Podcasts about harbor ucla

Over half of Americans now live with at least one chronic condition, yet our healthcare system still revolves around episodic, reactionary care instead of continuous, coordinated support.We talk with Dr. Jaewon Ryu—former CEO of Geisinger and now CEO of Risant Health—about how integrated delivery systems are reshaping the way care is paid for and delivered. With decades of experience spanning medicine, law, government, and leadership at some of the most respected healthcare institutions, Dr. Ryu offers a rare inside look at what it takes to scale value-based care in a fragmented system.We cover:

In this episode of EMRA*Cast's "Bridging Health and Humanity" series, host Natalie Hernandez, MD, MPH, speaks with Aslam Akhtar, MD, PhD, a fourth-year EM resident at Harbor UCLA, about his experience volunteering on a medical mission trip to Northern Gaza.

Welcome to Episode 237 of Autism Parenting Secrets. This week, we're joined by the esteemed Dr. Richard Boles. With an impressive background in pediatrics and genetics, including training at UCLA and Yale, Dr. Boles brings a wealth of knowledge on neurodevelopmental and functional disorders. He collaborates with Neuroneeds to create specialized supplements for autism, ADHD, and epilepsy, and today, he shares why whole genome sequencing is crucial for effective treatments.He explains his comprehensive diagnostic approach, the importance of understanding genetic and environmental factors, and how specific genetic variants can pave the way for targeted therapies. Dr. Boles shares the supplements he designed to improve biochemical functions, and he elaborates on the significance of mitochondrial energy metabolism, cation transport, and neurotransmission in autism care.This episode promises to be packed with valuable insights for parents navigating the complexities of autism, so stay tuned as we explore the cutting-edge genetic diagnostics and personalized treatment pathways with Dr. Richard Boles.The secret this week is... Sequence The WHOLE GenomeYou'll Discover:How Whole Genome Sequencing Works (5:41)Why Telehealth Can Be Better Than In-Person Visits (8:37)The Importance of Mitochondrial Function (19:45)Who You Want To Focus on Pathways (24:57)Specific Supplement Options (27:43)Why De Novo Mutations Are Incredibly Important Clues (34:25)About Our Guest:Dr. Boles is a Medical Geneticist with expertise in mitochondrial disease, other metabolic disorders, and channelopathies. He completed medical school at UCLA, a pediatric residency at Harbor-UCLA, and a genetics fellowship at Yale. Dr. Boles' clinical and research focus has been on the genetics of common, chronic neurological and functional disorders, including autism, ADHD, ME/CFS, pain, and cyclic vomiting. He has about 100 peer-reviewed published papers. After 20 years as a geneticist at Children's Hospital Los Angeles and faculty at USC, Dr. Boles was the Medical Director of a DNA sequencing laboratory for 6 years. He is currently in a virtual (Zoom) private practice, where he applies whole genome (DNA) sequencing to determine the cause of disease in his patients. Dr. Boles is also the Chief Medical & Scientific Officer of NeuroNeeds, a company that produces natural nutritional products to assist people with neurological conditions, including the conditions listed above.http://molecularmitomd.com/References in The Episode:NeuroNeedsAdditional Resources:Unlock the power of personalized 1-on-1 support; visit allinparentcoaching.com/intensiveTake The Quiz: What's YOUR Top Autism Parenting Blindspot?To learn more about Cass & Len, visit us at www.autismparentingsecrets.comBe sure to follow Cass & Len on InstagramIf you enjoyed this episode, share it with your friends.

The commercialisation of wellness and wellbeing has led us to the point where everyone has basically gone fucking nuts. With so much crap on the internet, how can ordinary folk spot the snake oil? How can we be more skeptical about the information we're presented with, and how can we be better scientists? In this episode, Dr Pete Olusoga and Dr Leah Washington talk to Dr Nick Tiller, exercise scientist at Harbor-UCLA, about Bad Science! Dr Tiller is the author of The Skeptic's Guide to Sports Science, a columnist at Skeptical Inquirer magazine, and a Fellow of the Committee for Skeptical Inquiry. Follow Nick on Twitter: @NBTiller Check out Nick's website: nbtiller.com, where you can buy his genuinely excellent book. And no, we're not on commission!

At the California Academy of Family Physicians, we know that Addiction Medicine is Family Medicine. In our latest series 1 in 5, we bring you stories of doctors - and their patients - who have worked together to reduce the harm done by opioid use disorder (OUD). These brief stories will bring you into the hearts and minds of our guests. We hope that this will inspire you to do everything in your power to bring medical attention to the OUD patients in your practice.  Episode 1: “To Help Others Find Doctors Like You”: A Patient and Her Doctor Talk MOUD   This episode introduces you to a patient and her doctor whose work together has enabled a family to stay together and a strong woman to change the course of her life. Guests: Dr. Gloria Sanchez, MD, MPH is a Harbor UCLA Family Medicine Residency faculty and is Board certified in addiction medicine. She has focused her career on assessing and trying to meet the needs of underserved communities. Teaching future physicians the critical skills necessary to assess and treat substance use disorders has become a primary pursuit. Her overall goal remains to create national initiatives in medical training and public policy that meet the needs of vulnerable patient's suffering from substance use disorders. Jessica is Dr. Sanchez's patient and, as of this podcast, a Patient Advocate. She is a 34 y/o woman who came to Harbor UCLA to deliver her second child. She met Dr. Sanchez then because she was looking for help with her fentanyl dependence. Jessica transferred from the hospital to an inpatient program, and then to a sober living location with her baby girl. She has been vocal and determined to find help, and is eager to share her experience with you today. She wants to help others find doctors like Dr. Sanchez.  Our interviewer, Dr. Tipu Khan is the Chief of Addiction Medicine, Fellowship Director, and Core FM Faculty at Ventura County Medical Center. He leads the Primary Care Hepatitis C Eradication Project and Backpack Medicine Team. Tipu serves as Director of Addiction Medicine for HealthRight360 Southern California and is an Adjunct Clinical Professor at USC Keck School of Medicine. He practices full spectrum Family Medicine, from ER to inpatient, OB and clinic and has a niche in managing SUD in pregnancy.   The Family Docs Podcast is hosted by Rob Assibey, MD, FAAFP.   Resources CAFP's SUD webpage, including MOUD Champions https://familydocs.org Article: Stigma Against Patients With Substance Use Disorders Among Health Care Professionals and Trainees and Stigma-Reducing Interventions: A Systematic Review The Bridge (formerly CA Bridge) https://bridgetotreatment.org  UCSF Warm Line https://nccc.ucsf.edu/clinician-consultation/substance-use-management/    Series Information The Family Docs Podcast series 1 in 5 is supported by the California Department of Health Care Services (DHCS).  The Family Docs podcast is developed, produced, and recorded by the California Academy of Family Physicians. The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the views or positions of any entities they represent or the California Academy of Family Physicians. Copyright 2024, California Academy of Family Physicians. More information at www.familydocs.org/podcast. Visit the California Academy of Family Physicians online at www.familydocs.org. Follow us on social media: Twitter - https://twitter.com/cafp_familydocs Instagram - https://www.instagram.com/cafp_familydocs Facebook - https://www.facebook.com/familydocs  

Have you ever considered rowing across the Atlantic? How about making it even more challenging by doing it whilst wearing an ECG monitor and filling in psychological questionnaires? Claudia Hammond speaks to the first Austrian woman to row the Atlantic, Ciara Burns, who collected data throughout her 42-day crossing. And to the professor who studied the data, Eugenijus Kaniusas from the Vienna University of Technology, about the three big dips in mood along the way. Ciara talks about the emotional highs and lows of rowing to America, about the night skies, meeting whales, and how it feels when the Atlantic comes crashing down on you. Sports psychologist Peter Olusoga from Sheffield Hallam University, discusses the mental challenges and dealing with emotions during an adventure like Ciara's.Claudia also speaks to Dr Nick Tiller, ultramarathon runner and exercise scientist at Harbor-UCLA, about the physical benefits and costs of taking part in ultra-endurance sports. Nick has run 100-mile races as well as running across the Sahara Desert. They discuss how peak performance in endurance events can peak at an older age than more fast-paced, high intensity sports, and whether anyone is physically able to take up an endurance sport if they set their mind to it. Also giving their thoughts on the physical impact of endurance sports are Yvette Hlaváčová who holds the women's world record for swimming the English Channel and Louise Deldicque who is professor in exercise physiology at UCLouvain in Belgium.Presenter: Claudia Hammond Producers: Jonathan Blackwell and Lorna Stewart Editor: Holly Squire

Nick Tiller, PhD is an exercise scientist at Harbor-UCLA. He is also the author of The Skeptics Guide to Sports Science, a columnist for Ultrarunning Magazine and the Skeptical Inquirer. You can find all of Nick's work here, https://www.nbtiller.com/ Our combined Twitter list- Louise Burke- @LouiseMBurke Asker Jukendrup- @JeukendrupBrad Schoenfeld-@BradSchoenfeldGuillaume Millet- @kinesiologuiStuart Phillips- @mackinprofMichael Joyner @DrMJoyner Kristy Sale- @ElliottSaleTrent Stellingwerff- @TStellingwerffInigo San Milan-@doctorinigoMarco Altini- @altini_marcoSian Allen- @DrSianAllenStephen Seiler- @StephenSeilerSUBSCRIBE to Research Essentials for UltrarunningBuy Training Essentials for Ultrarunning on Amazon or Audible.Information on coaching-https://www.trainright.comKoop's Social Media: Twitter/Instagram- @jasonkoop

A recap from IDWeek 2023. Check out the guests/correspondents below!Group 1:Dylan Koundakjian, third year internal medicine resident at Emory University, Atlanta, GA (who is applying to ID fellowship!)Jonathan Ryder, Assistant Professor at University of Nebraska Medical Center, Omaha, NE (who is back for this third IDWeek review!)Alainna Jamal, second year internal medicine resident at University of Toronto, Toronto, CanadaCarlyn Harris, fourth year medical student at Emory University, Atlanta, GA (applying to internal medicine and internal medicine primary care)Group 2:Bismarck Bisono-Garcia, second year adult ID fellow at Mayo Clinic, Rochester, MNAnais Ovalle, ID attending and Director of Population Health for internal medicine residents at Kent with Care New England - Brown affiliate, Providence, RIKailynn Jensen, second year medical student at University of Nebraska Medical Center, Omaha, NEBill Wilson, pediatric ID pharmacist specialist at UNC Childrens Hospital, Chapel Hill, NCRaul Macias Gil, ID attending and associate program director for ID fellowship at Harbor UCLA, Los Angeles, CA[and Jonathan Ryder, who was also in Group 1 above]Please check out and sign up for the new IDSA PROUDLY ID Interest Group Community, which Anais, Bill, and Raul mentioned in the episode. This platform is serving to provide a space for LGBTQIA+ advocacy, representation, and education. The link is here: https://docs.google.com/forms/d/e/1FAIpQLSeMtfcT5OOB9akApk-7r7bT9h4MtoL-qDYxhRpBJq06N2R1FA/viewform?usp=sf_linkGroup 3:Rija Alvi, second year adult ID fellow at Henry Ford, Detroit, MI (member of ID Digital Institute)Memar Ayalew, ID clinical pharmacist and co-director of antimicrobial stewardship at Walter Reed Hospital, Washington, DC (member of ID Digital Institute)Radhika Sheth, second year adult ID fellow, Oregon Health Sciences University (OHSU), Portland, OR (member of ID Digital Institute)Julie England, chief medical resident, University of Alabama Birmingham, Birmingham, AL (applying to ID!)Christina Lin, chief medical resident in research at Emory University, Atlanta, GA (applying to ID!)The IDWeek Out-BREAK escape roomPart 1 featured the organizers of the escape room:Victoria Chu, second year pediatric ID fellow, University of California San Francisco, San Francisco, CADiana Zhong, adult ID attending, University of Pittsburgh, ID Connect, Pittsburgh, PAAs well as the other members of the planning committee:Katie Lusardi, ID PharmD, Baptist Health Medical Center, Little Rock, ARJustin Searns, pediatric ID attending at University of Colorado / Children's Hospital of ColoradoJuri Boguniewicz, pediatric ID attending at University of Colorado / Children's Hospital of ColoradoPaul Pottinger, adult ID attending, University of Washington Medical Center, Seattle, WALiz Ristagno, pediatric ID attending, Mayo Clinic, Rochester, MNRachel Wattier, pediatric ID attending, University of California San Francisco, San Francisco, CAAdarsh Bhimraj, adult ID attending, Houston Methodist, Houston, TXNatalie Gabriel, IDSASara Dong, adult and pediatric ID attending at Emory University, Atlanta, GAPart 2 included 2 teams that experienced the escape room:Team 1:Rebecca Kiliany, PharmD, Atrium Health, Charlotte, NCDhananjay Kumar Sinha, nephrologist, Varanasi, Uttar Pradesh,...

Craig Goolsby, MD, Harbor UCLA by SAEM

Craig Goolsby, MD, Harbor UCLA by SAEM

Author Adharanand Finn speaks to Nick Tiller, exercise scientist at Harbor-UCLA and author of The Skeptics Guide to Sports Science. They examine the value of scientific consensus, the power of the placebo, and take a deep dive into running trends such as nasal breathing, barefoot running, paleo diets and ice baths. Nick also answers the question: is ultra running bad for you? Music by Starfrosch

One of the biggest questions in ECPR right now is how do we organize our system to provide ECPR in an effective and streamlined approach?  Nichole Bosson and her army of ECPR enthusiasts have successfully implemented a multi-hospital ECPR receiving center program in Los Angeles.  In this episode, Zack talks with Dr. Bosson about how they started, what they learned, and where they are going. A little about Dr. Bosson She is the Assistant Medical Director at the Los Angeles County EMS Agency. She is an Associate Clinical Professor at David Geffen School of Medicine at UCLA and faculty and EMS fellowship director in the Department of Emergency Medicine at Harbor-UCLA. Here is the link to her paper Bosson N, Kazan C, Sanko S, Abramson T, Eckstein M, Eisner D, Geiderman J, Ghurabi W, Gudzenko V, Mehra A, Torbati S, Uner A, Gausche-Hill M, Shavelle D. Implementation of a regional extracorporeal membrane oxygenation program for refractory ventricular fibrillation out-of-hospital cardiac arrest. Resuscitation. 2023 Jun;187:109711. doi: 10.1016/j.resuscitation.2023.109711. Epub 2023 Jan 30. PMID: 36720300. And here is Jason Bartos' editorial Bartos JA, Yannopoulos D. Starting an Extracorporeal cardiopulmonary resuscitation Program: Success is in the details. Resuscitation. 2023 Jun;187:109792. doi: 10.1016/j.resuscitation.2023.109792. Epub 2023 Apr 10. PMID: 37044354.

He is changing the way pharmaceutics source their research and development, reducing the cost and time while keeping high standards. He discusses the topic of insourcing versus outsourcing, and how to ensure your company is streamlining the cost and length of projects. Talking Points: {02:00} Charles's role as CEO of TARGEGEN Pharma{05:10} How to pivot and keep the organization working. {07:50} Insourcing versus Outsourcing.{11:30} The dynamic of how the money is parlayed when you develop drugs.{15:30} Non-diluted capital{19:09} Charles journeyCharles Theuer Bio:As President, CEO, and Board Member of TARGEGEN Pharmaceuticals, Dr. Charles Theuer is trying to solve the $2 billion drug problem facing the medical community. His work is aimed at transforming outcomes for cancer patients by helping pharmaceutical companies streamline the costly and lengthy process of research and development. Through their paradigm-shifting Product Development Platform (PDP), TARGEGEN Pharmaceuticals reduces the cost and time of drug development without compromising on the rigorous standards demanded by the FDA. Dr. Theuer has been a leader in the development of significant oncology breakthroughs including Sutent®, which transformed the treatment of advanced kidney cancer.Theuer earned his B.S. in Molecular Biology from the Massachusetts Institute of Technology before attending the University of California, San Francisco for his M.D. He received a Ph.D. in epidemiology from the University of California, Irvine and completed his residency at Harbor-UCLA Medical Center. Reflecting on his time at Harbor-UCLA, he remembers, “We were taught to treat each patient like they were a family member and do well by them. It's a lesson that I carry with me to this day.”While working as a board-certified general surgeon, Dr. Theuer was approached by a friend from medical school. His prior classmate was with the biotechnology firm IDEC Pharmaceuticals and thought Dr. Theuer's background in antibody research made him a natural fit. Dr. Theuer wrestled with the notion of walking away from surgery, and ultimately decided he would be better able to make a global impact on cancer patients through clinical research. He joined IDEC as the Director of Clinical Development in 2002.After IDEC, Dr. Theuer was a Director of Clinical Development at Pfizer, where he oversaw the development of Sutent in kidney cancer. He then joined TargeGen, Inc. as Chief Medical Officer prior to becoming the President and CEO of TARGEGEN Pharmaceuticals in 2006, where he works to this day.Dr. Charles Theuer works and resides in the San Diego area.Resources and Links:Website: https://charlestheuer.com/LinkedIn: https://www.linkedin.com/in/charles-theuer-31641811/Book: https://charlestheuer.com/book/Connect with Tom FinnLinkedIn: https://www.linkedin.com/in/therealtomfinn/Instagram: https://instagram.com/therealtomfinnYouTube: https://www.youtube.com/@therealtomfinnTiktok: https://www.tiktok.com/@therealtomfinnTwitter: https://twitter.com/therealtomfinn/Facebook: https://www.facebook.com/therealtomfinnPinterest: https://www.pinterest.com/therealtomfinn

Nessa live conversei com Daniel Mamede (@Daniel_Mamede). Daniel Mamede é apaixonado por esportes, nutrição e é um entusiasta sobre assuntos relacionados à saude, qualidade de vida e longevidade. Pratica triathlon e corridas de rua. Em 2023 completará a sua 10ª maratona e seu 3º Ironman. Em 2018, Daniel iniciou sua jornada em busca de uma melhor qualidade de vida e passou a estudar sobre nutrição, adotou uma dieta lowcarb e mudou por completo sua maneira de praticar atividades físicas. Em 2019 completou o seu primeiro triathlon 70.3 (meio Ironman), além de 3 maratonas em um intervalo de 21 dias. Em 2021, ao completar 50 anos, competiu no seu primeiro Ironman em Cozumel (México). Daniel é um Lean Mass Hyper-Responder (LDL > 200mg/dL; HDL > 60mg/dL; Triglicerídeos < 80mg/dL). Em 2022, foi recrutado para um estudo em andamento pelo Lundquist Institute for Biomedical Innovation at Harbor - UCLA, na California (página --> https://citizensciencefoundation.org/study/ paper —>https://pubmed.ncbi.nlm.nih.gov/36351849/). Daniel é casado com a Isabel. Eles têm 3 filhos de 16, 18 e 21 anos e vivem em Toronto desde 2015. Você também pode nos acompanhar no instagram, http://www.instagram.com/henriqueautran. E em nosso canal do YouTube: https://youtube.com/c/henriqueautran. Estamos também no telegram com um grupo exclusivo que você pode participar. Lá no telegram eu consigo compartilhar materiais exclusivos que não dá para compartilhar no Instagram. Além disso, toda quarta feira às 7:00 da manhã temos a Reunião da Rebelião Saudável com a participação de Profissionais de Saúde. Na reunião discutimos assuntos relevantes a respeito de saúde e qualidade de vida. Você pode acessar o grupo no telegram em https://t.me/RebeliaoSaudavel. Se você gosta de nosso trabalho, deixe um review 5 estrelas e faça um comentário no seu app de podcast. Essa atitude é muito importante para a Rebelião saudável e vai ajudar nosso movimento a chegar a cada vez mais pessoas.

In this episode of The Brave Enough Show, Dr. Sasha and Dr. Sarah discuss: The power of the pause  All or nothing thinking and how to break free from it  Boundaries with our kids  Taking time for yourself as a busy working mama  About the guest:  Dr. Sarah is a psychiatrist who has published quite a bit on burnout and depression at UCLA, UCSD, UCSB and Harbor-UCLA. She dabbled in the corporate world before medical training - She's devoted to helping working professionals feel their best again, especially when dealing with depression, anxiety or other psychiatric challenges associated with work stress, intense workload, deadlines, no work-life balance and others.  She incorporates exercise, nutrition, sleep, stress management, efficient time management (especially as a full-time psychiatrist and mom of 2 under 2), and other sustainable lifestyle changes. Episode Links:   Brave Enough 2023 CME Conference Brave Balance 2023 Order Brave Boundaries Boundary Rebel Book Club Follow Brave Enough:   WEBSITE | INSTAGRAM | FACEBOOK | TWITTER | LINKEDIN Join The Table, Brave Enough's community. The ONLY professional membership group that meets both the professional and personal needs of high-achieving women.

Nick B. Tiller Ph.D. is a senior researcher in exercise physiology at Harbor-UCLA and author of The Skeptic's Guide to Sports Science which was named one of Book Authority's "Best sports science books of all time". Tiller is a columnist at Skeptical Inquirer magazine, a columnist at Ultra-Running Magazine, and associate editor at the International Journal of Sports Nutrition and Exercise Metabolism. For over a decade, Tiller has been scrutinizing the commercial health and wellness industry through the critical lens of scientific skepticism.Nick is a renowned authority on the physiology and pathophysiology of ultra-endurance exercise. Nick ran his first marathon in 2001 at the age of 18 years and contested Ironman triathlon (Frankfurt; European Championships) in 2009. In 2010, he ran his first ultramarathon. Since then, Nick has contested some of the world's toughest endurance races including the Marathon Des Sables (Sahara Desert) and several 100-mile trail races. In recent years, Nick has unified his personal passion for ultra with his professional work in physiology, contributing numerous original research and review papers to premier exercise science journals. In addition to peer-reviewed research, Tiller contributes articles to mainstream outlets, and writes a monthly column in Ultra-Running Magazine.We have a conversation about his many of the topics that's in his book The Skeptic's Guide to Sports Science, Confronting Myths of the Health and Fitness Industry.Professor Tiller discusses the placebo effect and breaks it down for the listener. We discuss the common “placebo effect is still an effect so what's the big deal” response. We also talk about the potential downsides to placebo effect particularly with unproven methods.We have a conversation about acupuncture, cupping and dry needling, and why we've seen motivation of such alternative medicine among athletes and whether or not there is any demonstrated efficacy of such methods beyond placebo.We talk about nutrition and in particular fad diets and supplements driven by heuristics and biases that have led populations to seek quick fixes for weight loss under an increasing obesity epidemic.We discuss the efficacy of a myriad of athlete recovery protocols including, cold immersion, cryotherapy, massage or robot massage, compression garments and whether or not there is anything that has been scientifically demonstrated to meaningfully expedite performance or recovery.Finally, we talk about logical fallacies that are typically made by people and Professor Tiller discusses his response to such fallacies.About Nick Tiller Ph.Dhttps://www.nbtiller.com/Nick Tiller Ph.Dhttps://twitter.com/NBtillerLink to Professor Tiller's book The Skeptic's Guide to Sports Science, Confronting Myths of the Health and Fitness Industry by Nick Tiller Ph.Dhttps://www.amazon.com/Skeptics-Guide-Sports-Science-Confronting/dp/1138333123Follow Us:Facebook: https://Facebook.com/EventHorizon.TvTwitter: https://twitter.com/EventHorizonTvInstagram: https://instagram.com/eventhorizon.tvYouTube: https://youtube.com/c/EventHorizonTvSupport Us:https://Patreon.com/Endurancehttps://paypal.me/EnduranceExperience

Dr Glenn McConell chats with Dr Nick Tiller from Harbor UCLA. Nick is a COPD and exercise researcher with other interests such as ultramarathon. However, the focus of this episode is on his expertise in regards to the importance of being skeptical of health and fitness claims. He has written the book A skeptics guide to sports science. He makes some very important points re critical thinking, confirmation bias, logical fallacies, appeals to nature, false dichotomy, the role of social media, pre-bunking. A very articulate and interesting person. Twitter: @NBTiller 0:00. Introduction 3:05. Sits in Karlman Wasserman old office 4:58. Nick's respiratory medicine research. COPD patients etc. Ultramarathon research including sex differences. 11:11. Skepticism and sports science. His book: A skeptics guide to sports science. In the health and fitness industry science takes a back seat to marketing. 14:17. Lack of regulation in wellness industry. Tend to be able to make claims without evidence. BS mechanisms and false claims. 20:00. How we make decisions. Society has changed so much more than our genes. People want short cuts. 22:31. So many scammers etc now. Bombarded with so much data. Need to be able to think critically. 25:36. Skeptical vs critical vs cynical. Socratic method/scientific method. Carl Sagan. 26:48. Plausibility. 28:30. Scientific integrity/confirmation bias. 31:10. Snake oil salesman of old and social media now. Echo chamber 35:47. Debunking and pre-bunking. 41:15. Peer reviewed publication doesn't mean good research. 45:58. “The death of expertise”. Need to respect experts especially when there's scientific consensus 50:15. Making vague claims to avoid litigation 55:00. Logical fallacies and appeals to nature 58:35. False dichotomy 1:00:20. Twitter followers are not credentials 1:03:49. Censorship vs free speech re health etc 1:11:45. Can always sharpen your critical thinking. Inside Exercise brings to you the who's who of exercise metabolism, exercise physiology and exercise's effects on health. With scientific rigor, these researchers discuss popular exercise topics while providing practical strategies for all. The interviewer, Emeritus Professor Glenn McConell, has an international research profile following 30 years of Exercise Metabolism research experience while at The University of Melbourne, Ball State University, Monash University, the University of Copenhagen and Victoria University. He has published over 120 peer reviewed journal articles and recently edited an Exercise Metabolism eBook written by world experts on 17 different topics (https://link.springer.com/book/10.1007/978-3-030-94305-9). Connect with Inside Exercise and Glenn McConell: Twitter: @Inside_exercise and @GlennMcConell1 Instagram: insideexercise Facebook: Glenn McConell LinkedIn: Glenn McConell https://www.linkedin.com/in/glenn-mcconell-83475460 ResearchGate: Glenn McConell Email: glenn.mcconell@gmail.com Subscribe to Inside exercise: Spotify: https://open.spotify.com/show/3pSYnNSXDkNLH8rImzotgP?si=Whw_ThaERF6iIKwxutDoNA Apple Podcast: https://podcastsconnect.apple.com/my-podcasts/show/inside-exercise/03a07373-888a-472b-bf7e-a0ff155209b2 Google Podcasts: https://podcasts.google.com/feed/aHR0cHM6Ly9hbmNob3IuZm0vcy84ZTdiY2ZkMC9wb2RjYXN0L3Jzcw Anchor: https://anchor.fm/insideexercise Podcast Addict: https://podcastaddict.com/podcast/4025218 YouTube: https://youtube.com/channel/UChQpsAQVEsizOxnWWGPKeag

I welcome Dr. Sarah Pospos to the show to discuss her interesting career path in the world of psychiatry, specifically telepsychiatry. Dr. Sarah is a devoted B.rad listener, and in this show, you'll learn about her highly integrative approach to psychiatry—as you'll hear, I had to push and prod her to even talk about prescription medication! She is a strong supporter of incorporating exercise, nutrition, sleep, stress management, time management and breathing exercises and yoga in order to handle the very common, prevailing mental health struggles that have escalated in recent years, especially in the age of quarantine and the accordant lifestyle disruptions (such as anxiety, depression, PTSD, etc). The immediate successful interventions that can concur with something like a simple breathing exercise or a quick workout will be great takeaways from this show; in fact she cites research that proves a single workout can alleviate the acute symptoms of anxiety! You'll also hear about imposter syndrome: why it's become so prevalent and how to combat it without becoming overly arrogant, egoistical, and narcissistic, and learn a lot about how to achieve balance in both your brain and in your life. Dr. Sarah Pospos is a sports and perinatal psychiatrist and former student athlete. Her Masters in Psychopharmacology and Applied Psychology allow her to add even more insights on all things medication and human behavior—she has published quite a bit on work burnout, anxiety and depression at UCLA, UCSD, Harbor-UCLA and UCSB. Dr. Sarah is devoted to helping working professionals feel their best again, especially when dealing with anxiety, depression or other psychiatric challenges associated with work stress, intense workload, deadlines, no work-life balance and others. She incorporates exercise, nutrition, sleep, stress management, effective time management (especially as a full-time psychiatrist and new mom of 2 under 2), and other sustainable lifestyle changes.   TIMESTAMPS: Dr. Pospos is a psychiatrist who believes exercise, nutrition, and sleep and such are preferable to medication for handling life's struggles. [01:27] How closely related are the more traditional treatments vs. the lifestyle focus. [09:26] What are some of the challenges when people maybe are too depressed or anxious to adhere to the healthy lifestyle changes you are encouraging? [11:29] What role does medication play in intervention? [14:01] Does modern day psychiatric training include these important aspects like sleep, diet, exercise? [16:01] Telepsychiatry is convenient for busy folks.  There is no need to take commuting time away from work or errands. [18:12] Dr. Pospos's practice is out of network for insurance for many reasons. [20:45] Research on burnout, anxiety, depression shows a strong connection with lifestyle changes such as yoga and meditation being implemented is beneficial. [24:23] Anxiety relates back to our ancestors as a threat to survival. [29:16] Is cold-water therapy a good treatment for anxiety? [32:47] Exercise, art, and other activities can give you a sense of mastery, which, of course, helps with mental health. [35:13] Where do medications fit in? Are they overused, over prescribed? [37:34] There is such a continuum in diagnoses and labeling in this field. [43:29] There is a big effect on our mental health with navigating the internet and mobile devices. [50:09] Comparing yourself to others can lead to imposter syndrome. [52:16] It is important, especially for kids, to try to implement the mindset in the process rather than outcomes. The emphasis needs to be on effort and personal improvement. [58:34] How does Dr. Pospos keep her own life balanced in a healthy manner? [01:03:42]   LINKS: Brad Kearns.com Brad's Shopping page LifestyleTelepsychiatry.com Dopamine Nation Mindset The Inverse Power of Praise (How not to Talk to your Kids) Podcast with Ashley Merryman Nurture Shock Top Dog Dr. Pospos' website    Join Brad for more fun on: Instagram: @bradkearns1 Facebook: @bradkearnsjumphigh Twitter: @bradleykearns YouTube: @BradKearns TikTok: @bradkearns   We appreciate all feedback, and questions for Q&A shows, emailed to podcast@bradventures.com. If you have a moment, please share an episode you like with a quick text message, or leave a review on your podcast app. Thank you! Check out each of these companies because they are absolutely awesome or they wouldn't occupy this revered space. Seriously, Brad won't promote anything he doesn't absolutely love and use in daily life. 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BRAD15 for 15% off BradNutrition.com: Coming soon - the ultimate whey protein superfuel formula for peak performance and longevity Ultimate Morning Routine Online Course: Learn how to custom-design an energizing, focusing morning exercise routine. Enroll now for earlybird discount Check out Brad Kearns Favorites Page for great products and discounts See omnystudio.com/listener for privacy information.See omnystudio.com/listener for privacy information.

Join us with Dr. Richard Boles as we learn more about how to interpret genetic test results. The landscape today for a mitochondrial disease diagnosis is rapidly changing and now includes some genetic testing for most patients. However, many families are confused even further by the results. What is an VUS? What do the specific mutations mean? What does 30% depletion mean? Learn the nuts and bolts of interpreting today's genetic tests from Dr. Boles in this informative discussion. About the Speaker Dr. Boles completed medical school at UCLA, a pediatric residency at Harbor-UCLA, and a genetics fellowship at Yale. He is board certified in Pediatrics, Clinical Genetics and Clinical Biochemical Genetics. His current positions include Associate Professor of Pediatrics at the Keck School of Medicine at USC, attending physician in Medical Genetics and General Pediatrics at Childrens Hospital Los Angeles, and Medical Director of Courtagen Life Sciences. Dr. Boles practices the "bedside to bench to bedside" model of a physician-scientist, combining an active clinical practice in metabolic and mitochondrial disorders with clinical diagnostics and basic research through Courtagen. Dr. Boles' clinical and research focus is on polymorphisms (common genetic changes) in the DNA that encodes for mitochondrial genes, and their effects on the development of common functional disorders. Examples include migraine, depression, cyclic vomiting syndrome, complex regional pain syndrome, autism and SIDS.

Talking points include: -What does the medical literature say regarding the uses of nutritional therapies in the autism and related neurodevelopmental disorders? -What about the uses of nutritional therapies in functional disease such as pain, fatigue, GI dysmotility, dysautonomia, anxiety, and depression? -What exactly is Spectrum Needs, and how can it be used as nutritional support for the above conditions? -Spectrum Needs beyond the spectrum: What about the use of this product in the average "mito" patient? -How to integrate SpectrumNeeds into a complicated supplement regiment? About The Speaker: Richard G. Boles, MD Dr. Richard G. Boles completed medical school at UCLA, a pediatric residency at Harbor-UCLA, and a genetics fellowship at Yale. For over two decades, Dr. Boles' clinical and research focus has been on changes in genes involved in energy metabolism, and more recently ion channels, and their effects on the development of common functional disorders. Examples include autism, pain syndromes, chronic fatigue, cyclic vomiting, intestinal dysmotility/failure, and depression. Dr. Boles practices the "bedside to bench to bedside" model of a physician-scientist, combining an active clinical practice with basic research into the underlying genetic predispositions leading to the same conditions. He has over 80 published papers, mostly in mitochondrial medicine. For 20 years, Dr. Boles was a faculty member at the Keck School of Medicine at USC and a practicing medical geneticist and metabolic specialist at Children's Hospital Los Angeles. He was a Medical Director of Lineagen and Courtagen, which are/were genetic testing companies. Dr. Boles became involved in genetic testing in order to facilitate the translation of the vast amounts of acquired genetic knowledge into applications that improve routine medical care. Dr. Boles has an active private practice in Pasadena and Aliso Viejo, CA. About half of the patients he currently sees as a physician have one of more functional conditions, especially cyclic vomiting syndrome, other forms of complex migraine, and/or chronic fatigue syndrome. Most of the other half have an autistic spectrum disorder or related condition. His clinical practice is devoted to using information, including genetic testing, to guide options for therapy. His care philosophy, practice, and types of patients he accepts are discussed at http://molecularmitomd.com. A telemedicine practice has just started at https://cnnh.org. Dr. Boles also does legal consulting, especially for those with multiple functional conditions that others are considering fictitious disorder/Munchausen-by-proxy/medical child abuse. Finally, he is the primary designer of SpectrumNeedsTM, a nutritional product with 33 active ingredients designed for individuals with autism or other neurodevelopmental disorders, with an emphasis on assisting mitochondrial function (https://www.neuroneeds.com).

Tools for Testing Mitochondrial Disorders: The Latest Advances in Genetics and Genomics Guest speaker Dr. Richard Boles from Children's Hospital Los Angeles and Courtagen Life Sciences, Inc. to discuss: What is genomic sequencing and how does it change testing for mitochondrial disorders? Is NextGen testing appropriate for all people with suspected mitochondrial disease? How can DNA sequencing change information available about family inheritance of mitochondrial diseases? Do advances in genomic sequencing impact treatment options for Mito patients? About The Speaker: Dr. Boles completed medical school at UCLA, a pediatric residency at Harbor-UCLA, and a genetics fellowship at Yale. He is board certified in Pediatrics, Clinical Genetics and Clinical Biochemical Genetics. His current positions include Associate Professor of Pediatrics at the Keck School of Medicine at USC, Director of the Metabolic and Mitochondrial Disorders Clinic at Children's Hospital Los Angeles, and Medical Director at Courtagen Life Sciences Inc. Dr. Boles practices the "bedside to bench to bedside" model of a physician-scientist, combining a very active clinical practice in metabolic and mitochondrial disorders with basic research as Director of a mitochondrial genetics laboratory at the Saban Research Institute. Dr. Boles' clinical and research focus is on polymorphisms (common genetic changes) in the maternally-inherited mitochondrial DNA, and with new technology in the nuclear DNA (chromosomes), and their effects on the development of common functional disorders. Examples include migraine, depression, cyclic vomiting syndrome, complex regional pain syndrome, autism and SIDS. He has 50 published papers on mitochondrial disease. Dr. Boles is responsible for the final review of DNA sequences at Courtagen.

Nick Tiller (MRes, Ph.D.) is a senior researcher in respiratory medicine & exercise physiology at Harbor-UCLA. He writes and speaks about exercise, health, pseudoscience, and critical thinking, and explores their intersection in his column for Skeptical Inquirer Magazine. His book, The Skeptic's Guide to Sports Science, was named as one of Book Authority's "Best sports science books of all time". Nick has been running marathons since 2001 and ultra-marathons since 2010. During this time he has contested some of the world's toughest races, including the Marathon Des Sables (Sahara Desert), Ironman triathlon, and several 100-mile trail runs. In recent years, he has unified his passion for ultra-marathon with his scientific research and has become a leading authority on the physiology and pathophysiology of the sport. In this conversation we break down respiratory science, talk about it in relation to covid, we take a look at some of the science behind the ever-popular breathe work within the wellness space, we also look at critical thinking and how you can develop your own scepticism whilst not becoming cynical then we get stuck into Nicks own relationship to Ultra's and how he has applied his scientific mind to what happens to the body. You can find more of Nick's papers and writing on his website  I hope you enjoy the episode Danny  --- Send in a voice message: https://anchor.fm/thebigrunpodcast/message

General EM physicians are well trained to care for kids, and most of us care for them regularly in the ED. Usually it's for common things like viral upper respiratory infections or playground injuries. But every once in a while, a critically ill or injured child comes in. Are you ready? Is your ED ready? Do you have tiny endotracheal tubes and nurses who can place IVs in those tiny veins? What else do we need to do to be “peds ready”? We're glad you asked. In this episode, we talk with national leaders in the field of pediatric emergency medicine and pediatric emergency readiness. Listen to learn more about what it means to be peds ready and why it's so important! Is your ED peds ready? Have questions or want to learn more? Find us on social media, @empulsepodcast, on email empulsepodcast@gmail.com, or through our website, ucdavisem.com. We're working on an episode on what it's like to be a woman in emergency medicine. We'd be honored if you'd share your story? Contact us as above, or leave your story on a brief voicemail at 951-251-4804  (don't worry, we'll edit it to make it sound smooth!).  ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Dr. Marianne Gausche-Hill, Medical Director for the LA County EMS Agency, Professor of Clinical Emergency Medicine and Pediatrics at UCLA and Harbor-UCLA, Senior Consultant to the EIIC, and member of the steering committee of the National Pediatric Readiness Project Dr. Kate Remick, Pediatric Emergency and EMS Physician, Professor at the Dell Medical School at the University of Texas, Co-Director if the EIIC, and San Marco Hays County Medical Director Resources: PedsReady.org EMSC Innovation and Improvement Center Pediatric Readiness Project Toolkit NPRP assessment achieves 71% response rate! Moore B, Shah MI, Owusu-Ansah S, Gross T, Brown K, Gausche-Hill M, Remick K, Adelgais K, Lyng J, Rappaport L, Snow S, Wright-Johnson C, Leonard JC; AMERICAN ACADEMY OF PEDIATRICS COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE AND SECTION ON EMERGENCY MEDICINE EMS SUBCOMMITTEE; AMERICAN COLLEGE OF EMERGENCY PHYSICIANS EMERGENCY MEDICAL SERVICES COMMITTEE; EMERGENCY NURSES ASSOCIATION PEDIATRIC COMMITTEE; NATIONAL ASSOCIATION OF EMERGENCY MEDICAL SERVICES PHYSICIANS STANDARDS AND CLINICAL PRACTICE COMMITTEE; NATIONAL ASSOCIATION OF EMERGENCY MEDICAL TECHNICIANS EMERGENCY PEDIATRIC CARE COMMITTEE. Pediatric Readiness in Emergency Medical Services Systems. Pediatrics. 2020 Jan;145(1):e20193307. doi: 10.1542/peds.2019-3307. PMID: 31857380. Ames SG, Davis BS, Marin JR, L. Fink EL, Olson LM, Gausche-Hill M, Kahn JM. Emergency Department Pediatric Readiness and Mortality in Critically Ill Children. Pediatrics. 2019;144(3):e20190568. Pediatrics. 2020 May;145(5):e20200542. doi: 10.1542/peds.2020-0542. Erratum for: Pediatrics. 2019 Sep;144(3): PMID: 32354750; PMCID: PMC8190968. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Man-o-man do we have a special one today! I don't even know where to start with today's description. There isn't an aspect of professional burnout, how your blessings can become burdens, or getting and keeping your mind right that Dr. Clay Whiting and I didn't discuss. And the funny thing is, we met live for the first time right before we recorded this podcast!    Dr. Clay Whiting is a Level-1 trauma unit Emergency Medicine Physician in San Diego, California. He's a former US Navy Medical Corp Officer and is a husband and father of 2 children. And like so many of us, he's faced the challenge of burnout and needing to find a way to reset, reconnect and get his mind right to balance out all in his life.    As I mentioned, I had not met Clay before we recorded this podcast episode. He'll share how he stumbled upon the podcast, his personal struggles with professional burnout, feeling disconnected from his responsibilities, rediscovering his faith, and re-establishing a relationship with his father. And on top of it, he shares how he did it and how he's helping his colleagues do the same and inspire youth to be their best selves.     Strap in for this episode because we're about to get real. And dig real deep.   If you find value in today's podcast, and I know you will, please share it on your social media or send the link to your friends, family, colleagues, and co-workers who are looking for great content on leadership, teamwork, and high performance. And if you know anyone in the medical field or are a first-responder, please share this episode with them.   Please share today's episode on your social media and make sure you are subscribed so you don't miss a single episode. You can tag me at: IG/Twitter: @ToddDurkin FB: @ToddDurkinFQ10     Dr. Clay Whiting, Union-Tribune feature: Front-Line Voices   ---   More about Dr. Clay Whiting:   Clay Whiting, MD, believes in the "whole person" (mind/body and spirit) approach to living life to its fullest potential. He has a unique perspective of our global society having spent the last 30 years "soul searching" and striving to understand the human experience from his early days as a Creighton University medical student, to wearing the uniform proudly as a US Navy Medical Corps Officer, to building his foundation as an Emergency Medicine Resident at Harbor-UCLA and now serving as a Board Certified Emergency Medicine Physician as a frontline warrior and hero the last 19 years at Scripps Mercy San Diego.   Dr. Whiting wants to be an engaged voice in representing the everyday heroes serving as frontline healthcare workers 24/7/365 during the last two challenging years of our global pandemic. He wants to break down mental health barriers and overcome stigma for physicians (and the entire healthcare team) so we can share our stories to work together to heal and unite. Let's inspire one another to stay strong and continue to care for our fellow humanity with love, compassion, understanding, and humility.   —   FREE WEBINAR… Finding Fulfillment NOW!   Thursday, Feb 24th 11 am PST/2 pm EST https://gsd.todddurkin.com/free-virtual-workshop--optin-page    Chances are you are already successful. Chances are you already have built a great reputation. And you probably have tasted some of the good life as well.   But you KNOW there is more. You know there is another level you can get to.   So here is what I'm inviting you to attend virtually with me…   I'm offering a 1-hour (60-minute) educational workshop/webinar on this very topic. I want to go deep with you. I want to coach you. I want to HELP YOU discover even more fulfillment in your life.   Not just success (although we will talk about that too as we all want that also!) but SIGNIFICANCE.   Here are the details on the FREE WEBINAR:   Finding Fulfillment NOW… How to Clarify Your Calling, Overcome Fear & Overwhelm, & Create A Strategic Plan To Achieve Something More & Greater This Year   WHEN: Thursday, Feb. 24th 11 am PST/2 pm EST   Sign up today: https://gsd.todddurkin.com/free-virtual-workshop--optin-page    ---   Did you order your Get Your God-Sized Dreams Planner 2022 yet?   If you have not already ordered it, it's NOT too late. It has my entire “Annual Strategic Plan” questions for your year and life, quarterly planning, 10-Forms of Wealth & 3-in-30, WLAG's, my “win the day” formula…and then some. More than just a planner, it will help you fulfill your biggest dreams, vision, mission, and what God has called you to do! We reverse engineer your success starting from your life to your year, quarter, month, week, and day down to the hour. Get it TODAY!    GET IT TODAY on Amazon - The God-Sized Dreams Planner - Durkin, Todd: Books ---   Are you a Trainer, Coach, or Fitness Business Owner seeking to make a massive IMPACT in your business & life in 2022 and would like me to Coach you to fulfill your Full Potential?   You are only as good as the people you surround yourself with. Level up today with my “Best in Class” MASTERMIND program for fitness professionals. I invite you to connect, share, and grow with the fitness industry's top coaches, trainers, and entrepreneurs. My MASTERMIND is for passionate and purpose-driven fitness professionals who want to create success & significance in their personal and professional lives.  If that sounds like you, visit: ToddDurkinMastermind.com to enroll or apply today.   If you do so within the next 7-days, you will receive a FREE video of one of my recent “ALL MASTERMIND” coaching calls. There are so many lost souls right now that need “our” LIGHT.  Let's make a difference together, one life at a time!    www.ToddDurkinMastermind.com   ---   Please keep your questions coming so I can highlight you on the podcast!!    If you have a burning question and want to be featured on the IMPACT show, go to www.todddurkin.com/podcast, fill out the form, and submit your questions!    ---   Don't forget that if you want more keys to unlock your potential and propel your success, you can order my book GET YOUR MIND RIGHT at www.todddurkin.com/getyourmindright or anywhere books are sold.   Get Your Mind Right now available on AUDIO: https://christianaudio.com/get-your-mind-right-todd-durkin-audiobook-download   Want more Motivation and Inspiration?? Sign up for my newsletter The TD Times which comes out on the 10th of every month full of great content  www.todddurkin.com   ---   ABOUT:   Todd Durkin is one of the world's leading coaches, trainers, and motivators. It's no secret why some of the world's top athletes have trained with him for nearly two decades. He's a best-selling author, a motivational speaker, and founded the legendary Fitness Quest 10 in San Diego, CA. He currently coaches fellow trainers, coaches, and life-transformers in his Todd Durkin Mastermind group. Here, he mentors and shares his 25-years of wisdom in the industry on business, leadership, marketing, training, and personal growth.   Todd was a coach on the NBC & Netflix show “STRONG.” He's a previous Jack LaLanne Award winner, a 2-time Trainer of the Year. Todd and his wife Melanie head up the Durkin IMPACT Foundation (501-c-3) that has raised over $250,000 since it started in 2013. 100% of all proceeds go back to kids and families in need.   To learn more about Todd, visit www.ToddDurkin.com and www.FitnessQuest10.com.   Join his fire-breathing dragons' community and receive regular motivational and inspirational emails. Visit www.ToddDurkin.com and opt-in to receive his value-rich content.   Connect with Todd online in the following places: You can listen to Todd's podcast, The IMPACT Show, by going to www.todddurkin.com/podcast.   You can get any of his books by clicking here!  (Get Your Mind Right, WOW BOOK, The IMPACT Body Plan)

Nick Tiller Research is a fellow at the Lundquist Institute at Harbor-UCLA where he studies clinical respiratory and exercise physiology, and the physiology/pathophysiology of ultra-endurance exercise. He is also a columnist at Skeptical Inquirer Magazine, and the author of 'The Skeptic's Guide to Sports Science'Skeptical Inquirer MagazineNick's book Buy Koop's new book on Amazon or AudibleInformation on coaching-www.trainright.comKoop's Social MediaTwitter/Instagram- @jasonkoop

Historian Ben Baumann and Dr. Nick Tiller talk about the various myths regarding dieting and exercise, as well as the numerous pseudoscientific products and services being sold today. (Dr. Nick Tiller is a senior researcher in applied physiology at Harbor-UCLA, a columnist at Skeptical Inquirer Magazine, and author of the award winning book "The Skeptic's Guide to Sports Science: confronting myths of the health and fitness industry".) For more on Dr. Nick Tiller check out the following links: Website- https://www.nbtiller.com/ Book- https://www.amazon.com/Skeptics-Guide-Sports-Science-Confronting/dp/1138333123 Twitter- https://twitter.com/NBTiller Column- https://skepticalinquirer.org/authors/nick-tiller/ (The memories, comments, and viewpoints shared by guests in the interviews do not represent the viewpoints of, or speak for Roots of Reality)

Join us as we hear from Claudia Pineda-Muyir, PA-C and Katya Corado, MD along with a message about Combat COVID. Claudia Pineda-Muyir, PA-C opened her own clinic in 2020 because she wanted to provide a safe and comfortable place for Latinos seeking medical care for the uninsured and those who are not English dominant. When the pandemic hit, she refused to close her clinic because she knew that others were turning patients away. The clinic started getting overwhelming amounts of patients, and eventually had to use a ticket system to limit its intake to 100 patients per day.​​Dr. Katya Corado provides primary medical care to HIV patients at the Tom Kay Clinic in the Long Beach Comprehensive Health Center, affiliated with Harbor-UCLA. Dr. Corado also teaches and participates in research at Harbor-UCLA Medical Center. Most recently, her research has focused on COVID-19 vaccine trials as well as treatment trials. To learn more, visit: https://combatcovid.hhs.gov/.Thank you for joining us and subscribe today! Follow us on Twitter: https://twitter.com/SanaSanaLPH.

Kevin Green was a rookie firefighter with the LAFD who was off duty one night out on a date when he witnessed a car crash on the freeway late at night. After pulling his truck over to help, a drunk driver crashed into the disabled vehicle, knocking it into Kevin & crushing his leg against his own truck. What happens after is a story of survival, recovery, & the importance of the fire family as Kevin frees himself from the wreckage, helps the original victim, then treats his own shattered leg. Once en route to the trauma center the firefighters treating Kevin notify his station as well as his previous department, the Compton FD. Members from both departments meet Kevin at the hospital with his family, and stay with him every step of the way. We talk about the multiple surgeries and attempted surgeries Kevin endured, as well as not knowing if he would lose his leg. He describes hearing conversations while he was supposed to be completely unconscious but was only paralyzed. We also talk about the long road to recovery that saw Kevin miraculously return to work in a year. We talk about martial arts, discipline, growing up in Compton, filming a reality show as a rookie fireman, Compton FD stories, LAFD vs CFD drill towers, fat guys with Black Belts, Serra HS career day, Ernie Reyes, & we get a mention for one of Ben's MAC trauma centers, Harbor UCLA. Kevin is an awesome guy & his positive outlook on life is infectious as are his stories about growing up as a karate kid in Compton. This episode stands strong. 

Kevin Green was a rookie firefighter with the LAFD who was off duty one night out on a date when he witnessed a car crash on the freeway late at night. After pulling his truck over to help, a drunk driver crashed into the disabled vehicle, knocking it into Kevin & crushing his leg against his own truck. What happens after is a story of survival, recovery, & the importance of the fire family as Kevin frees himself from the wreckage, helps the original victim, then treats his own shattered leg. Once en route to the trauma center the firefighters treating Kevin notify his station as well as his previous department, the Compton FD. Members from both departments meet Kevin at the hospital with his family, and stay with him every step of the way. We talk about the multiple surgeries and attempted surgeries Kevin endured, as well as not knowing if he would lose his leg. He describes hearing conversations while he was supposed to be completely unconscious but was only paralyzed. We also talk about the long road to recovery that saw Kevin miraculously return to work in a year. We talk about martial arts, discipline, growing up in Compton, filming a reality show as a rookie fireman, Compton FD stories, LAFD vs CFD drill towers, fat guys with Black Belts, Serra HS career day, Ernie Reyes, & we get a mention for one of Ben's MAC trauma centers, Harbor UCLA. Kevin is an awesome guy & his positive outlook on life is infectious as are his stories about growing up as a karate kid in Compton. This episode stands strong. 

In today's episode, we discuss wrinkles, a topic not too many men talk about but one that a lot of men think about.  How do we know this? A recent study was conducted about the use of Botox, one of the most common treatments for wrinkles.  That study found that in 2019, men underwent nearly half a million botox injections in the US alone  That was nearly a 400% increase as compared to the year 2000.  So while men may not be openly talking about their wrinkles, they certainly appear to be thinking about them.  Joining us today to help us better understand the causes and management of wrinkles is Dr Jasmine Yun,  Dr. Yun is a board-certified and licensed dermatologist who earned her undergraduate degree from UCLA. She then received a joint MD/MBA from the UCLA School of Medicine and the Anderson School of Management at UCLA. She proceeded to complete her dermatology resident at MLK-Harbor and Harbor-UCLA and then completed a dermatopathology fellowship at the Ackerman Academy of Dermatopathology in New York. Dr. Yun serves as a Clinical Associate Professor of Dermatology at USC Keck School of Medicine where she has devoted much time educating resident physicians and also has spent time participating in medical missions in developing countries.  She also has a private dermatology practice in Los Angeles.SHOW LESS

On this episode of ChatMed, newly graduated Dr. Jhaimy Fernandez will be joining our hosts to talk about her passion for medicine and giving back to her community. Dr. Jhaimy Fernandez recently graduated from UVM Larner College of Medicine this year. She previously attended and graduated from UCLA for her undergraduate studies. Dr. Jhaimy Fernandez has also completed her post-baccalaureate at Cal State. Dr. Fernandez shared about her various entrepreneurial endeavors while working hard towards her career of becoming a family physician as she is about to start her residency at Harbor-UCLA. Dr.Fernandez also speaks about her non-traditional path into medicine and how she tackles on her entrepreneurial interests and passion for helping underrepresented communities in LA.

Very excited to announce this fantastic interview with  political Superstar Anne Dunsmore!Anne's nearly 40-year career in fundraising has spanned the development of new technologies and fundraising strategies. Always on the cutting edge of blending these technologies with business, Anne has developed one of the most comprehensive, technologically advanced fundraising operations in the country.After her early work on political campaigns in the late 70's, she founded Capital Campaigns, Inc. which has consulted to over 300 candidates, initiatives, referendums, businesses and charities including Muhammad Ali, UCLA School of Medicine, UCLA School of Theater, Film and Television, UCI School of Medicine, LA County Museum of Art, the House Ear Institute, the UCLA Department of Neurosurgery, Los Angeles BioMedical Institute at Harbor-UCLA, Juvenile Diabetes Research Foundation as well as numerous campaigns for President (George H.W. Bush, Bob Dole, Ronald Reagan, Pete Wilson, George W. Bush, Mike Huckabee, Mitt Romney and Rudy Giuliani), Governor (Pete Wilson, Arnold Schwarzenegger, George Deukmejian, Jeb Bush, George W. Bush), US Senate (over 100 campaigns around the country), The Republican National Committee, National Republican Senatorial Committee, National Republican Congressional Committee, and Republican Governors Association.  Most recently she has been credited with jump-starting and managing Mike Garcia's campaign thru his special election win in May of 2020.  Anne is a powerhouse in every sense of the word, moving mountains in pursuit of her vision for an improved world, an inspiration of personal power and organized action there is much to be learned from her  pragmatic wisdom. 

Nathan D. Ford MD is a graduate of the UCLA/Charles R. Drew School of Medicine, and a distinguished member of the board of the American Academy for Anti-Aging Medicine. He completed his initial year of training in the general surgery program at Harbor-UCLA medical center in Torrance, CA, and currently runs his private practice, ‘Ford MD’, based in Los Angeles, California. Since his introduction to the field of anti-aging and regenerative medicine, he has redirected his efforts toward implementing preventative and restorative methods of medical treatment. Using the theoretical pillars of biology combined with sound, research-based medicine, he incorporates medical optimization and restoration into patient care. A core tenet of Dr. Ford’s approach to care is empowerment of the patient through education. He believes informed patients make informed decisions. When given the proper tools, medical guidance and education, people have the ability to take control back of their lives, their health and ultimately, their happiness.

Hi everyone. I hope you are doing well wherever you are. The George Flyod trial finally finished up and I feel institutions are already forgetting how much more work there needs to be done. As always, the question is where do we go from here and what else can we do. Only time will tell. We shall see. But for today, I am interviewing Dr. Yewande Pearse, a neuroscientist and science communicator. Born and bred in North London, Yewande got her Ph.D. from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, and is now a Postdoctoral Fellow at The Lundquist Institute at Harbor-UCLA. Her research interests focus on rare genetic disorders of the brain, and stem cell therapy.I first learned about Yewande through a show she curated me in at Naval LA, where she sits on the Programming Committee. I also watched some of the programming related to the exhibition, which focused on the impact of genomic studies on three aspects of identity: race, gender and politics. Yewande also hosts a few monthly radio shows and podcasts, such as Sound Science, Inside Biotech, and First Fridays for the Natural History Museum LA. On top of Yewande's prolific output as a podcaster, Yewande writes for Massive, an online science publication. For all these reasons, I was excited to finally talk with Yewande about her scientific work, her podcasting work, and her special science experiment work with John Legend. As always, stay safe and healthy and I hope you enjoy this.Links Mentioned:Yewande's WebsiteYewande's InstagramYewande and John LegendSound Science PodcastYewande at Massive ScienceNavalRACE, GENETICS, AND THE 0.1% with Dr. Terence Keel and Dr. Aaron PanofskyBatten DiseaseSound Science interview with Dr. Shawntel Okonkwo: Black in STEMDr. Jennifer Mullan of Deoclonizing ThearapyEvelynn Escobar's Hike Clerb Inc.Follow Seeing Color:Seeing Color WebsiteSubscribe on Apple PodcastsFacebookTwitterInstagram

In this episode, STFM President Tricia C. Elliott, MD, presents the third of her President's Podcasts, which will be periodically released over the course of her term. “Women Leaders of Color In Medicine” features interviews with, Tochi Iroku-Malize MD MPH MBA, Jehni Robinson, MD, FAAFP and Alicia Monroe, MD.Guest Bios:Tochi Iroku-Malize MD MPH MBA is the inaugural chair of family medicine at Northwell Health and professor and chair of family medicine for the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. She is dual board certified in family medicine and hospice and palliative medicine and holds a masters degree in public health policy and management as well as one in business administration. Dr. Iroku-Malize is involved in diverse programs including, but not limited to, global & planetary health, clinical informatics, women’s & children’s health, special needs populations, cultural competency, advocacy and leadership. She has worked for over the past three decades on clinical, research and academic initiatives to enhance health and equity for both providers and patients across various communities locally, nationally and internationally. Jehni Robinson, MD, FAAFP: Dr. Jehni Robinson is a Professor and Chair of the Department of Family Medicine at the Keck School of Medicine at USC. She also serves as Associate Dean for Primary Care. Prior to coming to USC, she served as Chief Medical Officer for The Saban Free Clinic also known as The Long Angeles Free Clinic and taught in the Harbor UCLA Transforming Primary Care faculty development fellowship. Dr. Robinson has expertise in leadership development, care delivery redesign and care for the underserved. She teaches first year medical students in Professionalism in the Practice of Medicine and serves as Faculty Advisor for a student interest group on homelessness. Dr. Robinson received her undergraduate degree from Stanford and her medical degree from Morehouse School of Medicine. She completed her residency at Harbor-UCLA in Family Medicine and completed a one year faculty development fellowship. She has also completed the California Healthcare Foundation Health Care Leadership Fellowship program in 2013.Dr. Alicia Monroe has served as the Provost and Senior Vice President of Academic and Faculty Affairs, and Professor of Family Medicine at Baylor College of Medicine (Baylor), Houston, Texas since 2014. At Baylor, Dr. Monroe oversees Academic Affairs, Faculty Development, Faculty Affairs, Institutional Diversity, Inclusion, and Equity and Center for Professionalism. She currently serves as the chair of the AAMC Advisory Committee on Advancing Holistic Review, and she is a member of the AAMC Board of Directors and Baylor University Board of Regents.

In this follow-up episode to our discussion with Dr. Scott Weingart of EMCrit, we review the indications for performing a resuscitative thoracotomy, together with the potential application of a circulation first resuscitation strategy, and some intricacies regarding performing a surgical cricothyroidotomy.

June 22nd, 2020 Race and Representation in Medicine: Addressing Implicit Bias in the Workplace In light of the events unfolding across the country over the past few weeks, The Society for Vascular Surgery's  Diversity Equity and Inclusion Task Force and the Wellness Task Force sponsored a webinar around race in America and its impact on our field. We at Audible Bleeding thought this was an excellent start, and we would hope to keep the conversation going. As such, this will be the first in a series of episodes on race and representation in medicine. Today we would like to discuss the challenges of addressing implicit bias in the workplace. We are very pleased to have with us a number of guests at different levels of training to discuss their experiences and insights. Dr. Vincent Rowe is a Professor of Surgery at the Keck School of Medicine of USC. He is the Program Director of the Vascular Surgery Residency. He earned his medical degree from the University of Southern California School of Medicine, and trained in general surgery at Kaiser Permanente Medical Center in Los Angeles. He subsequently completed a two-year Vascular Surgery Fellowship at the University of Tennessee Medical Center in Knoxville Tennessee. Dr. Olamide Alabi is an Assistant Professor of Surgery in the Division of Vascular Surgery and Endovascular Therapy at the Emory University School of Medicine. She received her medical degree from the University of Nebraska College of Medicine, trained in general surgery at Loma Linda University Medical Center in Southern California, and completed a fellowship in Vascular Surgery at Oregon Health and Science University. Dr. Nina Bowens is an Assistant Professor in Surgery, UCLA School of Medicine, and a member of the Division of Vascular and Endovascular Surgery at Harbor-UCLA. She earned her medical degree at Weill Cornell Medical College and trained in general surgery at the University of Pennsylvania. She completed her Vascular Surgery fellowship at the New York Presbyterian Hospital.   Dr. Osarumen Okunbor is a graduate of Meharry Medical College, completed his General surgery at Louisiana State University in New Orleans, and will be starting his Vascular Surgery fellowship at University of Washington in Seattle.    If you enjoy our content, please contribute to Support Audible Bleeding. Help us improve through our Listener Survey. Follow us on Twitter: @AudibleBleeding

Dr. Dinora  Chinchilla was born in Lincoln Heights, California and completed her Bachelor of Science in Biochemistry with a Minor in Biology at California State University, Los Angeles. She then completed a Post-bac and received her medical degree at the University of California, Irvine. She completed her residency training in internal medicine at Harbor-UCLA. Dr. chinchilla credits her family and overcoming various health disparities as the drivers of her passion to become a pulmonary critical care physician.

Perseverance, or more simply stated, Grit, is a common trait amongst EMS providers.  It grants us the ability to endure in the face of hardship when others may consider quitting or failing.  In regards to COVID 19, we are all playing the long game, it is a marathon (unfortunately) rather than a sprint.  We must stay united as a group and stay true to our mission of supporting and protecting our communities despite the pandemic.  That is not to say that we are not human ourselves.  While perseverance is one of the characteristics I value most in EMS providers, another virtue I’d care to juxtapose it to is vulnerability. In any situation that presents a threat — be it physical or emotional — our natural instinct is to protect ourselves. That's just basic survival. We try to defend, hide or deny our own insecurities and weaknesses. Being vulnerable involves letting yourself feel all things — the good, the bad and the not-so-pretty — and then also letting someone else see it all. Trying to be invulnerable can be exhausting, as much as we’d like to be super heroes protecting the population from medical maladies we must also acknowledge our own humanity.  This is not easy and it’s okay to express that and seek support.  When we numb feelings like fear, embarrassment and pain, we also numb excitement, hope, gratitude and happiness. Allowing vulnerability into our lives can rejuvenate our senses and actually foster, build and restore our community and make us more connected. I’m including the link to Brene Brown’s TED talk on vulnerability that has nearly 50 million views. Thank you all again for always being in service and a very happy EMS Week.   https://www.ted.com/talks/brene_brown_the_power_of_vulnerability   Today’s episode brings us 2 EMS physicians from Stanford on the topic, “Where have all the STEMIs gone?” where we dive into the literature and statistics on cardiac arrest, dying at home, emergency department volume and numerous other items related to COVID19. Interestingly both domestically and abroad there has been a dramatic reduction in heart attacks, strokes and traumas that have been presenting via EMS to the ED.  We discuss potential hypotheses into this phenomenon and also explore other salient details related to COVID.    Bryan David Sloane, MD – Is the current EMS fellow at Stanford University.  He did his residency at Harbor UCLA where he lived out his EMERGENCY! Dreams.  He was an EMT in LA for 6 years before medical school and considers himself an EMT first and a physician second.  He hopes to take an attending position at Kaiser South Sacramento where he will also be working on many local EMS initiatives.   Gregory H. Gilbert, MD - Clinical associate Professor of Emergency Medicine at Stanford University. Medical Director of San Mateo County and EMS Fellowship Director at Stanford University. He grew up in New York State and received his MD, from SUNY Downstate with distinction for investigative scholarship. He completed his emergency medicine training in Atlanta, Georgia at Emory University and is dual boarded in EM and EMS.  Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource.  Checkout the blog at EMSNation.org and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour and a "happy" EMS Week!     

Happy Leap Year! Not only is it leap year, but it appears that Punxsutawney Phil didn't see his shadow!  Early spring for all! :) As you know, the PEC podcast aims to highlight EMS research brought to you by the Prehospital Emergency Care Journal.  We also hope that our podcast educates all levels of EMS by bringing lively conversations about crucial prehospital topics.  Our very own Joelle Donofrio-Odmann has been working with the Digital EMS California Academy of Learning or, DECAL (Including faculty and fellows from UCSD, Harbor-UCLA, USC, Arrowhead, Stanford and UCSF) to produce an educational EMS podcast that takes a deeper dive into the EMS core content and has special guest experts with Q&A sessions. In this episode, we have 2 fellows discussing “A Deeper dive into Termination of Resuscitation.”  So here is the episode by DECAL on Termination of Resuscitation.  Editing of this DECAL podcast was done by fellow podcaster Mike Verkest. Click here to download today! As always THANK YOU for listening! Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems)

As of several months ago, Dental Anesthesiology is the 10th specialty recognized by the American Dental Association.  With the growing need for general anesthesia services in the pediatric dental office, the creation of this newest specialty is certain to expand opportunities for providers and especially for our patients.  Listen to Dr. Jeff Brownstein, Pediatric Dentist, Anesthesiologist, and practice owner in both areas, talk about his views on how anesthesiology will grow and will provide fantastic new opportunities to all.  You will learn many new things in this enlightening podcast. Jeffrey N. Brownstein, DDS, MeCSD is the senior partner at West Valley Pediatric Dentistry & Orthodontics, a multi-facility Pedo-Ortho group practice situated in the western suburbs of Phoenix, Arizona providing dental & orthodontic care for infants, toddlers, adolescents and adults with special healthcare needs.  He is also a partner in Arizona Dental Anesthesia and Nebraska Dental Anesthesia, dental anesthesia groups providing mobile office-based care for pediatric and adult patients.  Dr. Brownstein completed his graduate dental training at the Medical College of Virginia/Virginia Commonwealth University and his pediatric dental specialty training at the University of Florida where he served as chief resident during his final year of training.  Following his pediatric residency program, Dr. Brownstein completed an extensive Craniofacial Fellowship in the dental management of Cleft Lip & Palate in the Department of Pediatric Plastic Surgery at Washington University School of Medicine/St. Louis Children’s Hospital. In 2009, after nine years of providing care in a private practice setting, Dr. Brownstein returned to the University of California at Los Angeles to further his training in the area of anesthesiology.  After completing a year of medical anesthesia training at Harbor-UCLA, a major trauma center in Southwest Los Angeles, he was appointed to the position of chief resident in the Department of Dental Anesthesiology at the School of Dentistry at UCLA where he eventually attained his certificate in Dental Anesthesiology.   Dr. Brownstein is board certified and a Diplomat of the American Board of Pediatric Dentistry, American Dental Board of Anesthesiology and National Board of Dental Anesthesiology.  He is an oral board examiner for the American Board of Pediatric Dentistry and is a clinical oral conscious sedation and general anesthesia permit examiner for the Arizona State Board of Dental Examiners.  Dr. Brownstein was appointed by the American Academy of Pediatric Dentistry to a position on the AAPD Council on Clinical Affairs. He is a member of the Dental Patient Safety Foundation, a Surveyor for the American Association for Accreditation of Ambulatory Surgical Facilities, and a member of the Arizona State Board of Dental Examiners’ Anesthesia & Sedation Committee.  As a full-time clinician in private practice, Dr. Brownstein’s primary emphasis is in the area of pharmacologic management of special needs children and adults, while providing care in office, hospital, and surgical center settings.  He is a Clinical Faculty Member at the Midwestern College of Dental Medicine and in the Department of Anesthesia/Dental Medicine at NYU-Langone Hospital. He helps to instruct oral and intravenous moderate sedation courses, provides medical emergency seminars, and is a certified Basic Life Support, Pediatric Advanced Life Support & Advanced Cardiac Life Support instructor.   Dr. Brownstein has authored and coauthored an array of published journal articles and textbook chapters on topics including craniofacial disorders, pediatric physiology and office-based general anesthesia.  He also provides peer review for articles within the American Society of Dentist Anesthesiologists journal publication, Anesthesia Progress. He is actively involved in several ongoing clinical research at Midwestern College of Dental Medicine including projects focused specifically on improving the quality of pediatric sedation and general anesthesia. Dr. Brownstein is a past president of the Arizona Academy of Pediatric Dentistry and is an active member of the American Dental Association, American Academy of Pediatric Dentistry, American Board of Pediatric Dentistry, Arizona Dental Association, Central Arizona Dental Society, Southeastern Society of Pediatric Dentistry, Western Society of Pediatric Dentistry, International Association of Pediatric Dentistry, California Association of Pediatric Dentistry, California Dental Association, California Pedodontic Research Society, Academy of Dentistry for Persons with Disabilities, American Society of Dentist Anesthesiologists, American Dental Board of Anesthesiology, Arizona Society of Dentists Anesthesiologists, American Dental Society of Anesthesiology, National Dental Board of Anesthesiology, California Society of Dentist Anesthesiologists, International Federation of Dental Anesthesiology Societies, Society for Ambulatory Anesthesia, Society for Pediatric Anesthesia, Arizona Academy of Pediatrics, Society for Pediatric Anesthesia, American Academy of Pediatrics, American Cleft Palate – Craniofacial Association, Special Care Dentistry Association, American Association of Hospital Dentists, Malignant Hyperthermia Association of the United States, and several local study clubs.  Dr. Brownstein was a past Bank Director on the Board of West Valley National Bank/Arizona Dental Bank, a community bank specifically dedicated to financing private medical and dental ventures throughout the state of Arizona.  As an active member of the Arizona Special Olympics, Autism Speaks, Council for Exceptional Children, Make-A-Wish Foundation, and Federation for Children with Special Needs, Dr. Brownstein dedicates much of his free time advocating for the nearly 5 million school-aged special needs children living throughout the United States. Dr. Brownstein is a second-generation pediatric dentist, and has spent a majority of his life, in one way or another, involved in the field of medicine & dentistry while working with special needs patients.  For over thirty-years his father, Dr. Marshall Brownstein, served as Dean of Admissions & Student Affairs at both the Medical College of Virginia School of Dentistry and University of Nevada at Las Vegas School of Dental Medicine and is regarded nationally for his dedication to dental academics.  While his mother, Dr. Marjorie Brownstein, obtained her doctorate in Special Education and focused her career on the education for this underserved population.    On a personal note, Dr. Brownstein’s wife, Dr. Sheri Brownstein, also a second-generation dentist, is an Associate Professor & Director of Preclinical Faculty at Midwestern University College of Dental Medicine in Glendale, Arizona.  Sheri & Jeff have three wonderful children, Emma, Rogan and Landon and enjoy an active lifestyle, which includes photography, hiking, running, basketball, and traveling.

Alyssa Mancao, LCSW received her Bachelor's degree at California Polytechnic State University,Pomona and Masters Degree at the University of Southern California (Suzanne Dworak- Peck School of Social Work). She has provided clinical treatment with the Child and Adolescent Psychiatric Clinic at Harbor- UCLA, with the Child and Family Guidance Center, and as an Independent Licensed Contractor with Counseling4Kids. She has experience providing therapy in the outpatient and residential setting. Her work in the residential setting includes providing trauma treatment for individuals that have endured the pain of childhood abuse and exposure to gang and community violence. She has 9 years of experience treating depression, anxiety, trauma, issues with self- esteem, body image, and the inner child. Alyssa has provided treatment for children, adolescents, adults, and families. Her professional experience also includes providing supervision for mental health professionals in the individual and group setting. In this episode, we talk about: The definition of trauma, including Big and Little T’s Healing through trauma by connecting with your inner child- the youngest version of yourself How EMDR is a somatic technique that helps get to the root of trauma stored in the body Cognitive-behavioral techniques for facing limiting beliefs Using the ‘wise mind’ to be the best version of yourself Connect with Alyssa: Instagram: https://www.instagram.com/alyssamariewellness/ Website: https://www.alyssamariewellness.com/ BLOG POST: https://www.joyenergytime.com/how-to-work-through-trauma-with-alyssa-mancao-lcsw/ Join our wellness club for healthcare professionals: https://www.joyenergytime.com/club/ NEW GRAD GUIDE https://joyenergytime.mykajabi.com/new-grad-guide Join the Joy Energy Time Collective, our bi-weekly wellness newsletter for healthcare professionals: https://www.joyenergytime.com/the-thriving-collective/ Our Instagram: www.instagram.com/burntouttolitup/ www.instagram.com/joy.energy.time/ Our website: joyenergytime.com/podcast

What if you were to treat your health as if it was your greatest asset? On this episode, Amanda and Michele Broad - a certified women's health and nurse practitioner - talk about how YOU ARE THE CEO OF YOUR HEALTH. Michele brings 25 years of experience to today's show to help you de-stress so you can build your health to create the vitality you need to be successful in life and business. Episode Highlights: *Your Body as Your Business *Self-Care for Business Builders *Foundational Health Habits *Health as a Journey *Stress & De-stressing *Meditation Tips *Powerful Self-Care Questions Michele's Top 3 Max Potential Health Habits: 1. Put Health on Your Schedule 2. Practice De-Stress Habits 3. Health Reflection Question: When you look at your health today, ask - is this where I want to be? If it's not, do something about it! Links to Michele: www.wellwomennetwork.com Well Women Healthy Lifestyle Podcast: https://wellwomennetwork.com/podcast/ Michele's Bio: Michele Broad, Certified Nurse Practitioner, is the founder of the Well Women Network, an online women's educational site. Her vision is to build a place where women find genuine answers to the health concerns they face day to day. Michele holds two Nurse Practitioner Certificates, the first in Obstetrics and Gynecology in which she also holds a national certification, the second in Adult Medicine. She is a graduate of UCLA, earning her Bachelor of Science in Nursing with honors. Her passion led her to earn her Nurse Practitioner Certificates from Harbor-UCLA and a Masters in Nursing from CSULB. She has practiced medicine for the past 25 years and owned her personal Nurse Practitioner practice in California for 8 of those years. She has worked with thousands of women over her career and has loved every minute of it.

What if you were to treat your health as if it was your greatest asset? On this episode, Amanda and Michele Broad - a certified women’s health and nurse practitioner - talk about how YOU ARE THE CEO OF YOUR HEALTH. Michele brings 25 years of experience to today’s show to help you de-stress so you can build your health to create the vitality you need to be successful in life and business. Episode Highlights: *Your Body as Your Business *Self-Care for Business Builders *Foundational Health Habits *Health as a Journey *Stress & De-stressing *Meditation Tips *Powerful Self-Care Questions Michele’s Top 3 Max Potential Health Habits: 1. Put Health on Your Schedule 2. Practice De-Stress Habits 3. Health Reflection Question: When you look at your health today, ask - is this where I want to be? If it’s not, do something about it! Links to Michele: www.wellwomennetwork.com Well Women Healthy Lifestyle Podcast: https://wellwomennetwork.com/podcast/ Michele’s Bio: Michele Broad, Certified Nurse Practitioner, is the founder of the Well Women Network, an online women's educational site. Her vision is to build a place where women find genuine answers to the health concerns they face day to day. Michele holds two Nurse Practitioner Certificates, the first in Obstetrics and Gynecology in which she also holds a national certification, the second in Adult Medicine. She is a graduate of UCLA, earning her Bachelor of Science in Nursing with honors. Her passion led her to earn her Nurse Practitioner Certificates from Harbor-UCLA and a Masters in Nursing from CSULB. She has practiced medicine for the past 25 years and owned her personal Nurse Practitioner practice in California for 8 of those years. She has worked with thousands of women over her career and has loved every minute of it. ********************* Links to Dr. B & NFA Coaching: Website: www.NFACoaching.com Insta: www.instagram.com/nfacoaching/ LinkedIn: www.linkedin.com/in/nfacoaching/ Facebook: www.facebook.com/NFACoaching/ YouTube: bit.ly/MaxPotentialHabitsonYouTube *********************** ➡️Get your FREE Video & PDF Download - NFA Top 10 Strategic Business Habits to Uplevel Your Game bit.ly/NFATop10BusinessHabitsDownload ➡️ Gain Access to the Money Magnet Guide: bit.ly/NFAMoneyMagnetGuide ➡️Enroll in NFA Business Builder Live Weekly Group Coaching: bit.ly/NFABusinessBuilderLive ➡️Schedule a NFA Max Potential Habits Coaching Consult Here: bit.ly/NFACoachingConsult

JJ Virgin is a 4 x New York Times Best Selling Author, TV show Host, Triple Board certified Celebrity Nutritionist and a warrior mum. In 2012 JJ's 16 year old son Grant was the victim of a hit and run accident and was left barely hanging onto life, after weeks in a critical condition and defying all the odds he slowly emerged from his coma with major brain trauma and 13 fractures and a near torn aorta. JJ was told from the outset he wouldn't survive the first night, that he wouldn't survive the airlift to the hospital, that he wouldn't survive the operation and that if by some miracle he did his brain damage would make it a life not worth living. But JJ is a fighter and she decided from the outset that her son would survive and thrive and that she wouldn't rest until he was 110%. The years of rehabilitation and the strategies she used to get him there is what we share in this interview. This powerful story resonated with me because I have been through the same experience with my mother and I too refused to give up, had to advocate for her rehabilitation and took a multple pronged approach to her recovery as did JJ with her son.   This incredibly powerful woman is a testament to what the right mindset combined with love, belief, faith and the ability to build a team around her can do to beat the odds.   We would like to thank our sponsors Running Hot - By Lisa Tamati & Neil Wagstaff If you want to run faster, longer and be stronger without burnout and injuries then check out and TRY our Running Club for FREE on a 7 day FREE TRIAL Complete holistic running programmes for distances from 5km to ultramarathon and for beginners to advanced runners.   All include Run training sessions, mobility workouts daily, strength workouts specific for runners, nutrition guidance and mindset help Plus injury prevention series, foundational plans, running drill series and a huge library of videos, articles, podcasts, clean eating recipes and more.   www.runninghotcoaching.com/info and don't forget to subscribe to our youtube channel at Lisa's Youtube channel  www.yotube.com/user/lisatamat and come visit us on our facebook group   www.facebook.com/groups/lisatamati Epigenetics Testing Program by Lisa Tamati & Neil Wagstaff. Wouldn’t it be great if your body came with a user manual? Which foods should you eat, and which ones should you avoid? When, and how often should you be eating? What type of exercise does your body respond best to, and when is it best to exercise? These are just some of the questions you’ll uncover the answers to in the Epigenetics Testing Program along with many others. There’s a good reason why epigenetics is being hailed as the “future of personalised health”, as it unlocks the user manual you’ll wish you’d been born with! No more guess work. The program, developed by an international team of independent doctors, researchers, and technology programmers for over 15 years, uses a powerful epigenetics analysis platform informed by 100% evidenced-based medical research. The platform uses over 500 algorithms and 10,000 data points per user, to analyse body measurement and lifestyle stress data, that can all be captured from the comfort of your own home Find out more about our  Epigenetics Program and how it can change your life and help you reach optimal health, happiness and potential at: https://runninghotcoaching.com/epigenetics You can find all our programs, courses, live seminars and more at www.lisatamati.com    Transcription from the show. Speaker 2: (00:02) Well, hello everybody. It's Lisa Tamati here at pushing the limits today. I have a really wonderful special guest with me all the way from Tampa in Florida. She's an absolute superstar of a lady. She's a celebrity nutritionist, four times New York Times best seller fitness hall of Famer and she's also a warrior mum and she has a very interesting story today that we're going to delve into both in her career and what she's achieved but also,uwas ubrain injury in regards to his son grants. We had a hit and run x events. So welcome to the show JJ. It's fantastic to have you. Thank you. Good to be here also. (00:42) So JJ, I just want to start a little bit of it with a background. If you wouldn't mind sharing, what you do and your, your books and your work a little bit. That'd be fantastic. Speaker 3: (00:54) All right. I am a nutrition and fitness expert and so I've got a bunch of books I've written over the years. Online programs. I speak, I do TV. I had a couple, I was kind of helped start reality TV because I was on Dr Phil's weight loss challenges for two years. It was really when that whole thing was kinda getting going. Then I had my own show on TLC called freaky eaters. So I've been really fortunate to just be able to work in something that I'm super passionate about, which is anything related to health and wellness. And then I also have an organization where we help other doctors and health experts get their message out to the world called mindshare. Speaker 2: (01:37) Oh Wow. And that is something that we definitely want to delve into a little bit too. So now I want to go back to you've got two sons, Bryce and Grant and in 2012 Grant was the victim of a hit and run accident. Can we share a little bit about that story and what you sort of went through with him and you know, it really resonated with me, your book and your story because a lot of the same dramas that you have over there, it was with the system a few like we have here as well. Probably even worse, the speaks and you had to be a real fighter and therefore the title of your, your book sort of really resonated with me as well. So can we go into that story a little bit and tell us what happened with Grant? Speaker 3: (02:29) Yeah, it's really a story I realized after the fact. It's really a story about what it takes to be a caretaker and I think that's important to underscore because it's a role all of us will have to play, right? I mean, at some point in your life you're going to be taking care of kids, you're going to be taking care of your parents. Maybe you're taking care of both at the same time or a spouse or siblings. So it's, it's one of those roles in life that you will probably face and how you show up during that role can make the difference between life and death for that person. So and also you know, how you show up is going to make a difference on your personal health too. So the grant was 16 years old. My other son was 15 years old. Speaker 3: (03:15) Bryce and grant went out to walk to a friend's house one night and got hit by a car and I didn't see this. A neighbour didn't see him getting hit. He just saw him lying on the street. You saw this woman get out of her car, gasp, get back in and drive off. And he then called nine one one and he was airlifted to the local hospital. When we got there, they told us that he had a torn aorta and it was going to rupture sometime in the next 24 hours unless it got repaired. But that he would never survive the airlift to the next hospital. They couldn't repair it there. He would have to, but that he wouldn't survive that. And even if you were to survive that, he would most likely not survive the surgery. And even if you were to survive that, he'd be so brain damaged. Speaker 3: (04:07) It wouldn't be worth it. I mean, literally they said that, I remember looking at this doctor going, he didn't, did he say that? And My 15 year old looked at the doctrine, he said, well, maybe like, is there a 0.25% chance he'd make it because the doctor already said his aorta was going to rupture sometime in the next 24 hours. And the doctor said, that sounds about right. Bryce could looked over at me. That's not zero. You know, and we're like, we'll take those odds. And because I think any, any parent out there or anyone who loves anybody would have to agree that as long as there's a chance, even if it's the teensiest little chance, like you've got to go for it, you know, you've got to fight for it. I mean, the idea that I was gonna let my son die here, there was absolutely no way I was going to do that. Speaker 3: (04:52) So we overruled. This doctor. Had Him airlifted. He survived the airlift, went through surgery, he survived that surgery. Now when he came out of the surgery, he had a stint in and he was, his aorta was fine, but he was in a deep coma. The neurosurgeons were like, we don't know if he'll wake up. And I remember standing in the hospital and he had 13 fractures. He was in this deep coma, multiple brain bleeds. And there were like literally Lisa, two little fingers I could hold on to everything else was either covered with road rash. It was bandaged shoes and cast. And I was standing there holding this little fingers and I said, grant, you know, I love you so much and nothing, you know, just the beeps of the machine he had, he was on a respirator, he had a central line. So it was all these things being monitored. Speaker 3: (05:43) And then I said, and your brother Bryce loves you so much. And I felt the littlest fingers squeezy and Huh. And then I said, you know, grandma loves you so much, nothing. And I said, your girlfriend Kenzie loves you so much. And that's when I felt this big by my hand getting picked a little bit up. And I said, you know, grant, you're going to be 110% your name means warrior. I got this. I've got so many friends in the business who can help, but I need you to fight. You've got to fight, you've gotta hang on for me and your name means warrior. Turns out. So I said, you just got to you. You've got to fight all, handle the rest and we're going to get you to be 110% and I just lived that 110%. I was so afraid to let anything else get into my brain that, that you know, the what ifs. Speaker 3: (06:31) Like what if he doesn't wake up? What if he can't walk away? I just, cause I felt like if I thought it, it would happen. So I've always been one of those people who believes that you can, you can create your reality. And I just managed my mindset. I stay focused on the 110% and you know, and there are a lot of times in there, things were not looking like they were even gonna make it to like 30%. You know, I'm much less a hundred, much less this like unrealistic number that doesn't exist. But I will tell you today, after being told that he would never survive an air lift or surgery, he'd be so brain damaged. He'd never wake up, he wouldn't walk, he couldn't hear like over and over and over again. He is better than before that accident is so, and you know, it has been this thing in our life that has made all of us in the family so much better and stronger because now you know, the, the things that would average most people would get rattled about, the average person would get upset about, they don't even like, they don't even trick, trick trigger us at all. Speaker 3: (07:39) Like we're like, Eh, no one's dying here. You know, and I'm sure you relate, right? I mean like stuff like this, you realize the stuff that people let get them upset on a regular basis. It just doesn't, who cares? You know, Speaker 2: (07:57) Actually. Yeah. And I mean, I've, my lesson is, know my story with my mom and very similar, not gonna survive if she does miss and brain damage, if she, you know, when she did wake up after weeks in a coma sh lights on, nobody home Speaker 2: (08:16) Years and years of rehabilitation and we're out a story's cross. And why this is so important for me is that you never gave up. You keep your mind on the know. Exactly. I had that 110% in my head too when I go around still saying that. And my mom's only at 90%, so I wa I've still got a wee way to go. But in their whole process, it's not that you don't have doubts and disappear and times where you're on the ground crying going, oh my God, how am I going to get through this? But it's keeping it standing back up every time, Speaker 3: (08:48) Every time. And Hey, here's the thing, Lisa. So you went for 110% and got to 90 Speaker 3: (08:55) That's a lot better than the zero they were giving you. Right. You know, like you look at it, I kept thinking, oh, I'm going to go for 110% if I get to like wherever I get to is better than the zero that they, the 0.25 they gave me. So you know, you just gotta keep going. And by the way, it's only been recently that he really has been getting to this hundred and 10% I just figured as long as he's alive, there's always something else I can do. It's something amazing I can do. So he is now better than before the accident. But now I'm not showing, you know, we're just going to keep Speaker 2: (09:27) Pushing. Exactly. And you've got to, you've got to keep that focus. One of the things, the, the title of my book that's coming out is called relentless. And that's exactly what you have to be is totally and utterly real. And I know, and with my journey, I came up against a huge opposition to the way that I was wanting to rehabilitate my mum in both the resources that I wouldn't try to get hold of. In my approach, I was criticized a lot for why are you putting you through such a rigorous and difficult training regime? Why don't you just let it be comfortable and know Speaker 3: (10:07) Rest, no wrestling cupcakes and just let her be Speaker 2: (10:10) Exactly. Cupcakes and this, I mean, I'm a ultra endurance athlete. I've been an athlete my entire life and I know so we, you know, do 200 300 kilometer races and things and I know how to overcome when your mind is trying to stop you. I know that people are capable of so much more than what we think we are. Yeah. What I have issue with, I understand that the medical professionals do not want to give you false hope, but to take away your hope creating. Huh. Any hope makes you have a weak action. Like you're not going to fight because you don't believe there's a waste at home. You know, here's the thing. Speaker 4: (10:55) Okay. Speaker 3: (10:55) No one can take our hope away. Speaker 4: (10:57) Cool. Speaker 3: (10:59) So what we've really got to manage is, is we're, we, we're putting people in the wrong places. What you're going when you're going to a doctor is you're getting an opinion. You can do what you want with the opinion. That's what you're getting as an opinion. You know, like the opinion of the doctor at the first hospital was the complete opposite of the opinion of the doctor in the second hospital. Why the first hospital doctor worked in Palm Springs, California, where the average age coming into the urgent care, the trauma center was about 75. Oh Wow. And for 75 year old with a torn aorta, multiple brain bleeds, multiple fractures, this would've been it. Speaker 3: (11:40) But for a 16 year old, it's not. And so the trauma center, we got them to, which is the second trauma centers, number two trauma center in the country in us, they see all sorts of gang fights, people thrown off, overpasses, all sorts of stuff. This was like not out of the norm. Right? So you're just getting their opinion based on what they know. And they're going to give you the best opinion they can based on the information that they have. And then you get to make the decision you want out of it. I think that we're giving people power where we shouldn't be, you know, so and yes, people thought I was absolutely crazy. But then they started to get behind it cause I started tell them what, you know, what I was doing and what we were going to have, especially when they walked in, said, oh he's never gonna walk again. Speaker 3: (12:30) I go, well, Huh. You know, he had a crushed heel. And I said, well what if Kobe Bryant were in this bed cause I'm pretty sure that you would be doing everything possible. So that's what we're going to do. And you know, then they told me he was in the second hospital, which was a rehab hospital. And they told me that you know, there was a swimming pool and they go in there. They go, oh he's not ready for that. And there was a gym and I would sneak into the gym with him and do stuff and they get mad at me. So then I got to t I got a little furlough where I got to take them out for four hours. So we took them to an Olympic size pool. We took a video of him swimming perfectly through this pool. Then we took him to the gym, and then I took the video of him doing all this workout stuff at the gym. And I said, he wants to be challenged. Human beings need to be challenged. They, you know, that's how we actually get stronger. We don't get stronger by doing a little less than what we're capable of. We get stronger by being pushed beyond what we think we're capable of. And that's what we have to do. Speaker 2: (13:34) I mean, that is just absolutely amazing. I mean, well, I had all this opposition when I was in the hospital that she would not even live for a few weeks even when she was stabilized. And that she would never, I would never be able to care for her. And I just, I, I was determined to take her home like this, you know, once they said, look, she's not improving, she's never going to do anything again. You have to put her in this, you know, a hospital institution. And I really fought tooth and nail to get her home and to get a little bit of support. So with caregivers in the morning for an hour and just, you know, for personal cares and some time out because she was 24, seven around the clock here and the, they would not give me the resources that I need. I had to really, really fight. Speaker 2: (14:23) And this is one of the important points that I've heard you make before too, and then abuse it. I've listened to did you have to really advocate for your loved one? You can go and, and you've, you're fighting against not only the, the, the accident or the aneurysm or you know, the, the results of that you're filing against the system that if you don't be a pushy, quite, you know, strong person. I mean, I'm, I'm lucky. I'm like, you, I don't really care if people don't like me when it comes to my mum, you know, like, I wouldn't Speaker 2: (15:00) Like a, a lot of, you know, oh, she's said pushy daughter. She's very forceful. You know, she's here again, me, I'm sure they hated me. And, and did not believe that I could do any of this. And I actually, at one stage, I remember going in and throwing my other two books at the doctor and saying, this is who I am and I am not putting my mom in a home and you better get used to it. You better give me what I need. And he still wouldn't, you know. So then I'm walking up brother, and who's very big man, and we got results. What we needed. You do, what ever you take to, to give your loved one the best chance possible. And you know, like with, with you taking grant into the gym and seeing, isn't it a, isn't it a beautiful feeling to actually get them out of the hospital situation and finally into some way like a gym or swimming pool surrounded with, with athletes and people that are actually all about improving themselves rather than being in a rehabilitation place where that's what I found that, you know, when she was surrounded by other young athletes training hard, she rose to the next Speaker 3: (16:15) Well think about, you know, what we know about obesity, that's super interesting. As they, you know, the studies in the U s about obesity being contagious, you catch it from your friends that you will tend to weigh what your closest friends way, even if they live across the country. And so one of the classic things I say when someone says, all right, well now I've gotten healthy and fit, how do I stay that way? I go find fit friends. So, you know, grant, when we took them, we took them out of the hospital after four and a half months earlier than they wanted us to. And then we had them in a Rehab Center for another month, but then I took them out of that, brought them home and I brought them to a training center that is the Athletic Training Center for that area. And they are amazing what they do. There are all sorts of, you know, like rope training, balance training power, like really cool stuff. And that's what we had them doing. And he's still now doing it to this day, like all sorts of crazy balanced stuff and you know, climbing and ropes and that kind of stuff that, you know, again, the average person won't do much less. Someone with rods in their thighs and, you know, he had ac joint problems, all sorts of stuff. And like Speaker 2: (17:37) He's fine, he's fine and he's fighting back. And did you with a brain injury? Did you have to teach grant everything from scratch again or did he start like with mum, it took me 18 months to teach mum just to roll over and bead, you know, it was that she couldn't push a button or she couldn't sit like she was completely floppy and no special awareness. Did grant have those issues as well? Speaker 3: (18:05) Yeah, that's very interesting. So grant was in a coma for a couple of weeks and I thought like in the movies, you know, in the movies someone's in a coma and then one day they wake up and they go, hi, I love you. So that is like shame on those movies. This does not happen this way. We, he didn't wake up from that coma overnight. It happened over time and a lot of time. And we basically got to start all over again at, first of all he did was stare off into space. He wouldn't make eye contact and you moved one arm has only thing that was in a cast. He moved one arm back and forth all day every day. And I was like, Oh, you know, and then we'd sleep off and on and then then you started, you know, being able to make eye contact. Then he started. Then one day I wasn't there at the time, which is so sad. His girlfriend came in and he said, I love you. And so he just, things started to come out, but we had to start all over again with teaching them how to brush his teeth, how to eat, how to go to the bathroom. He knew none of this, none of it. So it was quite like, it was like raising a very big, a 16 year old baby. Speaker 2: (19:16) Yeah. I had a 74 year old baby and they don't think very well. Speaker 3: (19:20) Yeah. Right. It's not a, it's very different. Speaker 2: (19:24) And, and, and this is what people don't quite understand is the dates of the rehabilitation. Every time you get something back, you realize there's another deficit that you haven't thought of. Yeah. You haven't come up against that problem until that one is sort of right. Right. Speaker 3: (19:37) That one installed and you're like, oh no, now they're going to get up. And they can't gonna have any balance. Oh, now that they want to get up, now they've got to go. You know, it's like, yeah. Every single thing was, Speaker 2: (19:49) Was relearning and retraining the brain. Now you were very, in a very lucky situation, you hit some of the world's top doctors and brain doctors like Dr. Daniel Amen. Who's amazing. They supported you through the students. [inaudible] Yeah, most of them don't have such amazing friends, if you like. And the opportunity to get the information that you needed. I want to go a little bit into the, like the supplementation side of things and then get into hyperbaric because hyperbaric is something that we both did. And I know with my mom, it was absolute key factor in her recovery. Can you tell us what your nutritionist, you're an amazing nutritionist, triple board certified, you know, everything about the right foods. What's wrong with the stuff that they give you in the hospital? Speaker 3: (20:41) Things grant said was, you know, when they tried to give him hospital food was disgusting. And I was like yeah, I made a point, especially at the first hospital, the second hospital had better food, but the first hospital had just the typical, it was a county hospital and it was all processed. It was horrible. Honestly. It was like ensure and white bread and I mean just horrible stuff. And he needed wholefoods. He needed you know, good and mega threes, he needed lots of vegetables. There was none, there was nothing there to be had. And so I made a point of bringing and it was a pain in the bucks. His hospital's parking lot was under construction, so I'd end up parking anywhere from a mile to two miles away every single day. And it wasn't in a great neighborhood. So sometimes this would be like six in the morning, nine at night. Speaker 3: (21:38) So it was like, I look at me, I don't, I don't know how the heck I would do this and I would bring a cooler bag of stuff cause there was nowhere to store it there. There was no fridge or freezer or anything else I could use. And so I would just bring this stuff in and I'd make him me smoothies where I'd put fish oil in and Greens and load him up with supplements that he needed. Cause my gosh, when you're healing like that, he had 13 fractures and your brain is healing. You need to be, have heavy duty nutrient dense food and supplements like you don't, this is when you need the most of it. And the last thing you should be doing is eating white flour and you know, bad fats and sugar. Like are you kidding me? You know, we don't want to waste calories here. We've got to make every single thing counts. So I was getting wild salmon and bone Brah and Avocados. I mean I was just loading him up with stuff and thankfully once he started to eat he was a pretty good eater. But you know, at first it was mainly smoothies. Speaker 2: (22:41) Yeah, a new triple a was my best friend. That was a thing I could get into mum cause she could only draw. And this is really, really important that you talk about fish oils and there's a whole lot of other supplements that can really help with brain health. And this is not general knowledge. This is I did CBD oils. I did you know, fish oils anything that was anti-inflammatory, tumeric and things like this. What are some of the secret sauce things, if you like that you grant, and I know you hit them on high doses of fish oil. Speaker 3: (23:20) Well, high dose fish oil was definitely the biggest one that we did. They wouldn't let us do it right away. Now, here's what I would say is prior to the accident he was doing five grams of fish oil a day. I believe that that was one of the key things that helped him get through this because it protects your brain. You never know when your brain is going to get injured, right? And if you've got that on to begin with before it happens, you're going to be in better shape. So he had an on board to begin with. Then as soon as I could, the hospital refused to give him more than two grams. So as soon as he took out his feeding tube, which he spit out himself, then I started in. And so that's how I got the fish oil up. Speaker 3: (24:04) Cause I gave this the hospital, the studies and they refused. And the next thing I did was make sure that he had a lot of protein on board and good amino acids because, and that's why something like bone broth or adding Collagen, you need all of that so he can, he can heal. He had all these broken bones, he had so much healing to do and he was sarcopenia. Q had been catabolic from you know, being coma and then not moving and then being on a feeding tube. So I kicked his, his protein way up and I was giving him also these really good amino acids. Super you know, bioavailable. And then a lot of, I did vitamin D. Um, I couldn't give him k cause he was on Warfarin, which you know, it was a little bit, I just gave him vitamin D and then I gave him trying to think about curcumin Acetylcarnitine a ton of brain nutrients like I just through the brain nutrient book at him at the time CBD wasn't out yet. Speaker 3: (25:10) So it wasn't a thing. Otherwise I would absolutely do that. I gave him progesterone and topical progesterone and I don't know, cause the studies, I did it based on Donald's Donald Donald Stein's work out of Emory university on how they saw that reduce brain inflammation. I don't know if it did or not, but here's the thing, like, you know, people ask what worked and I go, I don't know cause I did everything I possibly could and I figured I did things based on what was the pathway, how would it work and what's the risk versus what's the reward, the risk. We're so low on progesterone versus the potential reward, you know, same with like Fischel. There's no, there's no risk there. The rewards way bigger. So I, that's how I just started dosing. Everything is risk versus reward. When we got him out of the hospital, then I could start hyperbaric. Speaker 3: (26:01) We did multiple rounds of stem cells. I think five rounds of, of stem cells. We thread doing stem cells straight into a spine. Wow. And we did a lot of neurofeedback and a lot of exercise, a lot of bringing, like to me, if you to pick one thing that is the most under and has the biggest impact, it's exercise, it raises something called BDNF Alpha. It's going to help you create, you know, create a new brain so to speak. So super important fact that yeah, this is, this is really important. Oh yeah. Yeah. One other thing we did obviously first in the hospital was to and then I wrote to him on this a couple times. Obviously, you know, sugar and gluten are gone, but we had him on a ketogenic diet because when you have a brain injury, your brain can't get glucose in, but it can use ketones for fuel. So, and you can use you can use exotic genus ketones if you have an issue not being able to do that where you're at, like based on what they're feeding. So there's other ways to do it, but that's what we did. Speaker 2: (27:11) Yeah. And those are all really important things. So exalted in as keen t times you can get and things like that. MCT Oils and Speaker 3: (27:18) Yup. Oh, an MCT oil. Yes, we use that. And coffee. You know, coffee has helped him a lot too. So coffee, MCT oil, lot of healthy fats, a lot of fish. Doesn't really, sugar doesn't eat gluten Speaker 2: (27:35) And, and all these things. And this is one of the things that I've, you know, cause I get asked a lot too, what was the one thing that you did it, it's a multifaceted approach. There's no, there's no silver bullet. Speaker 3: (27:50) There is one. Lisa, there is one silver bullet and I think this is the most important part of this story is the most important thing that you did was to make this decision that you are going to do everything you possibly could to help her. And relentless and to do what it takes. And that's the decision I made that night in the hospital. And I think the important takeaway is when you make that decision, there's the most important thing that you have in your arsenal in order to pull that off is you. And in order for you to help your mom come back, the thing you have to do before all else is make sure that you, you put yourself in your health first, that when you think about caretaking, you're the first person you take care of because you cannot help someone else unless you are like at the top of your game. And this is a tremendous amount of stress. And I find with so many people, they just stopped taking care of themselves. So super duper important when you look at this to take care of yourself first. Never feel guilty about it. It's actually selfless to do it. Not Selfish because then you can really show up like you need to. Speaker 2: (29:00) Yeah. Is, and that's something I probably didn't do too well for the first couple of years and ended up quite sick myself. And, and you know, it was its own journey, but that's a really important point because when you, you're, you pouring in, you're giving all the time, every day, all day. You know, I still work with my mum seven hours a day, even though like now she's driving the car and got a full driver's license and walking and doing everything again, I'm still like, you're like, I want that 110%. Speaker 3: (29:29) Oh goodness. At this point of what she went through and how far she's come. Speaker 2: (29:34) He has no recollection of the first 19 months. And so she can't believe. And I, you know, I show her the videos and the little, you know, photos and stories that we've got and she's just like, Nah, that's, that's, you know, I, I can't remember any of that. Or I was like, you're very lucky. You don't really cause it was horrific and it's really horrific to look at the, in the eyes of your loved one and they don't know who you are and they don't know what's happening to them. And then to actually see them come back into, be like fully like your whole personalities. The same. She's intelligent woman again. You know, it's just so wonderful. I remember the first time my mum actually rang me on the phone after, I don't know, a year and a half or something and I was just crying my eyes out because she'd worked out how to use the phone, you know, and she could, you know, just the little things like that, you just know, oh, this is working. Speaker 2: (30:28) And she's coming back. And the, the biggest thing I found too was that on the day to day grind, because it is a grind, it's a day to day battle of training that you, you don't see the progress often for months at a time. You will see nothing happening and things are happening on the cellular level, but you don't see them. And this is where most people give up in that time when you're in a plateau. And if you can push through that, then you can look back and all of a sudden you have another, you know, another little jump in your abilities. And you'd get something back and you'd look back and how far you've come. But when you measuring it on a day to day basis, you're not actually Speaker 3: (31:09) Never, you know, I say this to grant now because he's made some tremendous strides and he doesn't see it. I go, because grant, you don't go out and look at the grass everyday and go, wow, look how much the grass grew from today. But if you went out and looked at the grass f not cutting it for two weeks, you'll look at the grass. Holy Moly. So I go, you cannot, you're going to have to take my word for it. And people who are like seeing you once a week or once a month, you're never going to see this ever. And that's really how life is. Like, you know, everyone wants to have that success. They see the person with the bestselling book or you know, win the race and they think that that just happened and they don't see the grind. And so to me, the paralleling life life is a grind and it's a little consistency every single day that create what we see. Like, people look at grant, I'm sure they're looking at your mom and they go, it's a miracle. I go, it was really flipping grind. Speaker 2: (32:10) A lot of miracle is fricking hard work. It is. And, and this is something that fascinated me with your story too because okay, I'm not as, as amazingly successful as you are. And but you had to continue your career. You keep writing your books. I remember you saying, you know, sitting on the side of your son's bed and trying to get your needs, you, your book out, which was at that very same time sort of thing. And Speaker 3: (32:36) I remember a sweet woman wrote in, posted on my Facebook page and she goes, don't worry about your job. It will be waiting for you. And I thought, yeah no app won't actually the New York publishers, that will be that, you know, it's like I have a, I have a book, I have everything invested in it. If it doesn't go, I will not get another book deal and I'll be bankrupt and then I will not be able to take care of my son. And so, you know, I don't have a job waiting for me. I run my own business. If I'm not there, it's not happening. And so there wasn't that option. There just was that, that realization that if I want my son to be 110%, I'm going to need to be even more successful because this is not free. You know? And a lot of this stuff that you do, like hyperbaric [inaudible] never covered that stem cells insurance never covered that. Speaker 3: (33:33) You know? So it's like, so many of the things that I was doing, insurance just didn't cover. You know, we had he had heavy metal poisoning from some of the stuff and insurance didn't cover that. I mean, just thing after thing after thing. Right. So it, you know, you just, you just do it. You have to do. And it's amazing what we have a capacity to do, you know? Yes. And I, I think for so many people, they're not where they want to be in life because they make success optional. And it wasn't optional here. Right. I mean, in order for me to do what I needed to do for my son, success was no longer an option. It was required in order for me to have what I needed to be able to take him, get him what he needed. And so that was that. Speaker 2: (34:24) Yeah. And you had to stay absolute. This is where the mindset stuff really, really kicks in. And I think because you know both you know, running your own companies and you, you have a huge city successful empire now, but it's the combination and years and years and years of work. And if you dropped the ball for five minutes, when you run your own company, that can be the, you know, it's, that cycle wasn't, as I said difficult to coordinate all this stuff. So you have to, I would have to work with mum all day and then I would come home at eight o'clock at night and work til one in the morning in. This is where I burnt out of course working on my businesses and then, you know, wake up at six in the morning and re repeat rinse. And repeat for day in, day out, seven days a week for the last, you know, four years nearly. Speaker 2: (35:17) In prior to that, it wasn't exactly not working either. You know, like you were still working like mad and it costs a lot of money to rehabilitate someone. I mean, we, we didn't have a hyperbaric er clinic over here at all, so I had to go into commercial dive company and begged them to be able to use their their chambers. And then I got xs for a little while and then it had to be taken off on a contract. So I had to mortgage the House and buy a hyperbaric chamber, a mild one. And then I actually opened up a clinic because I was such a success. Speaker 3: (35:50) Of course you did because you're an entrepreneur. Exactly. Speaker 2: (35:54) And I want to be able to have access to this planet. I'm so good on now. So someone else's running it, but people have access to it. And hyperbaric as a, as one of the key things that I just do not understand why it's not an every hospital in every country of the world. Why this is not often for so many things is because I know no lemon drug money behind it. And this is just tragic for so many people that could be helped by this amazing therapy if they would take it, you know, have enough treatments. So there's a lot of things wrong with the system, not only in America, but in New Zealand. So what would be your advice to people if they're facing something like a brain injury or anything in the hospital if they've got a loved one? How do you know, how do people, I mean, we have access to the Internet. We have resources. We know how to research. We know how to, you know, take action. A lot of people listen to the doctors, either experts and just leave it all up to them. That really isn't gonna work as it. Speaker 3: (37:00) So the doctors, the hospital saved my son's life. And literally put him back together again. And I think what we do wrong here is that we, they are, they're amazing at trauma. And at that piece of it, what they weren't, and they told me they go, this is not our part. We don't do the Rehab. We don't do this piece. They are in the urgent emergent here. Like these bones are broken. The say orders rupture. Like what, what do we need to do? And so just making sure that you're, like, for some reason we think of say a emergency room doctor is not where I would absolutely go if my son broke his leg is not the person I would go to if my son's moods were unstable or if he, you know, didn't have the energy he needed to have. Like we're going, we're assuming that they do everything. Speaker 3: (37:57) And when you really look at it, that is this trauma care, you know, and there's trauma care and then there's disease care and then there's health care or wellness care and there are all different things. But yet we go to two doctors expecting like expecting them to have all the answers, which doesn't make any sense. You'd never go to a gynecologist with a tooth problem. Right. You know, I mean it just, you wouldn't go to your hairstylist for a manicure. Like let's, let's put people ask the right things of the right people because in their zone of genius, like it's amazing. I mean, my son wouldn't be here except for some of these amazing at Harbor UCLA and at Children's Hospital La, you know, I mean they were just incredible. But then we expect them to all of a sudden change gears and do a part of medicine that's not their part. Speaker 3: (38:47) And I'd argue that health care really, you know, the wellness side of it probably isn't, that's not where they should even, that's not their part, their parts trauma and disease. Right. Those are different. So I think the first part of all of this though is just making that decision that you're going to be an advocate for your or your loved one. And I know in the hospital they were like, oh my gosh, cause I'd be there every morning when the grand rounds came through and I was doing my research and I was pulling in my expert opinions and I was getting help and I was, and I was walking through and I wanted to understand it. And I have every right to do that, you know, and, and guess what, we have the right to ask for more information to question things, to bring in other ideas. Speaker 3: (39:36) We can do that. They don't, you know, they like it though. So we, yeah. Well, you know what if someone, I actually had, I had amazing relationships with most of them. I've, I, you know, one woman who was a bit snotty. But for the most part they actually were pretty cool about all the stuff. And I finally at Children's Hospital La, the meetings, which would have all the doctors and therapists had, me too. I go, you know, I see. I know things you guys will never know because you are not the mom. Like, so I got into all the meetings and we all helped guide the care because, you know, and it was very, very different. So I think it's really coming in from a spirit of teamwork and how can we work together? If I've got a doctor who doesn't want to work with any other doctors, that is not going to be my doctor. Just like, like right now, I just moved to Tampa, we're remodeling the house. And if I'm, I, you know, we have an architect, well, if the, if the person who's going to do the construction doesn't want to work with the architect, we don't have a, we don't have anything going on. Like they're not going to work together. Right. With the doctors. Like they all have to work together. And this is just expectations and don't let someone intimidate you. You're the customer. Yes. You're exactly right. You know? Yeah. Speaker 2: (40:52) Him and I did by the, you know, I think we put doctors on a pedestal sometimes, which I mean they're amazing, you know, intellectual incredible people, but they don't always know every answer there is in, just because you don't have a doctorate doesn't mean that you haven't been able to research stuff and find the best doctors that can help you. And you've also got a brain in your head and you, and you're sitting there 24, seven or you know, your family is around the clock with that person. They can see the changes where a doctor hadn't, he has five minutes to spend with you before they move on to the next one. Speaker 3: (41:27) Quite often we can see, give them valuable. I had a son with a psych disorder with a brain injury. Yeah. And so I was like going, you know, I can tell you what's new and what's old and where like they would never have been able to tell any of that stuff and what he'd been on before and what worked and what didn't work and where we need to go from here. And I mean that it was a big learning curve and I could spot when things were starting to go sideways with them. Like I could see it right in the middle of his forehead. They could not see it. I go right now, you know, so cause we had to medicate him enough to keep him calm and stable but not so much as bring wouldn't heal. So I mean there's, there's just a lot that can happen when everyone comes as a team and you know, it comes from what I want is an Improv called the yes. And you know, instead of the yes, but philosophies. So, and that's what I found is for the most part, they all worked in the, yes. And especially when I got to children's Hospital La, they were very collaborative. They took it team approach. Everyone from the nurses to the therapist to the docs all had, you know, important things to say and it mattered. [inaudible] Speaker 2: (42:38) Well, and it's amazing that [inaudible] grant is now back into life and loving life again and fully well and like you, let's talk a little bit about your mind share summit in your, you know, the work that you do. Cause I want people to, you know, that are listening to this to follow what you do, to read your box, to hop online and learn all about you. So JJ, tell us a little bit about your mind share stuff and what you're into at the moment and where you're going with your career. Speaker 3: (43:07) Well my career I've probably got two more books that I'm going to write in the health space. Wow. one much more on how a cure a kind of a caretaker's guide to surviving and thriving. Because that's what really came out of all this with warrior mom is that this really is like we're all caretakers. And then one about really how to, how diets do work were just using them wrong and how to, how to navigate your health. Cause we don't, you know, we don't change our health. We, we haven't been feeling rotten and being sick for 10 years and now we're going to change it in 10 days. You know, it's like takes, it's a process. And what we can accomplish in anything over a year is amazing, but we all try to do it in a week and then beat ourselves up. So working on those two things. Speaker 3: (44:00) But my real passion now lies in fact that I have been fortunate over the years to know so many amazing practitioners and doctors and so I've really devoted my life to helping them identify their messages and their purpose and get that out to the world and then find other people to collaborate with. So that's what mindshare summit is, is bringing health care people, health experts, doctors help entrepreneurs together. They can share ideas, support each other collaborate, not feel alone like so many entrepreneurs do. And that's really kind of my bigger, bigger mission now is how do I help people have better resources? When I was in the hospital with grant, I had amazing resources. And you know, now that the Internet's out there, you don't have to be able to send Dr. Daniel Amen. A text message. You can now get to this information. And that's, that's what I want to see out there is more easy access to information so that when these things happen, you can just plug it in and find out. And, you know, biggest threat we have to all of that right now is, is Google and the search engines trying to dictate what you should be able to locate and find. So we're also working on that piece to make sure that, you know, this information stays open to all and it's not censored, which is so obscene. Huh? Speaker 2: (45:30) Well, yeah. Now how do we get involved with that? Can we get involved with that? You know, from New Zealand's, because I mean, I'm very passionate too about sharing this knowledge. And this is one of the reasons why I've got this book coming out is because I want people to have the tools that I didn't have when I went into this situation. Yeah. And I, I, you know, I got access to it via the Internet. You know, is there ways that we can be involved with that from New Zealand? Speaker 3: (45:57) Which one, which, you know, mind share is, is if you are a health expert doctor, entrepreneur, yes. Mindshare collaborative.com gives you a place to join. It's a membership and then within that we're working on a task force for the rest of this. Cause you know, it's like the whole thing is how do you create information that everyone has access to so that money isn't, isn't the defining line as to whether you can get healthy or not. And you know, the Internet should be the great equalizer. It shouldn't be. All of a sudden you find out that these bigger companies have grand schemes because they own pharmaceutical companies and now they're going to keep the information from you. Like it just, it just is discounted. Really. Yes. It's evil. It's evil. But I think it's, it sounds like it's going to get shut down. If not, you know, there's other options out there. That's hopefully what we get through here with this group Speaker 2: (46:56) And with the box and so on. So JJ, before, just as we wrap up as you, any messages that you want to get across that we've, we've covered a lot of ground today. I know that you've worked on, I did want to mention the broken brain series, which I've bought and, and devoured the, the work that those doctors and professionals are doing. This has been a really important thing. I think that's a huge resource. If I'd had that four years ago, we've been brilliant, you know? Speaker 3: (47:26) Yes. Oh my gosh. But mark Hyman and drew per it have put together an amazing, Mark's been a longtime friend for like 20 years. You know, he's, he's just doing incredible things. Anyone with any kind of brain stuff going on, broken brain is just incredible resource source for you know, loads of interviews, et cetera. And then drew continues with this broken brain podcast. So there's that too. Speaker 2: (47:52) It on jury's podcast. Maybe you can put on a good or on your thoughts for that, that her with the [inaudible] stories. Speaker 3: (47:58) Well, yeah, you have to be in person. You must be in La to do. Yeah. So there's that. But the point is there's a lot of resources. I think the most important thing is that first, you know, when you look at what happens in life, it isn't like a, I'll give you an example. Let's say that you want to have a new sofa in your living room. Use something as mundane as that. The first thing you have to do is envision that you want a sofa in your living room. Then you go out and find the sofa you don't like all of a sudden, you know, a sofa pops in and then you envision it. It always happens in your mind's eye first, right? Yep. So same with this. If, if, when I was facing this situation with grant, the first thing was in my mind's eye, I saw him at 110%. Speaker 3: (48:47) I saw him getting through this. Now anywhere along the line, something could have happened. He nearly died multiple times, but I knew that I was doing everything humanly possible and beyond that to help him get there. And that's what I, you know, that's what I could do. I could manage my mindset and do everything possible on my, on my end to do that. And I think that's really important is we create it first in our mind. Thoughts create. It's very powerful. It's amazing what we can do. So manage your mindset because it's the first thing that you have control over that and commit and make a decision into the situation and always push past what you think is possible. Which was why I said 110%, you know, versus Oh, I just want grant to be alive. Grant just being alive could have been grant in a wheelchair unable to talk or see or hear or anything. So, you know, go for it, go big for it and then go for the resources to make it happen. Speaker 2: (49:50) Well I think that's a beautiful place to wrap it up. JJ, thank you so much for being such a warrior for being such an a fantastic mum. And being such an amazing role model for other people going through these, these sorts of journeys takes for all the work you do in this area with broken brain, with, with all the books that you have out with the nutrition stuff that you do. We can people find you online and buy bio books and know more about JJ. Speaker 3: (50:21) Pretty easy. JJ Virgin, www.jjvirgin.com. Speaker 2: (50:29) Fantastic. Thank you so much for your time today. I really appreciate it. And I wish you son grant and Bryce of course all the best in the future and it'd be amazing to see what they do with the, with your mom too. She's got a, she's super lucky to have you as a daughter, Huh? He's a beautiful mom. I'll send you a book when it comes out. And yeah, it's, it's very special stories. Both of these and these stories are really important to share because it gives other people hope. And the biggest piece of the puzzle we've heard today is your mindset. And they never ever give up and that you throw everything in to the pot. You can't the universe, but you can control what you do. I think that was the biggest takeaway from today. I very much enjoyed today. Thank you. 

Show Notes Jeff: Welcome back to EMplify the podcast corollary to EB Medicine's Emergency Medicine Practice. I'm Jeff Nusbaum and I'm back with Nachi Gupta for the 30th episode of EMplify and the first Post-Ponte Vedra Episode of 2019. I hope everybody enjoyed a fantastic conference. This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Nachi: As the obesity epidemic continues to worsen in America, bariatric procedures are becoming more and more common, and this population is one that you will need to be comfortable seeing. Jeff: Thankfully, this month's author, Dr. Ogunniyi, associate residency director at Harbor-UCLA, is here to help with this month's evidence-based article. Nachi: And don't forget Dr. Li of NYU and Dr. Luber of McGovern Medical School, who both played a roll by peer reviewing this article. So let's dive in, starting with some background. Starting off with some real basics, obesity is defined as a BMI of greater than 30. Jeff: Oh man, already starting with the personal assaults, I see how this is gonna go… Show More v Nachi: Nah! Just some definitions, nothing personal! Jeff: Whatever, back to the article… Obesity is associated with an increased risk of hypertension, hyperlipidemia, and diabetes. Rising levels of obesity and associated co-morbidities also lead to an increase in bariatric procedures, and thereby ED visits! Nachi: One study found a 30-day ED utilization rate of 11% for those undergoing bariatric surgery with an admission rate of 5%. Another study found a 1-year post Roux-en-y ED visit rate of 31% and yet another found that 25% of these patients will require admission within 2 years of surgery. Jeff: Well that's kind worrisome. Nachi: It sure is, but maybe even more worrisome is the rising prevalence of obesity. While it was < 15% in 1990, by 2016 it reached 40%. That's almost half of the population. Additionally, back in 2010, it was estimated that 6.6% of the US population had a BMI> 40 – approximately 15.5 million adults!! Jeff: Admittedly, the US numbers look awful, and honestly are awful, but this is a global problem. From the 80's to 2008, the worldwide prevalence of obesity nearly doubled! Nachi: Luckily, bariatric surgical procedures were invented and honed to the point that they have really shown measurable achievements in sustained weight loss. Along with treating obesity, these procedures have also resulted in an improvement in associated comorbidities like hypertension, diabetes, NAFLD, and dyslipidemia. Jeff: A 2014 study even showed an up to 80% reduction in the likelihood of developing DM2 postoperatively at the 7-year mark. Nachi: Taken all together, the rising rates of obesity and the rising success and availability of bariatric procedures has led to an increased number of bariatric procedures, with 228,000 performed in the US in 2017. Jeff: And while it's not exactly core EM, we're going to briefly discuss indications for bariatric surgery, as this is something we don't often review even in academic training programs. Nachi: According to joint guidelines from the American Society for Metabolic and Bariatric Surgery, the American Association of Clinical Endocrinologists, and The Obesity Society, there are three groups that meet indications for bariatric surgery. The first is patients with a BMI greater than or equal to 40 without coexisting medical problems. The second is patients with a BMI greater than or equal to 35 with at least one obesity related comorbidity such as hypertension, hyperlipidemia, or obstructive sleep apnea. And finally, the third is patient with a BMI of 30-35 with DM or metabolic syndrome though current evidence is limited for this group. Jeff: Based on the obesity numbers, we just cited – it seems like a TON of people should be eligible for these procedures.

Show Notes Jeff: Welcome back to EMplify the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum and I’m back with Nachi Gupta for the 30th episode of EMplify and the first Post-Ponte Vedra Episode of 2019. I hope everybody enjoyed a fantastic conference. This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Nachi: As the obesity epidemic continues to worsen in America, bariatric procedures are becoming more and more common, and this population is one that you will need to be comfortable seeing. Jeff: Thankfully, this month’s author, Dr. Ogunniyi, associate residency director at Harbor-UCLA, is here to help with this month’s evidence-based article. Nachi: And don’t forget Dr. Li of NYU and Dr. Luber of McGovern Medical School, who both played a roll by peer reviewing this article. So let’s dive in, starting with some background. Starting off with some real basics, obesity is defined as a BMI of greater than 30. Jeff: Oh man, already starting with the personal assaults, I see how this is gonna go… Show More v Nachi: Nah! Just some definitions, nothing personal! Jeff: Whatever, back to the article… Obesity is associated with an increased risk of hypertension, hyperlipidemia, and diabetes. Rising levels of obesity and associated co-morbidities also lead to an increase in bariatric procedures, and thereby ED visits! Nachi: One study found a 30-day ED utilization rate of 11% for those undergoing bariatric surgery with an admission rate of 5%. Another study found a 1-year post Roux-en-y ED visit rate of 31% and yet another found that 25% of these patients will require admission within 2 years of surgery. Jeff: Well that’s kind worrisome. Nachi: It sure is, but maybe even more worrisome is the rising prevalence of obesity. While it was < 15% in 1990, by 2016 it reached 40%. That’s almost half of the population. Additionally, back in 2010, it was estimated that 6.6% of the US population had a BMI> 40 – approximately 15.5 million adults!! Jeff: Admittedly, the US numbers look awful, and honestly are awful, but this is a global problem. From the 80’s to 2008, the worldwide prevalence of obesity nearly doubled! Nachi: Luckily, bariatric surgical procedures were invented and honed to the point that they have really shown measurable achievements in sustained weight loss. Along with treating obesity, these procedures have also resulted in an improvement in associated comorbidities like hypertension, diabetes, NAFLD, and dyslipidemia. Jeff: A 2014 study even showed an up to 80% reduction in the likelihood of developing DM2 postoperatively at the 7-year mark. Nachi: Taken all together, the rising rates of obesity and the rising success and availability of bariatric procedures has led to an increased number of bariatric procedures, with 228,000 performed in the US in 2017. Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs. Nachi: According to joint guidelines from the American Society for Metabolic and Bariatric Surgery, the American Association of Clinical Endocrinologists, and The Obesity Society, there are three groups that meet indications for bariatric surgery. The first is patients with a BMI greater than or equal to 40 without coexisting medical problems. The second is patients with a BMI greater than or equal to 35 with at least one obesity related comorbidity such as hypertension, hyperlipidemia, or obstructive sleep apnea. And finally, the third is patient with a BMI of 30-35 with DM or metabolic syndrome though current evidence is limited for this group. Jeff: Based on the obesity numbers, we just cited – it seems like a TON of people should be eligible for these procedures. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Nachi: As far as types of procedures go – while there are many, there are 3 major ones being done in the US and these are the lap sleeve gastrectomy, Roux-en-Y gastric bypass, and lap adjustable gastric banding. In 2017, these were performed 60%, 18%, and 3% of the time. Jeff: And sadly, no two procedures were created alike and you must familiarize yourself with not only the procedure but also its associated complications. Nachi: So we have a lot to cover! overall, these surgeries are relatively safe with one 2014 review publishing a 10-17% overall complication rate and a perioperative 30 day mortality of less than 1%. Jeff: Before we get into the ED specific treatment guidelines, I think it’s worth discussing the procedures in more detail first. Understanding the surgeries will make understanding the workup, treatment, and disposition in the ED much easier. Nachi: Bariatric procedures can be classified as either restrictive or malabsorptive, with restrictive procedures essentially limiting intake and malabsorptive procedures limiting nutrient absorption. Not surprisingly, combined restrictive and malabsorptive procedures like the Roux-en-y gastric bypass tend to be the most effective. Jeff: Do note, however that 2013 guidelines do not recommend one procedure over another and leave that decision up to local surgical expertise, patient specific risk factors, and treatment goals. Nachi: That’s certainly an important point for the candidate patient. Let’s start by discussing the lap gastric sleeve. In this restrictive procedure, 80% of the greater curvature of the stomach is excised producing early satiety and weight loss from decreased caloric intake. This has been shown to have both low mortality and a low overall rate of complications. Jeff: Next we have the lap adjustable gastric band. This is also a restrictive procedure in which a plastic band is placed laparoscopically around the fundus leaving behind a small pouch that can change in size as the reservoir is inflated and deflated percutaneously. Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. Nachi: 20-50% chance of removal, revision, or other cause for return to ER - those are some high numbers. Finally, there is the roux-en-y gastric bypass. As we mentioned previously this is both a restrictive and a malabsorptive procedure. In this procedure, the duodenum is separated from the proximal jejunum, and the jejunum is connected to a small gastric pouch. Food therefore transits from a small stomach to the small bowel. This leads to decreased caloric intake and decreased digestion and absorption. Jeff: Those are the main 3 procedures to know about. For the sake of completeness, just be aware that there is also the biliopancreatic diversion with or without a duodenal switch, as well as a vertical banded gastroplasty. The biliopancreatic diversion is used infrequently but is one of the most effective procedure in treating diabetes, though it does have an increased risk of complications. Expect to see this mostly in those with BMIs over 50. Nachi: Now that you have a sense of the procedures, let’s talk complications, both general and specific. Jeff: Of course, it should go without saying that this population is susceptive to all the typical post-operative complications such as venous thromboembolic disease, atelectasis, pneumonia, UTIs, and wound complications. Nachi: Because of their typical comorbidities, CAD and PE are still the leading causes of mortality, especially within the perioperative period. Jeff: Also, be on the lookout for self-harm emergencies as patients with known psychiatric disorders are at increased risk following bariatric surgery. Nachi: Surgical complications are wide ranging and can be grouped into early and late complications. More on this later… Jeff: Nutritional deficiencies are common enough to warrant pre and postoperative screening. Thiamine deficiency is one of the most common deficiencies. This can manifest within 1-3 months of surgery as beriberi or later as Wernicke encephalopathy. Symptoms of beriberi include peripheral neuropathy, ataxia, muscle weakness, high-output heart failure, LE edema, and respiratory distress. Nachi: All of that being said, each specific procedure has it’s own unique set of complications that we should discuss. Let’s start with the sleeve gastrectomy. Jeff: Early complications of sleeve gastrectomy include staple-line leaks, strictures, and hemorrhage. Leakage from the staple line typically presents within the first week, but can present up to 35 days, usually with fevers, tachycardia, abdominal pain, nausea, vomiting sepsis, or peritonitis. This is one of the most serious and dreaded early complications and represents an important cause of morbidity with an incidence of 3-7%. Nachi: Strictures commonly occur at the incisura angularis of the remnant stomach and are usually due to ischemia, leaks, or twisting of the gastric pouch. Patients with strictures usually have n/v, reflux, and intolerance to oral intake. Jeff: Hemorrhage occurs due to erosions at the staple line, resulting in peritonitis, hematemesis, or melena. Nachi: Late complications of sleeve gastrectomies include reflux, which occurs in up to 25% of patients, and strictures, which lead to epigastric discomfort, nausea, and dysphagia. Jeff: I’m getting reflux and massive heartburn just thinking about all of these complications, or the tacos i just ate…. Next we have the Roux-en-Y bypass. Nachi: Early complications of the Roux-en-Y Gastric Bypass include anastomotic or staple line leaks, hemorrhage, early postoperative obstruction, and dumping syndrome. Jeff: Leak incidence ranges from 1-6%, usually occurring at the gastro-jejunostomy site. Patients typically present within the first 10 days with abdominal pain, nausea, vomiting, and the feeling of impending doom. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever. Nachi: Similar to the sleeve, hemorrhage can occur both intraperitoneally or intraluminally. This may lead to hematemesis or melena depending on the location of bleeding. Jeff: Early obstructions usually occur at either the gastro-jejunal or jejuno-jejunal junction. Depending on the location, patients typically present either within 2 days or in the first few weeks in the case of the gastro-jejunal site. Nachi: If the obstruction occurs in the jejuno-jejunostomy site, this can cause subsequent dilatation of the excluded stomach and lead to perforation, which portends a very poor prognosis. Jeff: Next, we have dumping syndrome. This has been seen in up to 50% of Roux-en-Y patients. Nachi: Early dumping occurs within 10-30 minutes after ingestion. As food rapidly empties from the stomach, this leads to distention and increased contractility, leading to nausea, abdominal pain, bloating, and diarrhea. This usually resolves within 7-12 weeks. Jeff: Moving on to late complications of the roux-en y - first we have marginal ulcers. Peptic ulcer disease and diabetes are risk factors and tobacco use and NSAIDs appear to increase your risk. In the worse case, they present with hematemesis or melena. Nachi: Internal hernias, intussusception, and SBOs are also seen after Roux-en-y gastric bypass. Patients with internal hernias usually present late in the postoperative period following significant weight loss. Jeff: Most studies cite a rate of 1-3% for internal hernias, with mortality up to 50% if there is strangulation. Nachi: And unfortunately for us on the front lines, diagnosis can be challenging. Presenting symptoms may be vague and CT imaging may be negative when patients are pain free, thus laparoscopy may be needed to definitively exclude an internal hernia. Jeff: Strictures may occur both during the early and late period. Most are minor, but significant strictures may result in obstruction. Nachi: Trocar site hernias and ventral hernias are also late complications, usually found after significant weight loss. Jeff: Cholelithiasis is another very common complication of bypass surgery, occurring in up to one third of patients, usually occurring during a peak incidence period between 6-18 months. Nachi: For this reason, the current recommendation is that patients undergoing bypass be placed on ursodeoxycholic acid for 6 months preventatively. Jeff: Some even go as far as to recommend prophylactic cholecystectomy to prevent complications, but as of 2013, the recommendation was only ‘to consider’ it. Nachi: Nutritional deficiencies are also common complications. Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. Patients typically take vitamins postoperatively to prevent such complications. Jeff: And next we have late dumping syndrome, which is far more rare than the last two complications. In late dumping syndrome, 1-3 hours after a meal, patients suffer hypoglycemia from excessive insulin release following the food bolus entering the GI tract. Symptoms are those typical of hypoglycemia. Nachi: Lastly, let’s talk about complications of lap adjustable gastric band surgery. In the early post op period, you can have esophageal and gastric perforations, which typically occur during balloon placement. Patients present with abd pain, n/v, and peritonitis. These patients often require emergent operative intervention. Jeff: The band can also be overtightened resulting in distention of the proximal gastric pouch. Presenting symptoms include abd pain with food and liquid intolerance and vomiting. Symptoms resolves once the balloon is deflated. The band can also slip, allowing the stomach to move upward and within the band. This occurs in up to 22% of patients and can cause strangulation. Presentation is similar to bowel ischemia. Nachi: Later complications include port site infections due to repeated port access. The infection can spread into connector tubing and the peritoneal cavity causing systemic symptoms. Definitely start antibiotics and touch base with the bariatric surgeon. Jeff: The connector can also dislodge or rupture with time. This can present as an arrest in weight loss. It’s diagnosed by contrast injection into the port. Of note, this complication is less common due to changes in the technique used. Nachi: Much like early band slippage and prolapse, patients can also experience late band slippage and prolapse after weeks or months. In extreme cases, the patients can again have strangulation and symptoms of bowel ischemia. More mild cases will present with arrest in weight loss, reflux, and n/v. Jeff: The band can also erode and migrate into the stomach cavity. If this occurs, it usually happens within 2 years of the initial procedure with an incidence of 4-11%. Presenting symptoms here include epigastric pain, bleeding, and infections. You’ll want to obtain emergent imaging if you are concerned. Nachi: And lastly there are two rare complications worth mentioning from any gastric bypass surgery. These are nephrolithiasis, possibly due to increased urinary oxalate excretion or hypocitraturia, and rhabdomyloysis. Jeff: That was a ton of information but certainly valuable as most EM clinicians, even ones in practice for decades, are unlikely to have that depth of knowledge on bariatric surgery. Nachi: And truthfully these patients are complicated. Aside from the pathologies we just discussed, you also have to still bear in mind other abdominal conditions unrelated to their surgery like appendicitis, diverticulitis, pyelo, colitis, hepatitis, pancreatitis, mesenteric ischemia, and GI bleeds. Jeff: Moving on to my favorite - prehospital care - as always, ABCs first. Consider IV access and early IV fluids in those at risk for dehydration and intra-abdominal infections. In terms of destination, if it’s feasible and the patient is stable consider transport directly to the nearest bariatric center - early efforts up front will really expedite patient care. Nachi: Once in the ED, you will want to continue initial stabilization. Special considerations for the airway include a concern for a difficult airway due to body habitus. Make sure to position appropriately and preoxygenate the patients if time allows. Keep the patient upright for as long as possible as they may desaturate quickly when flat. Jeff: We both routinely raise the head of the bed for all of our intubations. This is ever more important for your obese patients to help maximize your chance of first pass success without significant desaturation. Nachi: And though I’m sure we all remember this from residency, it’s worth repeating: tidal volume settings on the ventilator should be based on ideal body weight, not actual body weight. At 6 to 8 mL/kg. Jeff: Tachycardic patients should make you concerned for hypovolemia 2/2 dehydration, sepsis, leaks, and blood loss. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. A HR > 120 with abdominal pain should make you concerned enough to discuss urgent ex-lap with the surgeon to evaluate for the post op complications we discussed earlier. Nachi: If possible, obtain a view of the IVC also while doing your ultrasound to assess for volume status. But bear in mind that ultrasound will undoubtedly be more difficult if the patient has a large body habitus, so don’t be disappointed if you’re not getting the best views. Jeff: Resuscitation should be aimed at early fluid replacement with IV crystalloids for hypovolemic patients and packed RBC transfusions for patients presumed to be unstable from hemorrhage. No real surprises there for our listeners. Nachi: Once stabilized, gather a thorough history. In addition to the usual questions, ask about po intolerance, early satiety, hematemesis, and hematochezia. Definitely also gather a thorough surgical history including name of procedure, date, known complications post op, and name of the surgeon. Jeff: You might also run into “medical tourism” or global bariatric care. Patients are traveling overseas to get their bariatric care more and more frequently. Accreditation and oversight is variable in different countries and there isn’t a worldwide standard of care. Just an important phenomenon to be aware of in this population. Nachi: On physical exam, be sure to look directly at the belly, making note of any infections especially near a port-site. Given the reorganized anatomy and extent of soft tissue in obese patients, don’t be reassured by a benign exam. Something awful may be happening deeper. Jeff: This naturally brings us into diagnostic testing. Not surprisingly, labs will be helpful in these patients. Make sure to check abdominal labs and a lipase. Abnormal LFTs or lipase may indicate obstruction of the biliopancreatic limb in bypass patients. Nachi: A lactic acid level will help in suspected cases of hypoperfusion from sepsis or bowel ischemia. Jeff: And as we mentioned earlier, these patients are often at risk for ACS given their comorbidities. Be sure to check a troponin if you suspect cardiac ischemia. Nachi: If concerned for sepsis, draw blood cultures, and if concerned for hemorrhage, be sure to send a type and screen. Urinalysis and urine culture should be considered especially for early post op patients, symptomatic patients, or those with GU complaints. Jeff: And don’t forget the urine pregnancy test for women of childbearing age, especially prior to imaging. Nachi: Check an EKG immediately after arrival for any patient that may be concerning for ACS. A normal ekg of course does not rule out a cardiac cause of their presentation. Jeff: As for imaging, plain radiographs certainly play a role here. For patients with respiratory complaints, check a CXR. In the early postoperative period, there is increased risk for pneumonia. Nachi: Unstable patients with abdominal pain will benefit from an emergent abdominal series, which may show free air under the diaphragm, pneumatosis, air-fluid levels, or even dilated loops of bowel. Jeff: Of course don’t forget that intra abd air may be seen after laparoscopic procedures depending on how recently the operation was performed. Nachi: Plain x-ray can also help diagnose malpositioned or slipped gastric bands. But a negative study doesn’t rule out any of these pathologies definitively, given the generally limited sensitivity and specificity of x-ray. Jeff: You might also consider an upper GI series. Emergent uses include diagnosis of slipped or prolapsed gastric bands as well as gastric or esophageal perforations. Urgent indications include diagnosis of strictures. These can also diagnose gastric band erosions and help identify staple-line or anastomotic leaks in stable patients. Nachi: However, upper GI series might not be easy to obtain in the ED, so it’s often not the first test performed. Jeff: This brings us to the workhorse for diagnostic evaluation. The CT. Depending on suspected pathology, oral and/or IV contrast will be helpful. Oral contrast can help identify gastric band erosions, staple-line leaks, and anastomotic leaks. Leaks can be identified in up 86% of cases with oral contrast. Nachi: CT will also help diagnose internal hernias. You might see the swirl sign on CT, which represents swirling of the mesenteric vessels. This is highly predictive of an internal hernia, with a sensitivity of 78-100% and specificity of 80-90% according to at least two studies. Jeff: While CT is extremely helpful in making this diagnosis, note that it may be falsely negative for internal hernias. A retrospective review showed a sensitivity of 76% and a specificity of 60%. It also showed that 22% of patients with an internal hernia on surgical exploration had a negative CT in the ED. Another study found a false negative rate of 32%. What does all this mean? It likely means that a negative study may still necessitate diagnostic laparoscopy to rule out an internal hernia. Nachi: While talking about CT, we should definitely mention CTA for concern of pulmonary embolism. In order to limit contrast exposure, you might consider doing a CTA chest and CT of the abdomen simultaneously. Jeff: Next up is ultrasound. Ultrasound is still the first-line imaging modality for assessing the gallbladder and for biliary tract disease. And as we mentioned previously, ultrasound should be considered for your RUSH exam and for assessing the IVC. Nachi: We also should discuss endoscopy, which is the test of choice for diagnosing gastric band erosions. Endoscopy is also useful for evaluating marginal ulcers, strictures, leaks, and GI bleeds. Endoscopy additionally can be therapeutic for patients. Jeff: When treating these patients, attempt to contact the bariatric surgeon for guidance as needed. This shouldn’t delay imaging however. Nachi: For septic patients, make sure your choice of antibiotics covers intra-abdominal gram-negative and anaerobic organisms. Port-site infections require gram-positive coverage to cover skin flora. Additionally, give IV fluids, blood products, and antiemetics as appropriate. Jeff: Alright, so this month, we also have 2 special populations to discuss. First up, the kids. Nachi: Recent estimates from 2015-2016 put the prevalence of obesity of those 2 years old to 19 years old at about 19%. As obese children are at higher risk for comorbidities later in life and bariatric surgery remains one of the best modalities for sustained weight loss, these surgical procedures are also being done in children. Jeff: Criteria for bariatric surgery in the adolescent population is similar to that of adults and includes a BMI of 35 and major comorbidities (like diabetes or moderate to severe sleep apnea) or patients with a BMI 40 with other comorbidities associated with long term risks like hypertension, dyslipidemia, insulin resistance and impaired quality of life. Nachi: Despite many adolescents meeting criteria, they should be referred with caution as the long term effects are unclear and the adolescent experience is still in its infancy with few pediatric specific programs. Jeff: Still, the complication rate is low - about 2.3% with generally good clinical outcomes including improved quality of life and reducing or staving off comorbidities. Nachi: Women of childbearing age are the next special population. They are at particular risk because of the unique caloric and nutrient needs of a pregnant mother. Jeff: Pregnant women who have had bariatric surgery have an increased risk of perinatal complications including prematurity, small for gestational age status, NICU admission and low Apgar scores. However, these risks come with benefits as other studies have shown reduced incidence of pre-eclampsia, large for gestational age neonates, and gestational diabetes. Nachi: 2013 guidelines from various organizations recommend avoiding becoming pregnant for at least 12-18 months postoperatively, with ACOG recommending a minimum of 2 years. Bariatric surgery patients who do become pregnant require serial monitoring for fetal growth and higher doses of supplemental folate. Jeff: We also have 2 pretty cool cutting edge techniques to mention this month before getting to disposition. Nachi: Though these are certainly not going to be done in the ED, you should be aware of two new techniques. Recently, the FDA approved 3 new endoscopic gastric balloon procedures in which a balloon is inflated in the stomach as a means of simulating a restrictive procedure. Complications include perforation, ulceration, GI bleeding, and migration with obstruction. As of now, they are only approved as a temporary modality for up to 6 months. Jeff: And we also have the AspireAssist siphon, which was approved in 2016. With the siphon, a g tube is placed in the stomach, and then ⅓ of the stomach contents is drained 20 minutes after meals, thus limiting overall digested intake. Nachi: Pretty cool stuff... Jeff: Yup - In terms of disposition, decisions should often be made in conjunction with the bariatric surgical team. Urgent and occasionally emergent surgery is required for those with hemodynamic instability, anastomotic or staple line leaks, SBO, acute band slippage with dilatation of the gastric pouch, tight gastric bands, and infected port sites with concurrent intra abdominal infections. Nachi: And while general surgeons should be well-versed in these complications should the patient require an emergent surgery, it is often best to stabilize and consider transfer to your local bariatric specialty facility. Jeff: In addition to the need for admission for surgical procedures, admission should also be considered in those with dehydration and electrolyte disturbances, those with persistent vomiting, those with GI bleeding requiring transfusions, those with acute cholecystitis or choledococholithiasis, and those with malnutrition. Nachi: Finally, patients with chronic strictures, marginal ulcers, asymptomatic trocar or ventral hernias, and stable gastric band erosions can usually be safely discharged after an appropriate conversation with the patient’s bariatric surgeon. Jeff: Definitely a great time to do some joint decision making with the patient and their surgeon. Nachi: Exactly. Let’s close out with some Key points and clinical pearls. Jeff: Bariatric surgeries are being performed more frequently due to both their success in sustained weight loss and improvements in associated comorbidities. Nachi: There is an increased risk of postoperative myocardial infarction and pulmonary embolism after bariatric surgery. There is also an increased risk of self-harm emergencies after bariatric surgery, mostly in patients with known psychiatric co-morbidities. Jeff: Nutritional deficiencies can occur following bariatric surgery, with thiamine deficiency being one of the most common. Look for signs of beriberi or even Wernicke encephalopathy. Nachi: Staple-line leaks are an important cause of postoperative morbidity. Patients often present with abdominal pain, vomiting, sepsis, and peritonitis. Jeff: Strictures can also present postoperatively and cause reflux, epigastric discomfort, and vomiting. Nachi: Intraperitoneal or intraluminal hemorrhage is a known complication of bariatric surgery and may present as peritonitis or with hematemesis and melena. Jeff: After significant weight loss, internal hernias with our without features of strangulation are a late complication. Nachi: Late dumping syndrome is a rare complication following Roux-en-Y bypass occurring months to years postoperatively. It presents with hypoglycemia due to excessive insulin release. Jeff: Esophageal or gastric perforation are early complications of adjustable gastric band surgery. These patients require emergent surgical intervention. Nachi: Overtightening of the gastric band results in food and liquid intolerance. This resolves once the balloon is deflated. Jeff: Late complications of gastric band surgery include port-site infections, connector tubing dislodgement or rupture, band slippage or prolapse, and band erosion with intragastric migration. Nachi: Given the myriad of possible bariatric surgeries, emergency clinicians should be cognizant of procedure-specific complications. Jeff: Consider obtaining a lactic acid level for cases of suspected bowel ischemia or sepsis. Nachi: Endoscopy is the best method for diagnosing and treating gastric band erosions. Jeff: Septic patients should be treated with antibiotics that cover gram-negative and anaerobic organisms. Suspected port site or wound infections require gram positive coverage. Nachi: Pregnant patients who previously had bariatric surgery are at risk for complications from their prior surgery as well as pregnancy-related pathology. Jeff: A plain radiograph may be useful in unstable patients to evaluate for free air under the diaphragm, pneumatosis, air-fluid levels, or dilated loops of bowel. Nachi: CT of the abdomen and pelvis is the mainstay for evaluation. Oral and/or IV contrast should be considered depending on the suspected pathology. Jeff: Have a low threshold for emergent surgical consultation for ill-appearing, unstable, or peritonitic patients. Nachi: So that wraps up Episode 30! Jeff: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Nachi: And the address for this month’s cme credit is ebmedicine.net/E0719, so head over there to get your CME credit. As always, the [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at EMplify@ebmedicine.net with any comments or suggestions. Talk to you next month! Most Important References Altieri MS, Wright B, Peredo A, et al. Common weight loss procedures and their complications. Am J Emerg Med. 2018;36(3):475-479. (Review article) Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014(8):CD003641. (Cochrane review; 22 trials) Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21 Suppl 1:S1-S27. (Society practice guidelines) Phillips BT, Shikora SA. The history of metabolic and bariatric surgery: development of standards for patient safety and efficacy. Metabolism. 2018;79:97-107. (Review article) Contival N, Menahem B, Gautier T, et al. Guiding the nonbariatric surgeon through complications of bariatric surgery. J Visc Surg. 2018;155(1):27-40. (Review article) Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient, 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727-741. (Society practice guidelines) Chousleb E, Chousleb A. Management of post-bariatric surgery emergencies. J Gastrointest Surg. 2017;21(11):1946-1953. (Review article) Goudsmedt F, Deylgat B, Coenegrachts K, et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass: a correlation between radiological and operative findings. Obes Surg. 2015;25(4):622-627. (Retrospective review; 7328 patients) Michalsky M, Reichard K, Inge T, et al. ASMBS pediatric committee best practice guidelines. Surg Obes Relat Dis. 2012;8(1):1-7. (Society practice guidelines)

TITLE: Diagnosing fibromyalgia by physical exam and the power of the guaifenesin protocol - Dr. Congdon and Eva of WellacopiaDiagnosing fibromyalgia by physical exam - Dr. Congdon and Eva of Wellacopia (for the artwork only)---Get matched with your perfect practitioner at Wellacopia.comIf you are unable to find a good match in your location yet, Eva will do the personalized matching for you anywhere in the USA. Text: 1-646-883-3022 or Email: Contact@Wellacopia.comTo contact or learn more from Dr. Melissa Congdon, please visit MelissaCongdonMD.com--- What is your profession?I am a physician who treats children and adults with fibromyalgia. I am a board-certified pediatrician who was in private practice for 18 years until severe fibromyalgia symptoms forced me to retire from medicine. After going on the guaifenesin protocol and getting acupuncture my symptoms dramatically declined, enabling me to return to practice medicine 20 months after I “retired.” My fibromyalgia doctor, Dr. Paul St. Amand at Harbor UCLA medical center suggested that I not go back to practicing general pediatrics but become a fibromyalgia consultant instead. I trained with him and have been doing fibromyalgia consulting for children and adults since 2010.What is your illness(es)? FibromyalgiaWhere do you work? The San Francisco Bay AreaWho do you work with? I am in solo practice, but I communicate with my mentor Dr. St. Amand frequently. I also keep in touch with many integrative medicine providers and other health care practitioners to share insights about treatments and ways to help patients feel betterHow did your illness shape your career?I was sick for a long time before I was diagnosed with fibromyalgia. I have severe fatigue, dizziness, 15 migraines a month, chronic neck and shoulder pain, and irritable bowel symptoms. I thought surely I must be dying because I felt so sick and doctors could not figure out what was wrong with me. My children were young at this time, and I hoped that I would not pass away until my youngest was at least 7 years old, because I thought by that age she would remember her mother’s love. So I have been to that dark hopeless place that chronic illness can lead a person to, and I went from mostly housebound to feeling well again. My illness motivated me to help others do the same. It feels so good to feel good again!What do you do when you don't know what to do about a patient? First I like to think and meditate about it, then if I can’t come up with a treatment plan I will reach out to my network of healthcare providers to get insight.Are you/were you open about your illness with patients?YES. My patients tell me it is a great help to them that I truly understand what it feels like to have fibromyalgia (physically and emotionally), and that that is one of the reasons they have chosen me to help them feel better.What are you most passionate about in regards to your work?Two things. First of all, how to make an accurate diagnosis by physical exam, and no, I am not talking about the inaccurate tender point exam. My mentor, Dr. Paul St. Amand, taught me how to diagnose fibromyalgia using a physical exam technique called “mapping.” He has found that everyone with fibromyalgia has a pattern of very small swollen and contracted muscles along their left anterior thigh. He taught me how to detect them, and if a patient has these swellings, then they have fibromyalgia! It is not complicated! These swellings are so small and are not tender, so most people with fibromyalgia don't realize they are there -- but they are super easy to feel once you have been trained in this technique.Secondly, I love helping people with fibromyalgia decrease their pain, improve their mood, and increase their energy. There are a lot of helpful tips I can give them to achieve this, but one of the most life changing treatments I have found for fibromyalgia is the guaifenesin protocol. Guaifenesin is an expectorant (it is the active ingredient in Mucinex) and used in the right form (long acting dye free guaifenesin) and avoiding products that can block its action, guaifenesin can decrease our muscle spasm and pain over time (as well as increase energy, improve mood, intestinal function, etc). After I dramatically improved using the guaifenesin protocol, my mentor taught me how to administer the protocol to others. It has been so successful patients thank me every month for giving them their lives back! I feel so thankful to have found the guaifenesin protocol and thankful for the opportunity to help others with fibromyalgia feel better.How do you/did you handle flares while at work? I am able to set my own schedule, so if I need more down time I insert a break in my schedule.How do you did you handle being a patient and a professional in your personal life? When I am at work I am focusing on my patient, and I only bring up my personal experiences if my patient asks.Do you tell your patients what you tell yourself / do you practice what you preach? For the most part! I am committed to helping my patients feel better, and sometimes I spend more than the allotted time for the appointment answering patient’s questions. This can cause me to miss lunch!Has your condition made you more or less empathetic to those like you? MORE empathetic! I have come to understand that some healthcare professionals do not believe fibromyalgia is a real medical condition. They think that we are depressed, or stressed, or just lazy. I even heard one rheumatologist refer to Fibromyalgia as “The F word!” I KNOW fibromyalgia is real because I feel the symptoms (plus there are hundreds of studies indicating that those of us with fibromyalgia have unique physical and biochemical findings). I am passionate about helping validate my patients symptoms and help empower them to get the care they deserve.How do you research conditions? on your own? drug companies? medical journals? Colleagues? how do you convey this knowledge to patients? Every morning I go on a physician's site called Doximity to check what new research has been done on fibromyalgia, I also Google fibromyalgia and get a compendium of articles from various sources about what is happening the field of fibromyalgia and chronic pain. I talk to colleague regularly, I post every Tuesday on my professional FB page (usually sharing new research results or an article about fibromyalgia) and I send out newsletters on a regular basis to my patients updating them on the latest developments in the field.How do you feel about holistic medicine? what does it mean to you? The definition of holistic medicine I like best is that Holistic medicine is a form of healing that considers the whole person -- body, mind, spirit, and emotions -- in the quest for optimal health and wellness. ... In this way, if people have imbalances (physical, emotional, or spiritual) in their lives, it can negatively affect their overall health. This is from WebMD. I use the most natural methods and techniques with the fewest side effects when I treat my patients.Tell us about a special experience with a patient (uplifting)Ahh, Stefanie comes to mind. She is a wildlife biologist who developed pain as a child. Her doctors couldn't figure out what was wrong with her. She was having so many migraines and so much pain in her body her doctors told her “well, you are just one of those people with pain.” After 9 months on the guaifenesin protocol she felt a “dramatic decrease” in the pain she was in an increase in energy, so much so that she was able to do more and have the confidence to have a baby, and she did! To see her in the office holding her baby in her arms was so amazing. She said her improvement on guaifenesin “feels like a miracle, it just transformed my life.” There are so many stories like Stefanie’s of symptom improvement on the guaifenesin protocol! I produced a documentary called Fibromyalgia: Getting Our Lives Back--Success Stories on the Guaifenesin Protocol: https://www.youtube.com/watch?v=DtPPoOBeXTM for people who want to learn more.If you had one message to send out to every chronic illness patient out there what would it be? Don’t give up! You are not alone! Keep searching to find your tribe-- supportive healthcare practitioners that are experts in your condition and who are committed to working hard to help you feel better. The documentary Fibromyalgia: Getting Our Lives Back—Success Stories on the Guaifenesin Protocol: https://www.youtube.com/watch?v=DtPPoOBeXTM Dr. St. Amand’s website: http://www.fibromyalgiatreatment.com/Dr. St. Amand’s book What Your Doctor May Not Tell You About Fibromyalgia: http://www.fibromyalgiatreatment.com/books-and-dvds.html and https://www.amazon.com/What-Your-Doctor-About-Fibromyalgia/dp/1455502715/ref=pd_lpo_sbs_14_t_0?_encoding=UTF8&psc=1&refRID=0PKW88RSY6AXQDFFF0C1 This is the link to the latest editionOnline Guaifenesin Support Group: http://www.fibromyalgiatreatment.com/online-support-group.html Fibromyalgia Facebook Support Group for those on the Guaifenesin Protocol: https://www.facebook.com/groups/fibrofightersonguaifenesin/?epa=SEARCH_BOXWhere to purchase guaifenesin and personal care products that do not block guaifenesin’s action: http://www.fibropharmacy.com/Websites devoted to selling salicylate free products: https://www.andrearose.com/sensitive-skin-care-basics-s/100.htm and https://www.cleure.com/Default.asp Note: It is common to feel intermittently worse during the first 4 months on the protocol. We are here with tips to help you feel better during this time. See acast.com/privacy for privacy and opt-out information.

Episode 94 - Deborah Budding, PhD Dan Sterenchuk and Tommy Estlund are honored to have as our guest, Deborah Budding, PhD. Dr. Deborah Budding is a board certified neuropsychologist who works with children, adolescents, and adults in the Los Angeles area. She has a background in literature and magazine publishing prior to earning her Ph.D. in psychology. She is co-author of “Subcortical Structures and Cognition: Implications for Neuropsychological Assessment,” which was published in 2008, as well as peer-reviewed articles related to subcortical contributions to cognitive and emotional function, including a Consensus paper on cerebellar contributions to both movement and cognition published in 2013. She has strong interests in neuroscience, art, and video games, not necessarily in that order. Dr. Budding is a supervising faculty member at Harbor-UCLA's neuropsychology training program and is increasingly involved in research involving transcranial direct current stimulation (tDCS). She has particular interest in the cerebellum's contributions to non-motor function, in brain-behavior relationships in neurodevelopmental disorders, and in finding ways to amplify the voices of women and people of color in science education. Dr. Budding's website: http://deborahbudding.com Note: Guests create their own bio description for each episode. The Curiosity Hour Podcast is hosted and produced by Dan Sterenchuk and Tommy Estlund. Please visit our website for more information: thecuriosityhourpodcast.com The Curiosity Hour Podcast is listener supported! To donate, click here: thecuriosityhourpodcast.com/donate/ Please visit this page for information where you can listen to our podcast: thecuriosityhourpodcast.com/listen/ Disclaimers: The Curiosity Hour Podcast may contain content not suitable for all audiences. Listener discretion advised. The views and opinions expressed by the guests on this podcast are solely those of the guest(s). These views and opinions do not necessarily represent those of The Curiosity Hour Podcast. This podcast may contain explicit language.

Dr. John Torday, MSc, PhD, Professor of Pediatrics and Ob/Gyn, Harbor-UCLA, Division of Neonatology, discusses biomedical research, genomics, and life. Dr. Torday's extensive career in medicine and education has afforded him some choice opportunities, working and researching as a faculty member at prestigious universities such as Harvard Medical School, the University of Maryland School of Medicine, and the David Geffen School of Medicine. Dr. Torday discusses some of his early experiences in the field, as well as some of the incredible advances he has seen in science and medicine. He specifically talks about the landmark observation of his career: that the cortisol hormone could accelerate human development, which was the beginning of neonatology. The implications of this observation were immense and became the fodder for much research ongoing. The neonatology expert comments on the vast changes in biomedical research, from biochemistry to the transition to molecular biology, and the concept of genomics. He talks in depth about the importance of epigenetics. Epigenetics is the study of heritable phenotype changes that do not require alterations in the existing DNA sequence. He muses on the concepts of epigenetics, regarding embryogenesis (embryonic development). As he states, epigenetic inheritance is passed in more than one generation, which is a particularly interesting and vital point in regard to research. He answers questions regarding genetic expression and the idea of epigenetic heritability. As he states, environment such as habitation in water or on land, play a role in organism development. And additionally, he states that diet can have an influence as well. Speaking about evolutionary development, the PhD discusses some of his thoughts on various species, considering land and water environments. He provides extensive details on the complex biological factors that are involved. He talks in detail about three genes he states are necessary: parathyroid hormone-related protein gene, glucocorticoid receptor, and the beta adrenergic receptor. Additionally, he expounds upon the importance of intercepting the loss of homeostatic control, which would provide for profound advances in the way we treat disease. He discusses the distinguishing traits between species, and then recounts some of the concepts and theories he has studied regarding the origin of life.

In this episode #DrDarwin talks to #NewDentist Dr Priscilla Clinton about Life After Residency. Dr Clinton is a 2016 graduate of Indiana University Dental School and completed her GPR residency in 2017 at Harbor-UCLA in Los Angeles, CA. Overall, her goal is to influence, help and guide other underrepresented populations within the dental profession. She is currently working within a corporate dental practice model but is looking for other options that will enable her to truly practice her passion. She contacted DrDarwin in order to explore the options in the marketplace. Listen and Learn as DrDarwin discusses these 5 options instead of private practice dentistry: 1- Academia 2- Dental Products & Manufacturer Sales Rep 3- Military Dentistry 4- Organized Dentistry Groups 5- Local, State Government and Public Service For more videos in this series, click below: How to Become a Public Health Dentist https://youtu.be/fR8jlI5K6VU How to become a Faculty Professor/Clinical Team Leader: https://youtu.be/eZ9nSkTOcs4 How to Start a Dental Podcast: Always Misdiagnosed https://youtu.be/azWZ6yLw5Ds How to become a Military Dentist: https://youtu.be/pB_t4lw_nNI --- Thank you for watching this video – Please share it. I like to read comments so please leave a comment and Subscribe to My Channel http://www.youtube.com/c/DrDarwinSpeaks Turn on notifications so you are the first to receive new videos weekly on Sundays Wednesdays and Saturdays ! The #AskDrDarwin Q&A Show is DrDarwin's way of providing a multitude of value by taking your questions about oral health care procedures/services and new dentists challenges, tips, and strategies. He shares answers and solutions based on his experiences building a successful dental business, being a key opinion leader, influencer, a program director in advanced dental education, and as mentor, coach, and strategist to new dentists. The show is a weekly series of Professional Development strategies for New Dentists, and Oral Health information for Dental Consumers. **** Are you looking for answers, tips and strategies that help you reach your personal, professional or life goals? Do you need 1-on-1 career coaching and professional development that is personalized and specific to you? Hire DrDarwin as your coach and mentor, and he will help you get it done and reach your goals. Become a Smiles-to-Success client and receive an action plan, weekly and/or monthly phone calls and video chats from DrDarwin, reviews of your dental school or residency application documents, member-only discounts to DAT, NBDE Part 1 and 2, ADAT prep courses, direct network access to dentists/specialists/directors that are part of DrDarwin's exclusive network, professional career opportunities and much more! Become a Smiles-to-Success coaching client now! Send email to : newdentistcoach@gmail.com , subject line: Coach Me ** Send your questions, fears, problems, dilemmas, and challenges to me and I will help you. newdentistcoach@gmail.com drdarwin@thenewdentistcoach.com If your question gets selected to premiere on our podcast you will receive this gift after you sign up: QUIP Oral Health Care 6 months brush heads Free and Another 6-months of Refill Credits *** Sign Up and complete your order at https://getquip.com At checkout put in this referral code: SmileDrDarwin The code will need to be entered in the coupon field in the cart or on the order confirmation screen. **** Where to follow and listen to DrDarwin and The New --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/askdrdarwin/support

I avsnitt 8 gästar Mia Lundin. Hon berättar om hur hon ser på hormonhälsa och hur viktig den är för vårt välmående. Bl.a. berör vi PMS, PCOS, förlossningsdepression och klimakteriet. OM MIA LUNDIN: Mia Lundin är Leg. Sjuksköterska och Nurse Practitioner inom gynekologi och obstetrik, utbildad i Sverige och på Harbor UCLA, USA. Mia har varit verksam i 29 år inom behandling av hormonella rubbningar som PMS, förlossningsdepression, övergångsbesvär och klimakteriebesvär. Hon har även gedigen kunskap om vilken effekt hormonella fluktuationer har på hjärnans biokemi. 2005 grundade Mia kliniken The Center for Hormonal & Nutritional Balance Inc. i Santa Barbara, Kalifornien som hon drev i 17 år. Genom sina böcker ”Kaos i kvinnohjärnan” och ”Mat för hormonell balans” har Mia fått en stor publik bland svenska kvinnor. Här hittar du Fittlife: Hemsida: www.fittlife.se Facebook: "FITTLIFE - Underliv & hälsa" Instagram: @fittlife_official

In this episode I had the honor to speak with my friend for over 20 years Dr Antwan Treadway DMD MS. Dr Treadway is a board certified oral surgeon practicing in Atlanta GA. He completed his 4 year advanced specialty residency in Oral & Maxillofacial Surgery at the Martin Luther King/Charles R. Drew University's Medical Center in Los Angeles, California --now Harbor UCLA. He joined the faculty at the Medical College of Georgia and became the first African American full time faculty ever hired in the Dept. of Oral and Maxillofacial Surgery's history. After a move to private practice he became the first African American president of the Georgia Society of Oral and Maxillofacial Surgeons, chairman of the organizations Committee on Anesthesia for the state of Georgia and represents District III (the Southeastern US and Puerto Rico) for the American Association of Oral and Maxillofacial Surgeons to the national committee on Anesthesia. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/askdrdarwin/support

When you give only after you're asked, you've waited too long. – John Mason First, learn to bag Place a towel roll under the scapulae to align oral, pharyngeal, and tracheal axes: Karsli C. Can J Anesth. 2015. Use airway adjuncts such as the oropharyngeal airway or a nasal trumpet. Use the two-hand ventilation technique whenever possible:   (See Adventures in RSI for more)     Supraglottic Airways: for difficult bag-valve-mask ventilation or a difficult airway (details in audio) LMA Classic Pros: Best studied; sizes for all ages Cons: Cannot intubate through aperture   LMA Supreme Pros: Better ergonomics with updated design; bite bloc; port for decompression Cons: Cannot pass appropriate-sized ETT through tube   King Laryngeal Tube Pros: Little training needed; high success rate; single inflation port Cons: Flexion of tube can impede ventilation or cause leaks; only sized down to 12 kg (not for infants and most toddlers)   Air-Q Pros: Easy to place; can intubate through aperture Cons: Not for neonates less than 4 kg   iGel Pros: Molds more accurately to supraglottis; no need to inflate; good seal pressures Cons: Cannot intubate through (without fiberoscopy)   Summary • If you can bag the patient, you're winning. • If you have difficulty bagging, or anticipate or encounter a difficult airway, then don't forget your friend the supraglottic airway (SGA). • Ego is the enemy of safety: SGAs are simple, fast, and reliable. • Just do it.   References Ahn EJ et al. Comparative Efficacy of the Air-Q Intubating Laryngeal Airway during General Anesthesia in Pediatric Patients: A Systematic Review and Meta-Analysis. Biomed Res Int. 2016;2016:6406391. Black AE, Flynn PE, Smith HL, Thomas ML, Wilkinson KA; Association of Pediatric Anaesthetists of Great Britain and Ireland. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth. 2015 Apr;25(4):346-62. Byars DV et al. Comparison of direct laryngoscopy to Pediatric King LT-D in simulated airways. Pediatr Emerg Care. 2012 Aug;28(8):750-2.  Carlson JN, Mayrose J, Wang HE. How much force is required to dislodge an alternate airway? Prehosp Emerg Care. 2010 Jan-Mar;14(1):31-5. Diggs LA, Yusuf JE, De Leo G. An update on out-of-hospital airway management practices in the United States. Resuscitation. 2014 Jul;85(7):885-92. Ehrlich PF et al. Endotracheal intubations in rural pediatric trauma patients. J Pediatr Surg. 2004 Sep;39(9):1376-80. Hernandez MR, Klock PA Jr, Ovassapian A. Evolution of the extraglottic airway: a review of its history, applications, and practical tips for success. Anesth Analg. 2012 Feb;114(2):349-68.  Huang AS, Hajduk J, Jagannathan N. Advances in supraglottic airway devices for the management of difficult airways in children. Expert Rev Med Devices. 2016;13(2):157-69. Jagannathan N, Wong DT. Successful tracheal intubation through an intubating laryngeal airway in pediatric patients with airway hemorrhage. J Emerg Med. 2011 Oct;41(4):369-73.  Jagannathan N et al. Elective use of supraglottic airway devices for primary airway management in children with difficult airways. Br J Anaesth. 2014 Apr;112(4):742-8. Jagannathan N, Ramsey MA, White MC, Sohn L. An update on newer pediatric supraglottic airways with recommendations for clinical use. Paediatr Anaesth. 2015 Apr;25(4):334-45. Karsli C. Managing the challenging pediatric airway: Continuing Professional Development. Can J Anaesth. 2015 Sep;62(9):1000-16. Luce V et al. Supraglottic Airway Devices vs Tracheal Intubation in Children: A Quantitative Meta-Analysis of Respiratory Complications. Paediatr Anaesth 24 (10), 1088-1098. Nicholson A et al. Supraglottic airway devices versus tracheal intubation for airway management during general anaesthesia in obese patients. Cochrane Database Syst Rev. 2013 Sep 9;(9):CD010105. Ostermayer DG, Gausche-Hill M. Supraglottic airways: the history and current state of prehospital airway adjuncts. Prehosp Emerg Care. 2014 Jan-Mar;18(1):106-15.  Rosenberg MB, Phero JC, Becker DE. Essentials of airway management, oxygenation, and ventilation: part 2: advanced airway devices: supraglottic airways. Anesth Prog. 2014 Fall;61(3):113-8.  Schmölzer GM, Agarwal M, Kamlin CO, Davis PG. Supraglottic airway devices during neonatal resuscitation: an historical perspective, systematic review and meta-analysis of available clinical trials. Resuscitation. 2013 Jun;84(6):722-30. Sinha R, Chandralekha, Ray BR. Evaluation of air-Q™ intubating laryngeal airway as a conduit for tracheal intubation in infants--a pilot study. Paediatr Anaesth. 2012 Feb;22(2):156-60. Timmermann A. Supraglottic airways in difficult airway management: successes, failures, use and misuse. Anaesthesia. 2011 Dec;66 Suppl 2:45-56. Timmermann A, Bergner UA, Russo SG. Laryngeal mask airway indications: new frontiers for second-generation supraglottic airways. Curr Opin Anaesthesiol. 2015 Dec;28(6):717-26.   Supraglottic Airway on WikEM   This post and podcast are dedicated to Tim Leeuwenburg, MBBS FRACGP FACRRM DRANZCOG DipANAES and Rich Levitan, MD, FACEP for keeping our minds and our patients' airways -- open.  You make us better doctors.  Thank you. Powered by #FOAMed — Tim Horeczko, MD, MSCR, FACEP, FAAP Pediatric; Emergency Medicine; Pediatric Emergency Medicine; Podcast; Pediatric Podcast; Emergency Medicine Podcast; Horeczko; Harbor-UCLA; Presentation Skills; #FOAMed #FOAMped #MedEd

EM Basic is back with a re-broadcast from the awesome podcast Pediatric Emergency Playbook by Dr. Tim Horeczko.  Tim is a double boarded in EM and Peds EM and works at Harbor-UCLA hospital.  This was the first episode he published at the beginning of September and it is pure gold.  Tim goes beyond the febrile neonate and talks about how to consider all possible causes for a sick infant- not just anchoring on sepsis the whole time!  Tim presents a rational and systematic approach on how to deal with these young sick patients that get our anxiety and our adrenaline levels through the roof.

NAEMSP Conference 2016: Preconference Day 2   Hi fellow NAEMSP members from sunny San Diego!  Right click here to download. The highlights of the NAEMSP Conference Day 2 interviews include conversations with Dr. Scott Bourn PhD, RN, NREMT-P the QI/QA manager for Evolution Health and Chair of the Preconference Worshop, "Building a Robust Quality Improvement Program in your Service."   We also have a roundtable discussion with Dr. Joelle Donofrio of UCSD, Dr. Dipesh Patel of LA county/ Harbor UCLA, Dr. Anjni Patel from Emory University, Dr. Taibah Alabradainabi from the University of North Carolina, and Dr. Jeffrey Siegler from Washington University in Saint Louis.   As always stay safe and thanks for listening.   Stay tune for TODAYs highlights, tomorrow! Phil Moy MD, Scott Goldberg MD, Jeremiah Escajeda MD, Joelle Donofrio DO

Dr. Anita Nelson, a professor emerita at the David Geffen School of Medicine at UCLA, the former medical director of the women’s healthcare program at Harbor-UCLA medical center, and esteemed author of Contraceptive Technology, reassures us that medical researchers are actively pursing ways to advance and improve contraceptive technology.

Episode 15 with Dr.Gregory A. Smith M.D. executive producer of the film AMERICAN ADDICT. Dr. Smith is the former Director of Pain Management at Harbor UCLA and Assistant Clinical Professor at UCLA. He went on to form Comprehensive Pain Relief Group inc. in 2001. GS Medical in 2004 and Pain MD Productions in 2011. He has published numerous research articles, published over 12 books, hosted 2 radio shows and has appeared as guest on multiple local and national radio and television shows.

AIR DATE: July 11, 2013 at 7PM ETFEATURED EXPERT: FEATURED TOPIC: "Ketones & Brain Health" NOTE: Audio for this episode will be posted on Friday afternoon Since you listen to this podcast, you probably are already well aware of the tremendous benefits of low-carb, high-fat living on your overall health and longevity. But did you know that eating this way can actually make you smarter? Old-school thinking regarding the brain tells us that glucose is the sole source of fuel it can use. However, we are now learning through the very latest in nutritional health research that the brain can not only be fueled well by the ketone bodies produced by eating a low-carb, high-fat ketogenic diet, but these ketones may actually be a better fuel for the brain than glucose. That's the primary focus of the work our guest expert this week has been exploring. Nutritional scientist  from the University of California at Harbor-UCLA has become intricately involved in investigating the role of ketogenic diets on brain health ever since she stumbled across the cognition-enhancing properties of ketones when she personally started consuming a ketogenic diet. What she has discovered in her research is how ketones may prevent the neurocognitive deficits such as memory loss and dementia typically chalked up to the aging process, the therapeutic effects of ketones on patients with neurodegenerative diseases like Alzheimer's and Parkinson's and how elevated blood sugars levels are quite possibly contributing to a significant cognitive decline leading to neurodegeneration. Dr. Yount theorizes that human beings are meant to run most effectively on a ketogenic diet and that our hunter-gather ancestors millions of years ago not only survived but thrived in this keto-adapted state. That's what we'll be exploring further in Episode 41 of "Ask The Low-Carb Experts" addressing the topic "Ketones & Brain Health." SUGAR-FREE, LOW-CARB PEANUT BUTTER CUPSNOTICE OF DISCLOSURE:  LOWER YOUR BLOOD SUGAR LEVELS NATURALLY:NOTICE OF DISCLOSURE:  Here are just a few of the questions addressed in this podcast: LAWRENCE ASKS:Does the brain need glucose? STEVE ASKS:I have worked as a caregiver in an assisted living facility taking care of Alzheimer's patients for several years. So I have seen the devastating toll Alzheimer’s disease has taken on so many precious senior citizens. The diet they feed these people is absolutely horrendous—low-fat, low salt, high-carb and low-protein. It’s so tragic. I understand that brain cells may die if they are glucose dependent and also insulin resistant and that ketone bodies can fuel the brain in the absence of glucose by preventing more brain cells from dying. Would ketone bodies rejuvenate brain cells that were close to death and create new ones that would then improve the symptoms of Alzheimer's? In other words, given enough time, can someone completely or nearly completely recover from advanced stage Alzheimer's disease with the therapeutic use of ketones? FRANZISKA THE RD ASKS:What level of ketosis is required to achieve improvements in memory and prevent cognitive decline as we age? Does a person gain further benefit from being in a deeper state of ketosis due to significant carbohydrate restriction (ie Why is there so much variability regarding the need for protein restriction to enter into and remain in ketosis? I've heard of people needing to reduce their protein intake significantly in order to achieve ketonemia or ketonuria, while others eat very large amounts of protein yet manage to stay in ketosis. JOHN FROM THE UK ASKS:My 78-year old father has been diagnosed with Parkinson's Disease and his family has witnessed a very rapid mental decline over the past 3-4 years. He has no symptoms of shaking at all, but seems to suffer from muscle wastage and dementia. I personally think that his symptoms match those precisely of dementia with Lewy bodies. From the research you have come across, do you think a ketogenic diet could help him at all or is he too far gone? RICHELLE FROM AUSTRALIA ASKS:What does Dr. Yount know about Huntington’s disease and the ketogenic diet? Everyone always refers to Parkinson’s and Alzheimer’s as the key neurodegenerative diseases. But Huntington’s is a genetic condition with a huge variation in the age of onset and disease severity indicating epigenetic and environmental factors at play. I am a 46-year old female and I have Huntington’s (CAG mutation of 42). I have been using a ketogenic diet for 10 years off and on. The research I have found relates to Alzheimer’s, Parkinson’s, multiple sclerosis, epilepsy and brain cancer--but nothing for Huntington’s. Are you aware of any? I am sure I am on the right track but it would be good to read scientific studies that are specific to my problem. JEAN ASKS:In addition to the effects on brain health you report for a ketogenic diet, do you detect a key component involved due to the addition of coconut oil, particularly with regard to Alzheimer's Disease? ROBIN ASKS:I sometimes feel a little foggy or lightheaded while eating a low-carb, high-fat diet. My carbohydrate intake is generally 20g or less daily. I’ve been doing this for a couple of months now and even restricting my protein intake to around 60g daily. I am 54 years old and currently weigh 170 pounds. In the two months I’ve been doing this, I have not lost any weight yet but I'm seeing that my fasting blood sugar levels have come down to around 100 or less while my blood ketones today readings are 2.5 millimolar. Is it normal to have brain fog with numbers like these? RENEE ASKS:It’s my understanding that MCT oil is good for the brain, especially for patients with Alzheimer's disease. But what about MCT oil for people who don’t have Alzheimer's? I’ve done some research and discovered that there are two types of MCT oil--C8 and C10. Unfortunately, there’s nothing about this on the bottle. Is there any benefit to choose specific type or brand of MCT oil over another? KARL ASKS:Is the amount of ketones in your blood proportional to the benefits received by the brain? In other words, is having 3 millimolar of blood ketones better than having 1 millimolar? I have tried hard to stay in a 2+ millimolar level of blood ketones. But even when restricting carbs well under 50g, keeping protein low and eating quality fats I have a very hard time maintaining anything over 1 millimolar. Is my brain receiving the full benefits of being in ketosis? And how long do the ketones stay in your blood? I am considering trying to cycle carbs so I would do something like 5-7 days of a ketogenic diet, 3 days of higher carbs, 3 days moderate carbs then repeat. Assuming I only consumed nutrient dense carbs (not pizza and ice cream), would I keep enough ketones in my system to experience the brain health benefits? CHRISTINE ASKS:With the brain consisting of large quantities of fat, how does the process of breaking down fats into ketone bodies affect the brain or does it have an impact at all? So if the body breaks down fats from other areas to create ketones for fuel, then would it convert any unused ketones back into fat that could then be used to bolster the brain, build it up and recover from damage? PAUL IN AUSTRALIA ASKS:My mother was recently diagnosed with progressive supranuclear palsy. She is falling frequently and I am concerned that she will soon need to be confined to a wheelchair. It is unlikely that I can get her to make significant changes to her diet (she’s just too old and too stubborn) but I was wondering if coconut oil, MCT oil or any supplements can help her at this stage. Any suggestions you can make regarding food or would be appreciated. I suffer with depression and attention problems and in desperation started taking 40 ml of flaxseed oil daily after reading a post about it on the Internet. After two days I experienced a strange little emotion I’d completely forgotten about: joy. The following morning while getting dressed I was in the middle of putting on my jeans when I stopped, one leg on the ground and one leg in the air–I was balanced and didn’t need to touch the airborne leg down to avoid falling over. This felt odd to me. A while ago I noticed I couldn’t put my socks on without having one foot up on the bed or by leaning up against the wall. So I tried putting on my socks “stork style” and did so with ease, even putting on my shoes in the same manner. It felt great to have my balance back. I have cut back on the flaxseed oil because of concerns over blood clotting with a daily aspirin regimen. I’ve tried adding fish oil and coconut oil but can’t seem to get as much benefit as I was getting from 40ml of flaxseed oil. Can you please explain what might be going on with the flaxseed oil to improve my balance? ANDREW ASKS:Can you cause harm to the brain if you don't consume enough calories on a ketogenic diet? One of the problems I have eating this way is that I'm not really hungry very often so I forget to eat. When I go too long without food I start to get a dull ache sort of like pressure in my skull. I try to consume lots of calories from quality fats when I do remember to eat along with moderate protein and minimal carbohydrates. I like being ketogenic but I can’t help but wonder what impact this is having on my brain health. JEN FROM AUSTRALIA ASKS:I am brand new to low-carb and already feel much more energetic and thinking clearly--I must say I am loving how this feels! I’d like to hear what Dr. Yount says is an optimal day of eating for maximizing ketones to keep my cognitive function and physical health in the best shape possible. I’m an older mother who will be working into my late 60’s and need to be looking to the coming years of raising my child now at the age of 53. GREG FROM NEW ZEALAND ASKS:I am a 50-year old male and have been on low-carb, high-fat diet for the past seven months. Early on I was getting ketone levels around 1-2.2 in the evening. But lately they have dropped back down to barely 0.5, although I still have steady energy levels and fast intermittently for 16-20 hours at a time. In other words, I believe I am still keto-adapted. One significant aspect of my personal lifestyle is circadian dysrhythmia from long-haul flying and missing out on sleep. I also take the occasional sleeping pill (Triazolam) to help with the time zone changes at hotels. Does the brain function better with more ketones or is it fully satisfied at some particular level? Is the brain’s choice of energy source influenced by circadian dysrhythmia? And finally, do you have an opinion on raspberry ketone products for raising blood ketone levels? HEIDI ASKS:According to the book The Brain Trust Program by neurosurgeon Dr. Larry McCleary, ketones are the secret to remedying hot flashes, Alzheimer's, and a whole host of other brain illnesses. But I don’t think there's near enough information out there as to how to TRULY fight the effects of menopause--conventional wisdom says to eat your soy, take hormone replacements, and hope for the best. I've been taking the advice out of Dr. McCleary’s book, and along with coconut oil and the recommended supplements, have kept hot flashes at bay for months now. Hot flashes themselves are the brain's cry for more glucose, but the glucose can't get there any more, because the lack of estrogen to coat the glucose means it can no longer pass through the blood-brain barrier. So in order to feed the brain what it needs without using glucose it instead relies on ketones--and boy DO THEY WORK! Does Dr. Yount have any corroborating experience with using ketones for menopausal issues?

Guest speaker: Dr. Preet Chopra PROGRAM NOTES: (Minutes : Seconds into program) 02:56 Preet describes the study he is working on at Harbor-UCLA Medical Center where he and Dr. Charles Grob are giving psilocybin (the active ingredient in magic mushrooms) to end-stage cancer patients who are also suffering from anxiety. 05:17 A description of the inclusion and exclusion criteria for the study. 11:01 Preet takes us through a typical session with a study participant. 12:04 "According to some of the research that was done before prohibition, it was found that people who had more internal experiences were more likely to get the psychological intervention we're going for with this." 24:03 "In my treatments as a psychiatrist I've never treated a psychedelic addiction. I've treated a lot of addicts who are addicted to a lot of stuff and who also used psychedelics, but that [psychedelic addiction] has never come into my emergency room or office." 29:39 "I think it's kind of ridiculous to be a scientist and a doctor and not investigate and try to understand how we can use these tools in a Western culture safely." 36:11 "I think that ultimately the true wisdom about these plants comes from shamanic tradition, however, in today's Western society people will often come to a psychiatrist to address the issue that in a different tribal kind of society they would seek out the shaman." Download MP3 PCs – Right click, select option Macs – Ctrl-Click, select option Mentioned in this podcast "Counter-Transference Issues in Psychedelic Psychotherapy" by Gary Fisher, PH.D Additional papers by Gary Fisher, Ph.D.