Podcasts about eosinophils

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Dr. Melanie Ruffner, an Attending Physician with the Division of Allergy and Immunology and the Center for Pediatric Eosinophilic Disorders at Children's Hospital of Philadelphia. Dr. Ruffner describes her work in clinic and the paper she co-authored about pediatric and adult eosinophilic esophagitis (EoE). She covers the questions they considered in the paper and the conclusions they reached. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:49] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, Regeneron, and Takeda. Ryan introduces co-host Holly Knotowicz.   [1:17] Holly introduces today's topic, pediatric and adult eosinophilic esophagitis (EoE), and introduces today's guest, Dr. Melanie Ruffner.   [1:23] Dr. Melanie Ruffner is an attending physician with the Division of Allergy and Immunology in the Center for Pediatric Eosinophilic Disorders at Children's Hospital of Philadelphia. Holly welcomes Dr. Ruffner to Real Talk.   [1:50] As an attending physician in the Center for Pediatric Eosinophilic Disorders at Children's Hospital of Philadelphia, Dr. Ruffner sees patients who have eosinophilic esophagitis and other eosinophilic disorders, including eosinophilic GI tract disorders.   [2:09] Dr. Ruffner also leads a research group that studies how the immune system causes inflammation in response to certain foods, leading to EoE.   [2:20] Inflammation in the esophagus is tied to other diseases like epithelial barrier dysfunction and fibrosis.   [2:28] Our bodies use many different proteins that allow cells to communicate with one another. One type of signaling protein that causes inflammation is called cytokines.   [2:41] Dr. Ruffner's group is interested in how these signaling proteins called cytokines interact with epithelial cells and how that impacts the oral function of the esophagus in patients with EoE.   [3:02] In training, Dr. Ruffner became interested in eosinophilic esophagitis and other non-IgE-mediated food allergies because we don't have a lot of clear treatments or clear mechanisms that cause them.   [3:21] Dr. Ruffner felt there was a lot of work to be done in that area. It was rewarding to be in clinical encounters with those patients. Often, patients had spent a long time trying to find out what was happening and to find a treatment plan that worked for them.   [4:31] Dr. Ruffner's group sees some patients who have eosinophilic gastroenteritis and patients who are referred for hypereosinophilia with impacts of inflammation in other organ systems.   [5:06] Dr. Ruffner co-authored a paper about pediatric and adult EoE published in the Journal of Allergy and Clinical Immunology. It explored if EoE in pediatric patients and adult patients is a spectrum or distinct diseases.   [5:29] EoE is a chronic allergic condition that affects the esophagus. The esophagus carries food from the mouth to the stomach. In people with EoE, the immune system overreacts to foods and causes inflammation in the esophagus.   [5:47] Eosinophils are a type of white blood cell. Eosinophils infiltrate the tissue in the esophagus of people with EoE. Doctors look for eosinophils in the tissue of the esophagus as a sign that inflammation in the esophagus is EoE.   [6:04] The symptoms of EoE can vary in children and adults. That was one of the things the doctors were interested in when they were thinking about this paper. There are no blood or allergy tests that make it easy to diagnose EoE, which requires an endoscopy.   [6:31] An endoscopy is performed by a gastroenterologist. The gastroenterologists look at the appearance of the esophagus and take biopsies.   [6:49] A pathologist counts the eosinophils in the tissue to determine if there are eosinophils present. If there are more than 15 eosinophils in the high-powered field of the microscope and symptoms and clinical conditions are present, EoE is diagnosed.   [7:25] One of the variables Dr. Ruffner considers is that symptoms can be different in children versus adults. In older adolescents and adults, the classic symptom is difficulty swallowing or dysphagia. That is often caused by fibrosis in the esophagus.   [7:54] In younger children this is often not how EoE presents. They may vomit or refuse food. They may experience more weight loss. Symptoms vary over the lifespan. Pediatric EoE symptoms of nausea and abdominal pain can also show up in adults.   [9:54] Atopy refers to allergic conditions. In the paper, a history of atopy means a history of allergic conditions, like atopic dermatitis, IgE-mediated food allergy, allergic rhinitis, or asthma.   [10:37] These disorders tend to cluster together, over time, because they share many common genetic risks. They cluster in families because some of the genetic risks are the same. Not every family member will have the same atopic or allergic conditions.   [11:07] In families, perhaps one person will have atopic dermatitis and allergic rhinitis while another will have atopic dermatitis, allergic rhinitis, asthma, and EoE. They may have inherited different genetics or had different environmental exposures.   [11:50] Ryan says that describes his family. They each have different atopic conditions. Ryan got them all! Dr. Ruffner says it describes her family, as well.   [12:26] Dr. Ruffner says it's understandable for families to stress about atopic conditions. Unfortunately, right now, there's no way to predict who will develop which atopic conditions. It's on the minds of the medical and research communities.   [13:10] IgE is an antibody that binds to food allergens and mediates anaphylaxis, usually within 30 minutes, with hives, vomiting, and difficulty breathing. Not everyone with a diagnosed food allergy will be given an epinephrine auto-injector.   [13:44] IgE-mediated food allergies are influenced by type 2 cytokines. Cytokines are immune system signaling proteins that have been labeled as groups. The group that is involved in allergy most heavily is under the label type 2.   [14:15] These type 2 cytokines are responsible for influencing B cells to make IgE. In the tissue in EoE, we find that there is a large amount of these type 2 cytokines present.   [14:37] This is quite relevant because dupilumab, the monoclonal antibody that has been approved to treat EoE, targets type 2 inflammation by blocking type 2 cytokines.   [16:04] Dr. Ruffner says one of the biggest challenges in the field of EoE is we don't have a way to stratify who should get which treatment for EoE. Patients have to choose between diet and pharmacologic therapy.   [16:48] We don't know enough about the inflammatory profiles to give any patient the specific guided information that one therapy would be better than another.   [17:11] Pediatric and adult patients are given the same treatment options. Some dosing, such as proton pump inhibitors and dupilumab, is weight-based so different doses are needed.   [17:36] Over time, people's needs change. From early school age to when people leave home, they may have very different needs. They may do well on diet therapy when their diet is controlled by parents, but, on their own, that may not be the best option for them.   [18:20] Therapy may change over time to support each patient's individual goals. It can be challenging because therapies are imperfect. Each therapy has a percentage probability of success. Not every therapy is guaranteed to work for every individual.   [19:01] There is some flexibility and possibility of switching between therapies to support people. Ryan shares one of his experiences in changing treatments.   [20:03] Some patients are stable on a therapy for a time but then see symptoms creep back up. Dr. Ruffner strongly suggests they talk to their care team for an endoscopy and biopsy to see if they need to switch therapy and if their diet has changed.   [21:31] In young children, Dr. Ruffner sees a much higher incidence of feeding refusal. The child may have a preferred food or a preferred texture like puree, long past when that would be appropriate for the age.   [22:41] It can be very difficult to move past this learned behavior even if remission is achieved through therapy. The child may need feeding therapy to help with that. [22:59] Feeding behaviors in older individuals may be much more subtle. Talk about them with your care team. Needing water to eat, cutting food very small, and fearing to eat around people are common eating behaviors to discuss in older patients.   [23:53] These eating behaviors affect people's well-being deeply because they affect how social they feel when they are around people. Ideally, you want to be around people and share in social times.   [24:16] Holly has used these eating behaviors herself and notices them in other people. When adults come to her for therapy, she asks how many times they refill their water when they eat, and if food ever gets stuck. They are surprised that those are symptoms.   [26:01] Dr. Ruffner says it's important to recognize the difference in symptoms in diagnosing EoE. The main risk factor of EoE is fibrosis, over time. The thought is that early in EoE there is an inflammatory phenotype, but later, there is a fibrotic phenotype.   [26:51] The phenotype refers to the presentation or characteristic of disease. What is the appearance at endoscopy? What do we see in the biopsied tissue? Is there fibrosis or not?   [27:15] This is the crux of the paper: Is this on a spectrum, that the inflammation is driving the fibrosis, or are these two different things altogether? There is some evidence to suggest that the inflammation contributes to this fibrosis over time.   [27:40] One thing that is missing is following a group of patients from the start and having that evidence. There is mechanistic evidence from studies to show that inflammation can contribute to fibrosis. That was one of the discussions in the paper.   [28:29] In endoscopies, something that can be seen with fibrosis or fibrostenotic features is more of an appearance of rings and narrowing of the esophagus. A proportion of patients with strictures or narrowing need to have them dilated.   [29:11] For patients who have dilation, it can help with symptoms significantly. When pathologists look at the tissue with fibrosis, they can see changes in the protein structure. There is more collagen and other changes in the tissue, causing fibrosis.   [30:03] Some patients use adaptive eating behaviors to adapt to significant changes in their esophagus and go for many years without being diagnosed until they present with an impaction when food becomes stuck in their esophagus.   [30:46] This makes EoE a challenging disorder for many because it can be very difficult to diagnose. The journey to a diagnosis is very individual. As a group, adults are much more likely to have fibrosis, leading to dysphagia, strictures, or impaction.   [31:25] Statistically, across all patients, you see fibrosis more in adults than in children.   [32:42] In the paper, Th1 cells are mentioned. Th1 is an immune system term referring to a cell that produces interferon-gamma. Studies show there may be differences in interferon signaling in different age groups but it needs to be studied further.   [33:57] Dr. Ruffner's team had looked at a small group and saw that interferon signaling seemed to be relatively similar between children and adults. Both CD4 and CD8 T cells (types of immune system cells) are potentially producing interferon in the esophagus.   [34:32] More study needs to be done around those immune system cells and their potential significance in EoE, if any.   [35:33] The paper suggests that EoE in children and adults is essentially a spectrum of the same disorder rather than distinct diseases.   [35:42] Aspects of immunology, responses to different treatments across children and adults, the similar responses to diet and different medications, and over time in the same individuals, indicate these are changes and complications over time.   [36:41] Dr. Ruffner suggests that medical researchers need to understand which patients are at the highest risk of complications and work to identify the best treatments to prevent those.   [37:14] Dr. Ruffner is thinking about the response to proton pump inhibitor therapy. One of the things she is looking at is whether or not proton pump inhibitors affect how eosinophils migrate into the tissue.   [37:33] They are finding that it seems that PPIs can decrease the degree of migration of eosinophils into the tissue. They are very interested in looking at that. Ryan says when Dr. Ruffner gets that paper published, she'll have to come back on the show!   [38:06] Ryan thanks Dr. Ruffner. For our listeners who would like to learn more about eosinophilic disorders, including EoE, please visit APFED.org and check out the links in the show notes.   [38:15] If you're looking to find a specialist who treats eosinophilic disorders, we encourage you to use APFED's Specialist Finder at APFED.org/specialist.   [38:24] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections.   [38:33] Ryan thanks Dr. Ruffner for participating in the podcast episode. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, Regeneron, and Takeda for supporting this episode.   Mentioned in This Episode: Dr. Melanie Ruffner, MD, PhD, Attending Physician with the Division of Allergy and Immunology and the Center for Pediatric Eosinophilic Disorders at Children's Hospital of Philadelphia “Pediatric and adult EoE: A spectrum or distinct diseases?” by Stanislaw J. Gabryszewski, Melanie A. Ruffner, and Jonathan M. Spergel   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, Regeneron, and Takeda.   Tweetables:   “EoE is a chronic allergic condition that affects the esophagus. The esophagus carries food from the mouth to the stomach. In people with EoE, the immune system overreacts to food allergens and causes inflammation in the esophagus.” — Dr. Melanie Ruffner   “In EoE, there are no blood or allergy tests that make it easy to diagnose EoE without an endoscopy.” — Dr. Melanie Ruffner   “Is EoE on a spectrum, that the inflammation is driving the fibrosis, or are these two different things altogether? There is some evidence to suggest that the inflammation contributes to fibrosis over time.” — Dr. Melanie Ruffner   “When pathologists look at the tissue with fibrosis, they can see the changes in the protein structure.” — Dr. Melanie Ruffner   “There are some folks who have adapted their eating behavior quite significantly and may have quite a number of chronic changes in their esophagus that they have adapted around, and they go for many years without being diagnosed.” — Dr. Melanie Ruffner

Hello Friend, Have you ever been told, “Your blood tests are normal,” but deep down you know something isn't right? It's one of the most frustrating things to hear, especially when you're dealing with fatigue, brain fog, or other unexplained symptoms. Here's the truth: those “normal” lab results might still hold valuable clues about your health—if you know where to look. Your CBC panel, a test you've probably already had done, includes five key markers that can reveal so much about what's really going on inside your body. In this week's episode of Functional Medicine for Christian Women, I break down the CBC differential and explain how Neutrophils, Lymphocytes, Eosinophils, Basophils, and Monocytes can provide insight into your immune function, inflammation, and even chronic stress. I'll show you why this simple test is often the best starting place for uncovering the root cause of your symptoms—and how you can use it to take the first step toward feeling better. In health, Lacy Lain, FMCHC, LEHP P.S. If you've ever felt dismissed by conventional doctors, I made this episode with you in mind. Let's start finding the answers your body is trying to tell you. What's Next? Book Your Free Consultation: Sick Of Feeling Like Junk, Know Something's Not Right, Yet You're Told By Your Doctors That Your Labs Are “Normal”... Connect with Lacy: Apply to work with Lacy 1:1 (two spots now open!) The Stronger Collective App Learn more by clicking here. Related Episodes You Might Enjoy: 42. Why Am I Always Tired? Common Causes of Chronic Fatigue in Working Women 27. Why Career-Driven Women Should Care About Blue Zones, Air Quality, and Houseplants for Better Indoor Air 45. Unlock Your Energy: How Hormones Could Be the Key to Fixing Your Fatigue 33. Bandaid Solutions vs Functional Solutions in Women's Health 47. How NAD+ Can Help Exhausted Women Regain Their Energy Naturally - Disclaimer: Our life and health coaches do not diagnose, treat, prevent, or cure any disease or condition. Nothing we share with our clients is intended to substitute for the advice, treatment, or diagnosis of a qualified licensed physician. Lacy Lain, FMCHC may not make any medical diagnoses or claim, nor substitute for your personal physician's care. It is the role of Lacy Lain and her Practitioners to partner with their clients to provide ongoing support and accountability in an opt-in model of self-care and should be done under the supervision of a licensed physician. These platforms share personal experiences and provides education. Interaction on these platforms does not constitute a doctor/patient relationship.

Send us a textEver wondered what's behind that persistent difficulty swallowing or chest discomfort? On this episode of MedEvidence, Dr. Yuval Patel uncovers the mysteries of eosinophilic esophagitis (EOE), an often-misunderstood chronic allergic condition. We'll take you through the role of eosinophils, the specific white blood cells responsible for allergic reactions, and how their infiltration into the esophagus can lead to painful inflammation and food pipe narrowing. Our conversation expands to the “three Ds” of EOE treatment: drugs, diet and dilation. You'll gain a comprehensive understanding of first-line treatments while we also highlight the crucial role of dietary changes. We wrap up by discussing the vital importance of personalized treatment plans and groundbreaking clinical trials. Don't miss this chance to understand the long-term prognosis and the vital management strategies needed to prevent complications in EOE patients. Join us for an enlightening journey through the complexities of eosinophilic esophagitis!Talking Topics:Understanding Swallowing DifficultyTreatment Options for Eosinophilic EsophagitisManaging and Treating Eosinophilic EsophagitisAdvancements in EOE TreatmentRecording Date: August 7, 2024Be a part of advancing science by participating in clinical research.Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.comListen on SpotifyListen on AppleWatch on YouTubeShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedInWant to learn more checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.comMusic: Storyblocks - Corporate InspiredThank you for listening!

Please visit answersincme.com/PES860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in pulmonary disease discusses the implications of the latest evidence on biologic therapies targeting type 2 inflammation for the treatment of chronic obstructive pulmonary disease (COPD). Upon completion of this activity, participants should be better able to: Identify the rationale for investigating biologics targeting type 2 inflammation for the treatment of patients with chronic obstructive pulmonary disease (COPD); Review the clinical impact of emerging biologics in the treatment of eosinophilic COPD in patients at high risk of exacerbations; Outline strategies to implement biologics targeting type 2 eosinophilic inflammation into clinical practice, as they become available. This activity is intended for US healthcare professionals only.

Doctors Lisa and Sara talk to Respiratory Physiotherapist Thomas James about COPD. We start with what COPD is, when to suspect it, a standard work up, pitfalls and points of consideration about spirometry, before moving on to an overview of management. We then cover some changes in the way COPD exacerbations are managed in South Manchester and the role of Eosinophils in both acute and chronic management. Understanding the role of Pulmonary rehabilitation, prednisolone and exercise in management are particular highlights. We cover our learning points from the episode at the end.  You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Useful resources:  NICE COPD in adults (last updated Sept 2023): https://www.nice.org.uk/guidance/QS10 The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Spirometry Guide: https://goldcopd.org/gold-spirometry-guide/ Association for Respiratory Technology and Physiology (ARTP) advice on Spirometry Interpretation: https://www.artp.org.uk/en/spirometry Greater Manchester Medicines Management Group (GMMMG) COPD Management Plan Guideline (2021): https://gmmmg.nhs.uk/wp-content/uploads/2021/11/COPD-Treatment-Guideline-Nov-2021-V7.1.pdf Greater Manchester Medicines Management Group (GMMMG) COPD Inhaler Guide (2021): https://gmmmg.nhs.uk/wp-content/uploads/2023/05/GMMMG-COPD-Inhaler-Guide-update-Mar-2023.pdf Greater Manchester CURE Project for Smoking Cessation: https://gmcancer.org.uk/programmes-of-work/treatment/the-cure-project/ Greater Manchester Change, Grow, Live Services including Smoking Cessation: https://www.changegrowlive.org/ Primary Care Respiratory Society MRC Breathlessness scale: https://www.pcrs-uk.org/mrc-dyspnoea-scale Our podcast with Dr Lesley Henson and Dr Caitriona MacDermott on Breathlessness in Palliative Care (May 2024): https://pckb.org/e/breathlessness-in-palliative-care/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Emerging data suggests we may have been overzealous with systemic corticosteroid prescribing and that allowing patients to self-manage their exacerbations with steroid rescue therapy may be harmful. However, we can now identify a subgroup of COPD patients who might benefit from systemic corticosteroids to treat their exacerbation. Guest Authors:  Hope Shrader Sherman, PharmD and Maricar Conson, PharmD, BCACP Music by Good Talk

The CBC (complete blood count) with differential is the most common lab test performed on patients. Practitioners often look at the ranges indicated in the CBC. However, they don't look closely at the five critical markers that can tell what's happening inside the patient's body.Learning how to read blood work better is essential to providing quality care. Becoming a Functional Blood Work Specialist is possible no matter how simple or complex your background is. Today, I share how some practitioners elevated their practice by incorporating functional blood work into their treatment package. I also discuss the five markers inside this standard blood test to help you discover the gold inside your patient's CBC.Open enrollment for the 90-day Functional Blood Work Specialist Program is happening now. I'd be honored to have you join this cohort. We start and end together, so you'll need to decide before February 29th is over. We begin March 1st. Get all the details and become certified at drkylieburton.com/90“No matter how simple your background is or how complex your background is, the blood work your patients have is loaded with gold.”- Dr. Kylie BurtonIn This Episode:What is the CBC?What is the WBC, and what do the numbers mean?What are Neutrophils?What are Lymphocytes?What are Monocytes?What are Basophils and Eosinophils?Why join the 90-Day Functional Blood Work Specialist Program?Resources:Join the 90-day Functional Blood Work Specialist Program - https://drkylieburton.com/90day/Learn How to Read the Blood Work Your Clients Already Have in a Better Way - https://drkylieburton.com/cbc-live/Why Are My Labs Normal? By Dr. Kylie Burton - https://drkylieburton.com/product/why-are-my-labs-normal/Connect with Dr. Kylie:Website - https://drkylieburton.com/Instagram - https://www.instagram.com/drkylieburton/Facebook - https://web.facebook.com/drkylieburton/YouTube - https://www.youtube.com/channel/UCdqJbAS6ocKydcjNiDQoauw

Description: Co-host Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and co-host Holly Knotowicz, a speech-language pathologist living with EoE, who serves on APFED's Health Sciences Advisory Council, speak with Dr. Amanda Muir, an Assistant Professor of Pediatrics at the Children's Hospital of Philadelphia. In this episode, Ryan and Holly interview Dr. Muir about tissue remodeling and eosinophilic esophagitis (EoE). Dr. Muir describes remodeling and stiffening, its effects, and how it relates to treatment and inflammation.   Listen in for information on remodeling and a pediatric study Dr. Muir is planning. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:48] Co-host Ryan Piansky welcomes co-host Holly Knotowicz. Holly introduces Dr. Amanda Muir, an Assistant Professor of Pediatrics at the Children's Hospital of Philadelphia (CHOP). She has a translational lab that investigates esophageal remodeling in the setting of EoE. Holly thanks Dr. Muir for joining us today.   [1:51] Dr. Muir became interested in eosinophilic disorders as a GI Fellow. There were so many patients with eosinophilic esophagitis and eosinophilic gastrointestinal diseases but there weren't many good therapies and little was known about the long-term results for children. [2:24] Dr. Muir's first eosinophilic interest was eosinophilic esophagitis. She joined a lab that was looking at how the esophagus changes over time in the setting of inflammation. After being in the lab, training, and learning all the skills and techniques, she was able to launch her career and lab.   [2:46] Dr. Muir started her own EoE clinic at CHOP (Children's Hospital of Philadelphia) as part of their Center for Pediatric Eosinophilic Disorders. She sees patients at the clinic, then she can bring questions from the clinic to the lab and talk about them as a group.   [3:28] Dr. Muir explains esophageal remodeling. There is remodeling that happens in the epithelial compartment of the esophagus. Then there's remodeling that happens underneath the surface in the lamina propria. For the most part, when people talk about remodeling in eosinophilic esophagitis, they refer to the remodeling happening below the surface.   [3:50] There is a burgeoning field dedicated to studying the surface of the esophagus, and Dr. Muir is also very interested in that. For today's purposes, we are talking about the remodeling that happens under the surface.   [4:03] Eosinophils that get to the esophagus secrete chemicals that excite the cells below the surface to secrete collagen. Collagen is the glue that holds the body together. They're secreting glue to help the esophagus hold together, and the esophagus gets stiffer and stiffer, over time. That is remodeling. It's the body trying to heal itself.   [5:04] Are children and adults equally at risk for remodeling? Patients develop a stiffening of the esophagus more, later in life. It is thought that the more years you have this inflammation, the more stiff your esophagus gets. There are patients six to nine years old who already have signs of stiffening.   [5:28] Dr. Calies Menard-Katcher from Colorado published a paper where she described all of the eosinophilic esophagitis patients at her institution who got dilated. Dilation is the process of a balloon stretching your esophagus open when it's too narrow. She had patients as young as six in her cohort that she described as having EoE strictures.   [5:49] Remodeling happens with younger patients but we're not as good at finding it.   [6:08] Any type of inflammation in the GI tract can lead to some stiffening. The typical gastrointestinal disease that we think of as remodeling is Crohn's Disease. An inflammatory process happens in the small bowel or colon that leads to narrowing and stiffness in the intestines. [6:28] Also GERD (reflux) can lead to stricture, over time. It is just much more rare to see a GERD-induced stricture as opposed to EoE.   [7:13] We are not sure, but to some extent, we think of remodeling as not being reversible. Once there is a certain degree of stiffness, the esophagus does not seem to open up without these dilations. If you can control the inflammation, you can halt the stiffening. Maybe there is some degree of reversibility.   [7:44] In the Phase 2 dupilumab trials, investigators found that patients on dupilumab were seen to gain two millimeters in diameter of the esophagus, compared to the patients on placebo. We may be able to prevent some remodeling if we catch it soon enough. More research is needed.   [8:33] Dr. Muir tells of the work she is doing in her lab. They take biopsies from patients and grow collagen-secreting fibroblasts in a dish. The research is to find out what calms the fibroblasts down from actively secreting collagen.   [9:22] It's tough to follow the symptoms of EoE when patients only have difficulty swallowing foods that are hard to swallow. If patients are not challenging their esophagus, they might not notice having daily trouble swallowing. It's hard to ask a young kid who is eating a lot of soft foods if they feel like anything's getting stuck.   [10:06] Dr. Muir will ask teenage patients, “Do you ever want to eat chicken? Do you ever want to eat steak?” A lot of times they don't want to eat it, perhaps because it felt uncomfortable at some point in their life and they don't want to eat it, not based on taste but on repeated bad events. It's hard to tease out the symptoms, sometimes.   [10:27] Dr. Muir says, based on our Functional Luminal Imaging Probe (FLIP) studies, patients who had feelings of food that felt stuck in the last 30 days did seem to have a more narrow caliber esophagus. There is not a 100% correlation between symptoms and remodeling, but there seems to be some correlation.   [11:31] Ryan tells how patients have tendencies to get around their EoE symptoms, with a personal example of keeping food in his mouth and chewing it for a long time before swallowing. A scope would show he had bad inflammation of the esophagus. He had been diagnosed when young and was under treatment and on a restricted diet.   [12:26] Biopsies don't always get a sample below the surface to check for fibrotic cells so it is hard to find remodeling with biopsies. There are some visual signs. Seeing rings or trachealization in the esophagus, or narrowing, can be signs that there is some remodeling under the surface.   [13:38] For kids who have a lot of trouble swallowing, Dr. Muir performs an EndoFLIP test regularly. The test catches subtle narrowing that may not be visible to the endoscopist. Doing this test gives the doctor more information and a better sense of the patient's phenotype, such as inflammation, the esophagus being stretchy, or being stiff.   [14:49] The EndoFLIP is a balloon with an imaging probe that includes a TV for the doctor to see how many millimeters the esophagus is in diameter as the balloon inflates along the whole body of the esophagus. It's not an imaging test that goes to radiology. It's a balloon that is blown up slowly with salt water and that gives this measurement.   [15:18] The EndoFLIP is a helpful tool to help determine who may have some more stiffening or determine exactly what the diameter of the esophagus is before starting treatment.   [15:33] One of the things that Dr. Menard-Katcher of Colorado, Dr. Ackerman of the University of Illinois, and Dr. Muir collaborated on was to look and see if they could find any markers in the esophagus that would relate to some of the things that are obtainable on biopsy or the esophageal string test.   [15:57] What they found was that periostin — a protein made by the epithelium and by the fibroblasts, which is known to activate fibroblasts, and is very high in EoE — seemed to correlate with the EndoFLIP measurements. This makes Dr. Muir think that there might be some potential for biomarkers to detect remodeling.   [16:16] The thing that everyone wants for this disease is to find a biomarker where we don't have to do a scope. As far as finding a non-invasive biomarker, we're not there, yet. There are some things going on at the tissue level that might clue us in on how distensible the esophagus is.   [17:18] The thing Dr. Muir worries about the most with long-term inflammation is that the esophagus is going to get more narrow over time. That will make patients more susceptible to food impaction (although not all patients with food impaction have a stricture).   [17:36] One worry is that the esophagus will get so narrow that an endoscope will not be able to pass a stricture. That will lead to more swallowing problems. That is what Dr. Muir hopes to be able to prevent as we get better at treating this.   [18:09] Any of the treatments that stop the inflammation and help get you below that “magical” 15 eosinophil count that we all strive for, will help prevent remodeling. So, once you get everything calm, hopefully, the remodeling process will stop. However, with the stiffening, the fibroblasts get more excited and have a hard time turning off.   [18:53] Simply turning off the inflammation will not turn off the fibroblasts. Many people within the GI space are looking at fibroblast-directed therapy, especially in Crohn's disease, there's a real need to prevent a lot of surgeries that are happening. Dr. Muir hopes to apply some of these to the esophagus, as well.   [19:16] In the study by Dr. Menard-Katcher, Dr. Ackerman, and Dr. Muir, there were 80 patients. Some were on swallowed steroid treatment and others were on an elimination diet. There were not enough patients on each therapy to find a significant difference in remodeling between the therapies. Patients in remission had better distensibility.   [19:44] Dr. Evan Dellon showed in a paper that patients who have sustained remission have fewer dilations, in the long term. While we don't have a way to reverse the fibrosis that's happened, we hope to prevent it from getting any worse. Dr. Muir's research goal is to find something to calm fibroblasts down and prevent fibrosis or even reverse it.   [20:31] Dr. Muir explains that cells under the surface level are fibroblasts. When eosinophils and T cells come in and secrete antagonizing chemicals, the fibroblasts turn on and start secreting collagen. The fibroblasts also turn on when the epithelium is angry and inflamed. There is also evidence that surface cells can secrete collagen.   [22:46] Dr. Muir says it's hard to know how far along in development some anti-fibrotic drugs are. We have many promising targets. Understanding how the remodeling happens is very important to be able eventually to treat this disease. Even though it seems like incremental progress, Dr. Muir believes research is moving the field forward.   [24:16] Dr. Muir says her EoE patients at CHOP are generous with their blood and tissue. Getting consenting control patients for lab studies involves a lot of leaps of faith and trust that scientists will grow your cells ethically. Dr. Muir feels lucky she has a good research team that explains things in lay terms to control patients.   [26:50] Dr. Muir's team has videotaped pediatric EoE patients and control patients' eating. The time EoE patients spent chewing and how long it took to swallow correlated to their esophageal distensibility measured by the EndoFLIP test. She believes that how we feed and the difficulty we have swallowing have to do with esophageal remodeling.   [27:41] That's Dr. Muir's next area of study. It's being spearheaded by Dr. Kanak Kennedy, a fellow in Dr. Muir's lab, trying to figure out the relationship between pediatric feeding and remodeling.   [28:08] As part of their research, they are videotaping as many kids eating as they can. This involves many control patients who don't have EoE. Another area of research is on the enzyme lysyl oxidase which organizes collagen into bundles and makes it stiff. She is looking into ways to decrease the organization of the collagen.   [29:08] Ryan thanks Dr. Amanda Muir for coming on the podcast and giving a crash course on remodeling and EoE.   [29:14] To learn more about eosinophilic esophagitis, visit apfed.org/eoe. To learn more about Dr. Muir's research, read her paper.   [29:30] To find a specialist, visit apfed.org/specialists. To connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at apfed.org/connections.   [29:47] Ryan and Holly thank Dr. Amanda Muir again for joining them. Holly thanks APFED's education partners, linked below, for supporting this episode.   Mentioned in This Episode: Amanda Muir, MD. Children's Hospital of Philadelphia (CHOP) American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of AstraZeneca, Bristol Myers Squibb, Sanofi, and Regeneron.   Tweetables:   “I was able to start my own EoE clinic at CHOP as part of their Center for Pediatric Eosinophilic Disorders. I see patients who have eosinophilic gastrointestinal diseases and then I can go back to the lab and bring those questions from my clinic to the lab.” — Dr. Amanda Muir   “The thing that everyone wants for this disease is to find a biomarker where we don't have to do a scope.” — Dr. Amanda Muir   “Any of the treatments that stop the inflammation and help get you below that ‘magical' 15 eosinophil count that we all strive for will help prevent remodeling. So, once you get everything calm, hopefully, the remodeling process will stop.” — Dr. Amanda Muir   About Dr. Amanda Muir: Amanda B. Muir, MD, Attending Physician, Children's Hospital of Philadelphia, Research Institute. Dr. Muir investigates the mechanisms underlying esophageal fibrosis to improve therapeutic and diagnostic approaches.

In the latest episode of the Vibrant Wellness podcast, Dr. Emmie Brown hosts functional medicine expert Dr. Ashley de Luna to discuss holistic gut health and the overlooked issue of parasitic infections. Dr. De Luna shares her personal health journey, emphasizing the significant role of addressing parasites in her recovery. The discussion challenges the misconception that parasites are mainly a travelers' concern, highlighting their potential impact on anyone's health. The conversation covers the variety of symptoms linked to parasitic infections, from intermittent flare-ups to chronic conditions like sinus congestion and skin rashes.The episode delves into the complexities of the immune system, particularly the role of eosinophils and the utility of detailed stool analysis for detecting hard-to-detect parasites. Dr. De Luna and Dr. Brown explore how parasites thrive in toxic environments and their influence on brain chemistry and behavior. This part of the conversation illuminates the intricate relationships between parasites, the environment, and the human body.Concluding the episode, Dr. Brown and Dr. De Luna discuss comprehensive strategies for parasite cleansing. They emphasize the importance of preparing the body for detox, using potent anti-parasitic herbs like mimosa pudica, and the strategic timing of treatments. Dr. De Luna highlights strengthening the immune system and addressing biofilms as key components of a holistic treatment plan. This episode empowers listeners with valuable insights into enhancing gut health, encouraging them to integrate this knowledge into their professional practice for a more vibrant life.Chapters:(00:00) Holistic Gut Health and Parasites(04:26) Parasites and Underreported Health Impacts(12:00) Parasites and Symptoms(21:36) Immune System and Gut Health Analysis(27:02) Parasites and the Complexity of Symptoms(32:26) Management and Herbal Treatments for Parasites(44:19) Practicing Self Love and Acceptance(48:26) Infrared Saunas, Tea, Bucket ListsLinks:https://doctordeluna.com/Join Over 18,000 Leading Medical Professionals and Become a Vibrant Wellness Provider Today!

Overview: In this episode, join us as we discuss the use of blood eosinophils as a biomarker in severe asthma and whether there is prognostic value in measuring eosinophil levels. Episode key references and resource links:  Bruselle GG, and Koppelman GH. N Engl J Med. 2022;386(2):157–171. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2023. Available from: https://ginasthma.org/2023-gina-main-report/. Access date [June 2023]. de Groot JC, et al. ERJ Open Research. 2015;1(1):00024–2015. Bousquet J, et al. N Engl J Med. 1990;323(15):1033–1039. Yancey SW, et al. J. Allergy Clin Immunol. 2017;140(6):1509–1518.   Guest: Dareen Siri, MD, FAAAAI, FACAAI and Matthew Mintz, MD, FACP  

Overview White Blood Cells Normal Value Range Pathophysiology Special considerations Abnormal values (high) Abnormal values (low) Nursing Points General Normal value range WBC 4500-10000/mcL Differential Neutrophils 40-60% Bands 3-5% >8% indicates signal to WBC for more production Infection or inflammation is severe Eosinophils 1-4% Basophils 0.5-1% Lymphocytes 20-40% Monocytes 2-8% Pathophysiology WBC Formed in the bone marrow Responsible for responding to foreign invaders Creating antibodies (immunity) Phagocytosis (eating bacteria or fungi) Multiple types with different purposes Neutrophils – inflammation and first response to invader Eosinophils – Inflammation Allergic response Parasites Basophils Inflammation Allergic response Lymphocytes Create antibodies Recognize antigens Destroy cells T Cells B Cells Natural Killer cells Monocytes Macrophages Engulf and destroy invaders Indicative of infection Special considerations Lavender top tube Will commonly be submitted for Complete Blood Count with differential Abnormal lab values Increased White Blood Cell count (leukocytosis) Infection Inflammation Trauma/Stress Pregnancy Asthma Allergic Reaction Decreased lab values (leukopenia) Systemic Lupus Erythematosus (SLE)/Rheumatoid arthritis Cancers Chemotherapy/Radiation Medications Neutropenic precautions Masks Gloves Wash hands Consider yourself infectious Prevent spread of infection to the patient Assessment Consider the overall WBC count plus abnormalities in differential Evaluate patient Signs or symptoms of: Trauma Inflammation Infection Therapeutic Management Antibiotic therapies where indicated by infection (followed by cultures to determine efficacy of antibiotics) Anti-inflammatories for inflammation Provide neutropenic precautions when necessary Nursing Concepts Lab Values Infection Control Patient Education Educate patient on the finishing any antibiotics completely. Do not stop prior, even if the patient says they are feeling better.

Welcome to MedEvidence: Two Docs Talk Allergies and Asthma Part 4. Today, Dr. Koren and Dr. Joshi finished the series discussing current research on the role of eosinophils in asthma and the treatment options available for people with eosinophilic asthma. They also cover the importance of proper diagnosis and monitoring for effective management of asthma symptoms. Eosinophils are a type of white blood cell that can contribute to inflammation and airway hyperresponsiveness in people with asthma. This series is the perfect resource for learning about allergies and asthma. Tune in to gain a deeper understanding of these important healthcare topics.Listen to the whole series:Two Docs Talk: Allergies and Asthma Pt 1Two Docs Talk: Allergies and Asthma Pt 2Two Docs Talk: Allergies and Asthma Pt 3Common medications:The anti-IL5 products that affect eosinophil survival are mepolizumab (Nucala), benralizumab (Fasenra), reslizumab (Cinqair). The anti-IL4/IL13 product is dupilumab (Dupixent)The anti-IgE agent is omalizumab (Xolair)The anti-TSLP agent is Tezepelumab. (Teszpire) Sunil Joshi, MD, is the President and Managing Partner of Family Allergy Asthma Consultants in Jacksonville, Florida. The Past-President of the Duval County Medical Society (the largest and oldest Medical Society in Florida) and a graduate for the University of Florida College of Medicine. Dr. Joshi received his Allergy/Immunology fellowship training at the University of Rochester in New York.  He truly enjoys treating patients with allergic disorders and believes that education about these disease processes can bring better care to the public.Michael J. Koren, MD, is a practicing cardiologist and Chief Executive Officer at Jacksonville Center for Clinical Research, which conducts clinical trials at 7 locations in Florida. He received his medical degree cum laude at Harvard Medical School and completed his residency in internal medicine and fellowship in cardiology at New York Hospital/Memorial Sloan-Kettering Cancer Center/Cornell Medical Center.He is a fellow of the American College of Cardiology, fellow and two-time president of the Academy of Physicians in Clinical Research, and the regional chapter of the American Heart Association. Original Air Date: April 14, 2023Be a part of advancing science by participating in clinical researchShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedIn Powered by ENCORE Research GroupMusic: Storyblocks - Corporate InspiredThank you for listening!

Welcome to MedEvidence: Two Docs Talk Allergies and Asthma Part 3 The Evil Eosinophils.  In this episode, Dr. Michael Koren and Dr. Sunil Joshi explore allergy shots vs. allergy drops for managing allergic rhinitis. For people with allergic rhinitis, allergy shots and allergy drops are two options for managing symptoms. The doctors explain the difference between the two treatments and their effectiveness in reducing allergic rhinitis symptoms. They also discuss the pros and cons of each option and how to decide which one is best for you.This series is the perfect resource for learning about allergies and asthma. Tune in to gain a deeper understanding of these important healthcare topics.Listen to the whole series:Two Docs Talk: Allergies and Asthma Pt 1Two Docs Talk: Allergies and Asthma Pt 2Two Docs Talk: Allergies and Asthma Pt 4Common medications:The anti-IL5 products that affect eosinophil survival are mepolizumab (Nucala), benralizumab (Fasenra), reslizumab (Cinqair). The anti-IL4/IL13 product is dupilumab (Dupixent)The anti-IgE agent is omalizumab (Xolair)The anti-TSLP agent is Tezepelumab. (Teszpire) Sunil Joshi, MD, is the President and Managing Partner of Family Allergy Asthma Consultants in Jacksonville, Florida. The Past-President of the Duval County Medical Society (the largest and oldest Medical Society in Florida) and a graduate for the University of Florida College of Medicine. Dr. Joshi received his Allergy/Immunology fellowship training at the University of Rochester in New York.  He truly enjoys treating patients with allergic disorders and believes that education about these disease processes can bring better care to the public.Michael J. Koren, MD, is a practicing cardiologist and Chief Executive Officer at Jacksonville Center for Clinical Research, which conducts clinical trials at 7 locations in Florida. He received his medical degree cum laude at Harvard Medical School and completed his residency in internal medicine and fellowship in cardiology at New York Hospital/Memorial Sloan-Kettering Cancer Center/Cornell Medical Center.He is a fellow of the American College of Cardiology, fellow and two-time president of the Academy of Physicians in Clinical Research, and the regional chapter of the American Heart Association. Original Air Date: April 14, 2023Be a part of advancing science by participating in clinical researchShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedIn Powered by ENCORE Research GroupMusic: Storyblocks - Corporate InspiredThank you for listening!

Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist and feeding specialist living with EoE who serves on APFED's Health Sciences Advisory Council talk with guest Florence Roufosse, MD, PhD, Professor of Medicine, Internist and Clinical Immunologist at CUB-Hôpital Erasme, Brussels, and President, International Eosinophil Society. In this episode, Ryan and Holly discuss with Dr. Roufosse some of the many unmet needs related to eosinophil-associated diseases. The discussion covers diagnosis, treatment, access to multi disciplinary care, research, and awareness. Dr. Roufosse identifies specific questions she sees an urgency to address and discusses clinical trials. Listen in for a better understanding of some of the unmet needs of patients with eosinophil-associated diseases. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [0:50] Ryan welcomes co-host Holly Knotowicz. Holly introduces the topic: a global look at eosinophilic diseases and unmet needs.   [1:28] Holly introduces Dr. Florence Roufosse. Dr. Roufosse is a professor of medicine, an internist, and a clinical immunologist at Erasme Hospital in Brussels and is President of the International Eosinophil Society.   [1:43] In addition to her clinical work, Dr. Roufosse leads translational research projects to improve the understanding and treatment of hypereosinophilic syndromes (HES). She is also involved in international clinical trials evaluating treatment options for patients living with HES and eosinophilic granulomatosis with polyangiitis (EGPA).   [2:18] Dr. Roufosse is an internist working in an academic hospital. An internist is a diagnostician, whom people see if they have many complaints that involve various organs to find a unifying diagnosis for their problems.   [2:47] Dr. Roufosse's interest in eosinophils started when she met Dr. Elie Cogan. He had just published a case report on a patient with hypereosinophilic syndrome who also had T-lymphocytes present. The T-cells were producing growth factors for eosinophils.   [3:21] The hypereosinophilic syndrome in the patient was due to these abnormal T-lymphocytes. The case was in 1996. Dr. Cogan asked Dr. Roufosse if she would agree to do a doctoral fellowship on the topic and try to dive deeper into understanding the disease in this patient.   [3:37] Dr. Roufosse has been working on HES ever since, doing translational research, working with blood samples from patients she sees in the clinic, and studying the cells functionally and on a molecular basis. Dr. Roufosse is foremost a clinician who sees patients in the clinic every day.   [4:00] Dr. Roufosse regularly gets referrals for HES and EGPA. She has a large cohort of patients. Her main job consists of reaching a diagnosis and giving the best treatment to these patients.   [4:44] The main mission of the International Eosinophil Society (IES) is to bring together clinicians, investigators, and researchers interested in eosinophils and eosinophilic disorders. The society held its first meeting in 2001. The pandemic prevented them from celebrating their 20th anniversary in person, but they will meet this summer.   [5:20] IES brings together clinicians who see patients and people who investigate eosinophils in the lab. Close interactions between clinicians and investigators drive the motivation to understand the biology of these disorders, find the therapeutic targets, and work together, combining findings to make progress.   [6:52] There are common unmet needs for eosinophilic diseases and specific unmet needs for individual diseases. Transitioning from pediatric to adult care is an unmet need in eosinophilic esophagitis because the disease begins in childhood. However, eosinophilic syndrome and EGPA occur most commonly in adults.   [7:51] Diagnosis is a bottleneck. When people get the right diagnosis, they are already well on their journey of receiving treatment. Diagnosis combines the need for increased awareness among patients, the public, and physicians. A delayed diagnosis may have consequences for patients, such as a progressive disease that is not controlled.   [8:31] High levels of eosinophils have the potential to damage organs and induce functional damage and functional alterations. They favor fibrosis. The longer eosinophils stay at high levels, the more harm can occur, so there is a consequence in delayed diagnosis.   [8:55] Patients with high eosinophils in blood and tissues will often receive corticosteroid therapy. This is good for a few days but there are numerous side effects to corticosteroid therapy in the short-, middle-, and long-term. Also, the longer the journey is to diagnosis, the more people get discouraged and depressed.   [10:02] Part of the unmet need in diagnosis is awareness. There's a saying, “What you don't know, you can't diagnose.” Many physicians don't know about these eosinophilic conditions.   [12:13] APFED and Dr. Roufosse worked together to author “Improving Care in Eosinophil Associated Diseases: A Charter.” The charter outlines the needs and the rights of patients with eosinophil-associated diseases.   [13:03] The rights of patients include the right to a timely diagnosis, which implies awareness about the diseases among the public, healthcare providers, and policy makers. Patients also have the right to access multi disciplinary care teams, as the disease may affect different tissues and organs. A patient may even have several disorders at once.   [14:06] It's important that if treatment options are available; patients need to have access to them. This is not the case in all countries. Patients need rapid access to the therapies once an indication has been decided by a specialist.   [14:53] Quick diagnosis will decrease the accrual of damage due to the disease, inadequate treatment, and overexposure to corticosteroid treatment. From a psychological point of view, it's very reassuring to rapidly feel that a label has been given to the disease and that there's a plan. When there's no label, there's no plan.   [15:47] The key to shortening the diagnostic timeline is awareness at all levels of healthcare education and specialization. General practitioners need to be educated on what it means and what to do when they see a high eosinophil count in blood or tissue. There needs to be access to the tools to diagnose the associated disorders.   [17:00] Patients need easier access to referral centers where they see the experts and access the tools for diagnosis. Multidisciplinary team care is needed when diseases hit different organs.   [17:44] When EGPA is controlled with immunosuppressive therapy, often asthma remains a serious problem and very difficult to manage. You need a pulmonologist to take care of that aspect. You need an ear, nose, and throat doctor for complications in those areas. Cardiovascular complications need a cardiologist.   [19:21] Dr. Roufosse says it is still challenging for patients to access a multidisciplinary care team. Creating a multidisciplinary care team requires resources. It has to be supported by a hospital. The institution needs to be an academic institution with funding, as doctors meeting to discuss a difficult case does not generate income for the institution.   [20:39] Ryan worked with a multi disciplinary care team as a young EoE patient. He traveled every year from his home in Georgia to the multi-disciplinary care team in Denver, Colorado. The fact that his family was able to travel out of state was wonderful. The team was effective and he misses it. Now he has separate appointments for each type of doctor.   [22:32] New therapies, for those who have had access to them through clinical trials, are decreasing the need for corticosteroid therapy in many patients. Practically half of the patients with hypereosinophilic syndrome can be tapered off corticosteroids. Dr. Roufosse tells of one of her first patients, whose life was changed by these therapies.   [24:04] Not every aspect of disease responds as well to these new therapies, revealing new unmet needs that are being tested with additional new therapies. Dr. Roufosse's first patient has been helped greatly with biologics for almost 20 years now.   [24:55] Dr. Roufosse speaks of more unmet treatment needs. Eosinophils are only a part of the picture. EoE is a complex disease about more than eosinophils. We need more understanding of what the key pathogenic events are across the range of eosinophil-related disorders to be able to identify new therapeutic targets.   [26:00] With clinical trials, it can be difficult to find suitable endpoints for the trial and define the efficacy of a new treatment. When is the disease still active with treatment? When can we start decreasing the intensity of treatment? How long do we have to treat with these drugs? Many of these questions are still completely unanswered.   [26:53] Over the past 25 years, the time to diagnosis has decreased. Dr. Roufosse rarely now has a patient referred to her that already has severe, irreversible damage.   [27:21] How to score disease activity is an area where we still have a lot of work to do.   [27:37] Medical codes are used to classify and group diseases for reporting statistical information. In the U.S., they are important for diagnostics and what treatments you get access to. In 2020, new codes (ICD-10) were approved for various subsets of eosinophilic diseases.   [28:09] ICD-10 codes are used less in Belgium than in the U.S. but a disease does not “exist” if it doesn't have a code. Without a code, there is no access to diagnostic tools or reimbursement for therapy for the disease. You need codes to justify hospitalization. C codes also allow Holly's patients to receive feeding therapy.   [30:43] To help patients and caregivers identify medical professionals offering care for eosinophil-associated diseases, APFED hosts a Specialist Finder on its website. It largely has clinicians in the U.S. You can access it at apfed.org/specialists. There is also a badge for specialists who are members of the International Eosinophil Society.   [31:10] Dr. Roufosse suggests having handouts for patients listing patient associations and places to find information on their disease. Some people are more comfortable with something tangible and physical. Not everyone uses Google! Doctors need to use different means to share information on how to access specialists.   [32:11] Policymakers are important in bringing together information to give access to proper care for these disorders.   [33:56] Dr. Roufosse discusses unmet needs in research. We understand so little about these diseases, although great progress has been made in understanding that the eosinophil is a toxic cell that can cause damage and if you target those eosinophils, you are going to prevent some of that damage. We don't yet have the full picture.   [34:32] Some unmet needs are understanding what part of each of these disorders is influenced genetically or combines genetics with environmental triggers. What cells initiate the inflammatory process? What cells and mediators maintain the process? Which mediators should we target? How do we do it without compromising immunity?   [35:12] It appears that targeting eosinophils in humans is innocuous, but what are they for? We are learning about what eosinophils are for in mice, but very little about what they're for in humans. Are normal eosinophils irreplaceable or are there redundant functions with other cells? Some patients have high eosinophils without any illness.   [35:46] Some patients have lower eosinophil counts than others and they have rapidly progressive cardiac damage. What characterizes a bad eosinophil? We don't have the tools to recognize that, yet. We can't predict which patients are going to require more aggressive therapy earlier in their disease course. That's very important to research.   [36:39] Dr. Roufosse recommends using the apfed.org website with its Specialist Finder and relevant patient resources. Awareness is the key to faster diagnosis, accessing treatment, and avoiding harmful treatment.   [37:35] Ryan and Holly thank Dr. Roufosse for being on the podcast. Ryan shares the links including apfed.org, apfed.org/specialists, and apfed.org/eos-connections links. Holly and Ryan thank APFED's education partners, linked below.   Publications discussed: Patient charter: Apfed.org/advocacy/ead-patient-charter/  Link.springer.com/article/10.1007/s12325-022-02110-8 Pubmed.ncbi.nlm.nih.gov/29672914/   Mentioned in This Episode: American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram CUB-Hôpital Erasme, Brussels Episode 18: “Transition of Care from Pediatric to Adult Providers, with Dr. Giresh Hiremath” Episode 15: “Access to Specialty Care for Eosinophilic Esophagitis (EoE) with Dr. Emily McGowan” “Improving Care in Eosinophil-Associated Diseases: A Charter” apfed.org/specialists Real Talk: Eosinophilic Diseases Podcast   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GlaxoSmithKline, Mead Johnson Nutrition, Sanofi, and Regeneron.   Tweetables:   “The International Eosinophil Society is a dynamic ... society whose main mission is to bring together clinicians, investigators, and researchers ... interested in eosinophils and eosinophilic disorders. ” — Florence Roufosse, MD, PhD   “Transitioning from pediatric to adult care is typically an unmet need in eosinophilic esophagitis, which very commonly begins in childhood.” — Florence Roufosse, MD, PhD    “The unmet need, in … diagnosis, is awareness. … There's a saying that what you don't know, you can't diagnose. … Many physicians don't know about these eosinophilic conditions. … Turn toward someone … who is more likely than you to know.” — Florence Roufosse, MD, PhD     Featured speaker: Florence Roufosse, MD, PhD Professor of Medicine, Internist, and Clinical Immunologist at CUB-Hôpital Erasme, Brussels, President, International Eosinophil Society   Dr. Florence Roufosse is a Professor of Medicine, Internist, and Clinical Immunologist at CUB-Hôpital Erasme, Brussels, and is President of the International Eosinophil Society. She is in charge of a specialized consultation dedicated to diagnosing and treating eosinophil-related conditions, that is integrated in the European Reference Network: EuroBloodNet. She also manages patients with systemic auto-immune and auto-inflammatory conditions.   Besides these clinical activities, Dr. Roufosse leads translational research projects to improve the understanding and treatment of lymphocytic variant hypereosinophilic syndrome (HES) and participates in international research efforts to better delineate disease course and treatment responses of HES. She is involved in the design and conduct of international clinical trials evaluating the efficacy of novel treatment options in patients with HES and eosinophilic granulomatosis with polyangiitis (EGPA), as well as sub-studies that aim to identify biomarkers and/or disease variants predicting treatment responses.

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist and feeding specialist living with EoE who serves on APFED's Health Sciences Advisory Council talk with guest Ashley Spencer, patient advocate, a young adult from Bristol, PA, living with Eosinophilic Granulomatosis with Polyangiitis (EGPA). In this episode, Ryan and Holly discuss with Ashley her history with EGPA, how she was diagnosed, and some things you can do to advocate for yourself and others if you are living with EGPA. She explains the chronic nature of the disease and the treatments that help her in the day-to-day management of EGPA.   You will appreciate Ashley's positive attitude and determination to improve the outcomes of people living with EGPA.   Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [0:50] Ryan welcomes co-host Holly Knotowicz. Holly introduces the topic: Eosinophilic Granulomatosis with Polyangiitis (EGPA) Today's episode features the perspective of a patient living with EGPA.   [1:52] Holly introduces Ashley Spencer, a young adult from Bristol, Pennsylvania, living with EGPA.   [2:03] Ashley thanks Holly and Ryan for having her on the podcast.   [2:19] Ashley says it is not a walk in the park living with EGPA. When Ashley was 16, she started displaying symptoms of EGPA. At the time, because of her age, doctors didn't associate her symptoms with anything other than severe asthma.   [2:45] Two years later Ashley developed sinus issues that required surgery. Every year she displayed more symptoms.   [3:03] Ashley says EGPA has three stages and early diagnosis can halt its progress.   [3:36] EGPA stands for Eosinophilic Granulomatosis with Polyangiitis. Eosinophils in the body are high, causing inflammation within the body including major organs.   [4:01] Ashley had exercise-induced asthma. She played sports and danced, but all of a sudden, it went from exercise-induced asthma to severe asthma. She was admitted to the hospital for it and needed continuous albuterol treatments. From age 16 until now, Ashley has not been able to get off steroids, which can cause severe issues.   [5:05] Ashley displayed sinusitis issues when she was 18. Within two years, she had four sinus surgeries in all eight of her sinus cavities for sinusitis and nasal polyps.   [5:26] The polyps were starting to show eosinophilia but not enough for a full diagnosis. Because Ashley was moving from adolescence to adulthood, she had to be transitioned from doctors at Children's Hospital Philadelphia to an adult doctor. Her family doctor told her she was getting worse. He sent her to National Jewish in Denver, Colorado.   [6:12] Ashley checked into National Jewish Health for two weeks. Every day she saw doctors and had testing. Ashley was diagnosed with Churg-Strauss Syndrome, which is now known as Eosinophilic Granulomatosis with Polyangiitis (EGPA).   [7:28] By the time Ashley got the diagnosis, she was in the last stage of EGPA, which is the vasculitic stage.    [8:09] A common misconception about EGPA is that it doesn't affect children and young adults. Another misconception is that EGPA patients may visually look healthy, similar to many autoimmune disease patients. EGPA affects the internal body.   [9:18] Ashley's lungs, sinuses, and her nervous system have been impacted. One morning she woke up and she was paralyzed from the waist down. This shut down her bladder function and she developed mononeuritis multiplex which caused severe peripheral neuropathy from her knees down.   [9:48] Ashley was hospitalized for three weeks and then went to a rehab to relearn how to walk. Ashley worked with her urologist to get a medical device to signal when she needs to use the bathroom.   [10:33] Ashley also has heart issues but if she stays on her daily maintenance medications, she does well.   [11:09] Ashley talks about specialists she sees: a pulmonary doctor, an ear, nose, and throat specialist, a women's healthcare team for bone health, a urologist, a neurologist, and an allergist and immunologist.   [12:18] A good day for Ashley would be if she got out of bed, took a shower, and went to school. A bad day would be not being able to get out of bed and just staying in bed all day and sleeping.   [13:17] Ashley and Holly discuss the “spoon theory.” You start the day with 10 spoons and each activity takes away one or more spoons. When your spoons are gone, you are done for the day. You don't have more to give.   [16:45] How you can help a friend with EGPA: Join a Facebook group for EGPA. Ashley shares a personal story of an online friend who became an in-life friend. She encourages listeners to explore Facebook groups related to eosinophilic diseases.   [18:31] It's hard for someonewith no experience with eosinophilic disorders to understand someone with EGPA.   [20:33] There are situations you can explain that help your friends not living with eosinophilic diseases to better understand you.   [21:41] Ashley has medication and a medical deviceto help her manage EGPA.   [22:47] Ashley shares how her care has changed over the last ten years. When she started at the Cleveland Clinic, she went on a biologic to improve lung function that changed her life. She was able to work out again. Her stamina increased. It also helped a little bit with her neuropathy.   [24:40] Ashley shares experiences with school and social activities with EGPA. She was in a college physical therapy program when her sinuses caused her to be admitted to the hospital. The doctors told her it was not feasible for her to continue to her senior year and she was heartbroken. She did not graduate or become a physical therapist.   [26:23] Ashley's career now is advocacy. She often speaks to new EGPA patients about the disease and treatment options. She also talks to allergy patients. Years ago, Ashley made national news by going into anaphylactic shock on a plane when flying to the Cleveland Clinic and a Cleveland Clinic doctor on the plane saved her life.   [27:38] Ashley's advice for traveling with EGPA is to wear medical identification jewelry.   [30:03] Ashley refers to those living with EGPA as vasculitis warriors. She always invites them to connect with others on social media  and to reach out if they need help.   [30:58] Ryan shares the online resources to help with the day-to-day management of EGPA at apfed.org and apfed.org/connections.   [31:28] Ryan and Holly thank Ashley for sharing her experience. Holly and Ryan thank APFED's education partners, as well, linked below.   Mentioned in This Episode: American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Episode 06: “Understanding and Managing Eosinophilic Granulomatosis with Polyangiitis (EGPA) with Dr. Peter Merkel” Peter A. Merkel, MD, MPH Children's Hospital of Philadelphia National Jewish Health-Denver Churg-Strauss Syndrome Mononeuritis multiplex The Spoon Theory EGPA Facebook Group Eosinophilic Disease Group on Facebook The Cleveland Clinic The Vasculitis Foundation @Apfedorg on Instagram Apfed.org/egpa Apfed.org/specialists Real Talk: Eosinophilic Diseases Podcast   This episode of APFED's podcast is brought to you thanks to the support of AstraZeneca, Bristol Myers Squibb, GlaxoSmithKline, Mead Johnson Nutrition, Sanofi, and Regeneron.   Tweetables:   “To be real with you, it's not a walk in the park living with EGPA, let alone being diagnosed with EGPA.” — Ashley   “When I was 16, I started displaying symptoms of EGPA. But at the time, because of my age, they didn't associate it with anything other than just severe asthma. And then, two years later, I developed the sinus issue.” — Ashley   “By the time I got the diagnosis, I was in the last stage [of EGPA], which is the vasculitic stage. So it was very sad.” — Ashley “It's not really seen in youth patients and young adults.” — Ashley

To obtain credit – Click Here For more information – Click Here…

Healer, Doctor, Grandpa…Oh My! (Tribute to Girl Like Me by Dove Cameron) * original written by: Edwyn Collins ** dedicated to the one and only, Dr. Paul Dautenhan! Thank you for saving my life, for making me a part of your family, and for being a wonderful doctor, friend, & confidant; this tune is for you ;) Lyrics: Healer Keeping me alive so I have a life That's worth, for, fighting Thank you for the family My favorite kiddos, he's been sharing Without him, I'd be six feet under Not joyfully babysitting Eosinophils monitored Not letting white blood cells attack My favorite Doctor Never been any competition His Grandsons growing up like skyscrapers Outgrow me before their first dance Ho ho ho Let me help Santa buy presents Yeah yeah Always respected his bedside manner and his diagnosis form Healer, Doctor, Grandpa, oh my Healer, Doctor, Grandpa, oh my The medical cases he's solved Won't take any credit for Healer, Doctor, Grandpa, oh my Healer, Doctor, Grandpa, so mighty Wholesome Raising his Grandsons to be gentlemen If not for him, I'd be long gone Paid my medical ransom No other Doctor has what he's got When other specialists give up, he solves cases with careful thought He inspires my music: fa la la la Eosinophils monitored Not letting white blood cells attack He's my favorite Doctor Never been any competition Grandsons growing up like skyscrapers Outgrow me before their first dance Ho ho ho Let me help Santa buy presents Yeah yeah Always respected his bedside manner and diagnosis form Healer, Doctor, Grandpa, oh my Healer, Doctor, Grandpa, oh my The medical cases he's solved He'll never take any credit for Healer, Doctor, Grandpa, oh my Healer, Doctor, Grandpa, so mighty He'll pull you up from death's grip Scares the grim reaper back to his door He'll share his teaching on family, medicine, and more Always respected bedside manner and diagnosis form Healer, Doctor, Grandpa, oh my Healer, Doctor, Grandpa, so mighty Healer, Doctor, Grandpa, oh my Healer, Doctor, Grandpa, oh my Healer, Doctor, Grandpa, oh my Healer, Doctor, Grandpa, so mighty End Tribute by Melissa Smith: - Melzy of Wonderland on Youtube - Mel's Music on Spreaker, Spotify, Apple Podcasts, JioSaavn, Castbox, Deezer, Podcast Addict, Google Podcasts, iHeartRadio, Podchaser, Facebook & - Melissa_Martinek_Smith on Instagram (AKA: MelsMusic)

KSQD 10-26-2022: Gene of the week: FOXO3 is important for longevity; States with conservatives policies have higher mortality statistics; Genes selected for survival during bubonic plague (the Black Death during Middle Ages) has increased risks for other diseases; Suppressing tumors before they are detectable by inhibiting blood vessel growth; Why are my eosinophils and bilirubin levels high? Patient diagnosed with intractable cervical radiculopathy may also have a cerebrospinal fluid leak

In this Buddisode, we sit down with Dr. Emilie Cosway from the Institute of Immunology and Immunotherapy at the University of Birmingham (UK) to discuss her recent paper about the mechanisms behind thymic regeneration.

In this episode of The Daily Dose with Dr. Greg, Doc jumps into various questions He's received on all of the social media platforms, including: Hashimoto's, Anxiety, Endometriosis, Crohn's, Type 1 Diabetes, Eosinophils, Liver & Ana, and Mold. Bringing together functional medicine, research, and over 20-plus years of clinical experience, Dr. Greg Mongeon seeks to create easier access to living your best life by treating the root cause. Look for new episodes of "The Daily Dose with Dr. Greg" every Wednesday! Available on all of your favorite podcast platforms (iTunes, Spotify, Google, YouTube, and more!). NOTE: For a limited time, Daily Dose with Dr. Greg listeners can receive 50% off + Free Shipping on their first Lifeboost Coffee order! Head to coffeewithdoc.com for 50% off your first order! Affiliates Doc Recommends: Therasage - (Doc's go-to "at home" personal sauna) - Receive 10% off when you use code "DRGREGHEALTH" at Therasage.com. AWG Bakery - (Podcast guest Hanna Lane's Gluten-Free Bread) - Receive 10% off your order on by using "DRGREG10" at AWGBakery.com. Have a question for Dr. Greg and Vitae Clinic? Reach out to us on social media! All links can be found in the show notes. Show Notes: Vitae Clinic - Website (www.vitaefm.com), Tiktok (tiktok.com/@drgreghealth), Facebook, Instagram Order "DV3" - https://shopdrgreg.com/products/dv3/ Order "Revitin" - https://shopdrgreg.com/products/revitin-natural-toothpaste-single-tube/ Become a Vitae Patient - Click this link or head to https://bit.ly/drgregpodcasteval Want to become a patient of Vitae Clinic? Click this link to set up an initial consultation! (*If you are unable to click the link, head to https://bit.ly/drgregpodcasteval) (*Please note that the consultation schedule availability varies from month to month. If you are having trouble booking, please call by phone during normal business hours)

Description: Co-hosts Ryan Piansky and Holly Knotowicz talk with guest Nicole Arva, MD, PhD, about genetics and eosinophilic colitis. Dr. Arva is a pediatric pathologist at Ann & Robert H. Lurie Children's Hospital of Chicago. She is also an Associate Professor in the Department of Pathology at Northwestern University Feinberg School of Medicine. She has been a part of more than 50 publications, many of which explore eosinophilic diseases, and recently co-authored a manuscript entitled “Genetics of Eosinophilic Colitis Revealed.” In this episode, Holly and Ryan discuss with Dr. Arva her recent and upcoming research. They cover the purposes of molecular testing and a new molecular study that concludes that EoC is a unique disease, with specific genetic characteristics that set it apart from other EGIDs, Crohn's disease, and IBD. Dr. Arva explains how that uniqueness was discovered, and what it means for therapeutic options for EoC. Listen in to learn about this innovative research. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [1:44] Holly shares the topic of this episode, genetics and eosinophilic colitis (EoC), and introduces today's guest, Dr. Nicole Arva. [1:51] Dr. Nicole Arva is a Pediatric Pathologist at Ann & Robert H. Lurie Children's Hospital of Chicago and an Associate Professor in the Department of Pathology at Northwestern University Feinberg School of Medicine. [2:37] Dr. Arva wanted to understand the mechanisms of diseases to be able to treat them more efficiently. She tells of her professional journey after medical school, studying cancer and leukemia cell lines. She continued her medical training in pathology, specializing in pediatric pathology. [3:15] Dr. Arva's work involves assessing laboratory slides from pediatric tissue samples to establish a diagnosis.  [4:05] Dr. Arva explains molecular testing. An increasing number of diseases are found to have genetic abnormalities. Molecular testing can help lead to an accurate diagnosis. Dr. Arva describes getting a tumor diagnosis from molecular testing showing specific chromosomal translocations in correlation with microscopic examination. [5:23] By performing molecular testing, we can discover gene alterations that can help guide the development of new therapies. Molecular testing can uncover genes that can be targeted. [5:51] Genetic analysis can also provide insight into how a disease develops and shed light on the pathways that are involved. [6:35] Dr. Arva describes EoC. EoC affects the large bowel. Eosinophils cause inflammation in the colon. Patients usually have abdominal pain, diarrhea, which can be bloody, and fluid in the abdominal cavity. Patients can become malnourished. They may develop a bowel obstruction or perforation. [7:25] Studies have been performed on Eosinophilic Gastrointestinal Disorders (EGIDs) and Inflammatory Bowel Disease (IBD). But EoC is a poorly understood condition. When Dr. Arva and her colleagues started their study, they didn't know whether EoC should be considered to be within the spectrum of EGIDs or as an IBD. [8:03] The research team was looking to determine where EoC belongs because that would affect the way patients would be treated. Although EoC is similar to other EGIDs because eosinophils drive the inflammation,, EoC has a lower incidence than EGIDs, more severe symptoms, and co-morbidities. [8:38] EoC is similar to IBDs in that it is an inflammation of the large bowel, but a different type of cell is predominantly involved in IBD (neutrophil) with some eosinophils present.  [9:38] The diagnosis of EoC is challenging. Other, more common conditions can cause colonic eosinophilic inflammation.  When pathologists encounter eosinophilia in the large bowel, they have to think of other medical conditions that can cause that. A diagnosis of EoC is established only after other causes of gastrointestinal eosinophilia have been ruled out. [10:14] IBD, intestinal parasites, autoimmune or connective tissue disorders, and vasculitis can all mimic EoC. Certain medicines can induce eosinophilia. Eosinophils are normally found in the large bowel. [10:51] Pathologists have to establish eosinophil count values for each segment of the large bowel to best evaluate colonic biopsy; everybody needs to follow the standards when diagnosing EoC. [11:42] Patients suspected to have EoC may undergo lab testing, imaging, and colonoscopy to reach a diagnosis. The findings may vary, depending on which section of the bowel wall is infiltrated by eosinophils. [13:02] A biopsy may reveal an increased number of eosinophils. All these test results have to be combined to reach a diagnosis of EoC. [13:27] The focus of the study was performing molecular testing that was very helpful in diagnosing EoC. They found that nearly 1,000 genes were differentially expressed in EoC compared to normal participants or Crohn's disease subjects.  [14:30]  They found differences in gene expression between EoC and other types of EGIDs, such as eosinophilic esophagitis or gastritis. [15:02] The main chemotactic factor in EoC seems to be CCL11 (Eotaxin-1). CCL11 is a molecule that attracts eosinophils in the tissue. In eosinophilic esophagitis or gastritis, the main chemotactic factor appears to be CCL26 (Eotaxin-3). All these findings support the idea that EoC is a distinct entity, which is different from other EGIDs and IBD. [15:37] EoC seems to be driven by a mechanism that does not involve an allergic inflammation. The therapeutic strategy may be much different now that we have a better understanding of EoC. [16:23] Eosinophilic esophagitis has been shown to run in families and it would be beneficial to test family members with a blood test, allergy testing, or endoscopy if they develop symptoms. As eosinophilic colitis has a different epigenetic mechanism, it is not clear that the same testing is needed for EoC patients or family members. [17:26] Besides endoscopies and colonoscopies, blood tests looking for high IgE levels, allergy testing, and CT can be useful in testing for various eosinophilic disorders. [21:07] Dr. Arva explains how many eosinophils are seen in a high-power field of a slide from a colon biopsy to diagnose EoC. They established a normal count of eosinophils for the segment of the colon and the abnormal count would be twice the normal count. [22:20] Now that a different pathogenic mechanism has been discovered for EoC than for EGIDs and IBD, new treatments can be explored or developed. We are just beginning the research. CLC protein (galectin-10) is upregulated in EoC and may be a target for treatment development. Antibodies may be effective for relieving EoC inflammation. [23:34] It is challenging to treat EoC because the newly-discovered pathogenic mechanism shows that EoC is unlikely to be allergic in nature, making elimination diets and steroid treatments ineffective. New therapies will be required. [24:05] All EGIDs can have a significant impact on quality of life. People with EoC can develop serious complications, such as dehydration, malnutrition, intestinal strictures, and bowel obstruction. [25:04] Dr. Arva considers the difficulties pathologists face in analyzing eosinophilic diseases. There are few patients with EoC. Dr. Arva describes additional challenges. [26:25] Dr. Arva looks ahead. Most of her research goes in the direction of pediatric gastroenterology. She is working with a clinical colleague, Dr. Josh Weschler, to analyze the role of mast cells in EGIDs. They are finding that eosinophils are not the only offenders in EGIDs and are looking to establish a cohort of EGID patients to study. [27:43] Holly thanks Dr. Arva for taking the time to talk with us today. [27:51] Dr. Arva says we are just at the beginning of understanding the etiology of EoC. This study had a small sample size and the results will have to be validated with larger cohorts of patients. The analyses were performed on whole biopsies that contained all types of cells. Future studies using single-cell preparations will be important. [28:55] Ryan invites listeners to look at apfed.org/eoc to learn more about EoC. Ryan also encourages you to connect with the APFED online community at apfed.org/connections. [29:25] Dr. Arva thanks Ryan and Holly for having her on the podcast. She is grateful for the opportunity to research EGIDs and benefit patients suffering from these conditions.   Mentioned in This Episode: American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Nicole Arva, MD, PhD Ann & Robert H. Lurie Children's Hospital of Chicago® Department of Pathology at Northwestern University “Genetics of Eosinophilic Colitis Revealed” Apfed.org/eoc APFED Eos Connections Online Community Real Talk: Eosinophilic Diseases Podcast APFED Podcast Episode Featuring Holly Knotowicz Tetsuo Shoda Joshua B Wechsler   This episode is brought to you thanks to the support of our Education Partners Abbott, Bristol Myers Squibb, GlaxoSmithKline, Mead Johnson Nutrition, Sanofi, and Regeneron.   Tweetables: “I have always wanted to better understand the mechanisms of diseases because I considered that if we know how an illness occurs, we can treat that entity more efficiently.” — Dr. Nicole Arva “As testing increases, more and more diseases are found to have recurrent genetic abnormalities. … Molecular testing can help the pathologist to render the correct diagnosis.” — Dr. Nicole Arva “There are similarities and dissimilarities between EoC and other EGIDs and IBD.” — Dr. Nicole Arva “Findings support the idea that EoC … seems to be driven by a mechanism that does not involve an allergic inflammation.” — Dr. Nicole Arva

Eosinophils are part of a complex set of allergic mechanisms in eosinophilic asthma. But eosinophils are far from the only component or driver of disease. Here to share key insights on the role of eosinophils along with genetic and environmental factors in the pathophysiology of eosinophilic asthma is pulmonary and critical care physician Dr. Praveen Akuthota.

When your blood results are “normal” what does that really mean given that the average person is overweight, sick and expected to die of one of the diseases of civilisations? This is why if you don't feel well then you might need to take things into your own hands by learning how to read your bloods and identify autoimmune signs before you're too far down the rabbit hole.On this episode we reveal:Why most doctors miss the signs of autoimmune diseaseThe 4 steps to begin recovering from autoimmune diseaseHow to read your own blood work and supplementing vitamin D***Join the Busy Mum's Facebook Group here: https://mattylansdown.com/BusyMothersFBgroup ***SOCIAL MEDIA--DR. KYLIE BURTONWebsite: https://drkylieburton.com/InstagramTiktok--MATTY LANSDOWNJoin the Busy Mum's Facebook Group: >>HERE

Eosinophil-related diseases are a relatively recent discovery in the medical field, and patient advocacy in this area has an even shorter history. In this episode, host Ryan Piansky, guest host Beth Allen, and world-renowned expert Dr. Gerald Gleich discuss eosinophils, the evolution of patient advocacy, and progress within this field.   Dr. Gerald Gleich is a Professor of Dermatology and Medicine at the University of Utah and has had a lifelong professional commitment to understanding eosinophils. During his tenure, he established a research laboratory for allergic diseases at the Mayo Clinic and Foundation where he was a professor of medicine and immunology. He has contributed to more than 600 scientific articles and is a member of APFED's Board of Directors.   Co-host Beth Allen is the parent of a child who was diagnosed with eosinophilic gastrointestinal disease at a time when very little information about these conditions were available. She co-founded APFED in 2001 and is now serving as Senior Director of Strategic Sales at EvoEndo, which develops systems that enable unsedated endoscopic procedures.   In this episode, Dr. Gleich shares more about what sparked his interest in researching eosinophils and how he has contributed to various related research studies. He sheds light on his discovery of Gleich syndrome, some of the studies that have contributed to a better understanding of eosinophilic conditions and their treatment, and his hopes for further research in this area. Beth Allen also talks about the history of APFED and patient advocacy in relation to eosinophil-associated diseases, and how patients have contributed to research. Tune in to find out more.   Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [1:08] Ryan introduces his co-host for this episode, Beth Allen. [2:47] Ryan introduces the guest for this episode — Dr. Gerald Gleich. [3:15] As a specialist in dermatology, how did Dr. Gleich get interested in researching eosinophils and related diseases? [6:34] Where did Dr. Gleich's research begin and how did his initial research play out? [9:08] At what point did Dr. Gleich start seeing other eosinophilic cases or associated disorders? [12:12] Dr. Gleich shares more about why eosinophils are named as such. [16:21] Dr. Gleich discovered an eosinophil-associated disease called Gleich syndrome. How did he discover this condition? [22:03] What did patient advocacy look like 20 years ago? Beth Allen shares how APFED got started and what things were like in the early days. [31:03] How did Dr. Gleich get involved with APFED? [34:08] Dr. Gleich shares a little about some of the studies that have been done around granule proteins and eosinophils. [39:45] Dr. Gleich shares an anecdote of a patient who had a child while on eosinophil suppressing treatment. [42:24] Despite advances being made in research in this area, there is still a lot that we don't know and a lot more to learn. Patients have a huge role to play in contributing to research about eosinophils. [46:43] What are Dr. Gleich's biggest hopes for research in the field of eosinophil-associated diseases going forward? [52:32] What is Dr. Gleich currently working on? [54:08] Dr. Gleich reflects on the importance of being ready and prepared for things we may not predict or expect in the future.   Mentioned in This Episode: American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Dr. Gerald Gleich 2021 EOS Connection Patient Education Conference EOS Connections Online Community   This episode is brought to you thanks to the support of our Education Partners: GlaxoSmithKline.   Tweetables: “The eosinophil has its roots in Greek mythology, in German chemistry, and then in the wonderful insights that Ehrlich had to apply these dyes to tissues.” - Dr. Gleich   “The drive to discover the syndrome was really a matter of necessity.” - Dr. Gleich   “Advocacy in this community actually started with just trying to bring together education in a more uniform way [and] finding other avenues of support between us.” - Beth Allen   “The amount of support that came back from the simple asks that we had was surprising.” - Beth Allen

The immune system has been all the rage over the past year and half!  So we figured not would be a good time to do a bit of a deep dive!  Today we're going to cover who the major players are in the immune system.  Then, we're going to give you some of our favorite immune system-boosting foods, nutrients, and other actionable steps you can take to keep your immune system in tip-top shape! Don't forget!  Get 40% your first order of Life Boost Coffee by using promo code “AOE40” at lifeboostcoffee.com at checkout! Use this link to streamline the process: https://lifeboostcoffee.com/pages/healthy-coffee-ot2e-jhopkins?oid=1&affid=49Experience the lasting joy of cooking with Xtrema® 100% Pure Ceramic Cookware. Xtrema® redefines the cooking process by combining unparalleled versatility with the peace of mind, knowing that every piece of cookware will never leach chemicals, metal, cadmium, lead, or change the taste of your food.  Get 10% off Xtrema cookware using our code ARTOFEATING at checkout!With Culiraw, guilt-free desserts are possible!  They are made of natural organic ingredients that provide your body with fiber, minerals, vitamins and enzymes, sweetened with dates and agave only.  Use code is “aoepodcast” for 10% discount at checkout!Subscribe to Dr. Esposito's YouTube Channel: https://www.youtube.com/channel/UCHRpZFrFsbJIk5fbNIkj4pQ?sub_confirmation=1 Sign up for our newsletter at evokhealth.com and get our 14 Kick-start Recipes & Kitchen Secrets! Feel free to reach out to us at artofeatingpodcast@gmail.com.  You can also follow us on Instagram @artofeatingpodcast.   To reach your hosts, you can find Dr. Esposito at:Email: drvincentesposito@gmail.comIG: @drvincentespositoTikTok: @drvincentesposito Web: insideouthealthwellness.com You can find Dr. Kali at:Web: drkali.com   IG: @dr.kalind 

On this episode the Curious Clinicians investigate why corticosteroids often cause blood eosinophil counts to drop so quickly and dramatically.  Check out the show notes on our website.  Don't forget to pick up your CME/MOC credits, courtesy of VCU Health! Sound editing by Nodderly. 

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/severe-asthma-how-eosinophils-impact-evaluation-treatment Overview:  Did you know that approximately two-thirds of adults with severe asthma are eosinophilic? The presence of eosinophilia can have implications for asthma management as well. Join Dr. Nicola Hanania, pulmonologist and asthma expert, as he reviews the case of a patient with severe asthma and discusses how primary care clinicians can identify eosinophilia, using common biomarkers, and improve outcomes in patients with eosinophilic asthma. Guest: Nicola Hanania, MD, MS, FACP, FCCP, FRCPC

Eosinophils are a type of white blood cell that play a role in immune responses and help fight off infections. When these cells build up and cause inflammation in the digestive system, tissues, organs, and/or bloodstream, without a known cause, it may be the result of an eosinophil-associated disease. Join the American Partnership for Eosinophilic Disorders (APFED) for a series of conversations with researchers, clinicians, patients, and other community members as we discuss practical strategies for disease management and treatments, research, and other topics of interest.

This episode covers eosinophils!

Thanks 4 Saving My Life! (Parody of Monsters by All Time Low, featuring Demi Lovato & blackbear)Original written by: Alex Gaskarth, Andrew Goldstein, Demi Lovato, Jack Barakat, Kevin Fisher, & Matthew MustoThis song is dedicated to Mepolizumab/ Nucala(the research medication that continually saves my life), to the Mayo Clinic (for caring for me for all of these years), and to my wonderful friends and family, who have traveled with me through hell and back to keep me on this planet!!! I love you all!!!!P.S. Also, thank you to gastroenterologists Dr. Kane and Dr Bi for giving me the guts to make my music! Lyrics:Kind, thank you for saving me, GlaxoSmithKlineThank you, Kay Bachman,Keeping tracking every timeThank you for MepoWithout it, I would dieThanks for saving my lifeDecembers in Rochester, In Marriott hotels:Only with the best peopleFamily and friends, They’re more than swellMab’ explosions quickly changin’My body’s internal chemistry.I know my eosinophils are finally listenin’With a normal CBC!I’m thankin’ them, kind,Thank you for saving me, GlaxoSmithKlineThank you, Kay BachmanKeeping track every timeThank you for Mepo,Without it, I would have diedThanks 4 saving my lifeKind, thank you to Ryan, Adam, & Sam for the Mayo drivesMom, Dad, & Dan,You guys saved my lifeWithout you, I definitely would have diedThanks 4 saving my life!I’m indebted to the way you helped,From soothing words, to ice creamDriving from Rochester to Tulsa,Back and forth, can be exhausting You just bear my burdens sweetlyCause you’re all so truly lovingCharlton, Damon, Mayo, Gonda, and Hilton when I’m dyingKnow, you inspire my rhymes You create my dreamsClaire, Julia, and Svetlana Never gave up on meThank you Dr. Pardanani, Weiler, & Dr. Pongdee To Dr Paul, to Dr. Paul, Miles, & OliverI’m thankin’ them, kindThank you for saving me, GlaxoSmithKlineThank you, Colleen, for scheduling every timeThank you for MepoWithout it, I would have diedThanks 4 saving my lifeKind, thank you to Ryan, Adam, & Sam for the Mayo drivesMom, Dad, and Connie,You guys saved my lifeWithout you, I definitely would have diedThanks 4 saving my life!Valley of the shadow of death still don’t have my head.God’s love enraptured me instead Without Him, I definitely would have died Thanks 4 saving my life!Rad, thank you to Josh Jones and his sis MegsThank you to my Uncle Ray and to my Aunt BethMark, Steve, & Michael Without you, I definitely would have diedThanks 4 saving my life!I’m thankin’ them, kind,Thank you for saving me, GlaxoSmithKlineThank you to Colleen for scheduling every timeThank you for Mepo,Without it, I would have diedThanks 4 saving my life!Kind, thank you to Ryan, Adam, & Sam for the Mayo drivesDean, Dan, and BrettYou guys saved my life!Without you, I definitely would have died,Thanks 4 saving my lifeGrandma Kate, that’s rightThanks 4 saving my life!Amy Novander, that’s rightThanks 4 saving my life!Written by: Melissa Smith (AKA Melzy of Wonderland on Youtube, & Mel’s Music on Spreaker, Spotify, Apple Podcasts, JioSaavn, Castbox, Deezer, Podcast Addict, Google Podcasts, iHeartRadio, Podchaser, & Facebook)

Eosinophilic granuloma complex (EGC) is a unique clinical presentation in allergic cats. There are three clinical presentations of EGC and a cat can exhibit just one or all three! Can you name them? Listen to this week's episode to dabble in a little feline dermatology!

Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track! Check out today's questions:  Korindi: My 15 year old daughter who has Down Syndrome was recently diagnosed with Hashimotos Encephalitis. She has had some major mental behavior changes. Before the world shut down she was a happy high functioning freshman and was even on the cheer squad. I have fought hard for a diagnosis knowing this was not DS related and something more was going on. Is there one test that you recommend more than the other to order for her? Also what supplements are best to lower the inflammation on her brain. I have an appointment for a endocrinologist and a rheumatologist. Is there anything else you would recommend? I need my daughter back. TIA Paula: Hi Dr Cabral, I am a level 2 student and am really enjoying all the material. I travel to Brazil quite often because my family lives over there and I'm getting a bit concerned about getting infected with parasites or H. pylori... I have a few questions that I hope you don't mind answering:1. When eating out over there, I'm pretty sure they make ice out of tap water and not mineral water. Should I be worried or does the freezing process kill parasites/H.pylori?2. How would I know if I get infected with H. pylori/parasites? Would I experience some sort of diarrhoea/stomach pain or not necessarily?3. Any tips to reduce my risk of getting infected? Any supplements?Thank you so much! Mo: Hi Dr Cabral! Hope all is well. Today I have a question about my fathers blood work. His monocytes came back at a 0.4, Eosinophils at 0.2 and Basophils at 0.0, Neutrophils 2.2, Lymphocytes 1.6. He's 56, did the 21 day Dr Cabral Detox, Heavy Metal Detox, Intestinal Cleanse 2x, and is finishing up the CBO right now. He will also be doing the Mold Protocol soon after. Hes taking all EQ brand: Adrenal soothe at night and Adrenal Energy in the morning, Omega 3, D3, Full Spectrum Magnesium,Balanced Zinc,FullSpec C. Hes slowly coming off hormone therapy so he'll be taking natural supplements to boost his test levels. His diet is exactly what you recommend. Hes lost 20KG since starting these protocols (he had a terrible diet before) and he feels great. Also, his Potassium level is 5.3. I'm just hoping for some insight as to whether these numbers are okay being this low/high or if he should do anything about it. Thank you as always, you are the best! Anonymous: Hi Dr Cabral!I’m in my middle 20’s and I have a goal in mind to become a Functional Medicine doctor.I live in Europe so my only option is to going for the MD degree.I need your help with the details to put my mind at ease.How does it work with residency if you already know you want to practice functional medicine / integrative medicine?First it will be 5-6 years in med school, but what happens after that? Could I study FM after that and then open my practice or should I pick up a conventional residency first? And if, which one is most in line with FM?Sorry if the question isn’t that clear but I hope you get the point.You could answer the question in the way that if you where in my shoes, how would you be doing it if you know all what you know today (which is a lot, lol).I hope that you, your team and family has a wonderful day.God bless you! Olivia: Hello,I was wondering if you could let me know what courses/certifications I would need to complete in order to be considered as a potential candidate to be one of Dr Cabral's coaches? I have a very similar story (health derailed by long-term antibiotic use as a teenager, followed by long-term SSRI use). I've been on a personal journey of discovery for 25 years and have learned a great deal. Although I am a qualified personal trainer and yoga instructor, my knowledge includes aspects of Chinese medicine and acupuncture, and I am passionate about biochemistry, in particular endocrinology. I would very much appreciate some guidance on how best to optimise my knowledge, so that I can serve others under the leadership of a physician such as Dr Cabral. Healing myself and helping others understand their bodies in order to optimise health is my calling.Thank you in advance for your time.Best wishes, Olivia Erin: Hi Dr Cabral! I’m a longtime fan of yours. I learn so much from you and my family knows of you as “my mentor” :). I went to see if your virus protocol is available but saw it was taken down. Ugh!! I can’t take the censoring anymore :/ are you making this available through email ? Thanks for all you do! Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community’s questions!  - - - Show Notes & Resources: http://StephenCabral.com/1744 - - - Get Your Question Answered: http://StephenCabral.com/askcabral   - - - Dr. Cabral's New Book, The Rain Barrel Effect https://amzn.to/2H0W7Ge - - - Join the Community & Get Your Questions Answered: http://CabralSupportGroup.com - - -  Dr. Cabral’s Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Stress, Sleep & Hormones Test (Run your adrenal & hormone levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - > View all Functional Medicine lab tests (View all Functional Medicine lab tests you can do right at home for you and your family!)

Fast-Tracking a CoV-19 Vaccine: Why Should We Worry? Richard Gale and Gary Null PhD Progressive Radio Network, May 21, 2020   The CoV-19 pandemic is now exposing the hidden agendas and motives of the powers that be in government, in the pharmaceutical industry and Wall Street, and in the media. Despairingly opponents of vaccine mandates are largely divided. Many Trump supporters in the so-called anti-vaccination community believed he would be their savior to protect vaccine exemptions and avert compulsory mandates. Nevertheless, during his watch draconian mandate laws to ban religious exemption for children to attend public schools have been signed by the governors of California and New York. Throughout the CoV-19 pandemic, Trump has waffled wildly, jumping on and off the vaccine band wagon depending upon his daily whims. Early he stated there was no need for a vaccine since the virus would magically disappear and no longer be a threat. It was his gut feeling and not surprisingly he was wrong. Yet during a press conference on March 14th, Trump announced the unveiling of his Operation Warp Speed agenda to accelerate development of a CoV-19 vaccine and have it ready this year. Trump is now fully on board with the pro-vaccination agenda. Moreover, he ordered that the military will be "mobilized so at the end of the year, we're going to be able to give it to a lot people very, very rapidly."  His newly appointed Warp Speed advisor is a venture capitalist and a former chairman of GlaxoSmithKline's vaccine division, Moncel Slaoui. Often in order to understand Trump's strategies, follow the money trail, especially if the money trails leads to sealing loyalty to the president. However, his probable immediate motivation is for reelection and to increase the profits of pharmaceutical and investor profiles as repayment for those loyalties.  We can therefore reasonably expect, despite what has already been stated, that Trump may nationally mandate a CoV-19 vaccine. There are voices in Trump's camp who favor mandates. One of Trump's leading attorneys is Harvard law professor Alan Dershowitz who recently went on record saying, "Let me put it very clearly, you have no constitutional right to endanger the public and spread disease.... You have no right not to be vaccinated, you have no right not to wear a mask, you have no right to open up your business.... if you refuse to be vaccinated, the state has the power to literally take you to a doctor's office and plunge a needle into your arm." What might be the downside if a vaccine pushed on the public en masse is discovered to not work or is found unsafe in the long-term? Worse, what might be the consequences of a flawed vaccine that becomes mandated and required as policy to attend schools, work or even to leave the home to shop? We might be faced with an epidemic of vaccine-related illnesses and death on a scale that could dwarf the current CoV-19 pandemic. There would be a greater rationale to push forward a fast-tracked vaccine if the private vaccine manufacturers were held legally liable for vaccine-related injuries and deaths. However, this was laid to rest by the Reagan administration after the passage of the Vaccine Injury Compensation Act in 1986, which freed the pharmaceutical industry from personal injury lawsuits. Consequently, there is no incentive whatsoever for the vaccine industry to perform thorough due diligence analyses and reviews and to adopt gold standard scientific measures to create a safe and effective vaccine. In effect, they have free rein to develop vaccines according to their own rules. According to German oncologist Claus Kohnlein, we may well be in the era of "virus mania."  The prevailing medical establishment has become dominated by a rapidly expanding private industry obsessed with viruses and the invention of pandemics for enormous profit. This obsession has hijacked not only medical practice and legislators who are determined to mandate vaccination, but has also infiltrated the entire mainstream media. This is despite consensual confirmatory evidence that some of these viruses may not be dangerous enough to warrant a vaccine nor demand mass screening to monitor potential infection.  For example, University of Toronto professor emeritus of pathology, Dr. Etienne de Harven would have us ask: do molecular markers for retroviruses truly confirm the presence of a virus, or is this a human invention that substitutes the absence of identifiable viral proteins and particles? Embedded in all of the confusion over CoV-19 and the heated debates and uncertainty over life returning to normal, the mainstream chorus chants that stability will only resume after a vaccine is launched on the public. At this moment, Kohnlein's 2007 book Virus Mania: Avian Flu, Cervical Cancer, SARS, BSE, Hepatitis C, AIDS, Polio is essential reading to expose the life-threatening failures in modern medical science's efforts to tackle viral threats. And what Kohnlein outlines is being repeated again with CoV-19. The need for a vaccine in order for society and the economy to return to normal was clearly stated by Trump's Federal Reserve Chairman Jerome Powell. ".. for the economy to fully recover," he stated, "that may have to await the arrival of a vaccine." Unfortunately, besides the White House and nation being impatient and placing high hopes in a vaccine, we are also witnessing a careless zeal to cut regulatory corners. And this atmosphere could potentially end in a serious medical disaster on the not-too-distant horizon.  Virus mania is morphing into vaccine mania. That vaccine mania has become a reality is evidenced in the 133 vaccines currently in development worldwide targeted against CoV-19 according to the Milken Institute. Many challenges must be recognized and surmounted before an effective CoV-19 vaccine can be deemed safe..  The virus has already been shown to mutate rapidly despite beliefs that its RNA is stable. .Mutations of course naturally occur when a virus changes hosts, especially after jumping species. However, RNA viruses mutate more readily than larger DNA viruses such as herpes, HPV and smallpox.  University of Cambridge has identified three separate mutations since the Wuhan outbreak. Last month Los Alamos National Laboratory reported a recent mutation that is more contagious and transmittable than the original Wuhan strain.  Another strain was identified in India; the South China Morning Post reported that this Indian strain is being viewed as more virulent for the development of severe acute respiratory syndrome. The researchers from National Changhua University in Taiwan and Murdoch University in Australia warned that it "means current vaccine development against Sars-CoV-2 is at risk of becoming futile." The problem with mutations, similar to the challenges to create a universal flu vaccine, is whether or not any CoV-19 vaccine would generate sufficient immunity to combat future mutant strains and whether this is a cross-over of multi-strain immunity. Furthermore, some reports indicate that natural CoV-19 immunity may wane quickly.  This is an additional caution about any promises that a fast-tracked and poorly evaluated vaccine, which will bypass a rigorous regulatory review, will provide much if any long-term immunity. In a preliminary study, Columbia University researchers identified people who were reinfected with the same coronavirus strain within a single year. Twelve individuals tested positive two or three times for the same strain within 18 months.  Similar findings were noted in South Korea. The Columbia scientists' conclusion is that coronavirus "immunity seems to wane quickly."  Dr. Matthew Frieman at the University of Maryland is an expert in coronaviruses.  He states that "we get coronaviruses every winter even though we're seroconverted..... We really don't understand whether it is a change in the virus over time [ie., mutations] or antibodies that don't protect from infection." The consequences are that proposals for issuing immunity certificates or passports would be utterly futile, an extraordinary waste of funding and that would accomplish little. Since 2003 efforts have been made to develop coronavirus vaccines following the first SARS outbreak in China. All of these efforts failed either because of a lack in funding or because of observable serious adverse effects that necessitated the project to cease. To our knowledge, none of these efforts reached human trials because of serious adverse effects in animal trials. However, now we are witnessing one company Moderna bypassing animal studies with its new CoV vaccine and commencing with human trials. The company has already reported that its experimental vaccine showed signs of being "safe and provoked a strong immune response" in a first phase clinical trial; the vaccine was administered to a very small number of human participants (N=45) to determine safety and to measure the levels of volunteers' immune response. Just over half of the participants had recognizable antibodies, but these were "binding antibodies." What is critical for protection is neutralizing antibodies; and on this account only 4 of the 45 participants were actually "analyzed" to show promising neutralizing antibody results. Nor did Moderna report any T-cell activity, essential for fighting the virus. In other words, Moderna's premature reports are negligible for guaranteeing an effective and safe CoV-19 vaccine. We should remember this is only a first phase trial. The vaccine has a ways to go before it can be ruled effective. "If you look at vaccine development," stated Dr. Daniel Salmon, Director of Johns Hopkins' Institute for Vaccine Safety, "[there are] lots of vaccines that look good out of phase one that don't turn out to be good products." Prof. Michel Chossudovsky, a professor emeritus at the University of Ottawa, has documented NIAID's Dr. Anthony Fauci's support of Moderna's vaccine, and. according to Bobby Kennedy, Faico waved the needs for the company to test the vaccine in ferrets and primates and instead proceed directly into larger human trials. Both Moderna's and its German competitor CureVac's CoV-19 vaccine rely on mRNA technology, which carry strands of mRNA that encode CoV-19-specific proteins intended to stimulate the immune system to produce antibodies. Bill Gates says he is "particularly excited by two new approaches that some of the candidates are taking: RNA and DNA vaccines." But modern medicine has no practical experience with such vaccines being given to entire populations; therefore, there is absolutely no past history to monitor potential long-term risks, such as whether an engineered genetic code of a viral antigen will recombine adversely with the body's own DNA and trigger other life-threatening injuries we have to be aware of. Despite the hype over Moderna's apparent success and a huge 39 percent rise in its stock price, a recent article in Nature warns us not to pop the Champaign corks yet. Moderna's data remains unpublished and many scientists worry the results may be "murky." It is worrisome that the company would make such an announcement before any data is made available for independent review. Seemingly this was solely for financial reasons; Moderna's premature claims were rewarded with a $1.3 million stock offering to bankroll its vaccine. Trump is also throwing his weight behind Moderna's vaccine: it is manufactured in the US, funded by the government, and Warp Speed advisor Slaoui sits on the board of the Lonza Group that is collaborating with Moderna. One caveat is that Moderna has never brought a vaccine nor a therapeutic product to the market and is therefore largely inexperienced. There is also no public release of consent forms that the trial participants are required to sign. And no indication of how much volunteers were paid. Are they being compensated with inordinate amounts beyond the industry's standards to accept high risk? None of this information has been provided. The Nature article also quotes Baylor University vaccine scientist and coronavirus expert Dr. Peter Hotez's response to Moderna's announcement, "I'm not convinced that this is really a positive result."  The article notes that "... most people who have recovered from COVID-19 without hospitalization did not produce high levels of ‘neutralizing antibodies', which block the virus from infecting cells. Moderna measured these potent antibodies in eight participants and found their levels to be similar to those of recovered patients." The most promising vaccine, Hotez believes, is being developed by Sinovac Biotech in China, but it requires three separate inoculations. Sinovac's vaccine after being administered to rhesus monkeys showed no presence of the virus found in the throats, lungs or rectums of the primates. Another vaccine being developed at Oxford University protected monkeys (only six in the trial) from pneumonia but the primates;' nasal passages contained as much of the virus as those unvaccinated. In other words, all vaccinated monkeys became infected. In addition, the antibody titers were extremely low, which suggests the animals may not be fully protected. Nevertheless, Oxford is interpreting these weak results as a success and will also push forward with recruiting participants for a large human trial. This sets a very disturbing precedent that will likely be imitated by other vaccine companies either now or during a future infectious pandemic.  Still other vaccines in development are entirely experimental and have no predecessor on the market. Noroavx has created a recombinant nanoparticle vaccine -- an artificially engineered fake replica of the actual virus. Since there is no vaccine on the current CDC schedule utilizing this technology, we have no idea of its long-term safety.  So what do earlier efforts at developing a coronovirus vaccine tell us? In 2012, a vaccine being developed by the University of Texas at Galveston and Baylor University observed pulmonary immunopathology in an animal study with mice. The researchers proposed the vaccine's pathology may be attributed to an adverse cytokine response, an observation a large number of physicians and researchers have made with persons severely affected with CoV-19.  A later vaccine effort in 2016 by the same institutions targeted the MERS coronavirus strain and observed lung immunopathology similar to infection with the wild virus. A year earlier, another vaccine effort led by the University of North Carolina's Vaccine Institute noted an increase in eosinophilic proinflammatory pulmonary responses in a mouse model. Eosinophils are a type of white blood cell that are associated with infections, allergies and cancers. However, an abnormal increase in eos, a condition called eosinophilia, can result in nasal allergies and even cancer. This raises a question whether the North Carolina vaccine could have potentially contributed to lung cancer? The vaccine was also shown to provide poor protection from infection both in the adjuvant and non-adjuvant vaccines. A later 2018 SARS vaccine trial with rhesus macaques conducted at Wuhan University led to antibody-dependent vaccine induced infections. The project was supposedly discontinued. Another SARS vaccine trial with ferrets led by researchers at the University of Manitoba observed a promising neutralizing antibody response; however there severe inflammatory responses were observed in the animals' livers. The scientists concluded that the vaccine was "associated with enhanced hepatitis." That vaccine project too seems to have been shelved. Japanese scientists in 2008 developed a SARS vaccine that utilized a recombinant vaccinia virus that expressed the SARS spike protein. Immunized mice exhibited increased infiltration of esoinophils in the lungs, a thickening of the alveolar epithelium, an uptake in cytokines contributing to abnormal inflammatory storms, and aggravated severe pneumonia. Clearly, the past history to develop a coronavirus vaccine is not encouraging. Jennifer Sun, a molecular biologist at Princeton, warns that due to past coronavirus vaccine failures, the CoV-19 signatures need to be fully evaluated before any human trials commence in order "to prevent organ damage upon viral challenge." Baylor University, which has attempted to develop a vaccine, knows the problems all too well. According to Dr. Robert Atmar at Baylor's Department of Molecular Virology,  coronaviruses "are notoriously difficult when it comes to vaccine development.... the concern is that if these vaccines were used in people, they could end up causing harm." Other scientists have issued warnings against hastily approving a vaccine without proper large, long-term clinical trials and scrupulous evaluation. For example, Dr. Paul Offit at the Children's Hospital of Philadelphia and one of the nation's most vocal advocates for compulsory vaccination, has criticized the shortened vaccine timelines being stated. In a Philadelphia Inquirer interview, Offit cautioned for the need of "extensive animal model testing" to be certain the vaccine "is safe in animals." This process, Offit says, "takes a lot of time, typically years."  "If you're going to be testing this in otherwise healthy people who are very, very unlikely to die from this infection," he continues, "you better make sure it's safe. So you want those regulations in place.... The point being: We're not very good at assessing risk." Trump is pushing to have a vaccine ready by the end of this year. Offit and others argue two years is more realistic, and the global analytics firm Clarivate estimated that a vaccine "will require at least five years... to complete the development process through full regulatory approval." The good news is that the firm predicts that Moderna's mRNA vaccine has a 5% probability of success. The bad news is that the government and federal health agencies will very likely ram the first promising vaccine through the regulatory channels without having been properly evaluated for its efficacy and safety. Without serious critical thought, the demand for a vaccine now outweighs the risks. And there is the potential for many risks that remain completely unknown, which is the same for any vaccine. Trump said it will be available "in a fairly quick manner."  In an interview with philosophy professor Nicholas Evans at the University of Massachusetts, he raised concerns over the lack of proper animal model vaccine trials before administering it to humans. Unfortunately there are no US laws that require animal trials. Consequently the pharmaceutical companies are taking advantage of this derelict oversight in their race to be the first to get a vaccine approved and distributed. Evans also worries about "the shredding of regulations and regulatory norms as part of their [the federal health agencies] response to this outbreak and this is a very dangerous proposition." Rarely do politicians, and increasingly more and more scientists, make efforts to learn the lessons history offers.  Past efforts to develop a coronavirus vaccine have failed and the adverse effects observed in these efforts are clear indicators for why fast-tracking a CoV-19 vaccine would be frightfully irresponsible. But now this is all being ignored within the Trump White House, the CDC, and across most of the medical establishment, particularly the private vaccine makers. In addition, the media continues to fuel our vaccine mania, priming the public to willingly surrender their bodies to the syringe under a pretext of being protected from future CoV outbreaks. Perhaps the most disturbing problem our national public health faces is the failure of our leading health agencies -- the CDC, the National Institute of Allergy and Infectious Disease, and the World Health Organization -- to acknowledge the overwhelming evidence that no vaccine developed during the past half century is truly safe and effective for all.  Are there any scientific gold standard studies -- double blind, controlled trials using an actual inert placebo -- conducted for any vaccine currently on the market?  No? Have meticulous independent studies been performed to compare the quality of health between vaccinated and non-vaccinated participants?  Unfortunately there aren't any, and the CDC was forced to acknowledge this during a Congressional subcommittee hearing on autism. All of the media's vaccine propaganda is stacked with pro-industry scientists who have something to gain. They are always presented as the experts. On the other hand, independent scientists, as well as board certified physicians and pediatricians, who question the official vaccine dogma, are attacked by federal officials and the mainstream media as alarmists, anti-vaxxers and even threats to society if they speak out.  Several years ago the World Health Organization listed vaccine opponents among the 10 leading threats to global health. But no one considers that the many millions of people who either themselves or their children received a vaccine and experienced serious adverse effects were at one time pro-vaccination. It was for that very reason they submitted themselves to be vaccinated in the first place.  Now with the dramatic rise in vaccine injuries and deaths as more shots are added to the nation's vaccination schedule, we still await Congressional hearings at the federal and state levels that invite independent scientists, toxicologists and immunologists to explain the actual peer-review literature that would have us conclude there is no such thing as either a safe vaccine or vaccine that creates neutralizing antibodies for any given person. In other words, every vaccine may or not be effective and there is no proof they protect everyone.   There is also the utterly absurd notion that whenever someone receives a vaccine and does not come down with the disease, 100 percent of the credit is given to the vaccine's efficacy. And where are the real advocates who are speaking on behalf of the victims from vaccine injuries?  Certainly not the pharmaceutical industry that profits immensely without any liability for damages. Nor are advocates to be found in federal and state health agencies, in most of the medical community nor across the spectrum of the media. Rather, those who refuse to take unsafe vaccines are blamed for spreading fear, uncertainty, conspiracies and even infectious disease. But now those who have been injured or their loved ones are speaking out in greater unison. This is becoming increasingly uncomfortable for those who have profited for years from their pain. 

Join Yvonne Brandenburg, RVT, VTS SAIM and Jordan Porter RVT, LVT, VTS SAIM as we talk about: White Blood Cell Basics; what WBCs do and what to look for when WBCs are too high or too low.    Question of the Week How many of you do differentials in your clinics, and what are some of your favorite resources? Leave a comment at https://imfpp.org/episode25   Resources We Mentioned in the Show  IMFPP https://www.internalmedicineforpetparents.com/hematology.html Idexx hematology book:  https://www.amazon.com/gp/product/1893441687/ Small Animal Internal Medicine for Veterinary Technicians and Nurses https://imfpp.org/saimbook  E-Clin Path http://eclinpath.com/hematology/morphologic-features/white-blood-cells/     Thanks so much for tuning in. Join us again next week for another episode!  Get Access to the Technician Treasure Trove  Sign up at https://imfpp.org/treasuretrove    Thanks for listening!  – Yvonne and Jordan 

Join us as we discuss eosinophils, our fourth most abundant white blood cell! Thanks for listening! Follow us on Facebook, Twitter, Instagram, and Medium!

Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track! Check out today's questions:  Nicolle: Hi Dr C, Thanks so much for all you do. You truly have changed my life! I’m looking to have a bit of a mystery solved. I’ve spent since April of this year healing my body, first with the 3 week detox followed by the CBO protocol as I tested positive for candida. During the last week of the CBO I found out I was pregnant! Wonderful news, but very surprising. I’ve been off contraception for 2 years managing my cycle naturally through tracking, very successfully. I have a relatively normal cycle give or take a day or 2. Now the mystery- my conception date happened on the last day of my period. Normally the a safe zone I would have thought? I know the CBO can throw out your cycle but can it throw your cycle out that much? Clearly all of my healing turned me into a fertility machine which I feel very grateful for but would love to know how. :D Thanks again for all you do!! Nicolle Emma: Hey there Dr Cabral, First of all, let me just say that I am extremely grateful for your podcasts and everything you do. The gift of health knowledge that you have given to all of us is priceless for not only ourselves, but our children and loved ones. A few questions: 1) What do you think of the product Advanced TRS (toxin removal system) to remove heavy metals and of zeolites in general? TRS is a nanoparticle zeolite that crosses the BBB. Any safety concerns for adults and children? I have read some regarding aluminum content and I believe that since metals are estrogenic, using the full dose for 6 months caused me to have estrogen dominance. I took a heavy metals test after that and there was nothing concerning reported. Do I even need zeolites anymore in this case? I was using them to help heal my many chronic illnesses and with biofilms. Since I react to egg (I saw that Florafilm has an ingredient derived from egg), I wasn’t sure if I would be able to tolerate that. 2) My kids LOVE your new bars. Thank you SO MUCH for not putting stevia in them! I react severely to stevia which makes many “health products” unavailable to me. Would you consider making more stevia-free products such as the daily shake? I would also love to see some stevia free electrolyte powder! Thank you for everything that you do. Joanna: Hi Dr Cabral I have a question regarding breast health.This year so far iv done a 21 day detox the cbo, then after i went and did a 9 day panchakarma detox, since then my hormones went a little out of balance and lost my period for 1 month and is since always a bit late but starting to regulate. However my question is these changes my body is going through with these protocols has shifted my hormones, i did test for high testosterone high eostrogen and low prog earlier in the year, but my recent breast ultrasound show fibroadenomas and cyst.What is your advice for breast health and how to prevent breast cancer? What causes fibroadenomas Plus when rebounding is it best to wear a bra or not? Thankyou so much regards joanna Kelly: Hi Dr. Cabral, thank you for all the knowledge you provide. I see that there is only 4g of L- Glutamine in the Healthy Gut Support. Can I ask why you decided on 4g when the majority of studies that concluded a positive result from its supplementation were using above 25g on average? Lauren: Hi, recently found out i'm sensitive to salicylates and I know I have many other auto immune conditions. How do you heal your self with healthy nutritional foods, plant based supplements and herbs if you cant tolerate them. IGE is 780 and high Eosinophils. I was having your shake everyday but I cant even have this.... currently tying to treat via therapy. being allergic to healthy food! Thanks Dr Cabral   Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community’s questions!  - - - Show Notes & Resources: http://StephenCabral.com/1401 - - - Get Your Question Answered: http://StephenCabral.com/askcabral   - - - Dr. Cabral's New Book, The Rain Barrel Effect https://amzn.to/2H0W7Ge - - - Join the Community & Get Your Questions Answered: http://CabralSupportGroup.com - - -   Dr. Cabral’s Most Popular Supplements: > “The Dr. Cabral Daily Protocol” (This is what Dr. Cabral does every day!) - - - > Dr. Cabral Detox  (The fastest way to get well, lose weight, and feel great!) - - - > Daily Nutritional Support Shake  (#1 “All-in-One recommendation in my practice) - - - > Daily Fruit & Vegetables Blend  (22 organic fruit & vegetables “greens powder”) - - - > CBD Oil  (Full-spectrum, 3rd part-tested & organically grown) - - - > Candida/Bacterial Overgrowth, Leaky Gut, Parasite & Speciality Supplement Packages - - - > See All Supplements: https://equilibriumnutrition.com/collections/supplements  - - -   Dr. Cabral’s Most Popular At-Home Lab Tests: > Hair Tissue Mineral Analysis (Test for mineral imbalances & heavy metal toxicity) - - - > Organic Acids Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Thyroid + Adrenal + Hormone Test  (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Adrenal + Hormone Test (Run your adrenal & hormone levels) - - - > Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Omega-3 Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - > Stool Test (Use this test to uncover any bacterial, h. Pylori, or parasite overgrowth) - - - > Genetic Test (Use the #1 lab test to unlocking your DNA and what it means in terms of wellness, weight loss & anti-aging) - - - > Dr. Cabral’s “Big 5” Lab Tests (This package includes the 5 labs Dr. Cabral recommends all people run in his private practice) - - - > View all Functional Medicine lab tests (View all Functional Medicine lab tests you can do right at home for you and your family!)

Rapid declines in spirometric measures of lung function were associated with higher risks of cardiovascular disease today, risankizumab provides more effect in psoriasis that ustekinumamb, there is no link between screening and liver cancer mortality, and eosinophils are a possible marker for nonceliac gluten or wheat sensitivity.

We launched the Blood Chemistry Calculator six months ago and have come to rely on it for our Elite Performance Program clients as an initial screening tool and measure of ongoing progress. With the input of 39 basic blood chemistry markers, the calculator uses a machine-learning algorithm to predict health status in 6 specific areas: immune balance, toxicity, metabolic health, nutrition, oxidative balance, and a general 5-year wellness score. On this podcast, Tommy and I are talking specifically about the Immune Balance Score, the domain that forecasts immune system health and inflammation from 13 out of the 39 input markers and one forecasted value (CRP). Tommy discusses these markers in detail, citing research that supports using them to predict health outcomes. He also shares ideas for next steps to improve functioning in the area of immune balance. You can now try some features of the Blood Chemistry Calculator for free by visiting bloodcalculator.com and clicking “Free Report”. Here’s the outline of this interview with Tommy Wood: [00:00:30] Florida Institute for Human & Machine Cognition (IHMC); Podcast: Optimal Diet and Movement for Healthspan, Amplified Intelligence and More with Ken Ford. [00:00:49] Blood Chemistry Calculator. [00:01:03] Peer Review. [00:02:32] Immune Balance Score. [00:04:00] Dashboard of Blood Chemistry Calculator scores (example). [00:04:08] Predicted Age Score. [00:05:12] Who is the calculator for? [00:06:09] Building a health coach referral network. [00:07:05] Podcast: How to Measure Hormones, with Mark Newman. [00:08:31] Combining 2+ reports for longitudinal tracking. [00:09:08] Markers that make up the Immune Balance Score. [00:10:49] Sensitivity and specificity. [00:13:40] All-cause mortality: dying from any cause. [00:17:05] Evaluating scientific research: PubMed + Google. [00:19:53] C-Reactive Protein (CRP) > 0.5 associated with 75% increase in all-cause mortality; Study: Li, Yunwei, et al. "Hs-CRP and all-cause, cardiovascular, and cancer mortality risk: a meta-analysis." Atherosclerosis 259 (2017): 75-82. [00:21:10] Jeremy Powers; Podcast: National Cyclocross Champion Jeremy Powers on Racing, Training and the Ketogenic Diet. [00:22:30] Dr. Bryan Walsh - Timing of blood testing for athletes. [00:24:49] Albumin: less than 4 g/dL = increased risk of all-cause mortality; Studies: 1. Fulks, Michael, Robert L. Stout, and Vera F. Dolan. "Albumin and all-cause mortality risk in insurance applicants." J Insur Med 42.1 (2010): 11-17; 2. Proctor, Michael J., et al. "Systemic inflammation predicts all-cause mortality: a glasgow inflammation outcome study." PloS one 10.3 (2015): e0116206; 3. Lee, Won-Suk, et al. "Population Specific Biomarkers of Human Aging: A Big Data Study Using South Korean, Canadian, and Eastern European Patient Populations." (2018). [00:27:25] Gamma Gap (globulins): > 3 g/dL = increase in all-cause mortality; Studies: 1. Juraschek, Stephen P., et al. "The gamma gap and all-cause mortality." PloS one 10.12 (2015): e0143494; 2. Yang, Ming, et al. "The gamma gap predicts 4-year all-cause mortality among nonagenarians and centenarians." Scientific reports 8.1 (2018): 1046. [00:29:58] Table that shows reference ranges, scores assigned. [00:30:39] Ferritin - iron overload vs. indicator of inflammation; >200 ng/mL = 50% increase risk of all-cause mortality; Study: Kadoglou, Nikolaos PE, et al. "The association of ferritin with cardiovascular and all-cause mortality in community-dwellers: The English longitudinal study of ageing." PloS one 12.6 (2017): e0178994. [00:34:20] Iron overload podcast: Iron overload and the impact it can have on performance and health, with Dr. Tommy Wood; Blood donation. [00:34:37] Podcast: Rethinking Positive Thinking, with Gabriele Oettingen. [00:36:31] Hemoglobin - higher = more aerobic power; Lower = chronic inflammation or nutritional deficiency.   [00:37:27] Hemoglobin has U-shaped curve - increased all-cause mortality if too low or too high. Optimal: from 14.5 g/dL (13 for women) + 1.5-2 g/dL; Study: Fulks, Michael, Vera F. Dolan, and Robert L. Stout. "Hemoglobin Screening Independently Predicts All-Cause Mortality." (2015): 75-80. [00:39:02] Christopher Kelly’s combined report. [00:39:18] Fasting blood glucose: >100 mg/dL = higher all-cause mortality. Study: Bjørnholt, JØRGEN V., et al. "Fasting blood glucose: an underestimated risk factor for cardiovascular death. Results from a 22-year follow-up of healthy nondiabetic men." Diabetes care 22.1 (1999): 45-49. [00:40:57] Red Cell Distribution Width (RDW): ideal is below 12%; Study: Al-Kindi, Sadeer G., et al. "Red Cell Distribution Width Is Associated with All-Cause and Cardiovascular Mortality in Patients with Diabetes." BioMed research international 2017 (2017). [00:41:17] White Blood Cells. [00:41:28] Eosinophils >0.275 x10E3/uL= increased risk of 30-year all-cause mortality; Study: Hospers, Jeannette J., et al. "Eosinophilia is associated with increased all-cause mortality after a follow-up of 30 years in a general population sample." Epidemiology (2000): 261-268. [00:42:21] Ratios between markers. [00:43:20] Platelets - High is associated with increased risk of mortality after heart attack; Study: Tsai, Ming-Tsun, et al. "U-shaped mortality curve associated with platelet count among older people: a community-based cohort study." Blood 126.13 (2015): 1633-1635. [00:43:39] Lymphocyte:Monocyte ratio; Study: Xiang, Fangfang, et al. "Monocyte/lymphocyte ratio as a better predictor of cardiovascular and all‐cause mortality in hemodialysis patients: A prospective cohort study." Hemodialysis International 22.1 (2018): 82-92. [00:45:23] Where to go from here?   [00:45:40] Acute vs. chronic inflammation. [00:47:07] Antimicrobials: Monolaurin, Lauricidin, Selenomethionine; antibody testing. [00:47:40] Malcolm Kendrick Podcast: Why Cholesterol Levels Have No Effect on Cardiovascular Disease (And Things to Think about Instead). [00:48:51] bloodcalculator.com; Quest lab locator. [00:49:11] UK: Fibrhealth. [00:49:15] Australia: https://stephenanderson.com.au/nbt/; Podcast: How to Get Help and Feel Great in Australia Using Advanced Blood Interpretation, with Stephen Anderson.   [00:49:38] support@nourishbalancethrive.com

Thank you for joining us for our 2nd Cabral HouseCall of the weekend!  I’m looking forward to sharing with you some of our community’s questions that have come in over the past few weeks…  Let’s get started! Lena: Hey Stephen, You've got a listener from paris! I really like your podcast, it is very informative! keep the good work ;) I've got a question about myself, i would sooo love for you to answer I will really try to be short ;) My name is Léna, I'm 30 year old, vegan, gluten free girl and since last july, i've began having big pain in my belly every time i ate, like the pain one got with gastroenteritis, where you move in all directions with your hands around your belly but never feeling relieved. It was lasting about 2 to 3 hours (maybe the time of digestion) with big pains on my back every time i ate. My eosinophils were very high in august, around 2200 (the high limit is in about 580!) then it drops to 1800 and a few months later to 750 but i think it did go up again later (i didn't do another analysis but had giant pains). I did a lot of blood tests, there were no parasites founded (but i took an anti-parasite pill), no H pilory, i did biopsies, 2 fibroscopies, 1 coloscopy but nothing founded I have a appointment in internal medecine at a hopital in a few months to find why i got very high and anormal eosinophils I did have a test to know if i'm sensitive to some foods: there were brazil nuts, eggs and some other nuts (little reaction) and other foods that i don't even eat (like corn, barley, milk etc.) i totally stopped brazil nuts and eggs for now. I will try to reintroduce them in a few months Anyway, my pains hurt for six months and in december, when I was really tired of suffering every time i ate (it was getting worse again), i saw a nutritherapist and she said to stop eating carbs (fruits, butternuts and vegetables like carrots and beets) for a short period of time and to increase anti inflammatory oils and decrease proteins. A very low carb globally (more vegan ketolike actually). I have complements like turmeric (curcumin), vitamin D, zinc, b12, glutamine, fish oils (and estroblock but it has nothing to do with that!) And in 3 days my pains decrease immensely! It's been almost a month and I already feel better. Sometimes i feel unconfortable or i feel pain but nothing compared to before But, i'm feeling a bit tired and i find it weird to eat so much fat (like more than a 120 g a day, less than 50 grams of net carbs a day but i'm more at 25g, and 60 gr of protein). And i didn't have my period this month... I'm afraid of my thyroid, my hormones  and especially my acne since i had cystic acne all my life and it's been fine since the last year, one year after stopping the pill (which i had for 14 years!!!) So, my questions are: what do you think could explain my pains if it's not parasites or allergies? If you have an idea, what could be the solutions to feel better and have a normal life, which i so much want Should i maintain this "vegan keto diet" or what should I do? What complements should I take to regulate my hormones and not have acne. i feel so lost between opposite articles on the web about low carb / keto / diet / hormones, i feel quite abandonned by doctors, and it's just me, a young girl, stuck with this problem thank you so much for answering this, it would really mean a lot to me cheers from France because yes, even french people are listening to your podcast! ps: i always had trouble with digestion, but more like bloating and gas. I'm very sensitive. i'm very thin, i do sport, i eat a lot of vegetables ;)   Ryan: Hey Dr. Cabral I am reaching to you on a recommendation from one of my clients and I believe your friend, Dave Armstrong "Army", in regards to my father. In September 2017 he had a partial knee replacement that resulted in an infection followed by heavy antibiotic treatment. Since that time he has been suffering with a multitude of health issues concerning his kidneys, blood platelets, diabetes, as well as his pancreatic and digestive function.  He has seen over a half dozen different doctors and specialists and gone through just about every test or scan that they can think of.  Yet, collectively they have absolutely zero idea of what's going on.  The only answer they have given is more medication to mask the real problems. I fear that they will never get to the bottom of it and will just continue to medicate the symptoms away until one of the systems eventually fails. I'm not sure how your practice works but I would like to set up a consultation for him if possible. I will also be contacting your office as instructed by Julia via Dave.   J.A.: Hi Dr Cabral, Love your podcast and learning about natural medicine. I am on a healing journey to resolve 'chronic mystery pain' that came on me 2 years ago and has not left. I have addressed Heavy Metals and had extensive testing OAT, HTMA all look ok. The only thing left is elevated LFT and billirubin my practitioner thinks this could be causing excess estrogen/histamine. So working to balance hormones via the liver. Aside from this I want to do your 7 day detox but will have to tweak it as I am very sensitive to 'pea' on IGG so will use hemp protein and supps my ND has given me. My question - sorry took a while to get to it! but trying to give full picture is about meals. Since listening to your last podcast (705) on 3 meals per day I anted your take on how I eat to assist with the above. I eat a plantbased diet. My day starts with a smoothie at 5.30am (I start work at 7am) so it is a long day and hence I usually have a snack (e.g hummus on rice cakes at about 10am. Lunch which is a salad with quinoa/veg etc at 12.30pm. I then have another snack like a piece of fruit at about 2. then dinner at about 7. Because I have a longer day am I ok to snack? or am I overloading my body and delaying healing? should my snack be protein shakes? Weight is stable and I don't need to lose weight. Pitta/Kapha body type. Any additional comments on the whole situation appreciated. Happy New Year! I will be listening to every podcast :) Mel: Hi, not sure if you received my question last time... Sorry if you did... What ate your thought on baby formula if it has to be given along with breastfeeding? First foods for baby? Also, best contraception to avoid pill? Amelia: Hi Dr. Cabral, I'm in my 40's and have been researching the best supplements for hair growth and skin firming. I have heard about things like Collagen Love and Vital proteins, but I'm not sure what brands to trust to work. Can you please recommend a few that are great for both skin collagen and tightening as well as hair growth? Thanks Amelia Dee: Hi Dr Cabral, Can you recommend alternatives to plastic wraps and storage baggies? I’m seeing some silicone options, ((specifically Stasher brand)) but I was wondering if there’s anything better or more cost effective. Thanks for info Dee   Thank you for tuning into this weekend’s Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes & Resources: http://StephenCabral.com/758 - - - Get Your Question Answered: http://StephenCabral.com/askcabral    

Dysphagia Basics Having difficulty swallowing or the inability to swallow is known as dysphagia. Symptoms of dysphagia include: Pain while swallowing The sensation of food stuck in the throat or chest Drooling Hoarseness Regurgitation Reflux Unexpected weight loss Choking, coughing, or gagging when swallowing Taking tiny bites Dysphagia by Phase There are several conditions that can affect each phase of the swallowing process. Oral Phase Dysphagia during the oral phase, or voluntary phase, can be caused by neurological conditions like Multiple Sclerosis, Muscular Dystrophy, advanced Parkinson's.  Brain damage caused by trauma or stroke can also cause trouble swallowing in adults. Dysphagia in Kids Babies start out nursing or feeding through a bottle and their swallowing mechanism is reversed.  A reverse swallow is when the tongue is thrust forward or out of the mouth to open the throat and allow food or drink down the esophagus.  As children learn to eat solid food and drink from a cup, the swallowing procedure changes. Children can also have trouble swallowing, but the root causes are completely different.  Premature birth, low birth weight, cleft lip or palate, and tongue or lip ties can lead to swallowing issues if not corrected with therapy.  These issues can cause swallowing issues with the reverse mechanism as well as make it difficult to convert to a regular swallow.  Children with low muscle tone are also more likely to stick with the reverse swallow because it is easier. Pharyngeal Phase Pharyngeal diverticula are pouches that form in the mucous membrane above the esophagus.  These pouches can collect food particles that don't get swallowed.  This can cause bad breath, as well as coughing, and constant throat-clearing because it feels like something is stuck in the throat. Esophageal Phase There are several swallowing issues that stem from the esophagus and esophageal phase. Achalasia is an issue where the sphincter that opens into the stomach doesn't relax to allow food to pass through.  This can cause pressure in the chest and may possibly lead to regurgitation if it persists. Diffuse spasms happen when the peristalsis rhythm of the esophagus muscles is poorly coordinated. Stricture is also known as a narrowed esophagus.  It can be a result of injury and scarring from GERD. An esophageal ring is when a thin area of the lower esophagus is narrowed.  This is also a result of scar tissue from chronic GERD.  The scar tissue from acid damage tends to be less flexible which can cause pain. Eosinophilic esophagitis is the overpopulation of eosinophils in the esophageal lining due to food allergies.  Eosinophils are a type of white blood cells that show up in very specific situations - parasitic infections, cancer, or allergies. Dysphagia Risk The risk of dysphagia increases with age, mostly because the risk of the conditions that cause dysphagia increases with age as well.  And while dysphagia can be very uncomfortable, the biggest concern is with the risk of aspiration, or breathing food or drink into the lungs, that leads to pneumonia. Call Back Swallowing Muscle Tone discussion - Accordion in Your Brain Connect with me Support us on Patreon Give us your Feedback Join the Pharmacist Answers Podcast Community on Facebook Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio Like the Facebook page Music Credits: Up In My Jam (All Of A Sudden) by - Kubbi https://soundcloud.com/kubbiCreative Commons — Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 http://creativecommons.org/licenses/b...Music provided by Audio Library https://youtu.be/tDexBj46oNI

I'm excited to bring you part 2 of our weekend Cabral #HouseCalls where I answer our community questions on all things wellness, weight loss, and anti-aging! Here are today's questions: Kevin: Dr Cabral, So I have been following your work for about 5 years when I bought and implemented the teachings in "A Man's Guide to Muscle and Strength". I was looking for a program to follow, and this fit the bill perfectly. I've used the structure of the programs in the book ever since. I rotate these programs every 4-6 weeks, and try to increase the weight throughout the program before cycling off onto a new 4-6 week program. My question is around the SAID principle. There are many exercises that I've plateaued. For example, take a bench press or a seated row. Each of these are part of a 4-6 program so I may do these 6 times a year. And when I first started working out with your book as my guide, I was able to increase the weight as I went along. But with both, I've can't move past the weight that I'm currently at. And like you book lays out, when I cycle off the current program, the next program usually has another, yet different, version of each of these exercises. Logic tells me that I'm going to plateau with any exercise. It's not like I'd be able to keep adding weight, year in and year out, to each of these. What do you do when this happens? Thanks for being our guiding light in health, wellness and fitness...you've helped transform mine and my wife's life.  Pana: Hi dr Cabral! I love your podcasts and I listen every day since I found you! My 15 year old son came back from camp and all he wants to drink is powder aid because he was told that is good for him. In our house we do not have any soft drinks or ever juice. He just drinks water. Please let me what your thoughts are on powder drink and what Would be agood alternative to power drinks specially when he is very active? Thank you so much for all that you give us! Rebekah: Hello! I bought your healthy belly because I was sure I had h.pylori. I just got an endoscopy that confirmed I'm negative for the bacteria. How long is the shelf life for this and are there any alternative uses for it that I could benefit from? I hate to waste this unopened bottle. Thanks for all you do. I listen to every podcast without fail! Rena: Hi Dr. Cabral, So grateful for your podcast! I am in my 60's and have gout, and a bone spur in my foot. Could you possibly recommend any cures for this? I've heard you talk about CBD Oil and I wonder if this is something that I might try that would help? Also, I've been studying the blood type diet as someone recommended it to help with understanding my personal susceptibility to dis-eases (Hypothyroidism, Gout, osteoporosis) Is there any truth to the antigens on your blood, lectins on foods and how it affects the way your specific blood breaks down food? I am O+ and I definitely have the dis-eases that it lists that I am prone to for my blood type so I'm curious to try this type of diet but I wanted a professional opinion as there are so many fads out there and I am looking more for a lifestyle change rather than a temporary fix. I highly respect what you are doing for the world. Keep up the great work! Rena  Cara: Hi Dr. Cabral, I am so appreciative for your house calls, thank you and I always leave a stellar rating on iTunes review! You answered my question last weekend on having high Eosinophils. The high eosinophils came back on my annual CBC in July. This is the first time they've ever been high. I just had my food sensitivities / environmental allergy test ran through my PC. I have zero environmental allergies. My food sensitivities test was ran through Genova Diagnostics. They only food that was in the red, "very high" were grapes, which I rarely have. Maybe this is why I get a headache after one glass of wine. I have a couple of foods in the yellow, "very low" which include cabbage, garlic, green pepper, white potato, sunflower seed. I have quite a few foods in the green "very low" which sadly includes broccoli, egg yolk, mushrooms and more. Do I need to cut out all foods that showed up on this test, or only grapes which ranked "very high"? If so, how long do I eliminate them for? Could having the foods that are "very low" as well as "low" be the cause for my Eosinophils being 18.5? I just had my blood redrawn yesterday to confirm the lab did not make a mistake. Next will be a parasite test, which I'll likely have ran through my PC to try and cut the cost. Although, once I have some preliminary answers, I will schedule a consult directly with you (even though you're a few weeks out). I also read that high Eosinophils can indicate cancer, so I'm a little concerned. I eat super healthy, paleo-ish and I consume two servings of greens a day. They only thing I indulge and sometimes over indulge in is dark chocolate. Thank you for all that you do! In gratitude, Cara ADDITION to my previous email on high Eosinophils... My lab came back today and my Eosinophils dropped from 18.5 to 6.0. I called my doctor and he didn't seem concerned. I told him I was still concerned because I know that is still on the high end of the spectrum. He said I could do a stool test or re-test my blood in 3-4 weeks. He said I could either have a parasite, or I could have been exposed to something in my environment to cause the spike. When I asked his protocol if it is a parasite, he said sometimes antibiotics for stubborn bugs or supplements. What are your thoughts? In gratitude, Cara Ada: Hi Dr. Cabral, I've really enjoyed all the education and information from each of your podcasts and I get something out of every episode. Thank you for that! My question today is really where to start. I am in my early 40's and I have been struggling with trying to figure out why my weight has plateaued. I'm doing weight training three times a week and walks/hikes three-four times a week. I am medium athletic build but I feel I need to tone up a lot. I eat salads, fruits, veggies, some meats three-five days a week. I just feel like nothing works. I also feel extremely tired all the time. As soon as I hot the bed I am dead asleep. I don't know if what I need is a candida cleanse, a heavy metal detox, food sensitivity or your weight loss testing. I cant afford to do them all right now but I would love to know what my particular body needs as I know we are all different. Could you possibly recommend what test that would give me the most information on what my specific body needs in order to regain energy and lose weight? Thank you so much! Ada   I hope you enjoyed this weekend's Q&A and all the tips added in along the way! - - - Show Notes & Resources: http://StephenCabral.com/583 - - - Get Your Question Answered: http://StephenCabral.com/askcabral  

Mona Bafadhel discusses her work on using eosinophils as biomarkers in chronic obstructive pulmonary disease.

Machine learning is fast becoming a part of our lives. From the order in which your search results and news feeds are ordered to the image classifiers and speech recognition features on your smartphone. Machine learning may even have had a hand in choosing your spouse or driving you to work. As with cars, only the mechanics need to understand what happens under the hood, but all drivers need to know how to operate the steering wheel. Listen to this podcast to learn how to interact with machines that can learn, and about the implications for humanity. My guest is Dr. Pedro Domingos, Professor of Computer Science at Washington University. He is the author or co-author of over 200 technical publications in machine learning and data mining, and the author of my new favourite book The Master Algorithm: How the Quest for the Ultimate Learning Machine Will Remake Our World. Here’s the outline of this interview with Dr. Pedro Domingos, PhD: [00:01:55] Deep Learning. [00:02:21] Machine learning is affecting everyone's lives. [00:03:45] Recommender systems. [00:03:57] Ordering newsfeeds. [00:04:25] Text prediction and speech recognition in smart phones. [00:04:54] Accelerometers. [00:04:54] Selecting job applicants. [00:05:05] Finding a spouse. [00:05:35] OKCupid.com. [00:06:49] Robot scientists. [00:07:08] Artificially-intelligent Robot Scientist ‘Eve’ could boost search for new drugs. [00:08:38] Cancer research. [00:10:27] Central dogma of molecular biology. [00:10:34] DNA microarrays. [00:11:34] Robb Wolf at IHMC: Darwinian Medicine: Maybe there IS something to this evolution thing. [00:12:29] It costs more to find the data than to do the experiment again (ref?) [00:13:11] Making connections people could never make. [00:14:00] Jeremy Howard’s TED talk: The wonderful and terrifying implications of computers that can learn. [00:14:14] Pedro's TED talk: The Quest for the Master Algorithm. [00:15:49] Craig Venter: your immune system on the Internet. [00:16:44] Continuous blood glucose monitoring and Heart Rate Variability. [00:17:41] Our data: DUTCH, OAT, stool, blood. [00:19:21] Supervised and unsupervised learning. [00:20:11] Clustering dimensionality reduction, e.g. PCA and T-SNE. [00:21:44] Sodium to potassium ratio versus cortisol. [00:22:24] Eosinophils. [00:23:17] Clinical trials. [00:24:35] Tetiana Ivanova - How to become a Data Scientist in 6 months a hacker’s approach to career planning. [00:25:02] Deep Learning Book. [00:25:46] Maths as a barrier to entry. [00:27:09] Andrew Ng Coursera Machine Learning course. [00:27:28] Pedro's Data Mining course. [00:27:50] Theano and Keras. [00:28:02] State Farm Distracted Driver Detection Kaggle competition. [00:29:37] Nearest Neighbour algorithm. [00:30:29] Driverless cars. [00:30:41] Is a robot going to take my job? [00:31:29] Jobs will not be lost, they will be transformed [00:33:14] Automate your job yourself! [00:33:27] Centaur chess player. [00:35:32] ML is like driving, you can only learn by doing it. [00:35:52] A Few Useful Things to Know about Machine Learning. [00:37:00] Blood chemistry software. [00:37:30] We are the owners of our data. [00:38:49] Data banks and unions. [00:40:01] The distinction with privacy. [00:40:29] An ethical obligation to share. [00:41:46] Data vulcanisation. [00:42:40] Teaching the machine. [00:43:07] Chrome incognito mode. [00:44:13] Why can't we interact with the algorithm? [00:45:33] New P2 Instance Type for Amazon EC2 – Up to 16 GPUs. [00:46:01] Why now? [00:46:47] Research breakthroughs. [00:47:04] The amount of data. [00:47:13] Hardware. [00:47:31] GPUs, Moore’s law. [00:47:57] Economics. [00:48:32] Google TensorFlow. [00:49:05] Facebook Torch. [00:49:38] Recruiting. [00:50:58] The five tribes of machine learning: evolutionaries, connectionists, Bayesians, analogizers, symbolists. [00:51:55] Grand unified theory of ML. [00:53:40] Decision tree ensembles (Random Forests). [00:53:45] XGBoost. [00:53:54] Weka. [00:54:21] Alchemy: Open Source AI. [00:56:16] Still do a computer science degree. [00:56:54] Minor in probability and statistics.

In this week’s installment of the AJRCCM Discussion Podcast, Dr. Nitin Seam is joined Drs. Peter Lange and Jadwiga Wedzicha as they discuss whether blood eosinophil levels serves as a useful biomarker predicting COPD exacerbation.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPyzoites solve the case of the Uncommon Parasite, and discuss the role of eosinophils in promoting the growth of Trichinella in skeletal muscle.   Links for this episode: Eosinophils and IL-4 support nematode growth (PLoS Path) Balantidiasis (CDC) Letters read on TWiP 102  Case study for TWiP 102 This week's case involves a 24 yo housewife, from a village outside of Calcutta. Comes into a tertiary care hosp, 6 months coughing up blood, fever, no weight loss. Drinks rainwater, milks her cow. Dogs everywhere, no livestock except cows. Eats meat, well cooked. No extramarital encounters. Husband well. 4 children. Cistern for drinking water is covered.  No health issues. Reports salty, clear mucus. No blood in stool, no changes in stool. Exam: looks healthy, lungs clear. Lab tests: White count of 9000, 12% eosinophils (elevated). So she has eosinophilia. Chest X-ray and CT: lesion on left side in xray. CT: shows 4 cm cavity, with air pocket on left side, mid-lung. HIV negative. Dusty soil, birds. Send your diagnosis to twip@microbe.tv Send your questions and comments to twip@microbe.tv

David Price discusses a UK cohort study into the use of blood eosinophil count as a predictor of asthma exacerbations. 

Targeting interleukin 5 for eosinophilic asthma – discussion with Jean Bousquet and Richard Lane.

Eosinophils in the Pathogenesis of Allergic Airway Disease

Eosinophils in the Pathogenesis of Allergic Airway Disease

Eosinophils in the Pathogenesis of Allergic Airway Disease

Eosinophils in the Pathogenesis of Allergic Airway Disease

Eosinophils and eosinophil-related diseases (July 2010): Associate Editor Bruce Bochner reviews some of the highlights from our July 2010 theme issue, with insights from the articles' authors.