggerating." And then someone said... One friend of mine sent me a text message saying, "No, no, no, just read the court's transcript. Transcript, read it," and sent me a link to the court transcript. I read the whole thing and within an hour I think I read the whole thing, and I was in tears. I was so full of rage that I just felt like something had to be done and started a petition. Have tried really hard to get answers, to push people to look into this case but unfortunately, haven't got very far because we're dealing with people who have very much kind of shut us down and have said, "It's not your concern. This is a judge who made this decision and there's nothing you can do about it." 0:10:05.4 Louise: Really? 0:10:05.7 NL: So I'm pretty fired up. Yeah. 0:10:07.2 Louise: Oh, god. Oh, I mean, when you say it out loud, like my whole body is responding. When I read the court transcripts last night, I put it off because I knew that I just probably would have a massive reaction and I was crying too, because this transcript is literally fucking heartbreaking. 0:10:26.5 NL: Tears. 0:10:27.2 Louise: That they're all admitting that this is... No one wants to be split up, they love each other but there's this stupid idea, as if everybody is completely unaware of science and weight science and how fucked dieting is. 0:10:41.5 NL: Yeah. 0:10:42.2 Louise: And how it doesn't fucking work. 0:10:44.4 NL: No. 0:10:44.7 Louise: And it's in a pandemic. 0:10:46.0 NL: Yeah, yeah. 0:10:46.7 Louise: If I fail to lose weight in a lockdown, when the world was going mad... 0:10:51.6 NL: And I mean, actually, the story begins I think 10 years previously, the story begins when they were three and six. These were two children, a three-year-old and a six-year-old who were picked up most likely because... I don't know if it's the same in Australia, but in the UK we have a screening program, so in year one, which is between the age of five and six, you are weighed and measured by a school nurse, and they... 0:11:13.4 Louise: Really? 0:11:13.9 NL: Yeah. And do you not have that? No. 0:11:15.6 Louise: No. 0:11:15.7 NL: We have. This is the National Child Measurement Programme, there's a acronym, but I didn't bother to learn. 0:11:21.2 Louise: Oh my god. 0:11:21.6 NL: But it happens in year one, which is when you're between five and six, and again in year six, which is when you're between 10 and 11. 0:11:29.0 Louise: Oh Christ. 0:11:29.2 NL: Two of the worst times to weigh people... 0:11:30.0 Louise: Correct, yeah. 0:11:32.0 NL: If you're think about it, because of course, especially around the 10, 11 stage some people are heading towards puberty, pre-puberty, some people are not, and so those that are heading towards pre-puberty will often have gained quite a bit of weight because you know that always happens before you go through puberty, you kind of go out before you go up, and that's completely normal, but they get penalised. But anyway, so I imagine... I don't know, because that's not actually in the transcripts but I'm guessing that at six, the older sibling, the boy was shown to be grossly overweight or whatever they call it, morbidly obese. They probably just measured his BMI, even though he was six, they probably measured it, which is just ridiculous 'cause that's not what BMI is for, and rather than looking at growth charts, which is what we should be doing at that age, they will have just sent a letter home and the teachers would have got involved and somewhere along the line, social services would have been called just because of the weight, nothing else, just because of the weight, and social services... 0:12:25.8 Louise: Just because of the percentile of a BMI. 0:12:28.5 NL: That was all it was. It was just weight. There was literally no concerns of ever been raised about these kids apart from their weight. And at the age of three and six, social services got involved and started forcing these children to diet, and they will say that's not what they did, they tried to promote healthy eating, but when you take a three-year-old and a six-year-old and you tell them... You restrict what they eat, you force them to exercise, and you tell them there's something wrong with them, you are putting them on a diet at the age of three to six, and we know, for sure, with evidence, you know, I know, and everyone listening should know by now that when you put young children on a diet like that at such a young age and you make such a big deal out of their weight, they are going to develop disordered eating patterns, and they are going to... 0:13:06.8 Louise: Of course. 0:13:07.8 NL: Gain weight, so... 0:13:09.3 Louise: They're going to instead, that's a trauma process happening. 0:13:12.2 NL: That's true. Yeah, it's... 0:13:13.8 Louise: A trauma to get child protective services involved. 0:13:17.8 NL: Yeah, and live there for 10 years, and then... 0:13:21.4 Louise: Ten years? 0:13:22.5 NL: Got to the stage where they took the proceedings further and further, so that they kept getting more and more involved. And eventually, they decided to make this a child protection issue. Up until that point, child social services were involved, but then, about a year before the court proceedings, something like that, before the pandemic. What happened then was that they gave these children a set amount of time to lose weight, and they enforced it. They bought them Fitbits so that they could monitor how much exercise they were doing, they bought them gym subscriptions, they sent them to Weight Watchers. [chuckle] 0:13:55.9 Louise: Fantastic, 'cause we know that works. 0:13:58.4 NL: We know that works. And of course, as you said, it was during a lockdown. So, Corona hits and there was lockdown, there was schools were closed, and for us, it was really quite a difficult time. And in spite of all of that... 0:14:13.0 Louise: I can't believe it. 0:14:14.9 NL: When the children failed to lose weight, the judge decided that it was in their best interest to remove them from their loving parents. And dad, from what I can tell from the court transcripts. I don't know if you noticed this as well. I think mom was trying very hard to be as compliant as possible. 0:14:26.9 Louise: She was, and even she lost weight, the poor thing. 0:14:30.0 NL: Yes, but I think dad almost seems to be trying to protect them, saying, "This is ridiculous. You can't take my kids away just because of their weight," and I... 0:14:38.1 Louise: Seems like he was in denial, which I fully understand. 0:14:41.1 NL: I would be too, I would be outraged. And it sounds like this young girl... I don't know much about the boy, but from what I can see from the transcripts, this young girl really became quite sad and low and depressed, and obviously, shockingly enough, her self esteem has been completely ruined by this process. 0:14:58.7 Louise: I know, I know. I really saw that in the transcript. This poor little girl was so depressed and getting bullied. And in the transcript, the way that that is attributed to her size and not what abuse they're inflicting on this family. 0:15:13.3 NL: Right. Yeah, really quite shocking. And then of course, the other thing you probably noticed from the transcript is there is no expert testimony at this court proceeding. None whatsoever. There is no psychologist. 0:15:24.0 Louise: Actually, there was. 0:15:25.8 NL: There was... 0:15:26.6 Louise: Dr... What's her name? 0:15:29.4 NL: Yes. You're right, there was a psychologist, and you're absolutely right. She was not an eating disorder specialist or a... She was just a psychologist. 0:15:37.3 Louise: She's a clinical psychologist. Dr. Van Rooyen, and she's based in Kent, and she does court reports for child abuse. Yes, and I can see her weight stigma in there. She's on the one hand acknowledging that the kids don't wanna go, that the kids will suffer mentally from being removed, but you can also see her unexamined weight stigma. And that you're right, where the hell are the weight scientists saying, "Actually, it's biologically impossible to lose weight and maintain it"? Because in the transcripts, they do mention that the kids have lost weight, failed to keep it off. 0:16:16.5 NL: Exactly, exactly. And it's just shocking to me that there would be such a lack of understanding and no desire to actually establish the science or the facts behind this. If I was a judge... I'm not a judge, I'm not an expert, but if I was a judge and I was making a decision to remove a child from a home based purely on the child's inability to lose weight, I would want to find out if it was possible that this child simply couldn't lose weight on their own. I would want to consult experts. I would want to find out if there was a genetic condition. I'm not saying she has a genetic condition. You and I know that she doesn't need to have a genetic condition in order to struggle to lose weight, that actually, the psychology behind this explains it. But even if you've not got to that stage yet, there was no doctors, there was no dietitians, there was no... No one was consulted. It was a psychologist who had no understanding of these specific issues, who, as you said, was clearly biased. There was social workers who said, "We've done everything we can because we've given them a Fitbit and we've sent them to Weight Watchers and sent them to the gym, but they refuse to comply." 0:17:24.9 Louise: I know. It's shocking. 0:17:28.4 NL: Yeah, it strikes me that we live in a world where you just can get away with this. It's just universally accepted that being fat is bad, and it's also your fault, your responsibility. The blame lies solely on the individual, even if that individual is a three-year-old child, it is. And if it's not the child, then of course, it's the parent. The parent has done something wrong. 0:17:52.1 Louise: Specifically the mother, okay. 0:17:53.5 NL: The mother, yeah. 0:17:54.4 Louise: The one with the penis, okay, let's not talk about him, 'cause that was absent. It was the mom. And the only possibility that was examined in this is that it's mom's fault for not being compliant, like you said. That's the only thing. Nothing else like the whole method is a stink-fest of ineffective bullshit. 0:18:13.5 NL: And there's the one point in the transcript when they talk about the fact that she had ice cream or chips or something in the house. 0:18:19.7 Louise: That's Ms. Keeley, their social worker, who went in and judged them. And did you notice that she took different scales in during that last visit? That last visit that was gonna determine whether or not they'd be removed, she took different scales in and weighed them. And they say, "Look, we acknowledge that that could've screwed up the results, but we're just gonna push on with removal." 0:18:43.0 NL: It was their agenda. 0:18:45.0 Louise: It was. It's terrifying, and it's long-term foster care for this poor little girl who doesn't wanna leave her mom. I'm so fired up about this, because the impact of removing yourself from your home because of your body, how on earth is this poor kid gonna be okay? 0:19:05.7 NL: This is my worry. How is mom going to be okay? How is that boy going to be okay? And how is that young, impressionable girl... My oldest son is a little bit older, and my younger son is a little bit younger, she's literally in between the two, and I'm watching what the last two years or last year and a half has done to them in terms of their mental and emotional well-being. And to me, even without social services' involvement, my children's mental health has deteriorated massively. And I cannot even begin to comprehend what this poor girl is going through. I cannot imagine how traumatized she is, and I cannot see how is she ever going to get over this, because she's been going through it since she was three, and it's not at the hand of a parent, it's at the hand of a social worker, it is the social worker's negligence. And what's interesting is a lot of social workers and people who work in social services have reached out to me since I first talked about this case, and they have all said the same thing, the amount of weight stigma in social services in the UK is shocking. It is shocking. It is perfectly acceptable to call parents abusers just because their children are overweight. 0:20:21.8 Louise: Jesus. 0:20:22.2 NL: No other reason, just your child is over the limit, is on the 90th percentile or whatever it is, your child is overweight and therefore you as a mother, usually as you said, it's a mother, are an abusive mother, because you've brought your child up in a loving environment but they failed to look the way that you want them to look, that's it. 0:20:41.0 Louise: Okay. So, that's me, right. My eldest is in the 99th percentile, so I am an abuser, I'm a child abuser. 0:20:47.3 NL: Child abuser, I can't believe I'm probably talking to one. 0:20:49.3 Louise: I know. [laughter] 0:20:49.9 NL: I can't believe I'm probably talking to one. And you know, the irony, my son's been really poorly recently and he's been up in... I mean we've spent most of our life in the hospital the last few weeks, and... 0:20:58.1 Louise: Oh dear. 0:20:58.3 NL: Went to see a paediatrician and they did the height and weight, and he is on the 98th percentile, my son has a 28-inch waist. He is a skeleton at the moment because he's been really ill, but he is mixed race, and we all know that the BMI is not particularly... 0:21:12.9 Louise: It's racist. 0:21:13.2 NL: Useful anyway, but it's massively racist, so my children have always been, if you weigh them, a lot heavier than they look, because I mean he's... There isn't an ounce of fat on him. My point is that BMI is complete utter bullshit and it doesn't deserve to exist. The fact that we've been using up until now is shameful and as a doctor, I cannot accept that we use this as a measure of whether a person is healthy and certainly as a measure of whether a child is healthy, because until recently, we were told you don't do BMIs on anyone under the age of 16 but that's just gone out the window now, everyone... 0:21:48.5 Louise: I know. 0:21:48.6 NL: Gets a BMI, even a six-year-old. 0:21:50.1 Louise: You get a BMI, you get a BMI. [laughter] I think it's not supposed to be used for an individual anything, it's a population level statistic. 0:22:01.1 NL: And a pretty crappy one at that. 0:22:02.3 Louise: It's a shitty one. 0:22:02.6 NL: It is like you said. 0:22:04.2 Louise: Yes. 0:22:04.6 NL: It's based on what European men, it's not particularly useful for men, it's not particularly useful for any other race, it's just useful perhaps. Even when it came out, like even when... What's his face? I forget his name right now, Ancel Keys. When he did that study that first look, brought in the BMI into our medical world as it were, yeah, even he said at the time it was alright. It's not the best, it's not the worst, it will do. It's the best out of the bunch. I mean he didn't even have much enthusiasm at the time. He said specifically it's not meant to be used as an individual assessment. And even the guy who kind of didn't invent it, but he sort of invented it as a measure of "obesity" and yet... And even he didn't have much good stuff to say about it. If he was selling the latest iPhone, Apple would have a lot to say about that. [laughter] I just... This fact that we've become obsessed and we know why this is. We know this is because of the diet industry, we know this is because of people trying to make money out of us and succeeding, very successful at making money out of us. 0:23:02.9 Louise: It's actually terrifying how successful this is because when I read this transcript, I've been doing a lot of work against the Novo Nordisk impact and how our modern oh, narrative has been essentially created by the pharmaceutical company that's producing all of the weight loss drugs, they have 80% of the weight loss drugs market and they've shamelessly said in their marketing that this is their drive to increase... That it's to create a sense of urgency for the medical management of obesity. And here it is, this is where it bleeds, because they're telling us this bullshit that it's going to reduce stigma. No, it's going to create eugenics. This is hideous what's happening here and I can't believe that the world didn't stop and that the front page of newspapers aren't saying like get fucked, like get these kids back. There's no outrage. 0:24:04.2 NL: No, there is none whatsoever. We got just over 2,000 people supporting the petition and as grateful as I am for that, that's just what the fuck, that's 2,000 people who live in a country of 68 million and only 2,000 people had something to say about this and, we... That's how much we hate fat kids and how much we hate fat people. We just don't see them as worthy and nobody wants to defend this young girl, nobody sort of feels sorry for her and I just... I can't get my head around this whole thing. It's funny because I didn't really know about it, a year ago I was completely clueless. It's all happened rather quickly for me that I've begun to understand Haze and begun to understand who Novo Nordisk was and what they are doing and what Semaglutide actually is and how it's going to completely change the world as we know it. 0:24:56.5 NL: I think this particular drug is going to become part of popular culture in the same way that Viagra is, we use that word now in novels and in movies. It's so popular and so understood, nobody talks about... I don't know, give me a name of any drug, like some blood pressure medication, they don't talk about it in the same way they talk about Viagra. But Semaglutide is going to be that next drug because they have tapped into this incredibly large population of people who are desperate to lose weight and they've got this medication that was originally used to treat diabetes, just like Viagra was originally used to treat blood pressure and have said, "Wow, look at this amazing side effect. It makes people lose weight as long as you run it. Let's market this." And the FDA approved it. I mean, no... 0:25:45.1 Louise: I know. 0:25:45.8 NL: No thought as to whether or not this drug is gonna have a massive impact on people in their insulin resistance and whether they're gonna develop diabetes down the line. I don't think they care. I don't think anybody actually cares. I think it's just that everybody is happy, woo-hoo, another way to treat fat people and make a good deal of money out of it. 0:26:03.9 Louise: Right? So, Semaglutide is... It's the latest weight loss drug to be approved by the FDA from Novo Nordisk and it is like the Mark II. So, they were selling Saxenda, Saxenda's here in Australia, they're pushing it out and this Semaglutide is like the Mark II, like I think of Saxenda as like Jan Brady, and Semaglutide is like Marcia. [laughter] 0:26:29.3 Louise: 'Cause it's like, "Oh my God, look at Semaglutide. Look at this amazing one year trial." [laughter] Marcia, Marcia, Marcia, like oh my God, we can make so much weight loss happen from this intervention. Why? Why do we need all of this weight loss, all these percentages? And, "Oh, we can lose 15% and 20%," and we don't need to for health, but okay. 0:26:53.3 NL: Yeah. The other thing that we have to remember about it, I don't think it's actually that much better. I've used all of these drugs in treating diabetes. So many years, I used these drugs. The beauty of it, of course, is that it's a tablet, and Saxenda is an injection. I'm assuming you have the injectable form, yeah? 0:27:09.9 Louise: That's right. You have to inject, and it's very expensive. 0:27:14.0 NL: It's extremely expensive, as will... Marcia Brady will be more expensive, I'm sure. 0:27:18.6 Louise: So high maintenance. [chuckle] 0:27:20.2 NL: Absolutely, but she is easier to administer. A lot of people don't like the idea of injecting themselves, but taking a tablet is dead easy. So, that's what makes this special, as it were, because it's the only one of that whole family that is oral, as opposed to injectable. 0:27:37.6 Louise: Well, that's interesting, because the paper with all of the big, shiny weight loss was injectable, it wasn't tablet. 0:27:43.7 NL: Oh, really? Oh, but they're marketing it as the oral version, definitely. That's the one that's got approved. It's brand name is... 0:27:51.3 Louise: Wegovy. 0:27:52.2 NL: Oh no, well, I have a completely different brand name. Is it different, maybe, in Australia? 0:27:57.1 Louise: Well, this is in America. In Australia, they haven't cornered us yet. I'm sure that they're trying to do it, but it was the FDA approval for Wegovy, [0:28:05.4] ____. 0:28:05.9 NL: So, they obviously changed the name. That's not the same one we use in diabetes. Clearly, they've had to revamp it a bit. Irrespective of oral, injectable, whatever, I think that this is going to... Novo Nordisk is sitting on a gold mine, and they know it. And it's going to change our lives, I think, because bariatric surgery is quite a big thing, and it's something that often people will say, "I'm not keen on doing." And the uptake is quite low still, and so, in bariatric... 0:28:35.2 Louise: In the UK, not here. 0:28:36.2 NL: Yeah, [chuckle] yeah, but bariatric surgeons are probably very afraid right now, because there's drugs coming along and taking all of their business away from them. 0:28:43.5 Louise: Actually, you know what Novo were doing? They're partnering with the bariatric surgeons. 0:28:46.2 NL: Of course they are. 0:28:46.9 Louise: And they're saying to them, "Hey, let's use your power and kudos, and our drugs can help your patients when they start to regain." 0:28:56.4 NL: Oh my gosh. 0:28:58.0 Louise: It's literally gateway drug. Once you start using a drug to reduce your weight, you have medicalized your weight, and it's a small upsell from there. So, I think this is all part of a giant marketing genius that is Novo Nordisk. But I'm interested to hear your concerns, 'cause I'm concerned as well with the use of diabetes drugs as weight loss medications, and I read about it being that they're hoping that people will take this drug like we take statins. So, everyone will take it preventatively for the rest of their lives. What's the long-term impact, do you think, of taking a double dose of a diabetes drug when you don't have diabetes? 0:29:43.5 NL: Well, first of all, they don't know. Nobody knows, because they've only done a study for a year, and just how many diet drugs have we put out there into the universe since the 1970s, and then taken them back a few years later, 'cause we've gone, "Oh, this kills"? If you've got diabetes and you take this drug because you've got insulin resistance and this drug helps you to combat your insulin resistance in the way that it works, you've already got diabetes. And so, there is no risk of you developing diabetes, and this drug does work, and so, I have no issue with the GLP-1 analogs in their use in diabetes. I think all the diabetes drugs are important, and I'm not an expert. But you've really got to ask yourself, if you take a healthy body and you act on a system within the pancreas and within the body, in a healthy, essentially, healthy body, healthy pancreas, you've got to ask yourself if it's going to worsen insulin resistance over time. It's actually going to lead to increased cases of diabetes. Now, they say it won't, but... 0:30:47.4 Louise: How do they know that? 'Cause I've read a study by Novo, sponsored, in rats, that showed that it did lead to insulin resistance long-term. 0:30:57.6 NL: Right, I think common sense, because we understand that the way that the body works, just common sense. The way the body works suggests to me that over long periods of time, taking this medication in a healthy person is going to lead to increased insulin resistance, which in turn will lead to diabetes. That is what common sense dictates. But of course, as you said, we don't know. We don't have a study. Nobody has looked into this. And it makes me sad that we are using a drug to treat a condition that isn't a condition. 0:31:30.2 Louise: I know, yeah. [chuckle] 0:31:32.4 NL: And inadvertently, potentially giving people a whole... 0:31:36.0 Louise: Creating a condition. 0:31:36.6 NL: Creating an actual medical condition, which we all know to be life-threatening if untreated. And so, I cannot fathom why... Well, I can, I understand. It's for financial reasons only, but I can't understand why there are doctors out there that want to prescribe this. This is the issue that I have. I'm a doctor, and I can't speak on behalf of drug companies or politicians or anyone else, but I can speak to what doctors are supposed to be doing, and we have a very strong code of conduct that we have to abide by. We have ethical and moral principles and legal obligations to our patients. And so, doing no harm and doing what is in your patients' best interest, and practising fairly and without discrimination, and giving people... Allowing them to make an informed choice where they are aware of the risks and the side effects and all the different treatment options. 0:32:28.0 NL: When it comes to being fat, again, it seems to have gone out the window. None of these things are happening. We wouldn't dream of addressing other issues this way, it's just fatness, because it's just so commonly, widely accepted that fatness is bad and you've got to do whatever you can to get rid of it. I've had someone tell me today that they are pregnant with their first child and they had their first conversation with the anesthetist, who told them they had to do whatever they could to lose weight before they had their baby. This is a pregnant woman. 0:32:58.1 Louise: Whatever they had to do? 0:33:00.1 NL: Whatever they had to do, and she said, "What do you want me to do, buy drugs off the streets?" And the anesthetist said... Wait for it. The anesthetist said, "It would be safer for you to use a Class A drugs than it would for you to be fat in pregnancy". The anesthetist said that to this woman. She told me this and I just went "Please just... Can you just report him?" 0:33:21.7 Louise: Shut the front door, Jesus Christ! 0:33:24.6 NL: Can you imagine? First of all, that's not true. Second of all, he is saying that it is better to be a drug addict than to be a fat person. This is no judgment on drug addicts, but you do not encourage your patients to use Class A drugs to lose weight. That's stupid. Imagine if he'd said that about anything else, but in his... And it was a man, in his world, for whatever reason, his ethics just abandons them all in favor of fat shaming a woman. 0:33:52.4 Louise: This is where we're at with, it's self examined. It's like there's a massive black hole of stigma just operating unchallenged effortlessly and actually growing, thanks to this massive marketing department, Novo. It's terrify... That poor lady, I'm so glad she's found you and I hope she's not gonna go down the Class A drug route. [laughter] 0:34:19.3 NL: She's definitely not, but she was quite traumatized. She's on a Facebook group that I started and it's great because it's 500 people who are just so supportive of each other and it was within a few minutes 50 comments going "What a load of crap, I can't believe this," "You're great, this doctor is terrible". But it just stuck to me that one of my colleagues would dare, would have the audacity to do something as negligent as that. And I'm gonna call it what it is. That's negligence. But I'm seeing it all the time. I'm seeing it in healthcare, I'm seeing it in Social Services, I'm seeing it in schools, I'm seeing it in the workplace, I'm seeing it everywhere. You cannot escape it. And as a fat person, who was in the morbidly, super fat, super obese stage where she's just basically needs to just be put down like a... 0:35:16.3 Louise: Oh my gosh, it's awful. 0:35:18.5 NL: And as that person, I hear all of these things and I just think "I'm actually a fairly useful member of society, I've actually never been ill, never required any medication, managed to give birth to my children, actually to be fair, they had to come out my zip as opposed to through the tunnel." But that wasn't because I was fat, that was because they were awkward. But this anesthetist telling this woman that she's too fat to have a baby. I was just like "But I am the same weight. I am the same BMI as you". And I had three and I had no problems with my anesthetics. In fact after my third cesarean section, I walked out the hospital 24 hours later, happy as Larry, didn't have any problems. And I know people who were very, very thin that had a massive problems after their cesarean. So there's not even evidence to show how dangerous it is to have a BMI over 35 and still... And then caught when it comes to an anesthetic. This isn't even evidence-based, it's just superstition at this point. 0:36:12.8 Louise: It's a biased based and the guidelines here in Australia, so I think above 35 women are advised to have a cesarean because it's too dangerous. And women are not allowed to give birth in rural hospitals, they have to fly to major cities. So imagine all of... And don't even get me started on bias in medical care for women. It's everywhere, like you said, and it's unexamined and all of this discrimination in the name of, apparently, healthcare. It's scary. 0:36:43.9 NL: It really is. Gosh, you've got me fired up, it's almost 1:00 in the morning and I'm fired up. I'm never gonna get to sleep now. [laughter] 0:36:51.7 Louise: Okay, I don't wanna tell you this, but I will. 'Cause we're talking about how on earth is this possible, like why aren't there any medical experts involved to talk about this from a scientific basis, and I'm worried that even if they did have medical people in the court, they wouldn't have actually stuck up for the kid. I found this JAMA article from 2011. It's a commentary on whether or not large kids should be removed from their families, and it was supportive of that. 0:37:18.0 NL: Oh gosh. Of course it was. 0:37:22.0 Louise: And in response to that commentary, the medpage, which is a medical website, a newsletter kind of thing. They did a poll of health professionals asking should larger kids removed from their families, and 54% said yes. 0:37:40.7 NL: Of course. 0:37:41.3 Louise: I know. Isn't that dreadful? One comment on that said "It seems to me the children in a home where they have become morbidly obese might be suffering many other kinds of abuse as well, viewing in the size of a child. 'Cause we've all gotten bigger since the '80s. We're a larger population and viewing that as abuse and as a fault of parenting. Unbelievable. I also had a little dig around Australia, 'cause it's not isolated in the UK, there's so many more cases. 0:38:16.9 NL: They have. Yeah. 0:38:17.8 Louise: And I think actually in the UK, it might be a lot more common than in Australia. 0:38:22.1 NL: Yeah, I can believe that. 0:38:23.5 Louise: But it did happen here in 2012, there was some report of two children being removed from their families because of the size of the kids. And the media coverage was actually quite dreadful. I'll put in the show notes, this article, and the title is "Victorian authorities remove obese children, removed from their parents". So even the title is wrong, couldn't even get their semantics right. There's a picture, you can imagine what picture would accompany... 0:38:55.2 NL: Well of course it can't be of the actual children, because I think it leads to lawsuit. I'm assuming it's a belly. Is there a belly? Is there a fat person in it or a fat child eating a burger? 0:39:06.2 Louise: Yes. [laughter] 0:39:07.1 NL: Sorry, it's either the belly or the fat person eating the burger. So, a fat child eating the burger, sorry. 0:39:11.9 Louise: Helpfully, to help the visually impaired, the picture had caption and the caption reads "Overweight brother and sister sitting side by side on a sofa eating takeaway food and watching the TV." So not at all stereotyped, very sensitive, nuanced article this one. And then we hear from Professor John Dixon, who is a big part of obesity Inc here in Australia. He told the ABC that "Sometimes taking children away from their parents is the best option." In the same article, he also admits "There's no services available that can actually help kids lose weight", and he says that it's not the parents fault. Helpfully, this article also states that "Obesity is the leading cause of illness and death in Australia." [laughter] 0:39:58.7 NL: I love it when I hear that. How have they figured that out? What do they do to decide that? Where does this... 0:40:08.4 Louise: They don't have to provide any actual evidence. 0:40:10.5 NL: Right. They just say it. 0:40:12.1 Louise: Got it. 0:40:13.0 NL: Just say it. 0:40:14.4 Louise: Diet. And I checked just to make sure, 'cause in case I've missed anything. 0:40:18.4 NL: Yeah. 0:40:19.6 Louise: The top five causes of death in Australia in 2019; heart disease, number two dementia, number three stroke, number four malignant neoplasm of trachea bronchus and lung. 0:40:30.4 NL: Lung cancer. 0:40:30.9 Louise: Lung cancer. 0:40:31.5 NL: That's lung cancer. 0:40:32.3 Louise: And number five chronic lower respiratory disease. 0:40:38.4 NL: So translation. Heart attacks, dementia... In the UK it's actually dementia first, then heart attacks. So dementia, heart attacks, stroke, same thing in the UK, and then lung cancer and COPD. Both of those are smoking-related illnesses. And I can say quite safely that they are smoking-related illness because the chance of developing lung cancer or COPD if you haven't smoked is minuscule. So what the people are doing is they're saying, "Well, we can attribute all of these heart attacks and strokes and dementia to "obesity". And the way we can do that is we just look at all these people that have died, and if they are fat we'll just assume it's their fat that caused their heart disease. 0:41:20.0 NL: To make it very clear to everybody that is listening, if you have a BMI of 40, we can calculate your risk of developing a heart attack or a stroke over the next 10 years using a very sophisticated calculator actually, it's been around for some time. It's what we use in the UK. I'm assuming Australia has a similar one, don't know what it's called there. In the UK it's called a QRISK. So I've done this. I have calculated. I have found a woman, I called her Jane. I gave her a set of blood pressure and cholesterol, and I filled in a template. And then I gave her a BMI of 20. And then I gave her a BMI of 40. And I calculated the difference in her risk. I calculated the difference in her risk, and the difference in her risk was exactly 3%. The difference in her risk if she was a smoker was 50%. She was 50% more likely to have a heart attack if she was a smoker, but only 3% more likely to have a heart attack if she had a BMI of 40 instead of a BMI of 25. 0:42:15.0 NL: To put it into perspective, she was significantly more likely to have a heart attack if she was a migraine sufferer, if she had a mental health condition, if she had lupus or rheumatoid arthritis, if she was Asian, if she was a man, and all of those things dramatically increased her risk more than having a BMI of 40. So it's just very important that doctors will admit, 'cause it's about admitting to a simple fact, this calculator we use to predict people's risks. So if we know that weight only has a 3-4% impact on our cardiovascular risk as opposed to smoking which has a 50% impact, as opposed to aging which is why most people die because they get old and let's face it everybody dies some time. 0:43:04.0 NL: So what's happening is the... Whoever they are, are taking all these deaths from heart disease which was likely caused by the person aging, by the person being male or just being old and being over the age of 75, your risk of heart disease goes up massively irrespective of your weight. So instead of saying, "Well, it's just heart disease", they've gone, "Well, it's heart disease in a fat person and therefore it was the fatness that caused the heart disease." And that is offensive to me to the point that now, I have heard... And this is awful in this year, our patients that are dying of COVID, if they die of COVID in the UK, it's actually quite heart breaking, it's happened to someone that I was close to. If they die of COVID in the UK, and they happen to be fat, the doctor writes "obesity" on their death certificate... 0:43:51.8 Louise: No way. 0:43:52.4 NL: As a cause of death. They died of COVID. 0:43:55.2 Louise: What? 0:43:55.5 NL: They died of COVID. That's what they died of. They died of this terrible virus that is killing people in their droves but people are under the misguided impression that being fat predisposes you to death from COVID, which is not true. It's not true. That is a complete gross misrepresentation of the facts. But we've now got doctors placing that on a person's death certificate. Can you imagine how that family feels? Can you imagine what it feels like to get this death certificate saying, "Your family member is dead from COVID but it's their fault 'cause they were obese." And how can the doctor know? How could the doctor know that? 0:44:34.2 Louise: How can they do that? 0:44:35.6 NL: How can they do that? And this is my point, this doctor that's turning around and saying it's safer for children to be removed from their loving home. Obviously, this person has no idea of the psychological consequences of being removed from your family. But it's safer for that person to be removed from their home than to remain in their home and remain fat. What will you achieve? Is this person going to lose weight? No. I can tell you what this person is going to do. This person is going to develop... 0:44:58.9 Louise: They even say that. They even say that in the transcripts. We don't think that they'll get any more supervision. 0:45:03.1 NL: Yeah. In fact, we're gonna get less supervision because it's not a loving parent. You're going to develop, most likely an eating disorder. You're going to develop serious psychological scars. That trauma is going to lead to mental health problems down the line. And chances are you're just gonna get bigger. You're not gonna get smaller because we know that 95% of people who lose weight gain it all back again. We know that two-thirds of them end up heavier. We know that the more you diet, the heavier you're gonna get. And that actually, this has been shown to be like a dose-response thing in some studies. So the more diets you go on, the higher your weight is going to get. If you don't diet ever in your life, chances are you're not gonna have as many weight problems later on down the line. So, as you're saying, we are living in a society that's got fatter. And there's lots of reasons for that. It's got to do with the food that we're eating now. That we're all eating. That we're all consuming. 0:45:55.1 Louise: Food supply. Only some of us will express from there the epigenetic glory of becoming higher weight. 0:46:02.0 NL: Right. And that's the thing, isn't it? Genetics, hormones, trauma, medications. How many people do I know that are on psychiatric medications and have gained weight as a result, Clozapine or... It's just what's gonna happen. You name it. Being female, having babies, so many things will determine your weight. 0:46:21.0 Louise: Getting older. We're allowed to get... We're supposed to get bigger as we get older. 0:46:25.1 NL: And then you know that actually, there are so many studies nowadays, so many studies that we've labeled it now that show that actually being fat can be beneficial to you. There's studies that show that if you end up in ICU with sepsis, you're far more likely to survive if you're fat. If you've got a BMI over 30, you're more likely to survive. There's studies that show that if you have chronic kidney disease and you're on dialysis, the chances of you surviving more long-term are significantly higher if you're fat. Heart failure, kidney disease, ICU admissions, in fact, even after a heart attack, there's evidence to show that you're more likely to survive if you're fat. And they call this the obesity paradox. We have to call it a paradox because we cannot, for one moment, admit that actually there's a possibility that being fat isn't all that bad for you in the first place and we got it wrong. Rather than admit that we got it wrong, we've labeled a paradox because we have to be right here, we have to... 0:47:18.0 Louise: Yeah, it's like how totally bad and wrong, except in certain rare, weird conditions, as opposed to, "Let's just drop the judgment and look at all of this much less hysterically." 0:47:29.5 NL: Yeah. And studies have shown that putting children on a diet, talking about weight, weight-shaming them, weighing them, any of these things, have been linked to and have been demonstrated to cause disordered eating and be a serious risk for direct factor for weight gain. And that, in my opinion, is the important thing to remember in this particular case, because as I said, social services start in weight-shaming, judging, and talking about weight when these children were three and six, and they did that for 10 years. And in doing so, they are responsible for the fact that these children went on to gain weight, because that's what the evidence shows. And there's no question about this evidence, there's multiple papers to back it up. 0:48:14.1 NL: There's an article published in Germany in 2016, there was an article published last year by the University of Cambridge, and even the American Academy of Pediatrics agrees that talking about weight, putting children on a diet, in fact, even a parent going on a diet is enough to damage that child and increase their risk of developing disordered eating patterns and weight gain. 0:48:37.9 NL: And so, as far as I'm concerned, that to me, is evidence enough to say that it's actually social services that should be in front of a judge, not these children, but it's the social workers that should be held to account. And I have written... And this is something that is very important to say. I wrote to the council, the local authority, and I've written a very long letter, I've published it on my website. You can read it anytime, anyone can read it. And I wrote to them and I said, "This is the evidence. Here are all the links. As far as I'm concerned, you guys got it terribly wrong and you have demonstrated that there is a high degree of weight bias that is actually causing damage to children. I am prepared to come and train you for free and teach all of your social workers all about weight bias, weight stigma, and to basically dispel the myths that obviously are pervading your social work department." And they ignored me. I wrote to politicians in the area. They ignored me. I wrote to a counselor who's a member of my political party, who just claimed, "Yeah, I'll look into it for you." Never heard from her again. Yeah, nobody cares. 0:49:44.0 Louise: It's just such a lack of concern. 0:49:45.7 NL: I didn't even do it in a critical way. I had to do it in a kind of, "I will help you. Let me help you. I'm offering my services for free. I do charge, normally, but I'll do it for free for you guys." No one is interested. Nobody wants to know. And that makes me really sad, that they weren't even willing to hear me out. 0:50:03.0 Louise: I can't believe they didn't actually even answer you. 0:50:06.5 NL: Didn't answer me, didn't respond to any of my messages, none of the counselors, none of the... Nobody has responded, and I've tried repeatedly. 0:50:14.4 Louise: So, this is in West Sussex, yeah? 0:50:16.7 NL: That's right, West Sussex, that's right. 0:50:18.0 Louise: You know what's weird about that? I've actually attended a wedding at that council, that my ex-father-in-law got married there. And when I saw the picture there, I'm like, "Oh my God, I've actually been there." So, I had a poke, and I don't know if you know this, but hopefully, in the future, when those children, C and D, finally decide to sue the council, that they can use this as evidence. There is a report from a... It's called a commissioner's progress report on children services in West Sussex from October 2020, which details how awful the service has been for the past few years, and huge issues with how they're running things. And it says, "Quite fragile and unstable services in West Sussex." So, this family who've had their kids removed were being cared for by a service with massive problems, are being referred to programs that don't work, and that there's a massive miscarriage of justice. 0:51:17.3 NL: And I'm glad you're talking about it, and I'm glad we're talking about it. And I wish that we had the platform to talk about it more vocally. I'd want to be able to reach out to these... To see patients... They're not patients, child C and D. I want to be able to reach out to mum as well, and say... 0:51:36.3 Louise: I just wanna land in Sussex and just walk around the street saying, "Where are you? I wanna help." 0:51:40.2 NL: "Where are you? And let me hug you." And I'm very interest to know, I'd be very interested to know the ethnic origin of these young people. 0:51:48.9 Louise: And the socio-economic status of these people. 0:51:50.2 NL: Socio-economic status, 100%. I would very much like to know that. That would make a huge... I think that I can guess, I'm not going to speculate, but I had a very lovely young woman contact me from a... She was now an adult, but she had experienced this as a child. She had been removed from her home and was now an adult, and she had been in foster care, in social services, for a few years, and had obviously contact with her mum but hadn't been reunited with her mum ever. So it wasn't like it was for a time and then she went back. And we talked about this. She was in a London borough, I shall not name the borough, but I know for a fact that her race would've played a role in this, because she was half-Black, half-Turkish. 0:52:39.2 NL: And there're a few things in that court transcript that caught my attention. I don't know if you noticed there was a mention of the smell from the kitchen, and they didn't specifically said, you know, mould, or you know that there was mould in the kitchen, or there was something in the kitchen that was rotting, something like that, 'cause I think they would have specified. It was just a smell. And that made me wonder, is this to do with just the fact that maybe this family lived in poor housing or was it the type of food that they were cooking for their children? Is there a language issue, is there a cultural issue. What exactly is going on? 'cause we don't know that from the court transcript, so that's another thing that... Another piece of the puzzle that I would really be interested in. Is this a white wealthy family? Probably not. I don't think they are. 0:53:27.2 Louise: Yeah it didn't struck me that way either. Yeah, yeah this is potentially marginalization and racism happening that... 0:53:35.1 NL: Yeah. 0:53:35.9 Louise: And here in Australia, we've got an awful history of how we treated First Nations people and we removed indigenous kids from their families, on the basis of like we know better, and I just... Yeah honestly, elements of that here, like we know better. 0:53:51.5 NL: Yes. Right, this is it. We know better than you have to parent your child. I am have always been a big believer of not restricting my children's feed in any way. I was restricted, and I made the decision when we had the kids that there would just be no restriction at all. I have like been one of those parents that had just been like, that's the draw with all the sweet treats in it. They're not called treats, they're just sweets and chocolate and candy, there it is. It's within reachable distance. Help yourself whenever you want, ice pops in the freezer, there's no like you have to eat that to get your pudding. None of that. 0:54:27.6 NL: My kids have just been able to eat whatever they wanted, whenever they wanted, I never restricted anything, I wanted them to be intuitive eaters. And of course they are, and what amazes me is now my teenage son, when we were on lockdown, and he was like homeschooled, he would come downstairs, make himself a breakfast, and there was like three portions of fruit and veg on his plate, and not because someone told him that he had to, but just because he knew it was good for him and he knew it was healthy, there was like a selection, his plate was always multi-colored, he was drinking plenty of water. He would go and cook it, he cooked himself lunch, he knew that he can eat sweets and crisps and chocolate whenever he wanted to, and he didn't, he just didn't. Like it was there, that drawn, it gets emptied out because it's become a bit... But no, they don't take it, and sometimes they do, 'cause they fancy it, but most of the times they don't. And that is my decision as a parent, I believe that I have done what is in their best interest, I believe that I will prove over time that this has had a much better impact on their health, not restricting them. 0:55:26.4 Louise: Absolutely, Yeah. 0:55:27.6 NL: But the point is they're my children, and it was my damn choice, and even if my child is on the 98th percentile, it's still my damn choice, nobody gets to tell me how to parent my child. That is my child, I know what's best for them. And I believe that my children are going to prove the fact that this is a great way of parenting, and I know that actually most of their friends who had, were not allowed to eat the food that they wanted to eat used to come over to our house and just kind of like wide eyed. And they binge, they binge, you know, to the point that I have to restrict them and say I actually I don't think mom would like that if I gave that to you. 0:56:00.0 Louise: We know that that's what we do when we put kids in food deserts, we breed binge eating and food insecurity, and trying to teach our kids to have a relaxed and enjoyable relationship with food is what intuitive eating is all about. And without a side salad of fat phobia, we're not doing this relationship with food stuff in order to make sure you're thin, we're doing this to make sure that you feel really safe and secure in the world, and you know health is sometimes controllable and sometimes not, and this kind of mad obsession we have with controlling our food and the ability it will give us like everlasting life is weird. 0:56:39.0 NL: Yeah. 0:56:39.7 Louise: Yeah. Gosh, I'm so glad you're parenting those kids in that way and I've noticed the same thing with my kids. Like my kids, we are a family of intuitive eaters and it's just really relaxed, and there's variety, and they go through these little love affairs with foods, and it's really cute. [chuckle] And they're developing their palettes, and their size is not up to me. 0:57:05.8 NL: Yeah. 0:57:06.4 Louise: Yeah. 0:57:07.4 NL: Right. 0:57:08.1 Louise: It's up to me to help them thrive. 0:57:10.7 NL: That's right. And when people talk about health, I often hear people talking about health, and whenever they ask me that question, you know, surely you can agree that being fat is not good for your health, well, I'll always kinda go, "Oh Really? Could you just do me a favor here and define health?" Because I spend my whole life trying to define health, and I'm not sure that I've got there yet, but I can tell you without a doubt that this for me, in my personal experience as a doctor... And I've been a doctor for a long time now, and I see patients all the time, and I'm telling you that in my experience, the most important thing for your health is your mental and emotional well-being, that if you are not mentally and emotionally well, it doesn't matter how good your cholesterol is, it doesn't matter whether or not you've got diabetes, that is irrelevant, because if you're not mental and emotional... I'm not saying that 'cause you won't enjoy life, I mean, it has an impact on your physical health. And I spend most of my day dealing with either people who are depressed or anxious, and that's what they've presented with, or they've presented with symptoms that are being made worse or exacerbated by their mental and emotional pull, mental and emotional well-being. 0:58:19.1 NL: So giving my children the best start in life has always been about giving them a good mental and emotional well, start. It's about giving... It's not just teaching them resilience, but teaching them to love themselves, to be happy with who they are, to not feel judged or to not feel that they are anything other than the brilliant human beings that they are. And I believe that that is what's going to stand them in the greatest... In the greatest... I've lost my words now, but that's what's gonna get them through life, and that's why they're going to be healthy. And how much sugar they eat actually is quite irrelevant compared to the fact that they love themselves and their bodies, and they are great self-esteem, we all know that happiness is... Happiness is the most important thing when it comes to quality of life and happiness is the most important thing when it comes to length of life and illness, all of it. Happiness trumps everything else. 0:59:07.0 Louise: And to you know what that comes from. Happiness comes from a sense of belonging, belonging in our bodies, belonging in ourselves, belonging in the community, and all of this othering that's happening with the message that everyone belongs unless they're fat. That sucks ass and that needs to stop. This poor little kid when, in the transcript it mentioned that they found a suicide note... 0:59:29.9 NL: Yes. 0:59:30.1 Louise: And some pills. And she's fucking like 13. 0:59:34.8 NL: Yeah, and they called it a cry for help. 0:59:36.0 Louise: They called it cry for help 'cause of her body. 0:59:38.1 NL: Yeah. 0:59:38.4 Louise: They didn't recognize it since they've been sniffing around threatening to take her off her mom, and because she's being bullied for her size at school. This is like a calamitous failure to see the impact of weight stigma. 0:59:52.9 NL: She's been told that it's her fault that she's been taken away from her mum. They had told her that because she didn't succeed in losing weight, that she doesn't get to live with her mother anymore. Can you imagine? 1:00:02.4 Louise: So her mom. I can't even wrap my head around that. I can't. 1:00:07.2 NL: Well, she feels suicidal, I think I would too. I felt suicidal at her age and for a lot less. It's terrible, it's terrible. And I hope she's hanging on and I hope that... 1:00:14.6 Louise: I wanna tell her that she is awesome. 1:00:17.4 NL: Yes. 1:00:17.9 Louise: If she ever gets to listen to this. But I know the impact. So like when I was 11, my mom left and I remember how much it tore out my heart. 1:00:26.4 NL: Yeah. 1:00:26.9 Louise: You're 11... 1:00:27.5 NL: Yeah. 1:00:28.3 Louise: 12, 13. This is not the time to do this to kids, and this whole idea... The judge said something like, "Oh, you know, gosh, this is gonna be bad... " But here it is, I will read it to you. This is... She actually wrote a letter to the kids. 1:00:42.5 NL: Oh, gosh. 1:00:43.7 Louise: "I know you will feel that in making this o

ALL FIRED UP
Fat Kids Are Not Child Abuse With The Fat Doctor UK

ALL FIRED UP

Play Episode Listen Later Aug 14, 2021 73:37


Imagine being 13 years old, standing in front of a judge, accused of the "crime" of being fat. Imagine the incredible pain you would feel as the judge announces that in the interests of your 'health', you will be removed from your family. But there's no need to imagine. During the height of the UK COVID-19 pandemic, two children were removed from their loving home and put into foster care. The ONLY reason was that both kids were fat. This harrowing story raised the ire of the fabulous Fat Doctor UK, who advocated and pleaded and offered to help educate the social workers, judge, and anyone who would listen, but her valiant attempts have so far been ignored. Two kids have lost their families, thanks to fatphobia. Join me and the fabulous Fat Doctor UK as we get UTTERLY fired up about this travesty of justice. This is a tough listen so please make sure you have adequate spoons. Show Transcript 0:00:12.7 Louise: Welcome to All Fired Up. I'm Louise, your host. And this is the podcast where we talk all things anti-diet. Has diet culture got you in a fit of rage? Is the injustice of the beauty ideal? Getting your knickers in a twist? Does fitspo, make you wanna spit spo? Are you ready to hurl if you hear one more weight loss tip? Are you ready to be mad, loud and proud? Well, you've come to the right place. Let's get all fired up. 0:00:40.3 Louise: Hello, diet culture drop-outs. I'm so pleased to be with you again and very excited about today's episode. Okay, so first of all, I wanna say a massive thank you to all of the listeners who are so faithful and loving. And I love all your messages and emails, so keep them coming. And if you love the show, don't forget to subscribe so you don't miss the episodes as they pop out on a roughly monthly basis. And if you love us, give us five stars because the more five star reviews we get, particularly on Apple Podcasts, the louder the message is, the more listeners we get and the quicker we can topple diet culture. And that's the objective here. 0:01:24.7 Louise: If you're looking for some free stuff to help you with your anti-diet journey, gosh I hate that word. Let's call it an adventure. Anti-Diet Adventure, 'cause that's what it is. It's rocking and rolling. It's up and down. It's not predictable. But if you're looking for a resource where you might be going to medical visit, you might be trying to explain just what you're doing to friends and family, look no further than the free e-book; Everything You've Been Told About Weightloss Is Bullshit, written by me and the Anti-Diet Advanced doctor dietician, Dr Fiona Willer. In it we're busting the top 10 myths that float around diet culture like poo in a swimming pool, about the relationship between health and weight, and we're busting myths left, right and centre. 0:02:06.8 Louise: It's a really awesome resource. It's crammed full of science and facts and it will really help steel you and give you the armour that you need to push back against diet culture. So if you wanna grab a copy, it's absolutely free. Like I said, you can go to Instagram which is untrapped_ au and click on the link in the bio and grab a copy there. Or you can go to the website untrapped.com.au and a little pop-up will come and you will grab it there. More free stuff, if you are struggling with relationship with your body during the last couple of years in particular, Befriending Your Body is my free e-course. All about self-compassion, this amazing skill of being kind and befriending your body. And it's like a super power, self-compassion, because we're all taught from the moment we're born, practically, to disconnect and dislike and judge and body police ourselves. Not exactly a recipe for happiness and satisfaction. 0:03:05.9 Louise: So, this little e-course will help build the skill of self-compassion, which is absolutely awesome because if we can learn to connect with our imperfect bodies, we can learn to inhabit them, to look after them and to push back against the forces that are still trying to get us separate from them. You can find the Befriending Your Body e-course from Instagram. So, untrapped_au. Click on the link, Befriending Your Body, it's all free, it's beautiful. It's just so lovely to practice self-compassion meditations. Self-compassion is built for difficult times. And my friends, we're in a difficult time. So, get hold of that if you haven't already. 0:03:47.6 Louise: Big shout out and hello to all of the Untrapped community, the Master Class and online community, who we meet every week. We push back against diet culture together. We share our stories, we've been supporting each other through the various challenges of lockdown and it's just a wonderful community of awesome human beings. So, if you're struggling and you want to join a community, as well as learning all of the skills of how to do things like intuitive eating, returning to a relationship with moving your body that doesn't feel like hard work. Understanding weight stigma and weight prejudice, relationship with body, all of that kind of stuff is covered in this comprehensive course, Untrapped, which I co-created in 2017 with 11 other amazing anti-diet health professionals. 0:04:39.9 Louise: So if you wanna grab a hold of this program and join our online community, please do and now's the time. We're meeting weekly. So every Saturday, I meet with the whole community and we have an awesome chinwag about everything that's going on. You also get all of the material. And there's other things that happened throughout the year like events and retreats. Well, if they're not scuppered by COVID. [chuckle] In usual times, we are able to do that. Well, if that's not being scuppered by COVID, of course. But in ordinary times, we do extra stuff. So find out more about Untrapped on the website, untrapped.com.au. You can also find a link from Insta. So, I think that's a run through all of the preamble. 0:05:23.5 Louise: Now, we arrive at the exciting time. I am so excited to bring you today's episode. You would have heard of the Fat Doctor UK by now, because she burst onto the internet a few months ago. And it seems like she's everywhere and she is loud and she is angry and she's a GP. So, here we have a very fierce, fat-positive voice, straight out of the UK medical profession, which is sorely needed. And I've just got so much admiration for Natasha and everything that she's doing. And I was actually listening to the Mindful Dietician podcast when I first heard Natasha being interviewed by the wonderful, Fi Sutherland. And during that conversation, she mentioned an awful situation in the UK where two kids were removed from their family for being fat. 0:06:13.9 Louise: And I'd actually seen that story and was so horrified that I kind of shelved it a way. But hearing Natasha talk about it and what she decided to do about it herself, it just inspired me. I just knew I had to talk to her. So this episode is everything. It's a long one, and it's a bloody rollercoaster. We go a lot of places during this epic, fantastic conversation. So you are going to laugh, you are going to cry. You're gonna cry more than once, because I know I did. You're gonna be absolutely furious, because just what we're talking about is just so horrific. We are in the 21st century and kids are being removed from loving homes simply because of BMI and a failure to do the impossible, which is lose weight and keep it off via the epic fail of dieting. 0:07:06.8 Louise: So look, this is really a challenging episode to listen to. It's a horrible story but the conversation with The Fat Doctor, Natasha herself is nothing short of inspiring. This woman is on a crusade. She has got heaps of other people involved in changing the landscape in a meaningful way. She is a real champion in the UK and across the planet, and I know you're gonna enjoy this conversation, but have some tissues close by and keep your slow breathing going to help contain the rage 'cause it's real. So without further ado, I give you me and The Fat Doctor herself, Natasha Larmie. So Tash, thank you so much for coming on the show. 0:07:49.0 Natasha Larmie: Thank you so much for having me, I am so excited. Due to the time difference, it's past midnight now and I've never been this awake past midnight before, so I'm really looking forward to this talk. 0:07:58.8 Louise: Oh my god, I am so impressed with your fired up-ness. [laughter] [laughter] 0:08:04.6 Louise: Tell me what is firing you up. 0:08:07.3 NL: Just in general or specifically about this case? 'Cause obviously a lot of things are firing me up, but I mean, obviously... 0:08:11.7 Louise: Yes. 0:08:12.5 NL: We wanna talk about this particular case that's firing me up. 0:08:16.3 Louise: Yes, what is this case? 0:08:17.9 NL: Yeah, what's going on with this case. So I think it was back in September, October last year that it happened, but I became aware of it a few months later, where two young people, one was actually over the age of 16 and his sibling, his younger sibling is under the age of 16, had been removed from a very loving home, for all intents and purposes, a very loving, happy home and placed into foster care by a judge simply because they were fat, and there is really no other reason at all. There was no other signs of child abuse, neglect, physical abuse, emotional abuse, nothing. It's just because they were fat and they failed to lose weight, a judge removed them from a loving home and placed them in foster care, and the older sibling, I think he's 16, 17, didn't actually have to go in because he was too old and the younger girl, she's 13, and she was removed from her home. 0:09:11.5 NL: And when I read about it I think I was so disgusted, it sort of broke... One newspaper reports on it in the UK, and it was several weeks later I guess, because the court transcript had come out, and I read it, I read the article, and I just thought, "Well, this is just the press over-exaggerating." And then someone said... One friend of mine sent me a text message saying, "No, no, no, just read the court's transcript. Transcript, read it," and sent me a link to the court transcript. I read the whole thing and within an hour I think I read the whole thing, and I was in tears. I was so full of rage that I just felt like something had to be done and started a petition. Have tried really hard to get answers, to push people to look into this case but unfortunately, haven't got very far because we're dealing with people who have very much kind of shut us down and have said, "It's not your concern. This is a judge who made this decision and there's nothing you can do about it." 0:10:05.4 Louise: Really? 0:10:05.7 NL: So I'm pretty fired up. Yeah. 0:10:07.2 Louise: Oh, god. Oh, I mean, when you say it out loud, like my whole body is responding. When I read the court transcripts last night, I put it off because I knew that I just probably would have a massive reaction and I was crying too, because this transcript is literally fucking heartbreaking. 0:10:26.5 NL: Tears. 0:10:27.2 Louise: That they're all admitting that this is... No one wants to be split up, they love each other but there's this stupid idea, as if everybody is completely unaware of science and weight science and how fucked dieting is. 0:10:41.5 NL: Yeah. 0:10:42.2 Louise: And how it doesn't fucking work. 0:10:44.4 NL: No. 0:10:44.7 Louise: And it's in a pandemic. 0:10:46.0 NL: Yeah, yeah. 0:10:46.7 Louise: If I fail to lose weight in a lockdown, when the world was going mad... 0:10:51.6 NL: And I mean, actually, the story begins I think 10 years previously, the story begins when they were three and six. These were two children, a three-year-old and a six-year-old who were picked up most likely because... I don't know if it's the same in Australia, but in the UK we have a screening program, so in year one, which is between the age of five and six, you are weighed and measured by a school nurse, and they... 0:11:13.4 Louise: Really? 0:11:13.9 NL: Yeah. And do you not have that? No. 0:11:15.6 Louise: No. 0:11:15.7 NL: We have. This is the National Child Measurement Programme, there's a acronym, but I didn't bother to learn. 0:11:21.2 Louise: Oh my god. 0:11:21.6 NL: But it happens in year one, which is when you're between five and six, and again in year six, which is when you're between 10 and 11. 0:11:29.0 Louise: Oh Christ. 0:11:29.2 NL: Two of the worst times to weigh people... 0:11:30.0 Louise: Correct, yeah. 0:11:32.0 NL: If you're think about it, because of course, especially around the 10, 11 stage some people are heading towards puberty, pre-puberty, some people are not, and so those that are heading towards pre-puberty will often have gained quite a bit of weight because you know that always happens before you go through puberty, you kind of go out before you go up, and that's completely normal, but they get penalised. But anyway, so I imagine... I don't know, because that's not actually in the transcripts but I'm guessing that at six, the older sibling, the boy was shown to be grossly overweight or whatever they call it, morbidly obese. They probably just measured his BMI, even though he was six, they probably measured it, which is just ridiculous 'cause that's not what BMI is for, and rather than looking at growth charts, which is what we should be doing at that age, they will have just sent a letter home and the teachers would have got involved and somewhere along the line, social services would have been called just because of the weight, nothing else, just because of the weight, and social services... 0:12:25.8 Louise: Just because of the percentile of a BMI. 0:12:28.5 NL: That was all it was. It was just weight. There was literally no concerns of ever been raised about these kids apart from their weight. And at the age of three and six, social services got involved and started forcing these children to diet, and they will say that's not what they did, they tried to promote healthy eating, but when you take a three-year-old and a six-year-old and you tell them... You restrict what they eat, you force them to exercise, and you tell them there's something wrong with them, you are putting them on a diet at the age of three to six, and we know, for sure, with evidence, you know, I know, and everyone listening should know by now that when you put young children on a diet like that at such a young age and you make such a big deal out of their weight, they are going to develop disordered eating patterns, and they are going to... 0:13:06.8 Louise: Of course. 0:13:07.8 NL: Gain weight, so... 0:13:09.3 Louise: They're going to instead, that's a trauma process happening. 0:13:12.2 NL: That's true. Yeah, it's... 0:13:13.8 Louise: A trauma to get child protective services involved. 0:13:17.8 NL: Yeah, and live there for 10 years, and then... 0:13:21.4 Louise: Ten years? 0:13:22.5 NL: Got to the stage where they took the proceedings further and further, so that they kept getting more and more involved. And eventually, they decided to make this a child protection issue. Up until that point, child social services were involved, but then, about a year before the court proceedings, something like that, before the pandemic. What happened then was that they gave these children a set amount of time to lose weight, and they enforced it. They bought them Fitbits so that they could monitor how much exercise they were doing, they bought them gym subscriptions, they sent them to Weight Watchers. [chuckle] 0:13:55.9 Louise: Fantastic, 'cause we know that works. 0:13:58.4 NL: We know that works. And of course, as you said, it was during a lockdown. So, Corona hits and there was lockdown, there was schools were closed, and for us, it was really quite a difficult time. And in spite of all of that... 0:14:13.0 Louise: I can't believe it. 0:14:14.9 NL: When the children failed to lose weight, the judge decided that it was in their best interest to remove them from their loving parents. And dad, from what I can tell from the court transcripts. I don't know if you noticed this as well. I think mom was trying very hard to be as compliant as possible. 0:14:26.9 Louise: She was, and even she lost weight, the poor thing. 0:14:30.0 NL: Yes, but I think dad almost seems to be trying to protect them, saying, "This is ridiculous. You can't take my kids away just because of their weight," and I... 0:14:38.1 Louise: Seems like he was in denial, which I fully understand. 0:14:41.1 NL: I would be too, I would be outraged. And it sounds like this young girl... I don't know much about the boy, but from what I can see from the transcripts, this young girl really became quite sad and low and depressed, and obviously, shockingly enough, her self esteem has been completely ruined by this process. 0:14:58.7 Louise: I know, I know. I really saw that in the transcript. This poor little girl was so depressed and getting bullied. And in the transcript, the way that that is attributed to her size and not what abuse they're inflicting on this family. 0:15:13.3 NL: Right. Yeah, really quite shocking. And then of course, the other thing you probably noticed from the transcript is there is no expert testimony at this court proceeding. None whatsoever. There is no psychologist. 0:15:24.0 Louise: Actually, there was. 0:15:25.8 NL: There was... 0:15:26.6 Louise: Dr... What's her name? 0:15:29.4 NL: Yes. You're right, there was a psychologist, and you're absolutely right. She was not an eating disorder specialist or a... She was just a psychologist. 0:15:37.3 Louise: She's a clinical psychologist. Dr. Van Rooyen, and she's based in Kent, and she does court reports for child abuse. Yes, and I can see her weight stigma in there. She's on the one hand acknowledging that the kids don't wanna go, that the kids will suffer mentally from being removed, but you can also see her unexamined weight stigma. And that you're right, where the hell are the weight scientists saying, "Actually, it's biologically impossible to lose weight and maintain it"? Because in the transcripts, they do mention that the kids have lost weight, failed to keep it off. 0:16:16.5 NL: Exactly, exactly. And it's just shocking to me that there would be such a lack of understanding and no desire to actually establish the science or the facts behind this. If I was a judge... I'm not a judge, I'm not an expert, but if I was a judge and I was making a decision to remove a child from a home based purely on the child's inability to lose weight, I would want to find out if it was possible that this child simply couldn't lose weight on their own. I would want to consult experts. I would want to find out if there was a genetic condition. I'm not saying she has a genetic condition. You and I know that she doesn't need to have a genetic condition in order to struggle to lose weight, that actually, the psychology behind this explains it. But even if you've not got to that stage yet, there was no doctors, there was no dietitians, there was no... No one was consulted. It was a psychologist who had no understanding of these specific issues, who, as you said, was clearly biased. There was social workers who said, "We've done everything we can because we've given them a Fitbit and we've sent them to Weight Watchers and sent them to the gym, but they refuse to comply." 0:17:24.9 Louise: I know. It's shocking. 0:17:28.4 NL: Yeah, it strikes me that we live in a world where you just can get away with this. It's just universally accepted that being fat is bad, and it's also your fault, your responsibility. The blame lies solely on the individual, even if that individual is a three-year-old child, it is. And if it's not the child, then of course, it's the parent. The parent has done something wrong. 0:17:52.1 Louise: Specifically the mother, okay. 0:17:53.5 NL: The mother, yeah. 0:17:54.4 Louise: The one with the penis, okay, let's not talk about him, 'cause that was absent. It was the mom. And the only possibility that was examined in this is that it's mom's fault for not being compliant, like you said. That's the only thing. Nothing else like the whole method is a stink-fest of ineffective bullshit. 0:18:13.5 NL: And there's the one point in the transcript when they talk about the fact that she had ice cream or chips or something in the house. 0:18:19.7 Louise: That's Ms. Keeley, their social worker, who went in and judged them. And did you notice that she took different scales in during that last visit? That last visit that was gonna determine whether or not they'd be removed, she took different scales in and weighed them. And they say, "Look, we acknowledge that that could've screwed up the results, but we're just gonna push on with removal." 0:18:43.0 NL: It was their agenda. 0:18:45.0 Louise: It was. It's terrifying, and it's long-term foster care for this poor little girl who doesn't wanna leave her mom. I'm so fired up about this, because the impact of removing yourself from your home because of your body, how on earth is this poor kid gonna be okay? 0:19:05.7 NL: This is my worry. How is mom going to be okay? How is that boy going to be okay? And how is that young, impressionable girl... My oldest son is a little bit older, and my younger son is a little bit younger, she's literally in between the two, and I'm watching what the last two years or last year and a half has done to them in terms of their mental and emotional well-being. And to me, even without social services' involvement, my children's mental health has deteriorated massively. And I cannot even begin to comprehend what this poor girl is going through. I cannot imagine how traumatized she is, and I cannot see how is she ever going to get over this, because she's been going through it since she was three, and it's not at the hand of a parent, it's at the hand of a social worker, it is the social worker's negligence. And what's interesting is a lot of social workers and people who work in social services have reached out to me since I first talked about this case, and they have all said the same thing, the amount of weight stigma in social services in the UK is shocking. It is shocking. It is perfectly acceptable to call parents abusers just because their children are overweight. 0:20:21.8 Louise: Jesus. 0:20:22.2 NL: No other reason, just your child is over the limit, is on the 90th percentile or whatever it is, your child is overweight and therefore you as a mother, usually as you said, it's a mother, are an abusive mother, because you've brought your child up in a loving environment but they failed to look the way that you want them to look, that's it. 0:20:41.0 Louise: Okay. So, that's me, right. My eldest is in the 99th percentile, so I am an abuser, I'm a child abuser. 0:20:47.3 NL: Child abuser, I can't believe I'm probably talking to one. 0:20:49.3 Louise: I know. [laughter] 0:20:49.9 NL: I can't believe I'm probably talking to one. And you know, the irony, my son's been really poorly recently and he's been up in... I mean we've spent most of our life in the hospital the last few weeks, and... 0:20:58.1 Louise: Oh dear. 0:20:58.3 NL: Went to see a paediatrician and they did the height and weight, and he is on the 98th percentile, my son has a 28-inch waist. He is a skeleton at the moment because he's been really ill, but he is mixed race, and we all know that the BMI is not particularly... 0:21:12.9 Louise: It's racist. 0:21:13.2 NL: Useful anyway, but it's massively racist, so my children have always been, if you weigh them, a lot heavier than they look, because I mean he's... There isn't an ounce of fat on him. My point is that BMI is complete utter bullshit and it doesn't deserve to exist. The fact that we've been using up until now is shameful and as a doctor, I cannot accept that we use this as a measure of whether a person is healthy and certainly as a measure of whether a child is healthy, because until recently, we were told you don't do BMIs on anyone under the age of 16 but that's just gone out the window now, everyone... 0:21:48.5 Louise: I know. 0:21:48.6 NL: Gets a BMI, even a six-year-old. 0:21:50.1 Louise: You get a BMI, you get a BMI. [laughter] I think it's not supposed to be used for an individual anything, it's a population level statistic. 0:22:01.1 NL: And a pretty crappy one at that. 0:22:02.3 Louise: It's a shitty one. 0:22:02.6 NL: It is like you said. 0:22:04.2 Louise: Yes. 0:22:04.6 NL: It's based on what European men, it's not particularly useful for men, it's not particularly useful for any other race, it's just useful perhaps. Even when it came out, like even when... What's his face? I forget his name right now, Ancel Keys. When he did that study that first look, brought in the BMI into our medical world as it were, yeah, even he said at the time it was alright. It's not the best, it's not the worst, it will do. It's the best out of the bunch. I mean he didn't even have much enthusiasm at the time. He said specifically it's not meant to be used as an individual assessment. And even the guy who kind of didn't invent it, but he sort of invented it as a measure of "obesity" and yet... And even he didn't have much good stuff to say about it. If he was selling the latest iPhone, Apple would have a lot to say about that. [laughter] I just... This fact that we've become obsessed and we know why this is. We know this is because of the diet industry, we know this is because of people trying to make money out of us and succeeding, very successful at making money out of us. 0:23:02.9 Louise: It's actually terrifying how successful this is because when I read this transcript, I've been doing a lot of work against the Novo Nordisk impact and how our modern oh, narrative has been essentially created by the pharmaceutical company that's producing all of the weight loss drugs, they have 80% of the weight loss drugs market and they've shamelessly said in their marketing that this is their drive to increase... That it's to create a sense of urgency for the medical management of obesity. And here it is, this is where it bleeds, because they're telling us this bullshit that it's going to reduce stigma. No, it's going to create eugenics. This is hideous what's happening here and I can't believe that the world didn't stop and that the front page of newspapers aren't saying like get fucked, like get these kids back. There's no outrage. 0:24:04.2 NL: No, there is none whatsoever. We got just over 2,000 people supporting the petition and as grateful as I am for that, that's just what the fuck, that's 2,000 people who live in a country of 68 million and only 2,000 people had something to say about this and, we... That's how much we hate fat kids and how much we hate fat people. We just don't see them as worthy and nobody wants to defend this young girl, nobody sort of feels sorry for her and I just... I can't get my head around this whole thing. It's funny because I didn't really know about it, a year ago I was completely clueless. It's all happened rather quickly for me that I've begun to understand Haze and begun to understand who Novo Nordisk was and what they are doing and what Semaglutide actually is and how it's going to completely change the world as we know it. 0:24:56.5 NL: I think this particular drug is going to become part of popular culture in the same way that Viagra is, we use that word now in novels and in movies. It's so popular and so understood, nobody talks about... I don't know, give me a name of any drug, like some blood pressure medication, they don't talk about it in the same way they talk about Viagra. But Semaglutide is going to be that next drug because they have tapped into this incredibly large population of people who are desperate to lose weight and they've got this medication that was originally used to treat diabetes, just like Viagra was originally used to treat blood pressure and have said, "Wow, look at this amazing side effect. It makes people lose weight as long as you run it. Let's market this." And the FDA approved it. I mean, no... 0:25:45.1 Louise: I know. 0:25:45.8 NL: No thought as to whether or not this drug is gonna have a massive impact on people in their insulin resistance and whether they're gonna develop diabetes down the line. I don't think they care. I don't think anybody actually cares. I think it's just that everybody is happy, woo-hoo, another way to treat fat people and make a good deal of money out of it. 0:26:03.9 Louise: Right? So, Semaglutide is... It's the latest weight loss drug to be approved by the FDA from Novo Nordisk and it is like the Mark II. So, they were selling Saxenda, Saxenda's here in Australia, they're pushing it out and this Semaglutide is like the Mark II, like I think of Saxenda as like Jan Brady, and Semaglutide is like Marcia. [laughter] 0:26:29.3 Louise: 'Cause it's like, "Oh my God, look at Semaglutide. Look at this amazing one year trial." [laughter] Marcia, Marcia, Marcia, like oh my God, we can make so much weight loss happen from this intervention. Why? Why do we need all of this weight loss, all these percentages? And, "Oh, we can lose 15% and 20%," and we don't need to for health, but okay. 0:26:53.3 NL: Yeah. The other thing that we have to remember about it, I don't think it's actually that much better. I've used all of these drugs in treating diabetes. So many years, I used these drugs. The beauty of it, of course, is that it's a tablet, and Saxenda is an injection. I'm assuming you have the injectable form, yeah? 0:27:09.9 Louise: That's right. You have to inject, and it's very expensive. 0:27:14.0 NL: It's extremely expensive, as will... Marcia Brady will be more expensive, I'm sure. 0:27:18.6 Louise: So high maintenance. [chuckle] 0:27:20.2 NL: Absolutely, but she is easier to administer. A lot of people don't like the idea of injecting themselves, but taking a tablet is dead easy. So, that's what makes this special, as it were, because it's the only one of that whole family that is oral, as opposed to injectable. 0:27:37.6 Louise: Well, that's interesting, because the paper with all of the big, shiny weight loss was injectable, it wasn't tablet. 0:27:43.7 NL: Oh, really? Oh, but they're marketing it as the oral version, definitely. That's the one that's got approved. It's brand name is... 0:27:51.3 Louise: Wegovy. 0:27:52.2 NL: Oh no, well, I have a completely different brand name. Is it different, maybe, in Australia? 0:27:57.1 Louise: Well, this is in America. In Australia, they haven't cornered us yet. I'm sure that they're trying to do it, but it was the FDA approval for Wegovy, [0:28:05.4] ____. 0:28:05.9 NL: So, they obviously changed the name. That's not the same one we use in diabetes. Clearly, they've had to revamp it a bit. Irrespective of oral, injectable, whatever, I think that this is going to... Novo Nordisk is sitting on a gold mine, and they know it. And it's going to change our lives, I think, because bariatric surgery is quite a big thing, and it's something that often people will say, "I'm not keen on doing." And the uptake is quite low still, and so, in bariatric... 0:28:35.2 Louise: In the UK, not here. 0:28:36.2 NL: Yeah, [chuckle] yeah, but bariatric surgeons are probably very afraid right now, because there's drugs coming along and taking all of their business away from them. 0:28:43.5 Louise: Actually, you know what Novo were doing? They're partnering with the bariatric surgeons. 0:28:46.2 NL: Of course they are. 0:28:46.9 Louise: And they're saying to them, "Hey, let's use your power and kudos, and our drugs can help your patients when they start to regain." 0:28:56.4 NL: Oh my gosh. 0:28:58.0 Louise: It's literally gateway drug. Once you start using a drug to reduce your weight, you have medicalized your weight, and it's a small upsell from there. So, I think this is all part of a giant marketing genius that is Novo Nordisk. But I'm interested to hear your concerns, 'cause I'm concerned as well with the use of diabetes drugs as weight loss medications, and I read about it being that they're hoping that people will take this drug like we take statins. So, everyone will take it preventatively for the rest of their lives. What's the long-term impact, do you think, of taking a double dose of a diabetes drug when you don't have diabetes? 0:29:43.5 NL: Well, first of all, they don't know. Nobody knows, because they've only done a study for a year, and just how many diet drugs have we put out there into the universe since the 1970s, and then taken them back a few years later, 'cause we've gone, "Oh, this kills"? If you've got diabetes and you take this drug because you've got insulin resistance and this drug helps you to combat your insulin resistance in the way that it works, you've already got diabetes. And so, there is no risk of you developing diabetes, and this drug does work, and so, I have no issue with the GLP-1 analogs in their use in diabetes. I think all the diabetes drugs are important, and I'm not an expert. But you've really got to ask yourself, if you take a healthy body and you act on a system within the pancreas and within the body, in a healthy, essentially, healthy body, healthy pancreas, you've got to ask yourself if it's going to worsen insulin resistance over time. It's actually going to lead to increased cases of diabetes. Now, they say it won't, but... 0:30:47.4 Louise: How do they know that? 'Cause I've read a study by Novo, sponsored, in rats, that showed that it did lead to insulin resistance long-term. 0:30:57.6 NL: Right, I think common sense, because we understand that the way that the body works, just common sense. The way the body works suggests to me that over long periods of time, taking this medication in a healthy person is going to lead to increased insulin resistance, which in turn will lead to diabetes. That is what common sense dictates. But of course, as you said, we don't know. We don't have a study. Nobody has looked into this. And it makes me sad that we are using a drug to treat a condition that isn't a condition. 0:31:30.2 Louise: I know, yeah. [chuckle] 0:31:32.4 NL: And inadvertently, potentially giving people a whole... 0:31:36.0 Louise: Creating a condition. 0:31:36.6 NL: Creating an actual medical condition, which we all know to be life-threatening if untreated. And so, I cannot fathom why... Well, I can, I understand. It's for financial reasons only, but I can't understand why there are doctors out there that want to prescribe this. This is the issue that I have. I'm a doctor, and I can't speak on behalf of drug companies or politicians or anyone else, but I can speak to what doctors are supposed to be doing, and we have a very strong code of conduct that we have to abide by. We have ethical and moral principles and legal obligations to our patients. And so, doing no harm and doing what is in your patients' best interest, and practising fairly and without discrimination, and giving people... Allowing them to make an informed choice where they are aware of the risks and the side effects and all the different treatment options. 0:32:28.0 NL: When it comes to being fat, again, it seems to have gone out the window. None of these things are happening. We wouldn't dream of addressing other issues this way, it's just fatness, because it's just so commonly, widely accepted that fatness is bad and you've got to do whatever you can to get rid of it. I've had someone tell me today that they are pregnant with their first child and they had their first conversation with the anesthetist, who told them they had to do whatever they could to lose weight before they had their baby. This is a pregnant woman. 0:32:58.1 Louise: Whatever they had to do? 0:33:00.1 NL: Whatever they had to do, and she said, "What do you want me to do, buy drugs off the streets?" And the anesthetist said... Wait for it. The anesthetist said, "It would be safer for you to use a Class A drugs than it would for you to be fat in pregnancy". The anesthetist said that to this woman. She told me this and I just went "Please just... Can you just report him?" 0:33:21.7 Louise: Shut the front door, Jesus Christ! 0:33:24.6 NL: Can you imagine? First of all, that's not true. Second of all, he is saying that it is better to be a drug addict than to be a fat person. This is no judgment on drug addicts, but you do not encourage your patients to use Class A drugs to lose weight. That's stupid. Imagine if he'd said that about anything else, but in his... And it was a man, in his world, for whatever reason, his ethics just abandons them all in favor of fat shaming a woman. 0:33:52.4 Louise: This is where we're at with, it's self examined. It's like there's a massive black hole of stigma just operating unchallenged effortlessly and actually growing, thanks to this massive marketing department, Novo. It's terrify... That poor lady, I'm so glad she's found you and I hope she's not gonna go down the Class A drug route. [laughter] 0:34:19.3 NL: She's definitely not, but she was quite traumatized. She's on a Facebook group that I started and it's great because it's 500 people who are just so supportive of each other and it was within a few minutes 50 comments going "What a load of crap, I can't believe this," "You're great, this doctor is terrible". But it just stuck to me that one of my colleagues would dare, would have the audacity to do something as negligent as that. And I'm gonna call it what it is. That's negligence. But I'm seeing it all the time. I'm seeing it in healthcare, I'm seeing it in Social Services, I'm seeing it in schools, I'm seeing it in the workplace, I'm seeing it everywhere. You cannot escape it. And as a fat person, who was in the morbidly, super fat, super obese stage where she's just basically needs to just be put down like a... 0:35:16.3 Louise: Oh my gosh, it's awful. 0:35:18.5 NL: And as that person, I hear all of these things and I just think "I'm actually a fairly useful member of society, I've actually never been ill, never required any medication, managed to give birth to my children, actually to be fair, they had to come out my zip as opposed to through the tunnel." But that wasn't because I was fat, that was because they were awkward. But this anesthetist telling this woman that she's too fat to have a baby. I was just like "But I am the same weight. I am the same BMI as you". And I had three and I had no problems with my anesthetics. In fact after my third cesarean section, I walked out the hospital 24 hours later, happy as Larry, didn't have any problems. And I know people who were very, very thin that had a massive problems after their cesarean. So there's not even evidence to show how dangerous it is to have a BMI over 35 and still... And then caught when it comes to an anesthetic. This isn't even evidence-based, it's just superstition at this point. 0:36:12.8 Louise: It's a biased based and the guidelines here in Australia, so I think above 35 women are advised to have a cesarean because it's too dangerous. And women are not allowed to give birth in rural hospitals, they have to fly to major cities. So imagine all of... And don't even get me started on bias in medical care for women. It's everywhere, like you said, and it's unexamined and all of this discrimination in the name of, apparently, healthcare. It's scary. 0:36:43.9 NL: It really is. Gosh, you've got me fired up, it's almost 1:00 in the morning and I'm fired up. I'm never gonna get to sleep now. [laughter] 0:36:51.7 Louise: Okay, I don't wanna tell you this, but I will. 'Cause we're talking about how on earth is this possible, like why aren't there any medical experts involved to talk about this from a scientific basis, and I'm worried that even if they did have medical people in the court, they wouldn't have actually stuck up for the kid. I found this JAMA article from 2011. It's a commentary on whether or not large kids should be removed from their families, and it was supportive of that. 0:37:18.0 NL: Oh gosh. Of course it was. 0:37:22.0 Louise: And in response to that commentary, the medpage, which is a medical website, a newsletter kind of thing. They did a poll of health professionals asking should larger kids removed from their families, and 54% said yes. 0:37:40.7 NL: Of course. 0:37:41.3 Louise: I know. Isn't that dreadful? One comment on that said "It seems to me the children in a home where they have become morbidly obese might be suffering many other kinds of abuse as well, viewing in the size of a child. 'Cause we've all gotten bigger since the '80s. We're a larger population and viewing that as abuse and as a fault of parenting. Unbelievable. I also had a little dig around Australia, 'cause it's not isolated in the UK, there's so many more cases. 0:38:16.9 NL: They have. Yeah. 0:38:17.8 Louise: And I think actually in the UK, it might be a lot more common than in Australia. 0:38:22.1 NL: Yeah, I can believe that. 0:38:23.5 Louise: But it did happen here in 2012, there was some report of two children being removed from their families because of the size of the kids. And the media coverage was actually quite dreadful. I'll put in the show notes, this article, and the title is "Victorian authorities remove obese children, removed from their parents". So even the title is wrong, couldn't even get their semantics right. There's a picture, you can imagine what picture would accompany... 0:38:55.2 NL: Well of course it can't be of the actual children, because I think it leads to lawsuit. I'm assuming it's a belly. Is there a belly? Is there a fat person in it or a fat child eating a burger? 0:39:06.2 Louise: Yes. [laughter] 0:39:07.1 NL: Sorry, it's either the belly or the fat person eating the burger. So, a fat child eating the burger, sorry. 0:39:11.9 Louise: Helpfully, to help the visually impaired, the picture had caption and the caption reads "Overweight brother and sister sitting side by side on a sofa eating takeaway food and watching the TV." So not at all stereotyped, very sensitive, nuanced article this one. And then we hear from Professor John Dixon, who is a big part of obesity Inc here in Australia. He told the ABC that "Sometimes taking children away from their parents is the best option." In the same article, he also admits "There's no services available that can actually help kids lose weight", and he says that it's not the parents fault. Helpfully, this article also states that "Obesity is the leading cause of illness and death in Australia." [laughter] 0:39:58.7 NL: I love it when I hear that. How have they figured that out? What do they do to decide that? Where does this... 0:40:08.4 Louise: They don't have to provide any actual evidence. 0:40:10.5 NL: Right. They just say it. 0:40:12.1 Louise: Got it. 0:40:13.0 NL: Just say it. 0:40:14.4 Louise: Diet. And I checked just to make sure, 'cause in case I've missed anything. 0:40:18.4 NL: Yeah. 0:40:19.6 Louise: The top five causes of death in Australia in 2019; heart disease, number two dementia, number three stroke, number four malignant neoplasm of trachea bronchus and lung. 0:40:30.4 NL: Lung cancer. 0:40:30.9 Louise: Lung cancer. 0:40:31.5 NL: That's lung cancer. 0:40:32.3 Louise: And number five chronic lower respiratory disease. 0:40:38.4 NL: So translation. Heart attacks, dementia... In the UK it's actually dementia first, then heart attacks. So dementia, heart attacks, stroke, same thing in the UK, and then lung cancer and COPD. Both of those are smoking-related illnesses. And I can say quite safely that they are smoking-related illness because the chance of developing lung cancer or COPD if you haven't smoked is minuscule. So what the people are doing is they're saying, "Well, we can attribute all of these heart attacks and strokes and dementia to "obesity". And the way we can do that is we just look at all these people that have died, and if they are fat we'll just assume it's their fat that caused their heart disease. 0:41:20.0 NL: To make it very clear to everybody that is listening, if you have a BMI of 40, we can calculate your risk of developing a heart attack or a stroke over the next 10 years using a very sophisticated calculator actually, it's been around for some time. It's what we use in the UK. I'm assuming Australia has a similar one, don't know what it's called there. In the UK it's called a QRISK. So I've done this. I have calculated. I have found a woman, I called her Jane. I gave her a set of blood pressure and cholesterol, and I filled in a template. And then I gave her a BMI of 20. And then I gave her a BMI of 40. And I calculated the difference in her risk. I calculated the difference in her risk, and the difference in her risk was exactly 3%. The difference in her risk if she was a smoker was 50%. She was 50% more likely to have a heart attack if she was a smoker, but only 3% more likely to have a heart attack if she had a BMI of 40 instead of a BMI of 25. 0:42:15.0 NL: To put it into perspective, she was significantly more likely to have a heart attack if she was a migraine sufferer, if she had a mental health condition, if she had lupus or rheumatoid arthritis, if she was Asian, if she was a man, and all of those things dramatically increased her risk more than having a BMI of 40. So it's just very important that doctors will admit, 'cause it's about admitting to a simple fact, this calculator we use to predict people's risks. So if we know that weight only has a 3-4% impact on our cardiovascular risk as opposed to smoking which has a 50% impact, as opposed to aging which is why most people die because they get old and let's face it everybody dies some time. 0:43:04.0 NL: So what's happening is the... Whoever they are, are taking all these deaths from heart disease which was likely caused by the person aging, by the person being male or just being old and being over the age of 75, your risk of heart disease goes up massively irrespective of your weight. So instead of saying, "Well, it's just heart disease", they've gone, "Well, it's heart disease in a fat person and therefore it was the fatness that caused the heart disease." And that is offensive to me to the point that now, I have heard... And this is awful in this year, our patients that are dying of COVID, if they die of COVID in the UK, it's actually quite heart breaking, it's happened to someone that I was close to. If they die of COVID in the UK, and they happen to be fat, the doctor writes "obesity" on their death certificate... 0:43:51.8 Louise: No way. 0:43:52.4 NL: As a cause of death. They died of COVID. 0:43:55.2 Louise: What? 0:43:55.5 NL: They died of COVID. That's what they died of. They died of this terrible virus that is killing people in their droves but people are under the misguided impression that being fat predisposes you to death from COVID, which is not true. It's not true. That is a complete gross misrepresentation of the facts. But we've now got doctors placing that on a person's death certificate. Can you imagine how that family feels? Can you imagine what it feels like to get this death certificate saying, "Your family member is dead from COVID but it's their fault 'cause they were obese." And how can the doctor know? How could the doctor know that? 0:44:34.2 Louise: How can they do that? 0:44:35.6 NL: How can they do that? And this is my point, this doctor that's turning around and saying it's safer for children to be removed from their loving home. Obviously, this person has no idea of the psychological consequences of being removed from your family. But it's safer for that person to be removed from their home than to remain in their home and remain fat. What will you achieve? Is this person going to lose weight? No. I can tell you what this person is going to do. This person is going to develop... 0:44:58.9 Louise: They even say that. They even say that in the transcripts. We don't think that they'll get any more supervision. 0:45:03.1 NL: Yeah. In fact, we're gonna get less supervision because it's not a loving parent. You're going to develop, most likely an eating disorder. You're going to develop serious psychological scars. That trauma is going to lead to mental health problems down the line. And chances are you're just gonna get bigger. You're not gonna get smaller because we know that 95% of people who lose weight gain it all back again. We know that two-thirds of them end up heavier. We know that the more you diet, the heavier you're gonna get. And that actually, this has been shown to be like a dose-response thing in some studies. So the more diets you go on, the higher your weight is going to get. If you don't diet ever in your life, chances are you're not gonna have as many weight problems later on down the line. So, as you're saying, we are living in a society that's got fatter. And there's lots of reasons for that. It's got to do with the food that we're eating now. That we're all eating. That we're all consuming. 0:45:55.1 Louise: Food supply. Only some of us will express from there the epigenetic glory of becoming higher weight. 0:46:02.0 NL: Right. And that's the thing, isn't it? Genetics, hormones, trauma, medications. How many people do I know that are on psychiatric medications and have gained weight as a result, Clozapine or... It's just what's gonna happen. You name it. Being female, having babies, so many things will determine your weight. 0:46:21.0 Louise: Getting older. We're allowed to get... We're supposed to get bigger as we get older. 0:46:25.1 NL: And then you know that actually, there are so many studies nowadays, so many studies that we've labeled it now that show that actually being fat can be beneficial to you. There's studies that show that if you end up in ICU with sepsis, you're far more likely to survive if you're fat. If you've got a BMI over 30, you're more likely to survive. There's studies that show that if you have chronic kidney disease and you're on dialysis, the chances of you surviving more long-term are significantly higher if you're fat. Heart failure, kidney disease, ICU admissions, in fact, even after a heart attack, there's evidence to show that you're more likely to survive if you're fat. And they call this the obesity paradox. We have to call it a paradox because we cannot, for one moment, admit that actually there's a possibility that being fat isn't all that bad for you in the first place and we got it wrong. Rather than admit that we got it wrong, we've labeled a paradox because we have to be right here, we have to... 0:47:18.0 Louise: Yeah, it's like how totally bad and wrong, except in certain rare, weird conditions, as opposed to, "Let's just drop the judgment and look at all of this much less hysterically." 0:47:29.5 NL: Yeah. And studies have shown that putting children on a diet, talking about weight, weight-shaming them, weighing them, any of these things, have been linked to and have been demonstrated to cause disordered eating and be a serious risk for direct factor for weight gain. And that, in my opinion, is the important thing to remember in this particular case, because as I said, social services start in weight-shaming, judging, and talking about weight when these children were three and six, and they did that for 10 years. And in doing so, they are responsible for the fact that these children went on to gain weight, because that's what the evidence shows. And there's no question about this evidence, there's multiple papers to back it up. 0:48:14.1 NL: There's an article published in Germany in 2016, there was an article published last year by the University of Cambridge, and even the American Academy of Pediatrics agrees that talking about weight, putting children on a diet, in fact, even a parent going on a diet is enough to damage that child and increase their risk of developing disordered eating patterns and weight gain. 0:48:37.9 NL: And so, as far as I'm concerned, that to me, is evidence enough to say that it's actually social services that should be in front of a judge, not these children, but it's the social workers that should be held to account. And I have written... And this is something that is very important to say. I wrote to the council, the local authority, and I've written a very long letter, I've published it on my website. You can read it anytime, anyone can read it. And I wrote to them and I said, "This is the evidence. Here are all the links. As far as I'm concerned, you guys got it terribly wrong and you have demonstrated that there is a high degree of weight bias that is actually causing damage to children. I am prepared to come and train you for free and teach all of your social workers all about weight bias, weight stigma, and to basically dispel the myths that obviously are pervading your social work department." And they ignored me. I wrote to politicians in the area. They ignored me. I wrote to a counselor who's a member of my political party, who just claimed, "Yeah, I'll look into it for you." Never heard from her again. Yeah, nobody cares. 0:49:44.0 Louise: It's just such a lack of concern. 0:49:45.7 NL: I didn't even do it in a critical way. I had to do it in a kind of, "I will help you. Let me help you. I'm offering my services for free. I do charge, normally, but I'll do it for free for you guys." No one is interested. Nobody wants to know. And that makes me really sad, that they weren't even willing to hear me out. 0:50:03.0 Louise: I can't believe they didn't actually even answer you. 0:50:06.5 NL: Didn't answer me, didn't respond to any of my messages, none of the counselors, none of the... Nobody has responded, and I've tried repeatedly. 0:50:14.4 Louise: So, this is in West Sussex, yeah? 0:50:16.7 NL: That's right, West Sussex, that's right. 0:50:18.0 Louise: You know what's weird about that? I've actually attended a wedding at that council, that my ex-father-in-law got married there. And when I saw the picture there, I'm like, "Oh my God, I've actually been there." So, I had a poke, and I don't know if you know this, but hopefully, in the future, when those children, C and D, finally decide to sue the council, that they can use this as evidence. There is a report from a... It's called a commissioner's progress report on children services in West Sussex from October 2020, which details how awful the service has been for the past few years, and huge issues with how they're running things. And it says, "Quite fragile and unstable services in West Sussex." So, this family who've had their kids removed were being cared for by a service with massive problems, are being referred to programs that don't work, and that there's a massive miscarriage of justice. 0:51:17.3 NL: And I'm glad you're talking about it, and I'm glad we're talking about it. And I wish that we had the platform to talk about it more vocally. I'd want to be able to reach out to these... To see patients... They're not patients, child C and D. I want to be able to reach out to mum as well, and say... 0:51:36.3 Louise: I just wanna land in Sussex and just walk around the street saying, "Where are you? I wanna help." 0:51:40.2 NL: "Where are you? And let me hug you." And I'm very interest to know, I'd be very interested to know the ethnic origin of these young people. 0:51:48.9 Louise: And the socio-economic status of these people. 0:51:50.2 NL: Socio-economic status, 100%. I would very much like to know that. That would make a huge... I think that I can guess, I'm not going to speculate, but I had a very lovely young woman contact me from a... She was now an adult, but she had experienced this as a child. She had been removed from her home and was now an adult, and she had been in foster care, in social services, for a few years, and had obviously contact with her mum but hadn't been reunited with her mum ever. So it wasn't like it was for a time and then she went back. And we talked about this. She was in a London borough, I shall not name the borough, but I know for a fact that her race would've played a role in this, because she was half-Black, half-Turkish. 0:52:39.2 NL: And there're a few things in that court transcript that caught my attention. I don't know if you noticed there was a mention of the smell from the kitchen, and they didn't specifically said, you know, mould, or you know that there was mould in the kitchen, or there was something in the kitchen that was rotting, something like that, 'cause I think they would have specified. It was just a smell. And that made me wonder, is this to do with just the fact that maybe this family lived in poor housing or was it the type of food that they were cooking for their children? Is there a language issue, is there a cultural issue. What exactly is going on? 'cause we don't know that from the court transcript, so that's another thing that... Another piece of the puzzle that I would really be interested in. Is this a white wealthy family? Probably not. I don't think they are. 0:53:27.2 Louise: Yeah it didn't struck me that way either. Yeah, yeah this is potentially marginalization and racism happening that... 0:53:35.1 NL: Yeah. 0:53:35.9 Louise: And here in Australia, we've got an awful history of how we treated First Nations people and we removed indigenous kids from their families, on the basis of like we know better, and I just... Yeah honestly, elements of that here, like we know better. 0:53:51.5 NL: Yes. Right, this is it. We know better than you have to parent your child. I am have always been a big believer of not restricting my children's feed in any way. I was restricted, and I made the decision when we had the kids that there would just be no restriction at all. I have like been one of those parents that had just been like, that's the draw with all the sweet treats in it. They're not called treats, they're just sweets and chocolate and candy, there it is. It's within reachable distance. Help yourself whenever you want, ice pops in the freezer, there's no like you have to eat that to get your pudding. None of that. 0:54:27.6 NL: My kids have just been able to eat whatever they wanted, whenever they wanted, I never restricted anything, I wanted them to be intuitive eaters. And of course they are, and what amazes me is now my teenage son, when we were on lockdown, and he was like homeschooled, he would come downstairs, make himself a breakfast, and there was like three portions of fruit and veg on his plate, and not because someone told him that he had to, but just because he knew it was good for him and he knew it was healthy, there was like a selection, his plate was always multi-colored, he was drinking plenty of water. He would go and cook it, he cooked himself lunch, he knew that he can eat sweets and crisps and chocolate whenever he wanted to, and he didn't, he just didn't. Like it was there, that drawn, it gets emptied out because it's become a bit... But no, they don't take it, and sometimes they do, 'cause they fancy it, but most of the times they don't. And that is my decision as a parent, I believe that I have done what is in their best interest, I believe that I will prove over time that this has had a much better impact on their health, not restricting them. 0:55:26.4 Louise: Absolutely, Yeah. 0:55:27.6 NL: But the point is they're my children, and it was my damn choice, and even if my child is on the 98th percentile, it's still my damn choice, nobody gets to tell me how to parent my child. That is my child, I know what's best for them. And I believe that my children are going to prove the fact that this is a great way of parenting, and I know that actually most of their friends who had, were not allowed to eat the food that they wanted to eat used to come over to our house and just kind of like wide eyed. And they binge, they binge, you know, to the point that I have to restrict them and say I actually I don't think mom would like that if I gave that to you. 0:56:00.0 Louise: We know that that's what we do when we put kids in food deserts, we breed binge eating and food insecurity, and trying to teach our kids to have a relaxed and enjoyable relationship with food is what intuitive eating is all about. And without a side salad of fat phobia, we're not doing this relationship with food stuff in order to make sure you're thin, we're doing this to make sure that you feel really safe and secure in the world, and you know health is sometimes controllable and sometimes not, and this kind of mad obsession we have with controlling our food and the ability it will give us like everlasting life is weird. 0:56:39.0 NL: Yeah. 0:56:39.7 Louise: Yeah. Gosh, I'm so glad you're parenting those kids in that way and I've noticed the same thing with my kids. Like my kids, we are a family of intuitive eaters and it's just really relaxed, and there's variety, and they go through these little love affairs with foods, and it's really cute. [chuckle] And they're developing their palettes, and their size is not up to me. 0:57:05.8 NL: Yeah. 0:57:06.4 Louise: Yeah. 0:57:07.4 NL: Right. 0:57:08.1 Louise: It's up to me to help them thrive. 0:57:10.7 NL: That's right. And when people talk about health, I often hear people talking about health, and whenever they ask me that question, you know, surely you can agree that being fat is not good for your health, well, I'll always kinda go, "Oh Really? Could you just do me a favor here and define health?" Because I spend my whole life trying to define health, and I'm not sure that I've got there yet, but I can tell you without a doubt that this for me, in my personal experience as a doctor... And I've been a doctor for a long time now, and I see patients all the time, and I'm telling you that in my experience, the most important thing for your health is your mental and emotional well-being, that if you are not mentally and emotionally well, it doesn't matter how good your cholesterol is, it doesn't matter whether or not you've got diabetes, that is irrelevant, because if you're not mental and emotional... I'm not saying that 'cause you won't enjoy life, I mean, it has an impact on your physical health. And I spend most of my day dealing with either people who are depressed or anxious, and that's what they've presented with, or they've presented with symptoms that are being made worse or exacerbated by their mental and emotional pull, mental and emotional well-being. 0:58:19.1 NL: So giving my children the best start in life has always been about giving them a good mental and emotional well, start. It's about giving... It's not just teaching them resilience, but teaching them to love themselves, to be happy with who they are, to not feel judged or to not feel that they are anything other than the brilliant human beings that they are. And I believe that that is what's going to stand them in the greatest... In the greatest... I've lost my words now, but that's what's gonna get them through life, and that's why they're going to be healthy. And how much sugar they eat actually is quite irrelevant compared to the fact that they love themselves and their bodies, and they are great self-esteem, we all know that happiness is... Happiness is the most important thing when it comes to quality of life and happiness is the most important thing when it comes to length of life and illness, all of it. Happiness trumps everything else. 0:59:07.0 Louise: And to you know what that comes from. Happiness comes from a sense of belonging, belonging in our bodies, belonging in ourselves, belonging in the community, and all of this othering that's happening with the message that everyone belongs unless they're fat. That sucks ass and that needs to stop. This poor little kid when, in the transcript it mentioned that they found a suicide note... 0:59:29.9 NL: Yes. 0:59:30.1 Louise: And some pills. And she's fucking like 13. 0:59:34.8 NL: Yeah, and they called it a cry for help. 0:59:36.0 Louise: They called it cry for help 'cause of her body. 0:59:38.1 NL: Yeah. 0:59:38.4 Louise: They didn't recognize it since they've been sniffing around threatening to take her off her mom, and because she's being bullied for her size at school. This is like a calamitous failure to see the impact of weight stigma. 0:59:52.9 NL: She's been told that it's her fault that she's been taken away from her mum. They had told her that because she didn't succeed in losing weight, that she doesn't get to live with her mother anymore. Can you imagine? 1:00:02.4 Louise: So her mom. I can't even wrap my head around that. I can't. 1:00:07.2 NL: Well, she feels suicidal, I think I would too. I felt suicidal at her age and for a lot less. It's terrible, it's terrible. And I hope she's hanging on and I hope that... 1:00:14.6 Louise: I wanna tell her that she is awesome. 1:00:17.4 NL: Yes. 1:00:17.9 Louise: If she ever gets to listen to this. But I know the impact. So like when I was 11, my mom left and I remember how much it tore out my heart. 1:00:26.4 NL: Yeah. 1:00:26.9 Louise: You're 11... 1:00:27.5 NL: Yeah. 1:00:28.3 Louise: 12, 13. This is not the time to do this to kids, and this whole idea... The judge said something like, "Oh, you know, gosh, this is gonna be bad... " But here it is, I will read it to you. This is... She actually wrote a letter to the kids. 1:00:42.5 NL: Oh, gosh. 1:00:43.7 Louise: "I know you will feel that in making this o

Líderes del Futuro
Adverse Childhood Trauma

Líderes del Futuro

Play Episode Listen Later Aug 14, 2021 8:26


Many of us are having issues with COVID and the fires. The fact is that many of us are not aware that our unresolved childhood traumas increase these feelings. Drug use, alcoholism, COPD, heart issues and more are examples of the consequences of adverse childhood trauma. --- Support this podcast: https://anchor.fm/rafael-vazquez7/support

Physiotutors Podcast
Episode 029 Respiratory Physiotherapy & Covid-19 with Pat Camp

Physiotutors Podcast

Play Episode Listen Later Aug 7, 2021 81:43


In this episode of the podcast I get to speak with Pat Camp - a respiratory rehabilitation specialist and researcher with around 3 decades experience as a physiotherapist & over a decades experience in research for respiratory physiotherapy. Pat is also the host of the LungFit podcast where she discusses the latest in pulmonary rehabilitation. We speak about respiratory rehabilitation in chronic patients as well as addressing the elephant in the room that is Covid 19. We talk about structuring your rehab plan with chronic patients, how you can build with those patients and talk about what aspects from other lung diseases we may be able to carry over into Covid-19 rehab keeping in mind just how little is still known with regards to long term issues. Whilst we do discuss Covid 19 patients and I myself have seen a few covid recovered patients - both myself and Pat want to make note that this was recorded early in 2021 whilst not a lot of information was available for post-covid rehabilitation however we hope that you still have some take away moments from that aspect of the podcast!

Líderes del Futuro
The Physical Consequences of Emotional Trauma

Líderes del Futuro

Play Episode Listen Later Aug 6, 2021 9:18


Those individuals who have suffered from trauma and don't heal will likely pass such to their offspring. Psychotherapist Maria Hess always said "trauma is the gift that keeps on giving." When one doesn't heal, our body deteriorates and we experience heart palpitations, constant headaches, obesity, COPD and more. #trauma #healing #mentalhealth --- Support this podcast: https://anchor.fm/rafael-vazquez7/support

Medical Spanish Podcast
O2, Cancer Screening, Pulmonary Rehab in Spanish

Medical Spanish Podcast

Play Episode Listen Later Aug 5, 2021 8:05


This is our 5th free lesson covering Spanish for COPD. In this lesson, the doctor discusses oxygen monitoring and therapy, lung cancer screening and pulmonary rehabilitation in Spanish. The post O2, Cancer Screening, Pulmonary Rehab in Spanish appeared first on Podcasts by Doc Molly.

Let’s Talk With Sir Sax
Episode 31- Is It to Soon Yet? Yes! (Part2)

Let’s Talk With Sir Sax

Play Episode Listen Later Aug 4, 2021 45:56


We must warn you- Part 2 of this series is RAW and it “Ain't for No Weak Folk!” Join Sir Sax with his special guest and former classmate Michelle Hankins Pouncy. Michelle is a Trauma ER Nurse and still seeing the wrath of COVID-19 on a daily basis. Thinking about NOT getting the vaccine or REFUSING to wear a face mask? This episode is for you! You need to know this virus is an equal opportunity offender and your failure to comply doesn't just affect you, it could affect the innocent person who already has a co-morbidity disease such as COPD and Diabetes or the person who has cancer. Tell everyone you know to tune in. Be sure to stay to the end for a special Horn of Plenty Cafe treat featuring Saxophonist, Tim Cunningham. Interested in being a guest on the podcast or have a topic you would like to have Sir Sax discuss? Visit our website @ www.sirsaxgospelskateparty.com Be sure to tune in to the GSP Radio Network when you visit us. We've got great uplifting content and music. https://linktr.ee/sirsax77.

CorConsult Rx: Evidence-Based Medicine and Pharmacy
Patient Case: COPD, PAD, Angina, and More

CorConsult Rx: Evidence-Based Medicine and Pharmacy

Play Episode Listen Later Aug 4, 2021 54:48


On this episode, we are joined by MUSC forth year PharmD student, Matthew Brock.  We review a patient case that covers multiple co-morbidities. We start by discussing the patient's COPD management and the recommendations from the 2021 GOLD guidelines. We then review low dose rivaroxaban with lose dose aspirin in patients with PAD. Then, we talk about strategies for managing his angina and hypertension considering his past history of ischemic stroke. We close by briefly covering his diabetes and need for smoking cessation.  Thanks for listening! If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable Power Point slides for each lecture. You can find our account at the website below:  www.patreon.com/corconsultrx If you have any questions for Cole or me, reach out to us on any of the following: Text - 415-943-6116 Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com Instagram and other social media platforms - @corconsultrx This podcast reviews current evidence-based medicine and pharmacy treatment options. This podcast is intended to be used for educational purposes only and is intended for healthcare professionals and students. This podcast is not for patients and not intended as advice or treatment.

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast
134 - Hypertensive Emergencies Demystified: A Brief Clinical Review

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Play Episode Listen Later Aug 3, 2021 43:44


In this episode, we provide a concise review of the diagnostic criteria and general treatment approach to patients with hypertensive emergencies. Key Concepts Hypertensive “urgency” is a misnomer - patients do not require immediate therapy and definitely should not receive IV therapy. In most cases, the goal blood pressure in hypertensive emergencies is to decrease by no more than 25% in the first hour, achieve a BP of 160/100 in hours 2-6, then over the next 24-48 hours lower to a more normal blood pressure goal. Labetalol is the preferred IV push antihypertensive UNLESS patients have acute heart failure, bradycardia, or possibly in patients with asthma/COPD. Nicardipine is one of the most commonly used IV infusions for hypertensive emergencies. Most other continuous infusions are reserved for special types of hypertensive emergencies (e.g. nitroglycerin for pulmonary edema or acute MI, esmolol for aortic dissection).

Annals On Call Podcast
COPD: What Clinicians Need to Know-Part 2

Annals On Call Podcast

Play Episode Listen Later Aug 2, 2021 21:53


Dr. Centor continues his discussion about the care of patients with chronic obstructive pulmonary disease with Dr. Anand S. Iyer.

Keeping Current
Combination Therapy Choices in COPD -- State of the Art

Keeping Current

Play Episode Listen Later Aug 2, 2021 29:57


Expert faculty discuss how to optimize the management of patients experiencing COPD exacerbations while on bronchodilation therapy. Credit available for this activity expires: [07/30/22] Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/955597?src=mkm_podcast_addon_955597

PVRoundup Podcast
Specialist Spotlight: Pulmonologist, Dr. Richard Casaburi discusses COPD and the benefits of pulmonary rehab

PVRoundup Podcast

Play Episode Listen Later Jul 29, 2021 11:52


Dr. Richard Casaburi, a pulmonologist joins the podcast to discuss topics in COPD for this edition of the PV Roundup specialist spotlight.

Chomping Down the Dietetic Exam
Vitamin D Pathways, Randomized Clinical Trials, Parallel vs Crossover Designs

Chomping Down the Dietetic Exam

Play Episode Listen Later Jul 28, 2021 27:48


Today's listener requested topics are taken from @rdexampodcast on Instagram and FaceBook and covers Vitamin D Pathways, Randomized Clinical Trials, and Parallel vs Crossover Designs. This episode is sponsored by Pocket Prep. 1. What is the name for the active form of vitamin D? A. Cholecalciferol B. 7-dehydrocholesterol C. Calcitriol  D. Calcidiol 2. Which of the following is an example of an RCT? A. A study consists of two groups, A and B. Group a consisted of participants who had been smoking for 10 or more years. Group B consisted of participants who had never smoked. Both groups were followed for 10 years to see if they develop COPD. B. A study consists of two groups, A and B. Group a consisted of participants who had liver disease. Group B consisted of participants who did not have liver disease. Both groups were compared to see what proportion of them had been consuming alcohol on a regular basis for ten years C. A study examining the effects of a cholesterol drug randomly placed participants into two groups, a and b. Group a received the cholesterol drug whereas group b received a placebo. D. None of the studies mentioned are an example of an RCT   3. A study consisted of three groups. Participants were randomly assigned to groups in which they stayed throughout the study. Group A received treatment A. Group B received treatment B. Group C received a placebo. Which of the following best describes what type of design this study is an example of? A. Randomized Clinical Trial Crossover study B. Randomized Clinical Trial Parallel study C. Randomized Clinical Trial D. All of the above  

KYTOS Biology
Chronic Obstructive Pulmonary Disease (COPD) - A Short Introduction

KYTOS Biology

Play Episode Listen Later Jul 25, 2021 10:54


COPD or chronic obstructive pulmonary disease is the term given to a group of diseases which affect the lungs. These include emphysema and chronic bronchitis. They are inflammatory diseases and will obstruct air flow to and from the lungs. There is no cure for COPD as it causes permanent lung damage. Treatment can slow down the progression of the condition. However, people with COPD are also at increased risk of developing heart disease, lung cancer and other chronic illnesses. (With thanks to our sponsor 'Curriculum Press' for providing content for this podcast)

Medical Spanish Podcast
Pulmonary Function Tests in Spanish

Medical Spanish Podcast

Play Episode Listen Later Jul 22, 2021 6:44


This is our fourth free lesson covering Spanish for COPD. In this lesson, the doctor explains the pulmonary function tests (PFTs) in Spanish. The post Pulmonary Function Tests in Spanish appeared first on Podcasts by Doc Molly.

Living Life with Lynda Show
Keeping Maine's Population Healthy through Healthy Living for ME - Episode 143

Living Life with Lynda Show

Play Episode Listen Later Jul 22, 2021 53:56


Part 1 - Jen Paquet, Training Manager, for Healthy Living for ME™ joins me to talk about this amazing organization that is helping to keep Maine's population thriving into and through their elder years!  Through a network of local leaders, community organizations and health systems, Healthy Living for ME™ delivers programs to help adults manage chronic health conditions, prevent falls, and foster well-being. If you are coping with high blood pressure, heart disease, COPD, arthritis, diabetes or other chronic conditions, Healthy Living for ME™ can support your efforts to live life as fully and independently as possible. Part 2 - Weekly Words of Wisdom - Lynda talks about her beloved dog, Trevor, being ill recently and how she noticed that the healthcare system for pets is following the same pattern as for people.

Annals On Call Podcast
COPD: What Clinicians Need to Know-Part 1

Annals On Call Podcast

Play Episode Listen Later Jul 19, 2021 24:08


Dr. Centor discusses the care of patients with chronic obstructive pulmonary disease with Dr. Anand S. Iyer.

Mule Ranch Podcast
Is Steve's Saddle Really A Fix-All, Mules for Dressage (Winning Against Horses), and Much More

Mule Ranch Podcast

Play Episode Listen Later Jul 13, 2021 59:41


n this episode, Steve Edwards, owner of Queen Valley Mule Ranch in Queen Valley, Arizona takes time to talk about his Mule Saddles and if they really are a fix-all for problem behaviors, Mules being used for dressage competition and beating horses, and A Whole Lot More! Find Steve on Facebook and hang out on his future live streaming videos! https://www.facebook.com/muleranch​ **************************************** 0:00​ Welcome to Ask Steve and Cow Bells! 3:17​ What does the breaching do for the mule and why do you have to ride with it always? -Link to Mule Saddle Training Course (FREE), https://muleman.co/2YpleOQ​ 10:27​ How to get mule to stand still with the Come-A-Long rope? -Link to Ground Foundation Training kit, https://muleman.co/2YrrN3m​ 14:37​ Mule stung by bee on eye 15:10​ Mule Days in North Carolina 16:36​ Cutting saddle pad to fit mule back? -Link to Steve's Triple Duty Saddle Pad, https://muleman.co/2nbeMJA​ -Link to article, Everything You Need to Know About The Saddle, https://muleman.co/2XRqTcl​ 19:26​ Donkey with COPD? 20:51​ Is Steve's Saddle really a fix-all? 22:57​ Using the seven games with mules (training protocol) 27:46​ What type of shoe should I use for my mule that's never had shoes? -Link to St. Croix Shoes, https://muleman.co/2ndm3Zk​ 28:54​ Mule doesn't like hearing a gun moving in and out of scabbard 30:51​ 12-year old John that wants to stop 32:40​ Feeding beet pulp to donkeys 35:18​ Measuring for tack 38:01​ Desensitize an earshy mule 41:25​ What does it mean by creating 1-2 wrinkles at the mouth when using a bit? 42:55​ What kind of harness is needed for driving mules? 44:12​ New Cowboy Saddle and Dutch Warm-Blood Mule For Sale-Only One in US!-Best for Dressage - (641) 414-4353 47:55​ More resources available: -Link to Youtube Steve's Channel, https://muleman.co/2ndm3Zk​ -Link to Steve's Podcast, https://muleman.co/2S8snNh​ 49:05​ Buy mules for the job you want to do 56:43​ Why change to a finished bit if mule is doing well in the Mule Rider's Martingale? Follow Queen Valley Mule Ranch: Instagram, http://muleman.co/2DA4yZF​ Facebook, http://muleman.co/2DrSLJQ​ Twitter, https://twitter.com/muleranch​ Website, http://muleman.co/2G3RIBk​ Podcast, https://muleman.co/2S8snNh​ Steve's Free Saddle Training, https://muleman.co/2YBJ6u1

Lung Cancer Voices
Dr. Anne Gonzalez -Geoffrey Ogram Memorial Grant Recipient

Lung Cancer Voices

Play Episode Listen Later Jul 12, 2021 16:26


In this episode, Dr. Anne Gonzalez, MD, MSc, McGill University Health Centre, winner of the 2020 Lung Cancer Canada Geoffrey Ogram Memorial Research Grant, discussed her research on predicting risk of lung cancer in patients with COPD.

All Home Care Matters
Allergy Help for Seniors

All Home Care Matters

Play Episode Listen Later Jul 11, 2021 17:32


On today's episode, we are going to be talking about how to help seniors with allergies. We will start off with what allergies are and what causes them. Since seniors with allergies are also prone to hay fever, we will also cover what hay fever is, how to prevent it, and what to do if your loved one is experiencing it. We will also be talking about how to help your loved ones suffering from allergies, and we'll be discussing ways to spot when your loved one may be experiencing allergy symptoms, how to prevent their symptoms, and other ways to help them through allergy season.   Now let's get started.   Allergies affect more than 50 million Americans each year and are especially a nuisance for seniors. Seasonal allergies usually develop early, but they can develop later in life. According to Dr. Christopher Randolph of the American Academy of Allergy, Asthma and Immunology, allergies have a larger impact on the lives and health of the elderly. If you notice allergy symptoms in your loved one, let their doctor know. It can be hard for their doctor to diagnose allergies during a short visit, especially when they are monitoring other serious health issues or attempting to diagnose any new complications that you or your loved one presents them with.   You should also talk to their doctor before giving them over-the-counter allergy medicine. First-generation antihistamines, like Benadryl or the now discontinued Chlor-Trimeton, can have some pretty serious and even dangerous side effects. The American Academy of Allergy, Asthma and Immunology lists anxiety, confusion, sedation, drowsiness, urine retention, dry mouth and eyes, and dizziness as some of the potential side-effects.   Many of these side-effects can end up causing your loved one to fall and injure themselves or develop a painful urinary tract infection. Not only do these side effects have the potential to cause an injury to your loved one, but they make everyday life harder and more uncomfortable than it should be for older adults.   If your loved one chooses to take over-the-counter allergy medicine, you should speak to their doctor or pharmacist about second or third-generation antihistamines, like Zyrtec, Claritin, or Allegra. These options are still antihistamines and can still cause your loved one to experience many of the side effects that first-generation antihistamines cause, but they are less likely to do so.   It is also important to inform your loved one's doctor of any medications you give them, as they can potentially cause changes in mood or behavior in the elderly and may lead to dangerous interactions with other commonly prescribed medications. Keeping their doctor up to date on any medications your loved one is taking, including both prescription and over the counter, is an important task to remember.   Your loved one may be suffering from a stuffy nose, and you might just assume that it is just allergies or a slight cold, but there are a number of medications that offer this side-effect in the right conditions and their doctor won't be able to tell if their prescribed medications are being interfered with if they are not up to date on what your loved one is currently taking.   For seniors that have been dealing with seasonal allergies their whole lives, you most likely won't have to come up with a new treatment plan. They, like many Americans, probably have found a routine that works best for them, which might include a favorite antihistamine or nasal steroid. You may have to adjust their allergy treatment plan, though. What once worked for them may no longer be enough to combat their symptoms.   If they take antihistamines daily, but their usual choice of medicine isn't working, try switching brands and see if that helps. There are several second and third-generation antihistamines that can be found at your local pharmacy or grocery store. You can ask a pharmacist for help if you are unsure of which medicine you should try.   If your loved one has Alzheimer's or Dementia, they may not be able to let you know they are experiencing allergy symptoms or tell you what works best for them. You will have to be on the lookout for symptoms during peak allergy season. Do you already know they get seasonal allergies? You may be able to start giving them their allergy medicine if you notice the pollen count rising in your area. You can always talk to their doctor if you are unsure what to do in this situation.   If you are interested in learning more about Alzheimer's or Dementia, check out some of the episodes we've done covering these topics or visit our website for more information. You can also view our playlist on Alzheimer's and Dementia on our YouTube channel.   For those that have developed seasonal allergies later in life, those that are finding themselves needing a new way to manage their allergies, or those that want to manage their allergy symptoms without taking a daily antihistamine or other medication, there are a few ways to manage allergy symptoms without the use of medications.   Now, none of these will completely make your allergies disappear, but they may help alleviate some of the symptoms. And, paired with a daily antihistamine or other medication, can help your loved one feel more like themselves during peak allergy season.   First, you will want to make sure that your loved one has a high-efficiency particulate air, or HEPA, filter for their air conditioner and make sure it is routinely serviced. A HEPA filter removes allergens from the air and helps prevent them from circulating around the house. You should also refrain from leaving the windows or doors open when the pollen count is high. Check your local weather report to see what the pollen count is and try to limit outdoor exposure when it is too high. If you need to be outdoors, wear sunglasses to help prevent eye irritation and sun damage and wash your hands when you come back inside.   If possible, change clothes and take a shower, as well so you can limit the number of allergens in the home. Keeping a normal cleaning schedule that includes dusting and vacuuming the home can also help remove allergens inside. Having a clean space can also help improve your loved one's overall mood and if their allergies are making it difficult to enjoy time outside, having a clean house is one less thing they will have to worry about.   Eating foods that help lower inflammation, like apples, flaxseed, ginger, leafy greens, walnuts, and anything high in Vitamin C, may help decrease some of the symptoms your loved one might be experiencing, as well. Allergens cause irritation and inflammation in the body and foods that reduce inflammation, like those we just listed, may help your loved one manage their allergy symptoms. You should also dry their clothes, and your own, in a dryer and not hung up outside to prevent allergens attaching to the clothes before they are brought back inside.   For most Americans, allergies are a nuisance, but for seniors, they can present a real danger. Seniors with other health issues, like COPD or high blood pressure, can be severely affected during allergy season. The most common allergy symptoms, runny nose, itchy, watery eyes, sneezing, chest congestion, and difficulty breathing, can cause other reactions in seniors with respiratory illnesses or diseases.   If your loved one uses an inhaler to help manage their allergies, make sure to always have it on hand. Even if you are only leaving the house to run to the post office, make sure you bring their inhaler with you. You never know when your loved one may need it and it is better to always carry it with you. You can also talk to their doctor and ask them if they can prescribe your loved one backup inhalers, that way you can always have one at home and another to carry one with you. This is also a good practice to keep if you have asthma. And if your loved one does have asthma, allergies can definitely trigger an attack, so you will also want to make sure your loved one or you are always carrying an inhaler during allergy season in case they need it.   Seasonal allergies and their symptoms are not life-threatening, but they can be if your loved one takes any medications that their doctor is unaware of. Unless you are a doctor or a pharmacist, you probably don't know how a certain medication will interact with another, so it really is important to tell your loved one's doctors any and all medications they are taking.   If your loved one has allergies, they may have gotten hay fever at some point in their life or they may have it while you are providing care for them. You may be wondering, what exactly hay fever is. Hay fever, or allergic rhinitis, affects somewhere between forty and 60 million Americans a year. According to the American College of Allergy, Asthma and Immunology, allergic rhinitis develops when the body's immune system recognizes and overreacts to something in the environment that typically causes no problems in most people. The name hay fever is a bit of a misnomer. Hay can cause some people to develop hay fever, but not everyone that experiences it is ever around hay. And hay fever does not cause a fever. People experiencing hay fever may have a runny nose, itchy eyes, mouth or skin, sneezing, stuffy nose, and fatigue, which is usually due to getting poor quality sleep with a stuffy nose.   There are two types of hay fever that people experience, seasonal and perennial. Seasonal hay fever usually happens from springtime through early autumn and is usually caused by outdoor mold or pollen. Perennial hay fever is usually experienced year-round and is caused by inside allergens, like dust, pet dander or pet hair, cockroaches, and mold.   It is also possible for food allergies to present themselves as hay fever. If your loved one experiences perennial hay fever and almost constantly has nasal congestion, ask their doctor if there's a chance that they have any food allergies you are unaware of. Don't remove any food groups from your loved one's diet without consulting with their doctor first.   Since hay fever usually presents itself as prolonged nasal congestion, your loved one might not know they are experiencing any allergy symptoms and think they have just come down with the common cold, which they might! It is possible to mistake a cold for allergies and vice versa, but if your loved one always has a stuffy nose in the spring, it is highly likely that they have seasonal allergies.   Doctors usually suggest treating hay fever the same way you treat allergy symptoms. You will want to keep the windows closed during peak pollen periods and use a HEPA filter for your air conditioner. Wear glasses outside to minimize irritants getting in your eyes. They also suggest using mite-proof bed covers to limit exposure to dust mites and a dehumidifier to control mold. You should also wash your hands after petting an animal and have someone else groom your pet if you have hay fever.   According to the American College of Allergy, Asthma and Immunology, intranasal corticosteroids are the single most effective drug class for treating allergic rhinitis and can significantly reduce nasal congestion as well as sneezing, itching, and a runny nose. Your doctor or an allergy specialist can determine if these are the best medication for your loved one to take to control their hay fever symptoms. Since these are nasal sprays and not an oral medication, they avoid many of the side effects that come with taking antihistamines. The usual side effects of nasal sprays include irritation in the area sprayed and nose bleeds.   Antihistamines can also help your loved one manage hay fever, but they come with all the side effects we talked about earlier in the episode. Another option that can help with hay fever is a decongestant. If your loved one has high blood pressure or heart disease, check with their doctor first before using any decongestant. Decongestant nasal sprays work well. Most people that use them feel relief in minutes and it lasts for a few hours. If your loved one uses this option, make sure they only use it for a few days at a time, unless otherwise instructed by their doctor. Using a decongestant nasal spray for too long can end up causing more swelling in the nasal cavity.   If your loved one is constantly suffering from allergies or hay fever and medications just are not working well or the side effects are too much, immunotherapy may be an option for them. Immunotherapy is usually long-lasting and has far fewer side effects than a daily antihistamine. Your loved one may be able to receive allergy shots or sublingual tablets, which dissolve under the tongue. Allergy shots inject a small amount of allergens directly into the arm, increasing the dose each week until a certain level has been achieved.   At this point, the patient then gets a shot once a month until another level is achieved and then once every six months. The period of time between shots can vary from person to person, though. This process lasts anywhere from three to five years and the effects of the shots, either lessening the allergy symptoms or making them disappear completely, lasts several more years. Typically, you would need to start the cycle again in six years.   Allergy shots can be time-consuming and take a while to actually see any improvement. If you do not want to deal with the shots, a sublingual tablet may be for you. Your loved one can take these year-round or they can start a few months before allergy season begins for them. However, there are more restrictions for this treatment. Currently, sublingual tablets are only available to treat certain grass and ragweed pollens and indoor dust mites.   It is still a fairly new treatment, as it was approved by the FDA in 2014, and as the years go on, they will be able to treat more allergens. Sublingual tablets are taken daily and dissolve under the tongue. These can be taken up to three years. After that, you will need to devise a new treatment plan with your loved one's doctor. For both of these treatment types, your doctor may refer you to an allergist if you don't see one already.   Allergies can be miserable and make you feel terrible constantly. We hope this episode has been helpful to you and given you new ways to help you manage your loved one's allergies.   We want to say thank you for joining us here at All Home Care Matters and for being a part of our 100th episode. All Home Care Matters is here for you and to help families as they navigate long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form there where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone is who could benefit from this episode and please make sure to share it with them.   Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. Join us next time on All Home Care Matters where we will be discussing How to Communicate with a Loved One who has dementia.   Sources: https://www.agingcare.com/articles/help-elders-survive-allergy-season-150138.htm   https://www.homecareassistancenaples.com/how-to-manage-allergies-in-seniors/#:~:text=Allergies%20pose%20a%20greater%20threat,COPD%20to%20high%20blood%20pressure.   https://www.dispatchhealth.com/blog/how-to-care-for-a-senior-with-allergies/   https://www.lifecareservices-seniorliving.com/blog/survival-guide-allergies-aging/   https://www.medicalalertadvice.com/articles/seasonal-allergies-and-seniors/   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362176/   https://www.aafa.org/allergy-facts/#:~:text=How%20Common%20Are%20Allergies%3F,types%20of%20allergies%20each%20year.   https://acaai.org/allergies/types/hay-fever-rhinitis      

Dr. Berg’s Healthy Keto and Intermittent Fasting Podcast
Reduce Respiratory Mucus with Salt - Dr. Berg On Chest Infection, Chronic Bronchitis & Lung Cleanse

Dr. Berg’s Healthy Keto and Intermittent Fasting Podcast

Play Episode Listen Later Jul 8, 2021 3:12


In this podcast, I explain how you can easily treat respiratory mucus, whether caused by chronic obstructive pulmonary disease (COPD), chronic bronchitis, asthma, or a sinus infection. And even sleep apnea. • Take Dr. Berg's Free Keto Mini-Course! • How to Bulletproof your Immune System Course • Dr. Berg's Beginner Guide to Healthy Keto & Intermittent Fasting Plan • Intermittent Fasting Basics for Beginners • Dr. Berg's Healthy Ketogenic Diet Basics: Step 1: https://youtu.be/vMZfyEy_jpI Step 2: https://youtu.be/mBqpaAKtnXE Dr. Eric Berg DC Bio: Dr. Berg, 51 years of age is a chiropractor who specializes in weight loss through nutritional & natural methods. His private practice is located in Alexandria, Virginia. His clients include senior officials in the U.S. government & the Justice Department, ambassadors, medical doctors, high-level executives of prominent corporations, scientists, engineers, professors, and other clients from all walks of life. He is the author of The 7 Principles of Fat Burning. Dr. Berg's Website: http://bit.ly/37AV0fk Dr. Berg's Recipe Ideas: http://bit.ly/37FF6QR Dr. Berg's Reviews: http://bit.ly/3hkIvbb Dr. Berg's Shop: http://bit.ly/3mJcLxg Dr. Berg's Bio: http://bit.ly/3as2cfE Dr. Berg's Health Coach Training: http://bit.ly/3as2p2q Facebook: https://www.facebook.com/drericberg Messenger: https://www.messenger.com/t/drericberg Instagram: https://www.instagram.com/drericberg/ YouTube: http://bit.ly/37DXt8C

EMplify by EB Medicine
Episode 59 - HIV - An Interview With Dr. Daniel Egan

EMplify by EB Medicine

Play Episode Listen Later Jul 2, 2021 55:40


EMplify - July 2021 Announcements: Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month !! HIV- An Interview With Dr. Daniel Egan See the EB Medicine Article @ https://www.ebmedicine.net/topics/infectious-disease/HIV Why HIV?  2018 , 1,2 million people living with HIV, almost 40k new infections People living with HIV visit the ED 3 x per year on average HIV infected patients accounted for 6 in 1000 ED visits in 2017 New Transmission of HIV, Figure 1 What does acute infection look like ? What about chronic infection ?The chronic phase can last 10 years or more and be asymptomatic. Are people with HIV more likely to develop: CAD, COPD, DVT and why? What if they are on medication for HIV? Screening in the ED, everyone? Do they have to have symptoms or risks? What does universal screening mean? What does risk based screening mean? What are the risk factors? What if I see someone on PrEP who is in the ED for an unrelated complaint? History Ask about cd4 and viral load and last test Ask about he of opportunistic infections Ask about medication side effects What else? Exam Labs - rapid testing, 4th gen, viral load and cd4, etc Imaging Treatment Table 1 Highly effective and reduces transmission Medication side effects (we don't have to dwell on each Med and side effect and just reference the charts) hep B virus deactivation System Based Disease Heart Failure and CAD PCP (role of LDH) TB COPD Renal Disease - stones , radiolucent Neurologic- CVA, cryptococcal meningitis, toxo, progressive multi focal leukoencephalopathy, HAND GI - diarrhea causes, c diff, hep C Heme- cytopenia Endocrine - metabolic syndrome Musculoskeletal Psychiatric table 3 Derm Special Circumstances PEP PrEP  

Healthy Wealthy & Smart
547: Dee Kornetti & Cindy Krafft: Maintenance Therapy in the Home

Healthy Wealthy & Smart

Play Episode Listen Later Jul 1, 2021 53:01


In this episode, Co-Owners of Kornetti & Krafft Health Care Solutions, Dee Kornetti and Cindy Krafft, talk about all things maintenance therapy and care. Today, they talk about maintenance therapy in the home, diversifying revenue, and they bust a few maintenance therapy myths. How can maintenance patients have a goal statement if they're never going to get better? Hear about home-based therapy, teaching patients to self-manage, Medicare part B, and their book The Guide to Delivery of Home-Based Maintenance Therapy, all on today's episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “It's never been that if you don't improve, then services aren't covered.” “Rehab potential is the responsiveness to care.” “The myth of coverage has some roots in the denial issue.” “If there's room for improvement, a restorative or improvement course of care is what your skills would be indispensable for. That's what would make your care medically necessary under the Medicare benefit.” “If someone else can do it just as well as I can then this is no longer considered skill.” “We are helping patients be accountable for their chronic disease management.” “There are times that we are indispensable to help people improve and recover function back to a prior level or maybe beyond, and then there's times we are needed to preserve and stabilise their exiting function so that their quality of life can continue on in the fashion that it currently is.” “Be a bit more open-minded with how physical therapy really works in reality. Don't assume that what your path at the moment is THE path and can't vary and can't change. There are many other ways you can utilise your skill to benefit those around you.” “Don't be afraid to ask questions, and don't think you have to know it all.” “If you've got a great idea, or you have something that is a passion, and you've got that intersection of your passion and your skill set, go for it. Start to explore that. The possibilities are endless.”   More about Dee Kornetti Dee, a physical therapist for 35 years, is a past administrator and co-owner of a Medicare-certified home health agency. Dee now provides training and education to home health industry providers as Owner/Founder of a consulting business, Kornetti & Krafft Health Care Solutions, with her business partners Cindy Krafft and Sherry Teague. Dee is nationally recognized as a speaker in the areas of home care, standardized tests and measures in the field of physical therapy, therapy training and staff development, including OASIS, coding, and documentation, in the home health arena. Dee is the current President of the American Physical Therapy Association's Home Health Section and serves on the APTA's national Post-Acute Work Group. She serves as the President of the Association of Homecare Coding and Compliance, and a member of the Association of Home Care Coders Advisory Board and Panel of Experts.  She has served as a content expert for standard setting for Decision Health's Board of Medical Specialty Coding (BSMC) home care coding (HCS-D) and OASIS (HCS-O) credentialed exams. She holds current credentials in Home Health Coding (HCS-D) and Compliance (HCS-C) from this trade association.  Dee is also on Medbridge's Advisory Board for development of educational content on its  home health platform, and has authored several courses related to OASIS, Conditions of Participation (CoPs) and therapy. Dee is a published researcher. on the Berg Balance Scale, and has co-authored APTA's Home Health Section resources related to OASIS, goal writing and defensible documentation for the practicing therapist. Dee has contributed chapter updates to the Handbook of Home Health Care Administration 6th edition, and co-authored a book, The Post-Acute Care Guide to Maintenance Therapy published in 2015, along with an update in 2020 titled, The Guide to Delivery of Home-Based Maintenance Therapy that includes a companion electronic workbook. Dee received her B.S. in Physical Therapy from Boston University's Sargent College of Allied Health Professions, and her M.A. from Rider University in Lawrenceville, NJ. Her clinical focus has been in the area of gerontology and neurological disease rehabilitation.   More about Cindy Krafft Cindy Krafft PT, MS, HCS-O is an owner of Kornetti & Krafft Health Care Solutions based in Florida. She brings more than 25 years of home health expertise that ranges from direct patient care to operational / management issues as well as a passion for understanding regulations. For the past 15 years, Cindy has been a nationally recognized educator in the areas of documentation, regulation, therapy utilization and OASIS. She has and currently serves on multiple Technical Expert Panels with CMS Contractors working on clinical and payment reforms and bundled payment care initiatives. Cindy is an active member of the National Association of Home Care and Hospice (NAHC) and currently serves on multiple committees. She has written 3 books – The How-to Guide to Therapy Documentation, An Interdisciplinary Approach to Home Care and the Handbook to Home Health Therapy Documentation – and co-authored her fourth, The Post-Acute Care Guide to Maintenance Therapy with her business partner Diana Kornetti PT, MA, HCS-D.   Suggested Keywords Maintenance, Therapy, PT, Physiotherapy, Improvement, Assessment, Goals, Home Care, Rehabilitation, Accountability, Medicare, Myths, Health, Healthcare, Sustainability,   Book Discount Code (10% OFF): KK2021 The Guide to Delivery of Home-Based Maintenance Therapy   To learn more, follow Dee and Cindy at: Email:              kornetti@valuebeyondthevisit.com Website:          https://www.valuebeyondthevisit.com Facebook:       Kornetti Krafft HealthCare Solutions Twitter:            @Dkornetti                         @KornettiKrafft LinkedIn:         Kornetti Krafft HealthCare Solutions   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  Speaker 1 (00:01): Hi, D N Cindy. Welcome to the podcast. I'm happy to have you guys on. Welcome. Welcome. Thanks for having us happy to be here. Glad to be here. Excellent. So today we are going to be talking about maintenance therapy. So when a lot of physical therapists think about maintenance therapy, they often think that, well, this is something that's not reimbursed. This is something that maybe the patient doesn't quote unquote need. So today we're going to talk about what it is, some of the myths and a lot of other stuff surrounding maintenance care. So my first question is, can you define what maintenance care is or maintenance therapy? Speaker 2 (00:47): Okay. Karen, this is Cindy. I'll take that one. I think, you know, just as you were saying, the word maintenance, I'm sure at least one listener twitched, a little, the eye Twitch, the uncomfortable many times when you say the word maintenance, it looks like, you know, people react like you swore in church to like, oh, I don't do that. Or I, you know, somebody does that and get in trouble. And, and I think even the word has become a barrier. So Dee and I have tried to reframe the conversation by getting to the heart of what it is by referring to it as stabilization of function. So putting aside that baggage and the history of the word, the approach to care is saying I'm utilizing all the wonderful things I know as a therapist, my ability to assess and all of those great things and develop a care plan. But the end result that I'm going for is a stabilization or preservation of their functional level or slowing of decline. I think maintain can get people tied up in knots and miss the point or think that we have to do all kinds of different things, which we'll talk about in a moment with the myths. But I really think it helps to, to approach it as we're talking about stabilizing someone's function. Speaker 1 (01:58): That makes a lot more sense. And I really like that word. And you're right. I feel like maintenance care does kind of give people that, oh, I don't know if that's quite my lane, but when you say stabilization of function, preservation, decreased speed of decline. I think physical therapists are like, yeah, of course that's what we do. We'll think about it. We, we, we treat patients that have these chronic diseases right there. We don't share them. They go to doctors, numerous doctors, you know, cardiologists primary care, right. With their, with our heart conditions, they see nursing, right. They see all kinds of disciplines and all kinds of professionals. But they're never getting cured. They're it's management of their symptoms, right? So, so it's to like Cindy said, we are, we're going to preserve function. We're going to, you know, optimize their ability. Speaker 1 (02:50): We're gonna re hopefully use our skills, knowledge, and ability to reduce their demand or their requirement, higher cost centers of care. What happens when you have poorly managed symptoms of chronic disease, like COPD or CHF or diabetes, these people use urgent, emergent care. These people go in the hospital. This is extremely costly to our, to our medical system. And it's, it's not sustainable as an aging pie, you know, as we age as the population. And so this idea that there's things we can do to have people function optimally, no matter what phase or stage of this chronic condition they're in too, so that they're not as dependent or on higher cost centers of care, or they don't realize the kind of sequella, you know, think about a diabetic with poorly managed blood sugar, you know, that starts to develop retinopathy Neff, prophecy, peripheral neuropathy, right? All these other problems that happen. You know, that's all very manageable. If we can get an early and often and preserve an optimized, I even say optimize function. So we're not improving people necessarily because sometimes they haven't already experienced a decline. A lot of times we're just going in there to share what we know so that they can be accountable and manage these chronic diseases themselves. Yeah. That makes so much Speaker 2 (04:16): Karen. I would add to that, you know, for your listeners, cause some folks, you know, D and I have been talking about this for years. Some folks have a difficult time with this conversation, not just the word, but the concept. It sounds good. It sounds valuable. But I think we have to take a moment and acknowledge how deeply as therapists. We have defined ourselves by that word improvement. You can see it in our documentation. If you're going to get physical therapy, you're going to walk five feet more or 10 feet more, every time I get near you because that's, that's what I have to do. And that if I'm not improving you, we've all been told that if, you know, after a certain number of visits or certain number of treatments, if you don't see improvement, you're obligated to discharge people. When you start finding out that, that isn't really true and it hasn't really ever been true. Speaker 2 (05:06): I think we've got to give ourselves a little bit of grace here and realize that this can be quite the seismic shift internally about how we value ourselves as therapist, how we define ourselves and how we're defining ourselves to our patient populations. I think to the patients, to the potential patients, to our other members of the interdisciplinary team, we've done such a bang up job, talking about improvement, that when they don't feel that they're going to improve as, as the beneficiary or other members of the team say, well, that's patient, isn't going to get better. They don't even refer them to us. They don't even come to us because we've created this wall of you have to be able to get better, or you can't come to physical therapy. Speaker 1 (05:47): Yeah. Oh, I'm sorry. I was going to say, Cindy, what's your favorite line? When you talk about how we are addicted, like we, we are ingrained with improvement. What is your favorite line to say? Speaker 2 (05:57): Oh, well, I created a little, self-assessment like you answer these questions to get these points about how addicted are you. Because it, I feel very comfortable using that word because this challenge is a lot of those core beliefs. And we have identified ourselves by this. So tightly that it's like, okay, we, we have to step outside of our comfort zone a bit. And then as we see therapists start to do that, then we get the questions. Then we get the, okay. I kind of understand it, but what about this? And what about that? And what about this other thing? And that's when the myths all start to bubble up to the surface with where did that even come from? Speaker 1 (06:40): Yeah. So let's talk about some of those myths and see if we can bust them. So I will, I'll take, I'll throw it over to you guys. Either one of you can start, but let's talk about a couple of myths of maintenance therapy for me. One big one is, well, it's not covered. Speaker 3 (06:58): It's not covered by insurance. Speaker 1 (07:00): I'll take that one. This is thing. Yeah. Well you know, maintenance has been part of the Medicare benefit under any Medicare beneficiary part a or part B, since you can find it in the Medicare benefit policy manual, as far back as the, as the 1980s. So it's been around forever. This is not new, that Jimmo V Sebelius case that was brought forward. Just kinda shine the light on it, but it's never been that if you don't improve and services aren't covered or you don't have no, this idea that rehab potential is the ability to improve no rehab potential that we all typically document at some point is the responsiveness to care, right? That's what rehab potential is. Whether the care is going to allow you to improve from where you are at the baseline of assessment or to maintain or stabilize your function from where you are now without any unforeseen event in the next three, six, nine, 12 months, two years, are you going to be able to manage this condition and not decline, right? Speaker 1 (08:13): Or if you're in a progressive type of disease process, are you functioning optimally? And are we slowing that deterioration or decline? That is a normal part of the condition. So Cindy, I can pop a punch it over to you. And since we talk about it being paid, I think we busted that Karen. Right? We busted that pretty good. Okay. So, so other payers, I don't know, but anybody that is a Medicare provider, so under part a or part B, it, it is part of the benefit. Okay. So Cindy, talk to me about what are the type of conditions that are covered by maintenance as if the diagnosis determines it? What do we know about that? Speaker 2 (09:00): Well, very often what we hear is, okay, I understand maintenance therapy. I know what it's for. It's for people who have progressive neurological conditions. So it would make sense for Parkinson's. It makes sense for Ms. It makes sense for ALS. So it must be those three patient populations that are maintenance. Okay. We got to step back for a minute. There are patients with those three conditions that benefit and have the ability to improve with therapy. So it's not Parkinson's is synonymous with maintenance. And there's nothing in the coverage criteria that is diagnosis specific. Diagnosis is only one piece of the conversation. It is where are they functionally? What are the, what is the impact of this diagnosis and their resorted comorbidities on their functional ability? And what does a therapist know? What does that skill that you bring to the table that is unique to that discipline that is indispensable to this patient? Speaker 2 (09:56): But I think the myth of coverage has some roots in the denial issue. We, we can't go past this point without acknowledging that therapists have seen denials for providing maintenance therapy, that you did not show improvement in wham. They took away payment for part of this care, which is what drove the Jim versus civilians conversation that led to the court settlement with CMS to basically say, you know, Hey, we've looked at this benefit. It doesn't say you have to improve to get services. And, and we're, we're good friends with Judah Stein who was the lead attorney in that case, and still has the ability to call CMS back on the carpet and the legal sense about how that settlement has played out since, because CMS basically approached it with a oops, you're right. It doesn't say that shame on us, but it's like, wait a second. Speaker 2 (10:48): You've been denying coverage of services for a long time. And so it's very hard to say, yes, it's in there. And we understand it's in there. And D and I've explained the fundamental pieces of that, but there's still that I got denied, or I know somebody who got denied this can't possibly be true and it's unfortunate. And my personal opinion is I have a really hard time with CMS, just kind of Oop, seeing it versus, you know, ownership. And we saw a subsequent event to the initial Jimmo case that compelled CMS to put on their resources, particularly on their website, where they had to quote disavowal the improvement standard. So not just say oopsies, but say you have to flat out say that does not exist. And if beneficiaries qualify for these services, they absolutely should get them. Speaker 1 (11:36): Yeah. The, the, the woopsies sees that my bad defense never, ever seems to go over well, does it? No, no, no. Okay. So we talked about, is it covered? We talked about diagnoses covered. What other big myths are there surrounding maintenance therapy? All right. I Speaker 2 (11:59): Got one for you. D I got, you know, where I'm going. We very often hear they say, okay, so if it's not about their diagnosis, I need to assess the patient. Right. Figure this out. So now looking at what I typically do in an assessment, oh, test and measures. Well, those must not apply. Then I wouldn't be using tests and measures on a maintenance patient. And we would say, well, why not? Well, why would I measure something if I measure it again later? And it's the same, then why did I measure it to begin with? So any thoughts on those tests and measures in the maintenance patient D Speaker 1 (12:32): Yeah. Well, and, and I'm going to tie it to goal statements too, from there, right? So, so this idea, why do we take objective measurements of patients to establish a baseline, right? And we need to do that regard, you know, based on the presentation of the patient, regardless of their diagnoses and comorbidities, because we want to see if they're functioning at, or near where we would expect them think of a class three heart failure patient, are they functioning where you would expect, you know, a class three heart failure patient to function, or are they functioning like end stage, right. Class four, are they functioning below where you would expect them to function? And so obviously if there's room for improvement, a restorative or an improvement course of care is what your skills would be indispensable for. That's what would make your care medically necessary under the Medicare benefit part a part B that's what it would do so that the tests and measures, establish that baseline. Speaker 1 (13:30): And you compare, this is how the patient's functioning. This is how we'd expect them to function. Now, when you get a patient who is functioning at, or near where you would expect them to function with, with their PR their presentation, the question you have to ask yourself, as you don't just jump right to maintenance, right? You can't just say, okay, this a maintenance patient. They need me. Yeah. Basket. What do they need me for? You know, is there something I can teach them, train them, provide them so that they continue to stay, be stabilized, maintain, be accountable for their care over longer period of time. Right? And if the answer is yes, then you absolutely should pick them up on, on, on a maintenance course of care, because there's some sort of skills, your knowledge, your expertise, that which makes you, you, what I like to call the magic, that is me as a PT, right. Speaker 1 (14:21): And we've all had those magic. That is me moments. When you ever, whenever you walk or, or you, you readjust a, an assisted device to properly fit a patient and people look at you like, oh my gosh, why didn't we think of that? And it's just like, because you're not the magic. That is me. I mean, I, and we take it for granted. So the idea is that tests and measures absolutely help you establish a baseline and determine if there's room for improvement or they're functioning at, or near where you would expect them to function based on the severity, the course, the interplay of these disease processes. And then that helps you pick which course of care restorative or improvement, stabilization, or maintenance. And then you have to say, this is what my skills are going to be medically necessary for. So, so I'm going to tie that now to the next thing that comes, because if we get people this far down the myth-busting trail, Karen, the next thing they say is, well, how am I going to write a goal for that? I mean, if I'm not going to write something to improve, I mean, our, our documentation is called progress notes. I mean, you want to see how addicted we are. That's Cindy's line, right? We write on progress notes you know, Cindy, talk to us about goal statements. How can, how can maintenance patients actually have a goal statement if they're never going to get better? Speaker 2 (15:43): Well, I think, you know, we talked, we talked about coverage criteria, and then the documentation piece goes with that because I can't, and I'm going to kind of work backwards because what we'll see at times is therapists kind of go, okay, I understand it. And then you go to the goal statements and every one of them says, maintain this to maintain that I'm maintaining strength to maintain ADL's. And it's kind of like, okay, let's, let's take maintenance out of it for a minute. That that doesn't measure anything. What ADL's are you talking about? You didn't give any sort of quantifiable way to say what you're trying to maintain. So the goal solution is not to stick the word maintain in there as many times as humanly possible. It's still looking at it as we should be looking at it is what is that quantifiable element? Speaker 2 (16:29): How am I measuring something so that I can demonstrate whether or not we've improved it or stabilized it or slow the decline. And then the end piece is how was this functionally relevant to the patient? So I think what happens at times when D and I work with agencies about writing goal statements for maintenance, the by-product is actually their goal writing overall gets better. Because I think we've lost focus. We think, oh my gosh, I have to have an HCP goal, right? Because that's another addiction, you know, patient will have, you know, visual be independent with Hep. Well, it doesn't say what it's for. Why do you tend for them to do it forever? We don't know, but you have to have that goal. Then you have to have a strength goal. So, oh gosh, this has maintenance. I'm going to put, you know, increase a quarter grade. And yes, Karen, I have seen that documentation, the plan to increase one quarter grade, it's like, can you just go to maintenance and stop trying to improve in minuscule, teeny tiny amounts? Speaker 1 (17:27): How, how is that measured? I Speaker 2 (17:30): Have no idea. I thought half a grade was bad, but then we get into quarter grades. We see assessments that contain the terminology of severely poor. I thought poor was like the basement. I didn't know there was a tunnel under the basement. So this goal writing is really a good place to say, am I focusing in on, what am I quantifying? Why is this functionally relevant to this individual? Then we're setting the stage as to why therapy is in fact necessary for this person. I think the, I will maintain this to maintain that. Doesn't really speak to that. And then we'll go see, I got a denial. That means this whole thing is, is self fulfilling prophecy. They don't pay for maintenance. I will never do this again. And it's like, yeah, but did you really cover what you needed to cover and speak to why the therapy was important and why they needed to have it now? Yeah. Oh God, Speaker 1 (18:24): No. I was going to say, that's great. Thank you for that. Speaker 2 (18:29): But I think the extension of that, and I guess my way to push the ball back to D here as it were, is okay. So I've assessed them. I did my test and measures that wrote some goals. Now the issue becomes, I got to establish a care plan. So how often am I going to see them? And this is where at times, you know, when we had the ability to see folks in person, I swear people's heads are going to start spinning around in confusion because we start talking about things like you don't necessarily see these folks every week. You may see them once a month. And then D what about PRN visits? Can, can therapy use visit frequency? I mean, don't, we have to go or see them or interact with them at least once a week or else this won't be paid for. Speaker 1 (19:14): So talking about service utilization, you know, it's my answer is it depends. What does the, what does the beneficiary, what does the patient need, right? And so do I have to go three times a week for them to stabilize function? Do I have to go once every three weeks? What does it take? What is it that I'm doing that is indispensable for them that only can be provided by a therapist? You know, they can't go to the local you know, green, orange theory and have somebody work out with them in the gym and get the same benefit. What, why, why do you know, why does it have to be me? And so we, so we have to have an understanding of what's it going to take? How often do I have to go? And so when Cindy's talking about PRN visits, that's like a big no-no in home care for therapists, right? Speaker 1 (20:04): Under the Medicare part, a benefit in reality, it's not nurses do it all the time. You know, when they have to adjust Coumadin levels, right? For, or blood thinners, when they have to, if people still even on Coumadin, when they have to do sliding scale insulin adjustments, when they have to run labs, when they update or they're changing wound care orders, they write PRN visits all the time, but supposedly therapists can't do that. Well, that's not true because think about it. I think in, when I'm making this care plan, I'm not writing everybody for three weeks for I'm writing this person in five times a week, because they just got out of the hospital for an elective surgery. And I'm going to go every day, because if they went to an ER for SNIF, rather than home, they'd probably get daily therapy. Right. Okay. And this person was referred from maybe from their physician. Speaker 1 (20:54): And, and we're in the second episode of care, if you will, the second certification period. And there were still as ensuring that they are being, that they're stabilizing function. They're still teaching training oversight, checking, following up on 30 day reassessments to confirm that our interventions are actually working well, if I'm waiting on a piece of equipment, maybe that I decided, okay, we're going to get them a splint or something to meet, or we're going to get them this, this device. And we have to go through all the machinations with DME. I could write that I'm going to go out one time a week for four weeks. But what if that device doesn't come in for two weeks, what am I going to do? Just go, yada, yada yada. And the second week of that 30 day period, or do I just write like a PRN visit that says, you know, when the device comes, if it's not a, you know, when I would normally go out, if it's not going to be there, when I'm planning to go out, I'm not going to let it sit in my office or the back of my, you know, the boot of my car for another week. Speaker 1 (21:52): Or I'm not going to write an add on order. I'm going to have this PRN, but well, it's come in. I wasn't planning on seeing you for a week. I'll bring it out there, fit, adjust it, set it up, teach you how to put it on Don and doff it, you know, check your skin, how to wear it, everything you need to do. It's the same thing. Think about when you think about Karen, when you tell your patients, oh, Hey, if you have a problem with this exercise program, give me a call. How many calls do you get? I don't get that many calls. And then I go back out there and they're doing like rhythmic gymnastics with the Sarah band. And I'm like, that's not what we taught you. Right. That's not the correct exercise. So, so this is a way this, this kind of go out as often as you need to, and not one visit more is appropriate, not just for maintenance, right? Speaker 1 (22:37): So, so writing, writing utilization is really hard for people to understand, because they're used to seeing their patients every week and that doesn't sometimes have to happen. How long do you have to wait to see if the exercise program was efficacious two weeks, three weeks, four weeks, how long, you know, you've got to base it on what, you know, what the evidence shows us? What, what, what our, you know, our, our scientific literature says that's important. So, so I have one more myth to kind of finally push the ball back to Cindy since utilization depends. So now we've got people test to measure some kind of goals that aren't just written, maintain. We have utilization. That seems to be very beneficiary specific, Cindy now, cause they're on maintenance. I got to see them for the rest of their life, right? Speaker 2 (23:29): Yeah. That that's, that's very common and, and it kind of splits into different ways. Karen, sometimes it's the, I made a lifelong commitment because they could decline at any point in time. So by that standard, this is forever or there's the gleeful hot maintenance, a great way to go for patients that don't want to be discharged. So as opposed to them crying, when I talk about discharge or the daughter runs back to the doctor and keeps getting orders, I'll just put them on maintenance and then everybody's happy. Okay. You can't do either one of those things you still are accountable to skilled, reasonable, unnecessary. So the benefit is clear. You can't just keep going or having them come to see you at the clinic, just because you're nice. This does need to require the skills of a therapist. We're still accountable to all of those criteria. Speaker 2 (24:19): And as di said earlier, if there's nothing left to teach, train, or do I can't just do it because you either don't want to, unless I stand here or the caregiver doesn't want to have someone else can do it just as well as I can, that this is no longer considered skilled. And that's what drives the decision to discharge as well is when I have taught you what I, everything that I can the program I've given you is effective. It is in fact stabilizing function. There are no more adjustments to make. There are no things that need to be changed, then you really don't need me anymore. And that's where I think that it comes back to again, how are we finding our value that I think we've gotten very used to. They come to see us X number of times per week for this number of weeks in a row. Speaker 2 (25:07): Then we say, okay, you're done. The order is done. If anything goes wrong, then come back again. Where maintenance really makes us think about a term we use very often is how are we dosing ourselves? So thinking about ourselves, like a medication, when do they actually need that encounter with a therapist? And when we've reached a point where you don't need it, there's nothing I'm doing that is uniquely therapy, then we need to stop. But I think the hard part in that, Karen is some of our skill and touched on one, oh, I had just a piece of equipment in the family looks amazed because that is a skill. You, you know how to do that because of your training. I think sometimes the decision to discharge, we jumped the gun too fast, whether it's a maintenance approach to care or restorative by this. Oh yeah. Speaker 2 (25:53): They got it. They understand it. I don't really, you know, they're just doing the same thing, but are you still contributing something? Are you still making any sort of adjustments? Are you convinced? Because on the restorative side, I've never understood these, you know, lofty strength and improvement goals for a two week care plan that suddenly, you know, the, the they've gained a whole muscle grade in two weeks. I don't know what literature I missed, but this, this, this will be great because I'm going to go join a gym for two weeks when it's safe for me to do so. And then I will be fixed in two weeks. It's all done. So I think it, again, challenges us to think about, have we done everything that we can, are we confident as do? You've said more than once. I mean, we've taken care of mitigating concerns. Speaker 2 (26:37): I mean, if they may have a completely unexpected stroke next week, I'm not expected to be telepathic, but I have looked at your condition, given you the tools and resources. And in fact, whether there is nothing left for me to adjust to do, I am going to discharge. So there is active discharge, planning and maintenance care. We are, we are not saying because of this decline risk, then I'm here forever. And we also have to be careful because a lot of beneficiary advocacy groups have done a great job, educating our patients about this, who will then come at us with the resource. You can't discharge grandma because I've got this GMO thing. And it says, you have to, that's where I think some therapists have gotten caught and been like, oh, okay. That looks like an official document. I'm going to keep having you come to the clinic. I'm going to keep seeing you in the home. And it's like, wait a minute. That's why you have to know what the rules really are because yes, beneficiaries should be educated, but they don't necessarily understand the coverage criteria very well, just because they want this to continue. Doesn't mean it's automatic because of that, Jim. Okay. Speaker 1 (27:43): Yeah. And I think that that is where your judgment as a physical therapist and as the authority figure in that situation, you really have to come down from on that and, and be able to explain exactly why you're making that decision instead of just being like, oh, okay. I guess I'll just keep seeing the men, even though it's at this point, not medically necessary. So what, what advice do you have for the physical therapist who might be in that situation? How do they then speak to the caregiver, the patient, et cetera. So that's, that's happened to me cause I've been providing maintenance therapy. When I had my Medicare certified agency in central Florida, way back 2008, 2009, been doing it a long time because we get tired of people. We get them better and then they'd go off and then they decline and then they come back on. Speaker 1 (28:41): I'm like, we're missing something. We have to be able to monitor these people. I watched nurses do it all the time with the monthly catheter changes, right? Because most people are not good at self cathing and preventing infection and doing it accurately. So they'd end up in the hospital, you know, with some sort of puncture or something or an infection. So, you know, monthly catheter changes can happen for years and years with nurses. So what were we missing here? Here is the bottom line for clinicians. I, when I have taught and trained everything and my skills are no longer necessary. You ask yourself, is there somebody that could oversee that could carry this out with you? Because it really just requires sometimes the assistance of another person or a cheerleader or somebody to motivate you or supervise you. What we have a lot of patients that might have cognitive and limitations. Speaker 1 (29:31): And even if that person isn't available, just imagine, just ask yourself the question. If that person holographically appeared in the room, right, and said, teach me train. And they were capable. Would you give it to them? And if the answer is yes, then you should no longer be going anymore. So what I tell patients is I will say to them, I understand that you want me to come, but as a licensed physical therapist, I have a fiduciary responsibility to the payer and the payer has requirements. And one of them is medical necessity. And at this point you need to do this, but you don't need me as a physical therapist to do this. So I can teach and train you, your spouse, your family member, a paid caregiver, or you can pay me to come, right. But I cannot bill your insurance for this because I would be in essence, fraudulently saying, it's still required. Speaker 1 (30:27): My skills, knowledge and ability when I'm telling you it doesn't, it just requires another pair of hands or somebody that could be shown a lay person, how to do this. And so they're like, oh, well you calm. And then I'll tell them, this is what it costs to privately to pay for a physical therapist. And some people take me up on it. And some people say, oh no, I'll get my grandson to come over. Can you show him how to do it? And I'm like, that's great. So, so I think we have to, like Cindy was saying, we have to understand the regs. We have to understand this. Doesn't go on forever. We have to understand that when we are going to sign our name with our credentials, so hard earned right through through education and practice that we are basically signing an affidavit. If you will. Speaker 1 (31:13): That says, I attest that this meets the requirement of this third-party payer. If Benny therapists stopped, many clinicians heck stopped and thought about that. They might not provide some of the services that they're told they have to provide or do the things they have to do, but it's really comes down to our license. So when I sign that and say, this is medically necessary, I I'm going to make sure that I show that my skills and my contribution to that visit is a billable visit. If I no longer have needed for that, then I can teach and train someone else, or I can discharge them from the third-party payer and they can pay me privately. They could, it can be a cash based service. And that has happened. Speaker 3 (31:56): Yeah. Yeah. That Speaker 1 (31:57): Makes so much sense, guys. This was so good. I just know that therapists are going to have a much better idea of what stabilization care is versus maintenance care. We won't use that term anymore. Maybe we can, we can change that preservation of function, care stabilization of function, carrot just, it sounds it's. I think it sounds better for the therapist and quite honestly, like more humane, more human for the person that we're caring for. Instead of just maintaining someone, you know, we're preserving their function, we're their ability to do the things that they want to do. Just sounds so much more, I don't know, human than maintenance care. It sounds so cold and sterile. I don't know. Maybe it's just me. No, I think, you know, for me, when you say that, it makes me think that we are helping patients be accountable for their chronic disease management. Speaker 1 (33:01): Right. We are teaching them what we know and how important it is for people with aerobic impairments that they have to maintain that lung capacity you know, within the confines or the constraints of that disease process so that they can continue to do their self care, which is metabolically demanding. Right. So, so it, it really, it really shifts responsibility. I think maintenance is a very passive sort of thing that, you know, we're, we're maintaining range. You know, I, I think you know, people that were doing stuff to versus where we're in we're we're arming people with the ability to manage and be accountable for their chronic disease and to, and to function optimally within the constraints of those, that disease or those diseases through a stabilization or preservation of function. Yeah. Speaker 2 (33:55): And I think it's important to, to just kind of circle back a minute that we don't want the visual now to always be maintenance patients or stabilization patients are very debilitated, have to have a caregiver, very ill individuals. These, we can teach these types of programs to the patients themselves, for them to self manage. I think sometimes, you know, okay, I'll give it up. It's not Parkinson's ALS and Ms. I got that point, but these must be like really sick, bad off people. They might be, but they might not be, they might be the heart failure patient that's functioning pretty well right now, but has a history of pushing themselves too hard. So the now kicks in the fluid overload. It ends up back in the hospital because they're overdoing. How do you better task plan? How do you help someone understand when their disease process gives them good days and bad days? Speaker 2 (34:45): What, what do we want them to do on a good day? What do we want them to do on a bad day? Because we know many of our folks that are receiving therapy. Cause they basically think that we're gym instructors, we're gonna, you know, show up for the treatment, wearing spandex and tell them to drop and give us 20 anyway. So we're trying to get past that, but on a bad day, too many of our patients, regardless of diagnosis, sit and wait until they feel better, maybe, you know, with a recent orthopedic surgery, a little bit arrest, okay. We encourage some rest. That's not a problem. And some of these chronic diseases, you're one day turns to two days, turns to a week, you haven't done much of anything and now you've compounded the problem. So I think you're right. It does feel like we're utilizing our skills in a more person focused way meeting them where they are. Speaker 2 (35:34): But I think, you know, very often just briefly we'll get the, well, what are the treatment interventions for maintenance you didn't in this whole conversation, give us any treatment strategies because it's not about the treatment. It's not about the assessment. We do what we do. We have the tools in the toolbox, but what, what are we trying to get to? What is the end vision for this individual? And then I'm going to utilize what I know how to do best in that context. I just think for a lot of us, we felt that door was never open. That you were not supposed to do that. That if you could not show significant improvement that you had to discharge and Dee and I have seen therapists, when you see the wheels turning, I've said a couple of times we need to develop like a stages of grief equivalent for the discussion of maintenance, because we'll have people get mad. Speaker 2 (36:21): Like I can't believe nobody told me this. And then you'll see guilt, you know, oh my gosh, I've had patients and I discharged them. I thought I was doing the right thing. I'm a horrible therapist. What am I going to do now? And it's like, okay, let's just start looking at the information and change what we do going forward and not go backward and be all upset and think we're horrible or mad about who lied to me. It didn't tell me about this before, but we do need to start making a difference. Cause D and I heard far too often, you know what? That was interesting ladies, but we don't do that here in this clinic. We're not going to do maintenance therapy. And it's like, wow, you just get to unilaterally, decide you're out. If you want to be out, that's fine. But then you want to direct them to a clinic that does do it because if they need it and they qualify for it, then find them a provider who will, but this kind of, oh, I never heard of it. I'm not participating thing is, is very frustrating in the current environment. Speaker 1 (37:14): It's, it's not correct. I mean, we have to understand beneficiaries have paid into this benefit. They are entitled to it. And if their presentation is such, that stabilization of function is the appropriate course of care. They are entitled to it. It is part of their benefit package. You don't have a right to say, oh, we'll take you on care. But you know, you're not going to get that. That that's that's you, you can't do that. I mean, you either provide the care that is within the insurance. Right? I mean, think about it. If you went to Jiffy lube for your 32 point checkup and they charged you 90, 95 and, and you only got 10 of them because that, oh, we don't do those other 22. Would you be paying for, I wouldn't as like, listen, I'm entitled to this. This is what I'm appropriate for. Speaker 1 (38:07): It's part of my benefit. Maybe you don't do it, but you can't determine that I don't get it if it's part of my benefit package. So it really comes back to the beneficiary. If they're entitled to it, we, as professionals are not ones to say, we can recommend and say, I don't think that's the appropriate course of care. But to literally say, we're, you're not getting that component of your benefit. I don't think that would go over very well. Do you care? Do you not? No, not at all. Not at all. Especially with, you know, like you said, people have been paying into this, their whole working lives. If it is part of the benefit you should offer it. For sure. And if you're a physical therapist who says, I don't know how to do that, well, you better get educated and learn how to do it. Speaker 1 (38:56): Exactly. The things that I am not the most gifted at as a therapist. So I'm not just going to start dabbling in dry needling. Okay. That's that's not my area. Oh yeah. Just give me some, you know, go into the pin cushion and let me start working on you. It's a skill set and it's something that you have to understand the rules and regs. You have to understand what the payer source requirement is, but we as clinicians don't need any other evaluation skills. We don't need any other tests and measures. We don't need special interventions. What we need to understand is that there are times that we are indispensable to help people improve and recover function back to a prior level or maybe beyond. And then there's times we are, we are needed. We are indispensable to preserve and stabilize their existing function so that their quality of life can continue on in the fashion that it currently is perfect. I was going to say, do you want to button it up? But I feel like that did it, but now listen, before we wrap things up, let's talk about the book, the guide to the two delivery of home-based maintenance therapy. So talk about the book, where can people find it? And what will they get out of the book? If people go and purchase this book, what are they getting? Speaker 1 (40:16): Well, they're going to get DNA, Cindy. That's what I'm going to start with. They're going to get us, they're going to get us. They're going to get an updated version. I think it's the only book. And actually it's our second edition and really focused on community-based care part a and part B for Medicare, right? Whether it's part B in a clinic or part B in the patient's home. And we really focus on the rules and the regs. And we and, and literally walk you through common case scenarios. We try to myth bust, and we try to give you a how to like how to start to think about this, because I think theoretically or conceptually when, Cindy and I talk about this and we've been talking about this for eight or nine years now. And teaching on this, people don't disagree with this. They fundamentally understand, they just don't know how to operationalize it. They don't know how to, if they see it. Okay. Well, I understand what you're saying. I understand. I, I agree with you. That would be, I could see where that would happen, but then how do I do these things we've talked about? So Cindy, what does this second edition really afford them? This time around that, you know, it was kind of like a value. Speaker 2 (41:30): Well, I think part of it came from, we were folks, as you just said, understand the concept, but then struggling to say, I got chew on this for awhile. This is really going to change my core, that I am not just defining myself by improvement. I got to work through some stuff and figure out how to do that. And so our first edition started out. We have a consistent scenario throughout to really talk about assessment and goal writing and detail and all of those pieces. But then as we looked at the second edition, we said that that's a good place to go. You got a nice, consistent scenario. It builds throughout the entire book. So you have opportunity to do that. But then this time around you know, I think you got the sense. I tend to be more in the regulatory nitpicky, wheelhouse, and D tends to go toward the operationalization side. Speaker 2 (42:18): And so she brought up, why don't we put a workbook with it? Why don't we add to that idea of a consistent scenario and say, what are some additional knowledge application activities? How do you comment that same thing about assessment or goal writing a little bit differently than one scenario to really get the juices flowing about how to do this. Now, the challenge is, is there a right answer? Like, do I just go to the answer key? And there was only one way that could have been done while listening to this conversation. There was quite a few, it depends. How often would I go? What would I focus on? So the answers give you some context, some suggestions, some validation, but it was not meant to be, there's only one way to do this. And in a scenario, you know, five sentences long, you better figure out exactly what you would do all the way through this only one path, but it's really to help kind of put those guard rails on and say, well, did you think about this? Speaker 2 (43:14): Or what about that element to, to be able to say, okay, I am understanding this. So I could use that as an individual to go through that process, or I could use it in an organization and do it as a group activity, but to really help people continue to process what sounds like. Yeah, I got it. But now I have a patient in front of me and, and I'm still stuck. Old habits die hard. I still struggle with the goal. I still think I can fix this. I, I still feel that voice in my head. That's telling me if they're not getting better, you're not supposed to be here. So people need that opportunity. So we wanted to provide that in a tangible way that, you know, doesn't really lend itself to an educational event unless the thing was days and days long, and people camped out with us, which nobody wants to do. But gives them that opportunity to come to step away, think about and come back to it at their own pace. Speaker 1 (44:07): Awesome. And just so everyone, all the listeners out there the book, the guide to delivery of home-based maintenance therapy, it's on the Kornetti and craft website, but we will have a link that takes you directly to the book and, and listeners. If you use the coupon code KK 2021, you'll save percent on your purchase. We will have all of that at the show notes at podcasts on healthy, wealthy, smart.com under this episodes, you don't have to remember it. You don't have to send everybody DMS and things like that. Just go to podcast at healthy, wealthy, smart.com click on this episode, it'll be under the resource section in the show notes. So we will make it very, very easy. That's all you got to do is one click, and it'll take you right there. So now before we wrap things up, the question I ask everyone on the podcast is knowing where you are now in your life and in your career. What advice would you give to your younger self? Speaker 2 (45:19): Come on Cindy? I would say, well, I, I would say to my younger self to be a bit more open-minded with how physical therapy really works in reality. I think career-wise would come out. I came out very, this is what I'm going to do. And, and briefly my goal is I'm going to work in a traumatic brain injury unit. I loved working with that population as a student, I'm going to be a famous therapist in a big old rehab facility. And now I'm going on nearly 30 years in home health and have never actually worked in a, in a fancy schmancy rehab clinic. I started this kind of on the side, fell in love with it and never went back. I tell, I tell students all the time, don't assume that what your path is at the moment is the path and can't vary and can't change whether you go into teaching, whether you go into other avenues there's a lot more possibilities and it took me a little while to process that piece to say there, there are many other ways you can utilize your skill to benefit those around you. Speaker 1 (46:28): Excellent. D I would say to my younger self I may not come across that way now 30 going into my 36 years a PT, but I would say don't be afraid to ask questions and don't think you have to know it. All right. So I, I think that I kind of stayed in my box a little bit more and got really, really good at what I did. Some of that time, Cindy was in a traumatic brain injury a locked unit and I got very good at what I did, but I had a lot of questions about, but what if, but why not? Right. And I think sometimes I kind of just that maybe I shouldn't ask that question. I was a little bit too con you know, self-conscious about it. And so I, I think the idea is ask those questions, be fearless. Speaker 1 (47:18): And, and instead of asking, why would I do that? You know, look around. Why not? You know, I'm a big, why not, if you've got a great idea, you have something that is like a passion, and you've got that intersection of your passion and your skillset go for it. Right. A good friend of Cindy and mine Dr. Tanya Miller started event camp for kids. Like when she was like a new grad PT. It's like in it's what, 27th year. And she's written grants for it. And, you know, they take these kids on ventilators out in kayak. I mean, you can do it, you can do it. So be fearless and don't be afraid to ask questions. Don't don't, don't think, oh, well, I don't know as much as Karen Litzy or I don't know as much as Cindy craft, you know, start to explore that the possibilities are endless. That's what I would have told myself when I was younger, fabulous advice from both of you. And I couldn't agree more. Thank you so much for coming on for sharing all of this great information and your book, and it's just sounds great. So thank you so much, Dee, and thank you so much, Cindy, for coming in. Thanks for having us, Karen. It's always nice talking to you. Pleasure. We had a great time. Excellent. All right. And everyone who's listening. Have a great couple of days and stay healthy, wealthy and smart.  

The Great Trials Podcast
Eric Rosen | Vivian Turner, as Personal Representative of the Estate of Vivian Wilkinson v. R.J. Reynolds Tobacco Company | $13 million verdict

The Great Trials Podcast

Play Episode Listen Later Jun 29, 2021 83:25


This week, your hosts Steve Lowry and Yvonne Godfrey interview Eric Rosen of Rosen Injury Law (https://roseninjurylawyers.com/).    Remember to rate and review GTP in iTunes: Click Here To Rate and Review   Episode Details: Rosen Injury Law founder Eric Rosen explains how he secured justice for the family of Vivian Wilkinson, a lifelong smoker who died from Chronic Obstructive Pulmonary Disease (COPD) caused by her addiction to R.J. Reynolds Tobacco Company's cigarettes. Building upon the success of the 1994 Engle class action lawsuit comprised of Florida smokers, trial lawyer Eric Rosen successfully took Broward County, Florida jury members on a journey back in time to when smoking was deeply ingrained in American society, helping them see how that environment influenced Vivian's decisions as well as the actions of R.J. Reynolds Tobacco Company. Despite the defense's attempts to convince the jury that the timing of Vivian's initial COPD symptoms failed to meet the statute of limitations, the jury found in favor of Vivian's estate, awarding $3 million in compensatory damages to her children, Vivian and Eugene, and $10 million in punitive damages against R.J. Reynolds Tobacco Company for knowingly concealing information that ultimately contributed to Vivian's death. Click Here to Read/Download the Complete Trial Documents     Guest Bio: Eric Rosen Eric Rosen is a Fort Lauderdale injury lawyer and founder of Rosen Injury Law, P.A. Mr. Rosen is Board Certified by the Florida Bar as a civil trial specialist, a certification held by less than 2% of all attorneys licensed to practice law in Florida. Eric devotes his practice to representing plaintiffs who have suffered injury or death as a result of another person's or corporation's negligence. As lead trial attorney, Eric has obtained over $100 million in jury verdicts for his clients in catastrophic injury and wrongful death cases. Eric has also co-chaired and served on trial teams obtaining combined jury verdicts in excess of $300 million. His verdicts have been featured extensively in the Daily Business Review, Courtroom View Network and other media outlets. Eric began his legal career as a prosecutor at the Office of the State Attorney in Broward County, Florida, where he tried dozens of jury trials and countless bench trials to verdict. Mr. Rosen left public service to pursue his passion for helping people who have suffered due to someone else's misconduct. Mr. Rosen then rose through the ranks to become a partner at a prominent South Florida personal injury and wrongful death firm. For over a decade, Eric dedicated his practice to catastrophic injury and wrongful death cases. After unparalleled success, Mr. Rosen pursued his dream of opening his own law firm and established Rosen Injury Law, P.A. As a Fort Lauderdale accident lawyer, he expanded his practice to not only include catastrophic injury and wrongful death cases, but to also help those who have suffered a range of injuries that may not be life threatening, but still result in serious pain, inconvenience and loss of enjoyment of life. In addition to his law school education and his career in both public and private practice, Eric is also a graduate of the renowned Trial Lawyers College established by Gerry Spence; one of the country's premiere trial schools. This is an intensive three-and-a-half-week trial skills program held in Dubois, Wyoming, by top litigators and trial instructors from around the country. While there, Eric immersed himself in new trial techniques for jury selection, opening statement, direct and cross examination, and closing arguments. He incorporates those skills to this day. As a Fort Lauderdale injury lawyer, Eric has served on the faculty for the National Institute of Trial Advocacy where he has taught trial skills to lawyers from around the country. He also spends time teaching law students and high school students about personal injury practice, product liability, and trial practice. Read Full Bio   Show Sponsors: Legal Technology Services -LegalTechService.com Digital Law Marketing - DigitalLawMarketing.com Harris, Lowry, and Manton - hlmlawfirm.com   Free Resources: Stages Of A Jury Trial - Part 1 Stages Of A Jury Trial - Part 2

AMDA ON-THE-GO
CMDA | Aducanumab

AMDA ON-THE-GO

Play Episode Listen Later Jun 23, 2021 26:24


Dr. Lea Watson covers two drugs, Nuplazid and the new one  approved by the FDA, Aducanumab. Followed by Dr. Sing Palat, CMD and new President of CMDA who discusses the use of oxygen with nocturnal hypoxemia in COPD. Recording Date: 5/6/2021 Available Credit 0.25 CMD-Clinical

The Gary Null Show
The Gary Null Show - 06.22.21

The Gary Null Show

Play Episode Listen Later Jun 22, 2021 54:16


Clinical Significance of Micronutrient Supplementation in Critically Ill COVID-19 Patients with Severe ARDS  University Hospital Wuerzburg (Germany), June 12, 2021 Abstract The interplay between inflammation and oxidative stress is a vicious circle, potentially resulting in organ damage. Essential micronutrients such as selenium (Se) and zinc (Zn) support anti-oxidative defense systems and are commonly depleted in severe disease. This single-center retrospective study investigated micronutrient levels under Se and Zn supplementation in critically ill patients with COVID-19 induced acute respiratory distress syndrome (ARDS) and explored potential relationships with immunological and clinical parameters. According to intensive care unit (ICU) standard operating procedures, patients received 1.0 mg of intravenous Se daily on top of artificial nutrition, which contained various amounts of Se and Zn. Micronutrients, inflammatory cytokines, lymphocyte subsets and clinical data were extracted from the patient data management system on admission and after 10 to 14 days of treatment. Forty-six patients were screened for eligibility and 22 patients were included in the study. Twenty-one patients (95%) suffered from severe ARDS and 14 patients (64%) survived to ICU discharge. On admission, the majority of patients had low Se status biomarkers and Zn levels, along with elevated inflammatory parameters. Se supplementation significantly elevated Se (p = 0.027) and selenoprotein P levels (SELENOP; p = 0.016) to normal range. Accordingly, glutathione peroxidase 3 (GPx3) activity increased over time (p = 0.021). Se biomarkers, most notably SELENOP, were inversely correlated with CRP (rs = −0.495), PCT (rs = −0.413), IL-6 (rs = −0.429), IL-1β (rs = −0.440) and IL-10 (rs = −0.461). Positive associations were found for CD8+ T cells (rs = 0.636), NK cells (rs = 0.772), total IgG (rs = 0.493) and PaO2/FiO2ratios (rs = 0.504). In addition, survivors tended to have higher Se levels after 10 to 14 days compared to non-survivors (p = 0.075). Sufficient Se and Zn levels may potentially be of clinical significance for an adequate immune response in critically ill patients with severe COVID-19 ARDS.       Pilot Study of the Tart Cherry Juice for the Treatment of Insomnia and Investigation of Mechanisms Louisiana State University, June 20, 2021 Insomnia is common in the elderly and is associated with chronic disease, but use of hypnotics increases the incidence of falls. Montmorency tart cherry juice has improved insomnia by self-report questionnaire. Study Question:  Is insomnia confirmed by polysomnography and is tryptophan availability a potential mechanism for treating insomnia? Study Design:  A placebo-controlled balanced crossover study with subjects older than 50 years and insomnia were randomized to placebo (2 weeks) or cherry juice (2 weeks) (240 mL 2 times/d) separated by a 2-week washout. Measures and Outcomes:  Sleep was evaluated by polysomnography and 5 validated questionnaires. Serum indoleamine 2,3-dioxygenase (IDO), the kynurenine-to-tryptophan ratio, and prostaglandin E2 were measured. In vitro, Caco-2 cells were stimulated with interferon-gamma, and the ability of cherry juice procyanidin to inhibit IDO which degrades tryptophan and stimulates inflammation was measured. The content of procyanidin B-2 and other major anthocyanins in cherry juice were determined. Results:  Eleven subjects were randomized; 3 with sleep apnea were excluded and referred. The 8 completers with insomnia increased sleep time by 84 minutes on polysomnography (P = 0.0182) and sleep efficiency increased on the Pittsburgh Sleep Quality Index (P = 0.03). Other questionnaires showed no significant differences. The serum kynurenine-to-tryptophan ratio decreased, as did the level of prostaglandin E2 (both P < 0.05). In vitro, cherry juice procyanidin B-2 dose-dependently inhibited IDO. Conclusions:  Cherry juice increased sleep time and sleep efficiency. Cherry juice procyanidin B-2 inhibited IDO, increased tryptophan availability, reduced inflammation, and may be partially responsible for improvement in insomnia.         Many with migraines have vitamin deficiencies, says study   Cincinnati Children's Hospital, June 10, 2021    A high percentage of children, teens and young adults with migraines appear to have mild deficiencies in vitamin D, riboflavin and coenzyme Q10—a vitamin-like substance found in every cell of the body that is used to produce energy for cell growth and maintenance.   These deficiencies may be involved in patients who experience migraines, but that is unclear based on existing studies.   "Further studies are needed to elucidate whether vitamin supplementation is effective in migraine patients in general, and whether patients with mild deficiency are more likely to benefit from supplementation," says Suzanne Hagler, MD, a Headache Medicine fellow in the division of Neurology at Cincinnati Children's Hospital Medical Center and lead author of the study.   Dr. Hagler and colleagues at Cincinnati Children's conducted the study among patients at the Cincinnati Children's Headache Center. She will present her findings at 9:55 am Pacific time Friday, June 10, 2016 at the 58th Annual Scientific Meeting of the American Headache Society in San Diego.   Dr. Hagler's study drew from a database that included patients with migraines who, according to Headache Center practice, had baseline blood levels checked for vitamin D, riboflavin, coenzyme Q10 and folate, all of which were implicated in migraines, to some degree, by previous and sometimes conflicting studies. Many were put on preventive migraine medications and received vitamin supplementation, if levels were low. Because few received vitamins alone, the researchers were unable to determine vitamin effectiveness in preventing migraines.   She found that girls and young woman were more likely than boys and young men to have coenzyme Q10 deficiencies at baseline. Boys and young men were more likely to have vitamin D deficiency. It was unclear whether there were folate deficiencies. Patients with chronic migraines were more likely to have coenzyme Q10 and riboflavin deficiencies than those with episodic migraines.   Previous studies have indicated that certain vitamins and vitamin deficiencies may be important in the migraine process. Studies using vitamins to prevent migraines, however, have had conflicting success.     Research suggests mask-wearing can increase struggles with social anxiety University of Waterloo (Canada), June 21, 2021 People who struggle with social anxiety might experience increased distress related to mask-wearing during and even after the COVID-19 pandemic. A paper authored by researchers from the University of Waterloo's Department of Psychology and Centre for Mental Health Research and Treatment also has implications for those who haven't necessarily suffered from social anxiety in the past. "The adverse effects of the COVID-19 pandemic on mental health outcomes, including anxiety and depression, have been well-documented," said David Moscovitch, professor of clinical psychology and co-author of the paper. "However, little is known about effects of increased mask-wearing on social interactions, social anxiety, or overall mental health. "It is also possible that many people who didn't struggle with social anxiety before the pandemic may find themselves feeling more anxious than usual as we emerge out of the pandemic and into a more uncertain future -- especially within social situations where our social skills are rusty and the new rules for social engagement are yet to be written." Social anxiety is characterized by negative self-perception and fear that one's appearance or behaviour will fail to conform with social expectations and norms. Social anxiety disorder is an extreme manifestation that affects up to 13 per cent of the population.  The researchers reviewed existing literature addressing three factors that they hypothesized might contribute to social anxiety associated with mask-wearing: hypersensitivity to social norms, bias in the detection of social and emotional facial cues, and propensity for self-concealment as a form of safety behaviour. "We found that mask-wearing by people with social anxiety is likely to be influenced by their perception of social norms and expectations, which may or may not be consistent with public-health guidelines and can vary widely by region and context," said Sidney Saint, an undergraduate psychology student at Waterloo and lead author of the paper. The paper also highlights that people with social anxiety have difficulty detecting ambiguous social cues and are likely to interpret them negatively. These individuals also tend to worry about sounding incomprehensible or awkward. "We believe that both issues are likely to be magnified during interactions with masks," Saint said. Another highlighted impact is that masks can function as a type of self-concealment strategy that enables people with social anxiety to hide their self-perceived flaws. Therefore, the desire for self-concealment may motivate their use of masks over and above their desire to protect themselves from contagion. "Due to their self-concealing function, masks may be difficult for some people to discard even when mask-wearing is no longer required by public health mandates," Saint said.  In addition to contributing insights to guide clinicians toward effective assessment and treatment, the paper shows that people with social anxiety may be particularly vulnerable to periods of norm transitions where expectations for mask-wearing are in flux or become a matter of personal choice.       Going with your gut can result in better decision-making than using detailed data methods, study shows City University London, June 21, 2021 Managers who use their gut instinct together with simple decision-making strategies may make equally good, but faster, decisions as those who use data to reach an outcome, a new study has found. The report, co-authored by academics at the Business School (formerly Cass), King's Business School, and the University of Malta, finds that the reliance on data analysis in decision-making might be counterproductive as this reduces decision-making speed without ensuring more accuracy. The research, based on information from 122 advertising, digital, publishing, and software companies, finds that using data to inform decision making under high uncertainty is often not optimal. This may explain why 12 different publishers initially rejected the opportunity to publish "Harry Potter and the Philosopher's Stone' – because it had no data to inform its potential. A recent survey revealed that 92 percent of Fortune 1000 companies were reporting increased investment in data initiatives, although it appears this may not always be necessary. The authors asked managers how they made decisions on their most recent innovation project, including the extent to which they used data, instinct, and other simple heuristics (mental strategies). The findings outlined that among those decision-making methods were: Majority—choosing what the most people wanted Tallying—picking the choice with the greatest quantity of positive points Experience—selecting the option that the most experienced individual on the team wanted. Managers were asked whether they think they made the right decision and how fast they were in reaching that decision. Results showed that managers relied on their own instinct as much as data, using 'tallying' more than any other metric. Dr. Oguz A. Acar, Reader in Marketing at the Business School and co-author of the report, said: "This research shows that data-driven decision-making is not the panacea in all situations and may not result in increased accuracy when facing uncertainty. "Under extreme uncertainty, managers, particularly those with more experience, should trust the expertise and instincts that have propelled them to such a position. The nous developed over years as a leader can be a more effective than an analytical tool which, in situations of extreme uncertainty, could act as a hindrance rather than a driver of success." "Choosing among alternative new product development projects: The role of heuristics" is published in Psychology and Marketing.   Pretreatment by rosemary extract or cell transplantation improves memory deficits of Parkinson disease Damghan University (Iran) June 21 2021 According to news originating from Damghan, Iran, research stated, “The therapeutic effect of adipose tissue-derived stem cells (ADSCs) or RE on hippocampal neurogenesis and memory in Parkinsonian rats were investigated. Male rats were lesioned by bilateral intra-nigral injections of 6-OHDA and divided into six groups: 1. Lesion 2 and 3: RE and water groups were lesioned rats pretreated with RE or water, from 2weeks before neurotoxin injection and treated once a day for 8weeks post lesion. 4&5: Cell and alpha-MEM (alpha-minimal essential medium) received intravenous injection of BrdU-labeled ADSCs or medium, respectively from 10days post lesion until 8weeks later. 6: Sham was injected by saline instead of neurotoxin.” Our news journalists obtained a quote from the research from Damghan University, “Memory was assessed using Morris water Maze (MWM), one week before and at 1, 4 and 8weeks post 6-OHDA lesion. After the last probe, the animals were sacrificed and brain tissue obtained. Paraffin sections were stained using cresyl violet, anti-BrdU (Bromodeoxyuridine / 5-bromo-2'-deoxyuridine), anti-GFAP (Glial fibrillary acidic protein) and anti-TH antibodies. There was a significant difference of time spent in the target quadrant between groups during probe trial at 4 and 8 weeks' post-lesion. Cell and RE groups spent a significantly longer period in the target quadrant and had lower latency as compared with lesion. Treated groups have a significantly higher neuronal density in hippocampus compared to water, alpha-MEM and lesion groups. BrdU positive cells were presented in lesioned sites. The GFAP (Glial fibrillary acidic protein) positive cells were reduced in treated and sham groups compared to the water, alpha-MEM and lesion groups.” According to the news editors, the research concluded: “Oral administration of RE (Rosemary extract) or ADSCs injection could improve memory deficit in the Parkinsonian rat by neuroprotection.”     Inadequate vitamin D levels associated with interstitial lung disease Johns Hopkins University, June 20 2021.    An article appearing in the Journal of Nutrition documents a link between decreased vitamin D levels and a greater risk of early signs of interstitial lung disease (ILD), a group of disorders characterized by inflammation and scarring that can lead to lung damage. Although ILD can be caused by environmental and other factors, some cases have unknown causes. The investigation included 6,302 participants in the Multi-Ethnic Study of Atherosclerosis who had information available concerning their initial serum 25-hydroxyvitamin D concentrations and computed tomography (CT) imaging that included partial views of the lungs. Ten years after enrollment, 2,668 participants had full lung CT scans that were evaluated for presence of scar tissue and other abnormalities. Subjects who had deficient vitamin D levels of less than 20 ng/mL had more spots on their lungs that were suggestive of damage in comparison with subjects whose vitamin D was adequate. Among those who had full lung CT scans, deficient or intermediate (between 20-30 ng/mL) vitamin D levels were associated with a 50-60% greater risk of abnormalities suggestive of ILD. "We knew that the activated vitamin D hormone has anti-inflammatory properties and helps regulate the immune system, which goes awry in ILD," commented senior author Erin Michos, MD, MHS. “There was also evidence in the literature that vitamin D plays a role in obstructive lung diseases such as asthma and COPD, and we now found that the association exists with this scarring form of lung disease too." "Our study suggests that adequate levels of vitamin D may be important for lung health,” she concluded. “We might now consider adding vitamin D deficiency to the list of factors involved in disease processes, along with the known ILD risk factors such as environmental toxins and smoking.”

Relentless Health Value
EP326: The Unfortunate News About HRRP, With Insights on How to Fix It, With Rishi Wadhera, MD, MPP

Relentless Health Value

Play Episode Listen Later Jun 17, 2021 37:10


Here's the context, friends: As you may have noticed over the past few episodes, we have been digging into value-based care here at Relentless Health Value corporate work-from-home headquarters. Many lessons have been learned, and it's important that we sit back and think hard every now and then about how we are going to use these learnings to improve. While this show tackles the Hospital Readmissions Reduction Program (HRRP)—and wow, I was glued to my seat during this interview—the show is really about more than that, which I'll get into in 30 seconds. But let's start here: HRRP was originally part of the Affordable Care Act in 2010. In 2012, HRRP began imposing penalties on hospitals with higher-than-expected 30-day readmission rates for three conditions: heart failure, myocardial infarction, and pneumonia. Spoiler alert: More recently, CABG, THA/TKA, and COPD were added to the list. So basically, if a patient is in the hospital for any of these six things and then is readmitted to the hospital for any reason within 30 days, penalties can happen. Today's guest is Rishi Wadhera, MD, MPP. Dr. Wadhera authored a retrospective analysis in the BMJ about the HRRP, which we will talk about in this health care podcast. His findings are fascinating and relevant on a number of levels.  Dr. Wadhera is a cardiologist at Beth Israel Deaconess Medical Center. He also has a master's in public policy at the Harvard Kennedy School of Government and also a master's in public health from the University of Cambridge. Dr. Wadhera works on policy at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.  But here's the larger epiphany that pertains to all value-based care and all quality metrics which Dr. Wadhera brings up in this health care podcast and which my nerd heart could not love more: Goodhart's Law. This law is the root of so very many problems. Goodhart's Law is this (which I learned from Dr. Wadhera): “When a measure becomes a target, it ceases to be a good measure.” In other words, when we set a goal, people will try to take a shortcut to the goal, regardless of the consequences. And sometimes the consequences, paradoxically, are to do worse at the goal. For example, teaching to the test may not actually lead to students who deeply understand a subject. Here's another example, and Rebecca Etz, PhD, talks about this in EP295: If you want PCPs to do an amazing job managing diabetes, for example, the best measures are ones that quantify the doctor's relationship with the patient and the amount of trust between them. The second you start using their panel's average A1C as the performance metric, A1Cs at best don't improve. Why? Bean counters and admins and maybe even goal-oriented clinicians themselves will go right to the end goal, inadvertently skipping a whole bunch of (it turns out) rate-critical steps. It doesn't go well. It's like salespeople who try to close before they build a relationship. Time to goal counterintuitively is slower, and performance is poorer. Anyone building value-based care or quality programs might really want to include Goodhart's Law in their thinking. And anyone trying to achieve value-based care success, improve quality, form collaborations, or make sales might want to remember that old proverb, “Sometimes the shortest way home is the long way around.” You can learn more at Dr. Rishi's Harvard Catalyst profile and the Beth Israel Deaconess Medical Center Web site. Rishi K. Wadhera, MD, MPP, MPhil, is an assistant professor of medicine at Harvard Medical School, a cardiologist at Beth Israel Deaconess Medical Center (BIDMC), and the associate program director of the cardiovascular medicine fellowship at BIDMC. He is also health policy and equity researcher at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology. Dr. Wadhera received his MD from the Mayo Clinic School of Medicine as well as an MPhil in public health as a Gates Cambridge Scholar from the University of Cambridge. He completed his internal medicine residency and cardiovascular medicine fellowship at Brigham and Women's Hospital in Boston. During this time, he also received a master's in public policy (MPP) at the Harvard Kennedy School of Government, with a focus on health policy. Dr. Wadhera's research spans questions related to health care access, quality, and disparities, as well as understanding how local, state, and national policy initiatives impact care delivery, health equity, and outcomes. Dr. Wadhera has published more than 80 articles to date, and he receives research support from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institutes of Health (NIH). 03:10 What was the Hospital Readmissions Reduction Program intended to do? 05:05 Why did the Centers for Medicare & Medicaid (CMS) think some readmissions were preventable? 05:46 “The spirit of the Hospital Readmissions Reduction Program was to incentivize hospitals to improve … discharge planning, transitions of care, and post-discharge follow-up and care.” 06:54 How has research in the last few years changed the thoughts on the effectiveness of the Hospital Readmissions Reduction Program? 08:14 “The 30-day readmission measure—it's an incomplete measure.” 12:12 “I think patients … are smart, and they know what's going on.” 14:01 “What's happening is, we're just increasing the number of times they need to come back to the ER within that 30-day period.” 14:22 “The weird thing about the HRRP is that when it evaluates hospitals' 30-day readmission rates, it's a yes-no phenomenon.” 15:30 “What CMS does is, it risk adjusts … and that is what we should be doing.” 19:16 “This program has been incredibly regressive.” 19:51 “Poverty, neighborhood disadvantage, housing instability—these factors are out of hospitals' control.” 22:56 “Blunt policies like this that are rolled out nationally probably elicit mixed behavioral responses.” 23:12 “It just makes no sense to take resources away from hospitals.” 25:22 What's the way to improve quality of care globally? 27:19 “CMS's approach to improving quality of care has really anchored … [that] to payment.” 27:49 “It's time for us to rethink what our approach to quality improvement should be.” 31:28 “Policy makers have an obligation to rigorously test the impact of these types of policies before they roll them out nationally.” 34:05 Can you scale health care nationally? You can learn more at Dr. Rishi's Harvard Catalyst profile and the Beth Israel Deaconess Medical Center Web site. @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission What was the Hospital Readmissions Reduction Program intended to do? @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission Why did CMS think some readmissions were preventable? @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission “The spirit of the Hospital Readmissions Reduction Program was to incentivize hospitals to improve … discharge planning, transitions of care, and post-discharge follow-up and care.” @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission How has research in the last few years changed the thoughts on the effectiveness of the Hospital Readmissions Reduction Program? @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission “The 30-day readmission measure—it's an incomplete measure.” @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission “What CMS does is, it risk adjusts … and that is what we should be doing.” @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission “Blunt policies like this that are rolled out nationally probably elicit mixed behavioral responses.” @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission “It just makes no sense to take resources away from hospitals.” @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission What's the way to improve quality of care globally? @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission “It's time for us to rethink what our approach to quality improvement should be.” @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission Can you scale health care nationally? @rkwadhera of @BIDMChealth discusses #HRRP on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #hospitalreadmission

MelissaBPhD's podcast
EP64: What are the Stages of Alzheimer's Disease? Symptoms of Late- and End-Stage Alzheimer's Disease

MelissaBPhD's podcast

Play Episode Listen Later Jun 15, 2021 8:36


I've taken care of thousands of older adults living with Alzheimer's disease and ultimately dying either with or from this devastating disease. I hope the information in this podcast will help you to be prepared as your loved one moves through each stage of the disease. There is some variation in what different people think are the Stages of Dementia. I am of the mindset (pun totally intended) to keep things simple – so I think of this disease in 4 stages: Early-, Middle-, Late- and End-Stage; or Mild, Moderate, Severe and ultimately the dying process. Late-stage Alzheimer's – or Severe At this stage, the person is going to have severe symptoms and rely on others for all care. They lose the ability to carry on a conversation, respond to their environment, and eventually lose the ability to control movement. Common symptoms or difficulties in this stage include: ✔️ Difficulty communicating with words; which leaves their behavior to tell us what they might need. ✔️ Requiring around-the-clock assistance ✔️ Lose the ability to walk, sit and eventually they will have a hard time swallowing. In fact, nearly 80% of people in late-stage dementia will develop some form of an eating problem. ✔️ And because of the swallowing problems, they are at a higher risk for aspiration or bladder infections In the late-stage of this disease, the person will likely have trouble initiating engagement with you or their loved ones, but they still benefit from interacting in ways like listening to music together, singing, or receiving assurance through gentle touch. This is the time for caregivers to explore community services and supports like palliative and/or hospice care. If/when the time comes and your loved one is having trouble swallowing, I recommend working with a Speech Therapist to determine the best type of diet. This may range from mechanical soft foods to pureed and some level of thickened liquids to minimize the risk of aspiration. You should also seek the support of a local palliative care provider to help guide you through the end-of-life that is inevitable with this disease. No one has ever survived Alzheimer's disease. That means it is terminal illness – and you will either die with Alzheimer's disease - or from it. It is a highly emotional time for loved ones, but when you die from Alzheimer's disease, your loved one will not starve to death – they will die from Alzheimer's disease. Think about how nature handles death. Many forms of life stop eating and drinking when death is near, and this is not a painful process. Feeding tubes are not recommended in Alzheimer's disease because it is a terminal disease. Evidence has shown that feeding tubes don't do the things that most families wish they would: They do not decrease a person's risk for aspiration or infection; they don't improve quality of life, in fact, they are often pulled out which results in a trip to the emergency room or being hospitalized. It's not natural to have a tube hanging out of your body and when your brain has failed, you don't understand what it's doing there and it's natural to try to pull it out. If you find yourself in the situation of having to make a decision about a feeding tube, I'd like for you to learn more about handfeeding. Handfeeding is recommended over tube feeding until death. Offering supportive handfeeding using three different handfeeding techniques allows you to connect with your loved one - and offer food and fluids in the safest way. You can learn more about the handfeeding techniques by checking out my video titled “How to Help a Person with Dementia to Eat”. End-Stage Alzheimer's Disease – The Dying Process At a certain point, your loved one will enter the dying process. In this final phase of life, you will want to have a palliative care or hospice provider guiding the care of your loved one. Here are criteria that are generally used to mark End-stage Alzheimer's disease. At this point, your providers should be asked if they would be surprised if your loved one passed away in the next six months. A life expectancy of six months or less, along with these other key symptoms typically mean the person has transitioned to dying. ✔️ They are bedridden, meaning they are no longer able to walk or sit upright ✔️ Total loss of control of both their bowels and bladder ✔️ Difficulty swallowing or choking on food or fluid ✔️ Weight loss or dehydration due to the challenges of swallowing when eating/ drinking ✔️ Not able to speak more than six words per day ✔️ Another chronic condition such as congestive heart failure, cancer or COPD. ✔️ An increase in trips to the emergency room or hospitalizations ✔️ A diagnosis of pneumonia or sepsis Alzheimer's disease is one that makes us all take one day at the time and live in the present. It can be a very long process, so I hope this information and recommendations for finding support have been helpful.

Congressional Dish
CD233: Long COVID

Congressional Dish

Play Episode Listen Later Jun 14, 2021 63:45


"Long COVID" is the name for the phenomenon experienced by people who have "recovered" from COVID-19 but are still suffering from symptoms months after the virus invaded their bodies. In this episode, listen to highlights from a 7 hour hearing in Congress about Long COVID so that you can recognize the disease and know where to turn for treatment. Even if you didn't catch the rona yourself, Long COVID is far more common that you probably think and is almost certainly going to affect someone you know. Executive Producer: Michael Constantino Please Support Congressional Dish – Quick Links Click here to contribute monthly or a lump sum via PayPal Click here to support Congressional Dish via Patreon (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank's online bill pay function to mail contributions to: 5753 Hwy 85 North, Number 4576, Crestview, FL 32536 Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Recommended Episodes CD145: The Price of Health Care Articles/Documents Article: Why Impact of ‘Long Covid' Could Outlast the Pandemic, By Jason Gale, Bloomberg, The Washington Post, June 8, 2021 Article: Long covid has lasted over a year for 376,000 people in the UK, By NewScientist, June 4, 2021 Article: Long-COVID-19 Patients Are Getting Diagnosed With Rare Illnesses Like POTS, By Cindy Loose, Kaiser Health News, TIME, May 27, 2021 Article: Long Covid symptoms ease after vaccination, survey finds, By Natalie Grover, The Guardian, May 18, 2021 Article: A pandemic that endures for COVID long-haulers, By Alvin Powell, The Harvard Gazette, April 13, 2021 Article: Atlantic Council urges Biden to enforce regime change in Belarus, By Centers for Medicare & Medicaid Service News Release: Secretary Sebelius Announces Senate Confirmation of Dr. Francis Collins as Director of the National Institutes of Health, National Institutes of Health, August 7, 2009 Sound Clip Sources Hearing: THE LONG HAUL: FORGING A PATH THROUGH THE LINGERING EFFECTS OF COVID–19, House Committee on Energy and Commerce, April 28, 2021 Watch on Youtube Witnesses: Francis Collins, M.D., Ph. D. Director of the National Institutes of Health John T. Brooks, M.D. Chief Medical Officer for COVID-19 Response at the Centers for Disease Control and Prevention Steven Deeks, M.D. Professor of Medicine at the University of California, San Francisco Jennifer Possick, M.D. Associate Professor at Yale School of Medicine Director of Post-COVID Recovery Program at the Winchester Center for Lung Disease at Yale-New Haven Hospital Natalie Hakala COVID patient Lisa McCorkell COVID patient Chimere Smith COVID patient Transcript: 1:01:34 Francis Collins: We've heard troubling stories all of us have people who are still suffering months after they first came down with COVID-19, some of whom initially had very few symptoms or even none at all. And yet today these folks are coping with a long list of persistent problems affecting many different parts of the body, fatigue, brain fog, disturbed sleep, shortness of breath, palpitations, persistent loss of taste and smell, muscle and joint pain, depression and many more 1:02:35 Francis Collins: I would like to speak directly to the patient community. Some of you have been suffering for more than a year with no answers, no treatment options, not even a forecast of what your future may hold. Some of you have even faced skepticism about whether your symptoms are real. I want to assure you that we at NIH hear you and believe you. If you hear nothing else today here that we are working to get answers that will lead to ways to relieve your suffering. 1:03:13 Francis Collins: New data arrived every day. But preliminary reports suggested somewhere between 10 to 30% of people infected with SARS COVID2 to may develop longer term health issues. To get a solid measure of the prevalence, severity and persistence of Long COVID we really need to study 10s of 1000s of patients. These folks should be diverse, not just in terms of the severity of their symptoms and type of treatment received, but in age, sex, race and ethnicity. To do this rapidly, we are launching an unprecedented metacohort. What is that? Well, an important part of this can be built on existing longitudinal community based cohorts are also the electronic health records of large healthcare systems. These resources already include 10s of 1000s of participants who've already contributed years worth of medical data, many of them will by now suffer from long COVID. This approach will enable us to hit the ground running, giving researchers access to existing data that can quickly provide valuable insights on who might be most at risk, how frequently individual symptoms occur, and how long they last. 1:04:24 Francis Collins: Individuals suffering with long COVID including those from patient led collaborative groups will be invited to take part in intensive investigation of different organ systems to understand the biology of those symptoms. Our goal is to identify promising therapies and then test them in these volunteers. 1:05:07 Francis Collins: Finally we need a cohort for children in adolescence. That's because kids can also suffer from long COVID and we need to learn more about how that affects their development. 1:05:35 Francis Collins: As we recruit volunteers, we will ask them to share their health information in real time with mobile health apps and wearable devices. 1:08:09 John Brooks: Although standardized case definitions are still being developed, CDC uses the umbrella term Post COVID conditions to describe health issues that persist for more than four weeks after a person is first infected with SARS-CoV-2 to the virus that causes COVID-19. Based on our studies to date, CDC has distinguished three general types or categories of post COVID conditions, although I want to caution that the names and classifications may change as we learn more. The first called Long COVID involves a range of symptoms that can last for months. The second comprises long term damage to one or more body systems or an organ and the third consists of complications from prolonged treatment or hospitalization. 1:09:45 John Brooks: Among these efforts are prospective studies that will follow cohorts of patients for up to two years to provide information on the proportion of people who develop post COVID conditions and assess risk factors for their development. 1:10:00 John Brooks: CDC is also working with multiple partners to conduct online surveys about long term symptoms and using multiple de-identified electronic health record databases to examine healthcare utilization of patient populations after initial infection. 1:20:21 John Brooks: Not only are there persons who develop post COVID symptoms, who we later through serology or testing recognizes having had COVID. But there's also there also were people who develop these post COVID conditions who have no record of testing, and we can't determine that they had COVID. So we've got to think carefully about what that how to manage that when we're coming up with a definition for what a post COVID condition is. 1:20:55 John Brooks: One of the most important things is to make sure that this condition is recognized. We need to make sure that folks know what they're looking at, as you've heard it's sort of protean. There are all sorts of different ways. Maybe we'll talk about this later. But the symptoms and ways that people present are very varied. And people need to be thinking, could this be post COVID and also taking patients at their word. You know, we've heard many times of patients have been ignored or their symptoms minimized, possibly because they didn't recognize that and COVID previously. 1:24:33 John Brooks: It's common, it could be as common as two out of every three patients. Study we recently published in our flagship journal, the Morbidity and Mortality weekly report suggested two out of three patients made a clinical visit within one to six months after their COVID diagnosis. So that is unprecedented, but people who've recovered from the flu or a cold don't typically make a scheduled visit a month later. It does seem that for some people, that condition gets better but there are definitely a substantial fraction of persons in whom this is going on for months. 1:25:37 Francis Collins: Basically what we did was to think of all of the ways in which we could try to get answers to this condition by studying people, both those who already have self identified as having long COVID, as well as people who just went through the experience of having the acute illness to see what's the frequency with which they ended up with these persistent symptoms. And if you look around sort of what would be the places where you'd find such large scale studies, one would be like we were just talking about a minute ago, with Mr. Guthrie, the idea of these long standing cohort studies, Framingham being another one where you have lots of people who have been followed for a long time, see if you can learn from them who got long COVID. And what might have been a predisposing factor that's part of the medical work. You could also look at people who have been in our treatment trials, because there are 1000s of them that have enrolled in these clinical trials. And they've got a particular treatment applied like a monoclonal antibody, for instance, it would be really interesting to see if that had an effect on how many people ended up with long COVID did you prevent it, if you treated somebody acutely with a monoclonal antibody, and then there are all these patient support groups, and you'll be hearing more for them in the second panel, were highly motivated, already have collected a lot of data themselves as citizen scientists, we want to tap into that experience and that wise advice about how to design and go through the appropriate testing of all this. So you put those all together, and that's a metacohort, where you have different kinds of populations that are all put together in a highly organized way with a shared database and a shared set of common data elements so we can learn as quickly as possible. 1:32:59 John Brooks: Extreme fatigue. I mean fatigue, as you probably heard, so bad, you can't get out of bed, it makes it impossible for you to work and limits your social life, anxiety and depression, lingering, chronic difficulty breathing with either cough or shortness of breath. That loss of smell persists for a very long time, which incidentally is particularly unique to this infection to the best I know. 1:37:10 Francis Collins: So the idea of trying to assemble such a large scale effort from multiple different kinds of populations of patients, is our idea about how to do this quickly and as vigorously and accurately as possible. But it won't work if we can't actually compare across studies and figure out what we're looking at. So part of this is the ability to define what we call common data elements, where the individuals who are going to be enrolled in these trials from various sources have the same data collected using the same formats so that you can actually say, if somebody had shortness of breath, how did you define that? If somebody had some abnormality in a lab test, what were the units of the lab test that everybody will agree so you can do apples to apples comparisons? That's already underway, a part of this metacohort is also to have three core facilities. One of those is a clinical sciences core, which will basically come up with what are the clinical measures that we want to be sure we do accurately on everybody who's available for those to be done. Another is the data sciences core, which will work intensively on these common data elements and how to build a data set that is both preserving the privacy and confidentiality of the participants, because these are people who are human subject participants in a trial, and also making sure that researchers have access to information that they can quickly learn from. And then there's a third core, which is a bio repository where we are going to be obtaining blood samples and other kinds of samples. And we want to be sure those are accurately and safely stored. So they can be utilized for follow up research. All of that has to fold into this. And so I'm glad you asked that question. That is the mechanism by which we aim to make the whole greater than the sum of the parts here even though the parts are pretty impressive. The whole is going to be pretty amazing. 1:41:03 Francis Collins: Tomorrow is the one year anniversary of the launch of RADX, Rapid Acceleration and Diagnostics. Another program made possible by the Congress by providing us with some additional funds to be able to build new platforms for technology to detect the presence of that SARS COVID-2 virus, increasingly being able to do those now as point of care instead of having to send your sample off to a central laboratory. And even now doing home testing, which is now just in the last month or so become a reality and that's RADX that developed those platforms. 1:41:30 Francis Collins: It was a pretty amazing experience actually. 1:41:40 Francis Collins: We basically built what we call the shark tank. And we became venture capitalists. And we invited all of those people who had really interesting technology ideas to bring them forward. And the ones that looked most promising, got into the shark tank and got checked out by business people, engineers, various other kinds of technology experts, people who knew about supply chains and manufacturing and all of that to make sure that we put the funds into the ones that were most promising. And right now, today, Congressman, there's about 2 million tests being done today, as a result of RADX that otherwise would not have been. 2 million a day, or 34 different technologies that we put through this innovation funnel. And that has opened up a lot of possibilities for things like getting people back to school where you have testing capacity that we didn't have before. 1:42:32 Francis Collins: What did we learn about that that applies to long COVID? Well, one thing I learned was we can do things at NIH in really novel ways that move very quickly when we're faced with a crisis like COVID-19 pandemic, we're applying that same mentality to this effort on long COVID normally would have taken us more than a year to set up this kind of metacohort. We're doing it in a couple of months because we need to utilizing some of those same mechanisms that you gave us in the 21st Century CARES bill, which has been a critical part of our ability to move swiftly through something called Other Transactions Authority. 1:43:16 Francis Collins: You saw in the President's budget proposal for FY-22, something called ARPA H, which is basically bringing the DARPA attitude to health that also builds on these experiences and will give us, if approved by the Congress, the ability to do even more of these very rapid, very ambitious, yes, high risk, but high reward efforts as we have learned to do in the face of COVID and want to continue to do for other things like Alzheimer's disease, or cancer or diabetes, because there's lots of opportunities there, too. 2:02:53 John Brooks: The number of people seeking care after recovering from COVID is really unprecedented. And it's not just people who had severe COVID it may include people had very mild COVID and in fact, we know there's a number of people who never had symptomatic COVID who then get these long symptoms. 2:03:09 John Brooks: Just historically, the other disease I can think of that may have a little analogy to this is polio. It was a more devastating sequentially that people lived with the rest of their lives. But it was thanks to the enrollment of some early cohorts of these patients followed over the course of their life, that when post polio syndrome later came up in the population, we had the wherewithal to begin to understand it. And it happens with been a condition in many ways, sharing some characteristics of this post COVID condition. 2:16:33 Francis Collins: The virus has been evolving. So one question is, how long will you be immune to the same virus that infected you the first time. And we think that's probably quite a few months. But then are you immune to a variant of that virus that emerges like the one called B117, which now is almost 60% of the isolates we're seeing in the United States after it ran through the UK and then came to us, that degree of immunity will be somewhat lower. The good news here, though, is that, and this may surprise people, the vaccine actually provides you with better broad immunity, then the natural infection, and you don't quite expect that to be the case. Usually, you would think natural infection is going to be the way that revs your immune system to the max and the vaccine is like the second best, it's flipped around the other way in this case, and I think that's because the vaccine really gets your immune system completely awake. Whereas the natural infection might just be in your nose or your respiratory tree and didn't get to the rest of your body. With a vaccine. We think that immunity lasts at least six months. But is it longer than that? We don't know yet because this disease hasn't been around long enough to find that out. And so far, the vaccines, the Pfizer, the Moderna, do seem to be capable of protecting against the variants that are now emerging in the US like this B117. 2:26:09 John Brooks: Anosmia are the loss of smell or change and smell is an often overlooked, but surprisingly common problem among people. This disease really seems to target that and cause it. I can say this, you know, I've been I've had a particular interest in this topic, the reading that I've been doing seems to suggest that the virus isn't necessarily targeting the olfactory nerves, the nerves that transmit smell, but more of the nerves that are sort of around in supporting those nerve cells, and it's the swelling and the inflammation around those cells that seems to be leading to some kind of neurologic injury. I will say the good news is that many people will eventually recover their sense of smell or taste, but there are others in whom this is going to be a permanent change in terms of treatment, smell training, interesting therapy, but it really works. And it's I really want to raise people's awareness around that because the earlier you can begin smell training, the better the chances that you'll recover your sense of smell. 2:43:13 John Brooks: We hold regular webinars and calls for clinicians they can call into these often are attended by 1000s of providers. We use these as an opportunity to raise awareness because I think you made a really critical point that patients feel like their doctors don't recognize their problem or they don't accept that it's possible they have this condition. We use those calls and webinars to raise awareness that this is a real entity. We also then publish papers and put out guidelines that illustrate how to diagnose and begin to pull together what we know about management. 2:52:27 Francis Collins: But it certainly does seem that the risk of developing Long COVID goes up. It's fairly clear that the initial seriousness of the initial illness is somewhat of a predictor. Certainly people are in the hospital have a higher likelihood of long COVID than people who stayed out of the hospital but people who weren't hospitalized can still get it. It's just at a somewhat lower rate. 2:53:07 Francis Collins: Risk factors. older age people higher likelihood, women have a slightly higher chance of developing long COVID than men. BMI, obesity also seems to be a risk for the likelihood of long COVID. Beyond that, we're not seeing a whole lot of things that are predictive. And there must be things we don't know about yet. That would give you a chance to understand who's most vulnerable, to not be able to just get this virus out of there and be completely better, but we don't know the answer is just yet. 3:29:30 Francis Collins: First of all, let me say anxiety and depression is a very common feature of long COVID. But there are instances of actual induction of new psychoses sees individuals who previously were normally functioning who actually fall really into a much more serious psychiatric illness. We assume there's must be some way in which this virus has interfered with the function of the brain maybe by affecting vascular systems or some other means of altering the the way in which the brain normally works. But we have so little information right now about what that actual anatomic mechanism might be. And that's something we have to study intensively. 3:33:13 Francis Collins: When you look at what is the likelihood that somebody who is just diagnosed with COVID-19 is going to go on too long COVID It looks as if it's a bit higher for older people, but on the other hand, they're more young people getting infected. So if you go through the mathematics, you can see why it is that long. COVID seems to be particularly prominent now. And younger people who may not have been very sick at all with the acute infection, some of them had minimal symptoms at all, but now are turning up with this. 3:34:10 Francis Collins: We have 32 million people who've been diagnosed with the acute infection. SARS-COVI-2 to COVID-19. Let's say 10% is right. That means there are 3 million people going to be affected with this are already are and whose long term course is uncertain and may very well be end up being people with chronic illnesses. 3:35:07 John Brooks: It's a great opportunity to remind young people they're not immune to this right? This is really the audience you want to reach. Vaccination is something you should strongly consider. This affects people like you. 3:44:06 John Brooks: Some of the symptoms are the ones you see in adults, as you would expect, particularly pulmonary conditions, persistent shortness of breath, maybe cough, as well as persistent fatigue. There is also some evidence that he experienced what is called a brain fog, but it's probably some issue or probably neurocognitive in nature. And this is important for kids when they're growing and developing that, that we understand what's happening there because we don't want that to impair their ability to learn and grow properly. 4:35:54 Lisa McCorkell: I'm testifying today as a long COVID patient and as a member at the leadership team of the patient led research collaborative, a group of long COVID patients with backgrounds in research, policy and data analysis, who were the first to conduct research on Long COVID. My symptoms began on March 14 2020. Like many of what we call first waivers, I was not afforded a COVID test, because at the time tests were limited to hospitalized patients and those with shortness of breath, cough and fever, the last of which I didn't have. I was told that I had to isolate and within two weeks I'd be recovered. A month later, I was in worse health than in that initial stage. I couldn't walk more than 20 seconds without having trouble breathing, my heart racing and being unable to get out of bed the rest of the day. 4:37:18 Lisa McCorkell: Our ost recent survey asked about 205 symptoms over seven months and received almost 7000 responses. In our recent paper, 92% of respondents were not hospitalized, but still experienced symptoms in nine out of 10 organ systems on average. We found that patients in their seventh month of illness still experienced 14 symptoms on average. Most commonly reported were fatigue, post exertional, malaise and cognitive dysfunction. In fact, 88% experienced cognitive dysfunction and memory loss impacting their ability to work, communicate and drive. We found that this was as likely an 18 to 29 year olds as those over 60. Lesser known symptoms include tremors, reproductive changes, months long fevers and vertigo. Over two thirds require a reduced work schedule or cannot work at all due to their health condition. 86% experienced relapses were exerting themselves physically or mentally can result in a host of symptoms returning. 4:38:14 Lisa McCorkell: Long COVID is complex, debilitating and terrifying. But patients aren't just dealing with their symptoms. They're dealing with barriers to care, financial stability and recovery. Due to the lack of a positive COVID test alone, patients are being denied access to post COVID clinics, referrals to specialists, health insurance coverage, COVID related paid leave, workers comp, disability benefits, workplace accommodations and participation in research. When we know that not everyone had access to COVID testing that PCR tests have false negative rates of 20 to 40%. That antibody tests are more accurate on men and people over 40 and that multiple studies have shown that there's no difference in symptoms between those with the positive test and those without. Why are we preventing people who are dealing with real symptoms from accessing what they need to survive? 4:39:00 Lisa McCorkell: Even with a positive test patients are still being denied benefits or have to wait months until they kick in. Medical bills are piling up. People are being forced to choose between providing for themselves and their family and doing what's best for their body. 4:39:58 Lisa McCorkell: The stimulus checks that you all provided us to get through the pandemic. I do really appreciate them. But every cent of mine was spent on urgent care and doctor's visits where I was repeatedly told that mycotic cardio my inability to exercise and brain fog was caused by anxiety and there was no way that I could have had COVID since I didn't have a positive test. 4:41:37 Jennifer Possick: I hope to share my perspective as a pulmonologist caring for people with post COVID disease including Long COVID. So in Connecticut, the surge initially arrived in March of 2020. And within weeks thereafter, people were reaching out to us about patients who remained profoundly short of breath after their acute illness had passed. My colleagues and I were struck by how difficult it was to tell the difference between people recovering from mild, acute COVID and those who had required ICU level care. Both groups had the physical, cognitive and psychological fallout we would expect from a critical illness or a prolonged intubation. And in addition to being short of breath, they reported a host of other symptoms. I saw a teacher who had recurrent bouts of crushing chest pain, mimicking a heart attack, a young mother, who would have racing heartbeat and dizziness every time she played with her toddler, a local business owner who couldn't remember the names of his long term customers or balance his books, and a home health aide who didn't have the stamina or strength to assist her elderly clients. 4:42:53 Jennifer Possick: We've spent this year learning alongside our patients, about half of whom are never hospitalized. They are mostly working age, previously high functioning. Many were frontline or essential workers. Many were initially disbelieved. Their quality of life has been seriously impacted. Some can't walk to the mailbox or remember a shopping list, much less resume their everyday lives and work. 4:43:16 Jennifer Possick: They've used up their paid sick leave. They've cut back their hours they have left or lost jobs. They have difficulty accessing workman's compensation benefits and FMLA or securing workplace accommodations. Some have even cut back on food, rent or utilities to pay for mounting medical expenses. 4:44:03 Jennifer Possick: Consensus practice supports many forms of rehabilitation services but insurance approval and coverage have been beyond challenging and demand outpaces availability in any case. For patients with ongoing oxygen needs, requests for portable oxygen concentrators can be delayed or even denied complicating physical recovery and mobility. 4:44:27 Jennifer Possick: We are a well resourced program at an academic medical center. But we are swamped by the need in our community. This year, we have seen more patients with post COVID-19 conditions in our clinic alone then we have new cases of asthma and COPD combined. Looking ahead, the magnitude of the challenge is daunting. There are over 31 million survivors of acute COVID-19 in the United States, and we don't know how many people will be affected, what kind of care they will need, or how long, or what kind of care that will entail or how long they'll need it. Research will ultimately help us to understand the origin of the symptoms and to identify effective treatment, but in the meantime, their care cannot wait. 4:49:37 Steven Deeks: First, we don't have a way of measuring this, right? Everyone everyone has got a cohort or a clinic measures it differently. They report stuff differently. As a consequence, the epidemiology is a mess, right? We don't really have a good sense of what's going on we need and this has been said before, a general consensus on how to define the syndrome, how to measure it and study so that we can all basically be saying the same thing. Deeks we don't know prevanlence Deeks we don't know prevanlen... 270.5 KB 4:50:06 Steven Deeks: We don't really know the prevalence of either the minimally symptomatic stuff or the very symptomatic stuff. 4:50:27 Steven Deeks: Women in almost every cohort, women are more likely to get this than the men. And This to me is probably the strongest hint that we have in terms of the biology, because women in general are more susceptible to many autoimmune diseases and we know why. And so paying attention to that fact why it's more common in women I think is providing very important insights into the mechanism and is directing how we are going about our science to identify therapies. 4:51:09 Steven Deeks: The same time people are getting acute COVID. They're living in a society that's broken. There's lots of social isolation. There's lots of depression, there's lots of people struggling, who did not have COVID. And the way this social economic environment that we're living in, has interacted with this acute infection is likely contributing to what's happening in ways that are very important but I think ultimately going to be hard to untangle and something that has not been discussed. 6:00:36 Jennifer Possick: I don't think that we can broadly say that there is any treatment that is working for all patients. We don't have that answer yet. As Dr. Deeks had suggested, there are things we try empirically. Sometimes they work for some patients other times not, but we're not in a position yet to say that this is the regimen, this is the treatment that works. Cover Art Design by Only Child Imaginations Music Presented in This Episode Intro & Exit: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio)

Microbe Talk
Episode 121: Microbiology Today: the impact of air pollution on bacteria

Microbe Talk

Play Episode Listen Later Jun 11, 2021 14:55


In this episode of Microbe Talk, Laura speaks with Lillie Purser, PhD student at the University of Leicester. Lillie’s research explores how air pollution can affect the way bacteria behave, specifically strains of bacteria involved in the health condition chronic obstructive pulmonary disease (COPD). Find out more about Lillie and her colleagues at the University of Leicester’s research and follow her on Twitter @lilliepurser: Air pollution alters Staphylococcus aureus and Streptococcus pneumoniae biofilms, antibiotic tolerance and colonisation (doi: 10.1111/1462-2920.13686) The role of air pollution and bacteria in COPD (doi: 10.1099/acmi.ac2020.po0231) Find out more about how microbes have adapted to climate change and associated events in May’s issue of Microbiology Today Life on a Changing Planet. (https://microbiologysociety.org/publication/current-issue/life-on-a-changing-planet.html)

Cram The Pance
S1E26 Chronic Obstructive Pulmonary Disease (COPD)

Cram The Pance

Play Episode Listen Later Jun 10, 2021 37:11


Chronic Obstructive Pulmonary Disease (Emphysema, Chronic Bronchitis) review for your Pance, Panre and Eor's. ►Paypal Donation Link: https://bit.ly/3dxmTql Affiliate links to support the podcast (Thank you!): 1) Amazon Prime Student Membership- 6 month free trial https://amzn.to/3yMmH0i 2) Audible Plus- Free Trial and 2 free Audiobooks https://amzn.to/2SG3mNP 3) Pance Prep Pearls V3 https://amzn.to/3uxMUfC 4) Paramount + Sign Up https://amzn.to/2R2EaAu 5) Amazon Music 30 day free trial https://amzn.to/3uy0OhV --- Support this podcast: https://anchor.fm/scott--shapiro/support

The Holistic Herbalism Podcast
Breathing Exercises & Herbs for Breath Work

The Holistic Herbalism Podcast

Play Episode Listen Later Jun 4, 2021 62:07


“Take a breath, it’ll help!” You’ve heard it before. But what if breathing is difficult or constrained? Breathwork is the answer.Breathing is like any other movement: there are ways to build efficiency and resilience through practice. Simple exercises can get you breathing deeper, and give you a visceral massage or “inside yoga”. And there are herbs for breath work, too! They can remove the obstacles to deep breathing and help to enhance your practice.In this episode we’ll share some simple breathwork practices for you to explore. Then we’ll highlight three favorite herbs we turn to for help enhancing our breathing exercises: lobelia (Lobelia inflata), New England aster (Symphyotrichum novae-angliae), & elecampane (Inula helenium).Mentioned in this episode:New England aster monograph, jim mcdonaldBreathing Easy Much Faster With New England Aster, Kristine BrownOur Respiratory Health course includes more discussion of the importance of breathing, as well as key herbs to work with and methods for targeting herbal remedies to the sinuses & lungs. Asthma, cold/flu/corona, COPD, and other troubles are covered in detail. Your purchase also gives you access to our twice-weekly live Q&A sessions, so you can connect with Ryn & Katja directly; as well as student communities, discussion threads, printable guides, and plenty more!PS: Make sure to listen to the end of the episode for a discount code worth $50 off any of our courses!!As always, please subscribe, rate, & review our podcast wherever you listen, so others can find it more easily. Thank you!!Our theme music is “Wings” by Nicolai Heidlas.Support the show (https://commonwealthherbs.com/supporters/)

Last Week in Medicine
Antibiotic Duration for Prosthetic Joint Infections, Colorectal Cancer Screening Guidelines, Hospital Observation after ACS Ruled Out in ED, Morning Discharges, Personalized Steroid Regimen for COPD Exacerbation

Last Week in Medicine

Play Episode Listen Later Jun 3, 2021 63:27


Today is our season 2 finale, and we have a master class on prosthetic joint infections from Dr. Laura Certain.  Is 6 weeks as good as 12 weeks for prevent recurrent infections?  How does the surgeon decide what kind of surgery to do?  Should we use oral or IV antibiotics?  When should you use rifampin??  Dr. Certain answers all these questions and more. We also talk about the new colon cancer screening guidelines from USPSTF, hospital admission for chest pain after ACS ruled out in the ED, whether morning discharges improve patient throughput, and a study looking at personalized steroid dose for COPD exacerbations. We will be back in the fall of 2021! Antibiotics for Prosthetic Joint InfectionsColorectal Cancer ScreeningHospital Admission for Chest Pain after ACS Ruled OutMorning Discharges and LOSPersonalized Steroid Regimen for COPD exacerbation Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

The Resus Room
June 2021; papers of the month

The Resus Room

Play Episode Listen Later Jun 1, 2021 34:13


This month we've got three papers that have challenged our practice both from an in-hospital and pre-hospital perspective. Firstly we consider a paper that looks at admission saturations for patients with exacerbations of COPD and compare this to the BTS guidance on oxygen therapy, regarding altering oxygen saturations for those proven not to be hypercapnoeic. Should we be aiming for 88-92% or 94-98%? Next we look at a paper from the team at KSS looking at dispatch to older trauma victims and consider whether current triggers for HEMS dispatch are set at the appropriate level to catch those in this cohort that may benefit from critical care interventions. Lastly we look at a paper evaluating the QRS width in PEA cardiac arrests and consider firstly whether a broad QRS complex is predictive of hyperkalaemia and secondly whether we would treat patients based off this finding? Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon and Rob