Podcasts about heart institute

I got a ride from Norma to the Heart Institute and decided to run the eight kilometers home from there. Richmond Road was too noisy, so I turned onto a quiet street I'd never explored before, Ernest Avenue. I tried to take a shortcut through a bushy path but ended up tangled in blackberry thorns and had to reroute. After getting a bit lost behind the University of Victoria, I finally found my way back toward Mount Tolmie. I finished my run through Lambrick Park, where I had taken my very first run in Victoria back in 1997.

Host Lisa Salberg chats with Dr. David Owens and welcomes UW Medicine Heart Institute aboard as a Center of Excellence (COE).   This conversation was recorded March 21, 2025.

Host Jeremy C. Park talks with Tom Wills, Chief Administrative Officer with the Baptist Heart Institute at Baptist Memorial Hospital - Memphis, who highlights the Baptist Heart Institute's cardiac care services, operations, and community engagement efforts, and emphasizes the importance of preventative health and self-care. During the interview, Tom talks about the Institute's organizational philosophy, emphasizing its partnership with surgeons, cardiologists, and referring physicians. He highlights the Institute's role as a referral center, particularly in high-risk surgeries. Tom further details the heart transplant program, which has been in operation for 40 years, and the use of mechanical circulatory support. Tom shares his experience with the recent heart transplant reunion event, which was well-attended and emotionally impactful. He also mentions the Institute's holistic approach to patient care, including disease management and the use of AI technology, including how AI is being used to identify incidental aortic valve calcium.Tom discusses the Baptist Heart Institute's community engagement and patient education efforts, emphasizing the importance of preventative health and self-care. He talks about how Baptist continues to conduct community outreach programs, including hands-only CPR training and participation in health fairs. Tom highlights the institute's various accreditations and awards, and encouraged community members to take advantage of health fairs and patient assistance programs. Tom then shares warning signs for heart-related issues and stresses the importance of open communication between patients and healthcare providers. He concludes by sharing some of his goals for the future and expressing the institute's continued goal of saving one more life at a time.Visit https://www.baptistonline.org to learn more about the Baptist Heart Institute, Baptist Memorial Hospital - Memphis, and Baptist Memorial Health Care.

WHAT YOU NEED TO KNOW. Morales stays with the crew for LIT Monday at CHLA Make March Matters campaign. GUEST Dr. Jon Detterich. Part of the Heart Institute, explains low-field MRI. RADIO TINDER. GUEST Dr Juliet Emamaulle MD, PHD, joins the show. Learn more about your ad choices. Visit podcastchoices.com/adchoices

I am excited to welcome my learned and insightful colleague, Dr. Miles Nichols, back today to conclude our two-part series on the inevitables of aging. In this episode, he explains how to test for the inevitables discussed in Part 1 using AI, genetics, epigenetics, microbiome analysis of the gut, skin, nose, and reproductive tissues, and blood nutrient testing. He also dives into the dangers of microplastics. Ways to Reduce Microplastic Exposure Drink filtered water (reverse osmosis is most effective) Use glass or stainless steel instead of plastic containers Avoid hot liquids in plastic-lined cups Do not store fermented foods in plastic Improve air quality in the home with filtration and ventilation Dr. Miles Nichols's Bio: Dr. Miles Nichols is a functional medicine doctor specializing in Lyme, mold illness, gut, thyroid, and autoimmunity. After personally struggling with chronic fatigue in his early 20s, Dr. Miles dedicated himself to figuring out the root causes. He suffered and recovered from thyroid dysfunction, autoimmunity, a gut infection, Lyme co-infections, and mold illness. Dr. Miles has authored two books. He founded the Medicine with Heart functional medicine clinic in Colorado as well as the Medicine with Heart Institute that trains other doctors in functional medicine. In this episode: Various categories and sub-categories of testing for the inevitables of aging Dr. Miles shares his favorite interventions when creating a personalized approach for his patients How environmental toxins impact health Why addressing dampness and mold in the home is critical for longevity Dr. Miles discusses the challenges of diagnosing and treating Lyme disease The benefits of herbal therapies and advanced testing for managing chronic infections The importance of self-awareness, gratitude, positive mindset, and mindfulness in health management Links and Resources: Use code GLUTATHIONE to get 10% off GLUTATHIONE Use code MOOD to get 10% off 5HTP Use code BIND to get 10% off ENVIROBIND Follow Your Longevity Blueprint  On Instagram| Facebook| Twitter| YouTube | LinkedIn Get your copy of the Your Longevity Blueprint book and claim your bonuses here Find Dr. Stephanie Gray and Your Longevity Blueprint online   Follow Dr. Stephanie Gray  on Facebook| Instagram| Youtube | Twitter | LinkedIn Integrative Health and Hormone Clinic Podcast production by Team Podcast  Relative Links for This Show: Medicine With Heart Functional Medicine Blog  

I am excited to welcome Dr. Miles Nichols for a two-part series where he shares his wealth of knowledge on the inevitabilities of aging. In Part 1 today, we dive into five inevitables that hinder our health span and impact our longevity. Inevitable aspects of aging: Physical deterioration Cardiovascular issues Cellular aging Metabolic decline Brain atrophy A risk of dementia, Alzheimer's, or memory loss. Dr. Miles Nichols's Bio: Dr. Miles Nichols is a functional medicine doctor specializing in Lyme, mold illness, gut, thyroid, and autoimmunity. After Dr Miles personally struggled with chronic fatigue in his early 20s, he dedicated himself to figuring out the root causes. He suffered and recovered from thyroid dysfunction, autoimmunity, a gut infection, Lyme co-infections, and mold illness. Dr Miles has authored two books. He founded the Medicine with Heart functional medicine clinic in Colorado, as well as the Medicine with Heart Institute, which trains other doctors in functional medicine. In this episode: Miles explains the difference between lifespan and healthspan Some inevitables that could hinder longevity How the atherosclerotic process impacts the body The role inflammatory markers and advanced lipid panels play in assessing cardiovascular risk Why early detection of Alzheimer's and dementia is essential How environmental exposures and genetic predispositions can lead to a cancer risk Why muscle mass and bone density are critical for preventing fractures Why metabolic health is crucial for longevity Links and Resources: Use CODE BERBERINE to get 10% off Berberine Use code COQ10 to get 10% off COQ10 Use CODE BERGAMOT to get 10% off Citrus Bergamot Follow Your Longevity Blueprint  On Instagram| Facebook| Twitter| YouTube | LinkedIn Get your copy of the Your Longevity Blueprint book and claim your bonuses here Find Dr. Stephanie Gray and Your Longevity Blueprint online   Follow Dr. Stephanie Gray  On Facebook| Instagram| Youtube | Twitter | LinkedIn Integrative Health and Hormone Clinic Podcast production by Team Podcast  Relative Links for This Show: Medicine With Heart Functional Medicine Blog  

In this episode, "Live Long and Die Strong," Dr. Carnahan is joined by the renowned Miles Nichols to delve deep into pressing health issues that affect many of us today. Miles Nichols is a celebrated expert in integrative and functional medicine, and together with Dr. Jill Carnahan, they explore the intricate connections between thyroid dysfunction, autoimmunity, gut infections, Lyme co-infections, and mold illness. Their in-depth discussion promises to provide valuable insights and practical advice on how to build resilience in the face of these health challenges. Throughout the episode, Dr. Jill Carnahan and Miles Nichols share their wealth of knowledge and experience, offering listeners actionable steps and strategies to improve their health and wellbeing. They discuss the latest research, treatment approaches, and the importance of a holistic perspective in managing complex health conditions. Whether you're struggling with thyroid dysfunction, dealing with autoimmunity, facing gut infections, battling Lyme co-infections, or overcoming mold illness, this episode of Resiliency Radio is packed with crucial information to help you navigate your health journey and achieve optimal wellness. Don't miss out on this opportunity to learn from two of the leading experts in the field. Tune in now and discover how to "Live Long and Die Strong" with Dr. Jill Carnahan and Miles Nichols. Key Points ✅ Dr. Nichols experienced severe chronic fatigue in his early 20s, leading to the discovery of underlying health issues such as thyroid dysfunction, autoimmunity, gut infections, Lyme co-infections, and mold illness.  ✅ His personal recovery through functional medicine protocols inspired his commitment to help others facing similar health challenges ✅ We discuss integration of mind-body practices, including meditation and breathwork, into his treatment approach. 

What is Buteyko breathing? How can Buteyko breathing support kids with ADHD? How long does it take after beginning a practice of Buteyko breathing to see improvements?  In this week's episode of the Soaring Child podcast, Dr. Miles Nichols joins the show to tell us all about Buteyko breathing.  Dr. Miles Nichols is a functional medicine doctor specializing in Lyme, mold illness, gut, thyroid, and autoimmunity. After Dr. Miles personally struggled with chronic fatigue in his early 20's, he dedicated himself to figure out the root causes. He suffered with and recovered from thyroid dysfunction, autoimmunity, a gut infection, Lyme co-infections, and mold illness. Dr. Miles has authored two books. He founded the Medicine with Heart functional medicine clinic in Colorado as well as the Medicine with Heart Institute that trains other doctors in functional medicine. Link Mentioned in the Show:  ADHD Symptom Reduction Tool - http://adhdthriveinstitute.com/tool  Key Takeaways: [4:45] The science behind Buteyko breathing [13:26] How Buteyko breathing could help kids with ADHD [18:56] What is Buteyko breathing? [28:00] Buteyko breathing exercise guided practice [40:10] How soon might parents notice positive changes from Buteyko breathing? [46:47] Where to find Dr. Miles online Memorable Moments: ”I really wish I had this tool back then because we know now, there's data and there's peer reviewed clinical trials, that we can really improve asthma…” “If I knew back then that CO2 was so important to bronchial dilation…if I had known back then that I could simply hold my breath and breathe less and have my bronchial dilation improve and I could actually start to get air again during that acute episode, I may not have had to go to the hospital…” ”Carbon dioxide does act as a vehicle to produce nitric oxide in the sinuses, and nitric oxide is one of the things that the lungs use to bronco-dilate.” ”Carbon dioxide is directly related to this breathing technique, and it's directly related to what I would say is the underpinnings of a lot of problems in children and adults today.” ”When it comes to ADHD, that nervous system is incredibly important, and this chronic sympathetic activation can be problematic.” “We want to reduce the minute volume of air into the lungs.” ”Light, slow, deep breathing is a very basic technique that will help to be able to increase the amount of CO2, or carbon dioxide…” “Not only is this safe for children, but there's also been data collected that's shown improvements on things like asthma for children….We do see the capacity to regain function in an incredible way.” ”The goal is to feel this tolerable ‘air hunger' where you're still calm. When you start to notice your heart rate increasing, that's a sign to back off a little bit.” “For most people, between 5 to maybe 8 breaths per minute for most people is going to be a rate for most people where we see heart rate variability.” ”For children as a starting point, it's great to make it into a game and to do it together.” ”Sometimes as little as 4-6 weeks is enough to retrain the brain for base level breathing.” ”Within 1-3 months, we are seeing significant shifts if there is regular training.” How to Connect with Dr. Miles Nichols Facebook - https://facebook.com/medicinewithheart Instagram - https://instagram.com/medicinewithheart Functional Medicine Clinic - https://MedicineWithHeart.com Functional Medicine Training Institute for Practitioners - https://MindBodyFunctionalMedicine.com      Dana Kay Resources:

Thomas Diacovo, MD, is chief of the UPMC Newborn Medicine Program and director of Neonatal Cardiovascular Research at the Heart Institute. Dr. Diacovo discusses how he became interested in Thrombosis research, his journey to Pittsburgh, and his research testing new drugs for neonatal intensive care patients, particularly those with congenital heart disease who are at high risk for forming blood clots. Dr. Diacovo also credits the parents of our patients for the success of his clinical trials.

Dr Xuyu Liu from the University of Sydney and the Heart Institute says there could be even broader applications.See omnystudio.com/listener for privacy information.

Haissam Haddad inadvertently horrified his family when he signed up for engineering courses in his first year of university. The teenager returned the next day to change his major to medicine -- a move he's glad he made. Dr. Haddad practiced family medicine in Syria for three years, then arrived in Canada in 1986 to visit his wife's family, who urged him to stay. Haddad faced an uphill battle when he investigated the possibility of becoming a Canadian doctor. One colleague even told him he'd be better off opening a Syrian grocery store. “This gave me a lot of energy to prove him wrong,” said Haddad. His early years in Canada were characterized by relentless perseverance, as Haddad confronted the arduous process of certification and integration into the medical system. He focused on learning English every weekday, picking up back-to-back twelve-hour shifts at a Halifax laundromat every weekend, to support his family. “The first day it took me, like, almost 16 hours to read one page,” Haddad said. “I had no option to fail.” After three years of English lessons and intensive studying, Dr. Sam Haddad earned a passing score on Canada's medical licensing exam. In this episode, Dr. Haddad recounts pivotal moments that steered him towards cardiology, including formative experiences in cardiac surgery during his residency at Dalhousie, which took place during the HIV epidemic. “I've always liked the heart,” said Haddad. "I decided to do cardiology because it has less blood and less risk.” Haddad's dedication to improving patient outcomes through research soon became evident, as he tackled clinical gaps and treatment efficacy in heart failure management and heart transplant protocols. “Almost on a weekly basis, you have a patient who did not respond to the usual treatment,” said Haddad. “This is the research question. How come this patient is not getting better?” As his expertise grew, Haddad became one of only two Canadian cardiologists who were part of the National Institutes of Health Heart Failure Network. His patients took part in clinical trials that led to significant advancements.  “A lot of our patients didn't have private insurance,” Haddad said. “We can do a lot of work to help patients who are not able to buy their own medication." Haddad led the cardiac transplant and heart failure programs at the University of Ottawa's Heart Institute, exponentially increasing the number of transplants performed. At the same time, he said at cardiovascular medicine was making revolutionary strides with artificial hearts and improved anti-rejection medications. When he began, half of heart failure patients died within a year. Now, over 90 per cent survive. After moving to Saskatoon to become Saskatchewan's Provincial Head of Medicine in 2016, Haddad continued his clinical practice, taking on leadership roles in medical education and research. Instrumental in recruiting almost half of the specialists practicing in Saskatchewan today, Haddad also established the University of Saskatchewan Cardiovascular Research Group, fostering a collaborative environment for innovative research initiatives. Last year, Dr. Haddad was appointed as an Officer of the Order of Canada.. “Nothing comes easy,” said Haddad. “You have to work hard. You have to fail multiple times before you're successful.”

With Henrike Arfsten,Medical University of Vienna - Austria & Antoni Bayes-Genis, Heart Institute, University Hospital Germans Trias and Pujol de Badalona - Spain In this episode of HFA CardioTalk, Henrike Arfsten interviews Antoni Bayes-Genis on circulating biomarkers in heart failure. They focus in particular on natriuretic peptides and discuss the benefits of biomarkers assessment and their fundamental role in heart failure diagnosis and disease progression. NEW! If you want to know more on this topic, access some recommended readings from the speakers: - Bayes-Genis A, et al.; Eur J Heart Fail. 2023 Sep 15 - Mueller C, et al.; Eur J Heart Fail. 2019 Jun;21(6):715-731. - Bayes-Genis A, et al.; Eur J Heart Fail. 2021:23,1432–1436. - Huelsmann M, et al.; J Am Coll Cardiol. 2013 Oct 8;62(15):1365-72 - Tsutsui H, et al; Eur J Heart Fail. 2023 May;25(5):616-631.

Get ready for construction in Lawrenceville as UMPC Children's Hospital of Pittsburgh announced plans for a Heart Institute Expansion project today. Diane Hupp, the president of UPMC Children's joined Rick Dayton on KDKA Radio to talk about the 50,000 square foot addition at the Lawrenceville hospital.  In the past year, more than 600 children have had heart surgery at UPMC Children's Hospital.

Featuring leading cardiology experts, this podcast episode navigates atherosclerotic cardiovascular disease (ASCVD), including plaque morphology, residual risk, secondary treatment options, and guidelines from the National Institute for Health and Care Excellence (NICE). They also detail how these different treatment options work, and conclude the episode by sharing relevant patient case studies that reflect the themes discussed.   Lale Tokgözoğlu, Professor of Cardiology, Hacettepe University, Ankara, Turkey; and Pierre Sabouret, Heart Institute, ACTION Study Group-CHU Pitié-Salpêtrière University Hospital, Paris, France, join EMJ to share their expert insights on this pertinent topic.   Following the recording of this podcast the European Society of Cardiology (ESC) 2023 Guidelines have been updated. Please refer to your local guidelines and relevant prescribing information for the most up-to-date information.   Disclaimer: This podcast is sponsored by an educational grant by Amarin. The speakers opinion is entirely their own and did not receive an honorarium for their part.

The Heart Institute of the Caribbean (HIC) is engaged in an ongoing battle against heart disease in Jamaica and throughout the Caribbean region.Situated in the vibrant city of Kingston, the Institute, under the visionary leadership of Dr. Ernest Madu, is spearheading a groundbreaking mission to ensure accessible and affordable cardiovascular care for all. Dr. Madu's exceptional expertise and qualifications have paved the way for innovative initiatives reshaping the landscape of heart health. One of the Institute's most remarkable achievements is the democratization of cardiovascular care. The institute has taken proactive measures to make top-tier heart healthcare accessible to everyone, regardless of background. By providing comprehensive training to local talents, including budding physicians, the Institute has fostered a network of skilled professionals across the nation, reinforcing the healthcare infrastructure for the benefit of all citizens. Recognizing the geographical barriers that often hinder timely access to critical care, the Institute has established strategic centers in Mandeville and Ocho Rios. These centers have been strategically placed to alleviate the need for arduous travel to Kingston. The result? A smoother journey towards receiving essential cardiovascular treatment. In this episode of Impacting Jamaica Dr. Madu speaks with host Keisha Hill about the Institute's work and plans for the future. Hosted on Acast. See acast.com/privacy for more information.

Episode 102 of Ask Dr Jessica with Dr Michael Silka MD, electrophysiologist and pediatric cardiologist.  On this episode we discuss fainting! (also known as syncope).  We talk about reassuring signs of fainting (often known as vasovagal syncope) and how to distinguish it from times when losing consciousness may be more concerning (for example, how to know when it's cardiac (the heart)?  Dr. Silka is an innovator in the fields of pediatric cardiology and electrophysiology and has pioneered the development of guidelines for the use of implantable cardiac rhythm devices. He previously served in the role of chief of Cardiology and co-director of the Heart Institute from 2000 to 2014.Dr. Silka has published over 200 peer-reviewed articles and book chapters and served as lead investigator for multiple NIH-funded studies as well as multi-center collaborative research efforts.Dr. Silka has held posts in several national organizations committed to advancing the care of children, most notably as past president of the Pediatric Electrophysiology Society.   Dr Silka currently practices medicine at Children's Hospital of Los Angeles.Get matched with a therapist by using Better Help! Give it a try---invest in your mental health: https://betterhelp.com/askdrjessica for 10% off your first month of therapy. Thank you to Better Help for supporting the Ask Dr Jessica podcast.Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner. Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com. Dr Jessica Hochman is also on social media:Follow her on Instagram: @AskDrJessicaSubscribe to her YouTube channel! Ask Dr JessicaSubscribe to this podcast: Ask Dr JessicaSubscribe to her mailing list: www.askdrjessicamd.comThe information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Sudden cardiac arrest often happens without warning. There have been several recent cases of cardiac arrest in young athletes, covered in the news. The thought of your child's heart stopping, is truly terrifying. But instead of worrying that it could happen, we recommend everyone prepare, so you are ready if you ever witness a sudden cardiac arrest.  In this episode, Dr. Adam Powell, a pediatric cardiologist, and Brenda Williams, an RN in the Heart Institute and Simulation Center, are here to discuss cardiac arrest and project ADAM. We define sudden cardiac arrest, talk about warning signs and discuss AEDs and why they are so important. Project ADAM is helping schools become heart safe, and we talk about their work and how schools can get involved. This episode is loaded with information and advice that could be a difference-maker if you ever witness a sudden cardiac arrest. Parents of athletes in particular, need to listen to this one.  For more information on Project ADAM, please visit: https://www.cincinnatichildrens.org/service/h/heart-institute/project-adam  

Flashback with Michael Smyth, Bruce Djite - Executive Director of Property Council of Australia and Nick Read - CEO of the RAA on working from home, James Chapman - CEO of the Food Centre, Tom DoeDee from the Adelaide Crows, Professor Shaun Jackson - Lead Researcher at the Heart Institute, and Behind Closed Doors. See omnystudio.com/listener for privacy information.

Professor Shaun Jackson the lead researcher at the Heart Institute joins Will and Lucy with news a trial is set to begin with new medication to treat strokes. The Royal Adelaide Hospital is taking part in the trial.See omnystudio.com/listener for privacy information.

Acrisure said it wanted to be deeply rooted in Pittsburgh. This morning, the company that purchased the naming rights to the home of the Pittsburgh Steelers and Pitt Panthers made a $7.5 million investment into the Heart Institute at UPMC Children's Hospital of Pittsburgh. Rachel Petrucelli tells Rick Dayton it is the largest investment into the health and well-being of cardiac patients and their families.

In episode 9, we welcome Dr. Thais Coutinho, cardiologist and division head of Prevention and Rehabilitation at the University of Ottawa Heart Institute, as well as Associate Professor of Medicine at the University of Ottawa. Additionally, Dr. Coutinho sits as the chair of the Heart Institute's Canadian Women's Heart Health Centre, and is an internationally recognized clinician scientist in the field of arterial health.  We discuss her calling to medicine, work-life balance, scope of practice, and future goals. Dr. Coutinho also offers some insight in regard to the mitigation of risks associated with arterial diseases in women, as well as the unspoken realities of her professional domain. She further provides an overview of the utilization of her grant from the Public Health Agency of Canada (PHAC). The views expressed in this podcast belong solely to the speakers and do not necessarily reflect any institution/associations they are affiliated with.  This podcast should not be considered a substitute for medical advice. Ottawa Heart Institute - Women's heart health: https://foundation.ottawaheart.ca/?gclid=CjwKCAjwge2iBhBBEiwAfXDBRwZARPv_Y6i0GlXRPyQ2j3YuAOmvXknvCcoA0lQX8IbKtF8TQ7YvthoCAlcQAvD_BwE  Women's Cardiac and Cerebrovascular Health Committee (WCCH) with FMWC: https://fmwc.ca/advocacy/advocacy-wcch/

Our guest, Webb A. Smith, PhD, chats with us about his role as the Clinical Exercise Physiologist in the Heart Institute and Pediatric Obesity Program at Le Bonheur Children's Hospital in Memphis, TN. He discusses the multidisciplinary team of pediatricians, registered dietitians, fitness specialists and behavioral health coaches that help children and adolescents manage their weight.Our show host is Brittany Spence and our Executive Producer is Lydia Gettings.Subscribe today to stay up to date and don't forget to leave a rating and review!

In this episode, we are joined by Dr. Paul Kantor, Division Chief of Cardiology & Co-Director of the Heart Institute at Children's Hospital Los Angeles (CHLA), to discuss sudden death and the importance of athlete screening, what the future holds for transplants in babies, groundbreaking research in heart failure and cardiomyopathy, and leadership best practices.

Instantly unlock the growing library bonus content including weekly bonus episodes, guided meditations, worksheets and journal prompts and support Kate to keep making this show, become a PatreonEPISODE SUMMARY & SHOW NOTESRachel Philips Co-founded  The Heart Institute of Whidbey, which hosts grown up summer camps, heart journaling events and other joyful art-based escapades in and around Whidbey island in Washington State. She makes and teaches HeART journaling which is something that extends far beyond what you might think ordinary journaling might be about - there is deep wisdom and medicine woven into her teachings. I can hardly wait for you to dive into this episode.  Rachel has gifted every listener of Creative Genius $25 off her HeART journalling course.  WHAT WE TALK ABOUT-The importance of storytelling in all its various forms (including journaling) and how it is so much more than just words. -The thing she would do to change about society (if she had a magic wand)-The quiet yet profound transformation she sees take place over and over again when people start to journal with the technique she developed

Dr. Zachary Steinberg, MD, is a board-certified Interventional Cardiologist and Adult Congenital Heart Disease specialist with the UW Medicine's Heart Institute. Dr. Steinberg specializes in the care of adults born with heart defects and performs transcatheter intervention on this complex patient population.  He has a wide array of interventional expertise including complex coronary artery revascularization, transcatheter valve implantation, septal defect closure, and balloon pulmonary angioplasty for patients with chronic thromboembolic pulmonary hypertension (CTEPH).00:55 - Dr. Specialization13:00 - "A Profession of Lifelong Learning"15:10 - Intervention Cardiology First19:45 - A Day in the Life - Chronic thromboembolic pulmonary hypertension28.25 - Learning Chronic Pulmonary Angioplasty36:45 - Approaching Orphan Diseases37:30 - Our Interventional Team39:50 - Repairing Congenital Defectsuwheart@uw.edu

The inaugural episode of A Cut Above features guest speakers, Dr Igor Mokryk and Dr Ihor Stetsyuk, describing the impacts of the war in Ukraine on their day-to-day practice as a cardiothoracic surgeon and resident. Dr Mokryk and Dr Stetsyuk talk to our hosts, Can Gollmann-Tepeköylü and Miia L Lehtinen, about the challenges they face as a result of this unimaginable situation and how we can support them during this difficult time.     Guest Speakers: Dr Igor Mokryk has been Chief of the Department of Adult Cardiac Surgery at the Heart Institute in Kyiv since 2017. He has worked in both adult and paediatric cardiothoracic surgery for more than 20 years. Dr Ihor Stetsyuk is a  4-th year resident of the department of adult cardiac surgery at Heart Institute, Kyiv. He specialises at miniinvasive AVR, MVR and CABG off-pump.

Dr. Miles Nichols is the 37-year-old co-founder of the highly regarded Denver, Colorado based Lyme and mold treatment clinic: Medicine with Heart. He also co-founded the Medicine with Heart Institute to provide professional training to clinicians in the treatment of complex chronic diseases. Born into a high achieving Ivy League educated family, Dr. Nichols followed the family tradition and was accepted into gifted and talented educational programs through middle school. By the time he entered high school, a multitude of nagging childhood illnesses merged and presented as chronic fatigue causing his grades to decline. Debilitating fatigue forced Dr. Nichols to seek alternative educational models. He attended a school founded by a Buddhist Monk and then he gritted his way through graduate school. Unfortunately, his physician father and scores of doctor colleagues could not solve Dr Nichols' chronic fatigue puzzle. Finally, in 2016, Dr Nichols tested positive on a blood test for Lyme disease. In 2019, he tested positive for Babesia and Barronella. If you would like to learn more about how Lyme disease inspired a doctor to build a heart centered treatment institute in an effort to end suffering caused by Lyme and mold diseases, then tune in now! PS Micaela Hoo special guest co-hosted this interview with Rich from Tick Boot Camp!

Eric Krieger, MD, FACC, is a board certified Adult Congenital Heart Disease (ACHD) Cardiologist at UW Medicine's Heart Institute.  He directs the Adult Congenital Heart Disease Program and ACHD fellowship training program. He practices at the University of Washington and Seattle Children's Hospital.  1:05 - From Philosophy to Medicine4:20 - The Why6:15 - Advanced Fellowships in Boston7:15 - Growing the UW ACHD Program9:00 - The unique nature of the UW ACHD Fellowship12:35 - Collaboration with Seattle Children's Hospital14:35 - Importance of Trust in Congenital Heart Disease17:15 - Patients' Transition of Care (Pediatric to Adult)24:00 - The intangibles of an ACHD Cardiologist26:00 - "No Jerks"29:30 - Supporting WAMI Region (Washington, Alaska, Montana, Idaho)32:00 - Centrality of Imaging in ACHD35:35 - Role of Specialized Cardiac Sonographers & Other Imagers37:40 - How to define and best care for "Complex Congenital Heart Disease"ekrieger@uw.edu

Meet Dr. Hugo Martinez, director of Cardiovascular Genetics and co-director of the Hypertrophic Cardiomyopathy Program at Le Bonheur. In this episode of the Peds Pod, learn more about Dr. Martinez, why he chose to become a doctor and what he likes to do when he's not helping the children at Le Bonheur's Heart Institute.

Today's Episode Dr Raj talks with Lilly Rocha about her past work in Silicon Valley, her life in London, and a life-changing health scare at age 37. They discuss how these life events all led to her current work as an advocate for Latinx culinary professionals and women's cardiac health awareness.  Today's Guest  Lilly Rocha is the current CEO of Latino Restaurant Association, an 800+ member national organization in Los Angeles, California. She is also the founder of Sabor Latino Food Industry Trade Show, the world's largest Latino food trade show. A graduate of the University of California Berkeley, she also attended St. Mary's University in London, England. Lilly graduated from UC Berkeley during the height of the dot-com bubble in Silicon Valley, and her first job was as a project manager for Nokia in Mountain View, California. Lilly developed a serious interest in trade show and conference management which eventually led to her to earn both CNP and CMM certifications, the highest in the meeting planning industry. Lilly eventually founded the Sabor Latino Food Industry Trade Show in 2013 once she noticed there was a huge gap in the industry for Latino foods. With Lilly's expertise in sales, marketing, and project management, Sabor Latino has become a recognized brand in the trade show industry and serves as a premier business platform for Latin food professionals.  Lilly also has a passion for healthy eating and has led to a lifelong commitment to wholesome living. She enthusiastically shares her passion for healthy eating by volunteering for organizations such as the American Heart Association, Long Beach Memorial Women's Heart Institute, and the Heart and Vascular Institute at LBMMC. She serves on the boards of HONOR PAC - a Latinx/LGBTQ+ Political Action Committee, and Asociacion de Empresarios Mexicanos (AEM).   Lilly Rocha on Instagram  Latino Restaurant Association Website  About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles.   Want more Dr. Raj? Check out the Beyond the Pearls lecture series! The Ultimate High Yield Bundle: The complete review of high-yield clinical medicine topics necessary for graduate medical education board exams including NBME, USMLE Steps 1/2/3, ITE and ABIM Boards. You can also listen to the Beyond the Pearls podcast.   Check out our other shows: Physiology by Physeo Step 1 Success Stories The InsideTheBoards Study Smarter Podcast The InsideTheBoards Podcast   Produced by Ars Longa Media To learn more about us and this podcast, visit arslonga.media. You can leave feedback or suggestions at arslonga.media/contact or by emailing info@arslonga.media. Produced by: Christopher Breitigan and Erin McCue. Executive Producer: Patrick C. Beeman, MD The information presented in this podcast is intended for educational purposes only and should not be construed as professional or medical advice. Learn more about your ad choices. Visit megaphone.fm/adchoices

Join us as our guest speaker for this week's talk about how mold can be a factor that could contribute not just to our overall health but most especially to our fertility health.   This week's guest speaker for Egg Meets Sperm podcast is Dr. Miles Nichols! Dr. Miles Nichols is a functional medicine doctor specializing in Lyme, mold illness, gut, thyroid, and autoimmunity. After Dr. Miles personally struggled with chronic fatigue in his early 20s, Dr. Miles dedicated himself to figuring out the root causes. He suffered and recovered from thyroid dysfunction, autoimmunity, a gut infection, Lyme co-infections, and mold illness. Dr. Miles and Dr. Diane Mueller co-authored “How to Use Your Mind to Heal Your Mold and Lyme” and “Stress Resilience”. They also founded the Medicine with Heart functional medicine clinic in Colorado as well as the Medicine with Heart Institute which trains other doctors in functional medicine.   Follow Dr. Miles Nichols on: Facebook: https://facebook.com/medicinewithheart  Instagram: - https://instagram.com/medicinewithheart Twitter: https://twitter.com/medicinewheart YouTube: https://youtube.com/channel/UCYzWbI2ySSteHndDgN0s9mg  Functional Medicine Clinic - https://MedicineWithHeart.com Functional Medicine Training Institute for Practitioners: https://MindBodyFunctionalMedicine.com  "Use Your Mind to Heal Your Mold and Lyme" book: https://amzn.to/3f4Sq53 (https://amzn.to/3f4Sq53 Follow me on: Instagram: @holisticfertilitydoctor TikTok:  @holisticfertilitydoctor YouTube:  @Holistic Fertility ExpertFacebook: Join our private Fertile AF tribe!  

Enduring CME will expire on 9/7/2024 Disclosures: Grant/research support: Amarin, Amgen, Boehringer Ingelheim Objectives: 1. To review the cellular and molecular basis of vascular calcification 2. To review population studies of coronary calcification 3. To understand the clinical utility of coronary artery calcification (CAC) testing Accreditation and Designation: The Northeast Georgia Medical Center & Health System, Inc. is accredited by the Medical Association of Georgia to provide continuing medical education for physicians. The Northeast Georgia Medical Center & Health System, Inc. designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s) TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

A complex open heart surgery is an undertaking full of inherent risks, during which many things hang in the balance. But, what if some of that unforeseen risk could be mitigated?  What if the surgeon could hold your heart in their hands, study every detail, visualize every structure, even practice their operation on your heart before they ever made an actual cut, or even entered the operating room?  What if?Recent state-of-the-art developments in 3D imaging and 3D printing have been making this a reality in many hospitals, and have been changing the world of pediatric medicine - especially for children with congenital heart disease.From realistic, patient-specific heart models used in surgery planning and patient education, to medical devices specific to the smallest babies - this incredibly flexible and affordable technology has the potential to innovate care for many of the smallest patients and their families. At the same time, like many emerging technologies, the laws and regulations that govern 3D printing in the medical space have been outpaced by the speed of innovation. Dr. Justin Ryan of the Helen & Will Webster Foundation 3D Innovation Lab at Rady Children's Hospital, in San Diego, CA says that sometimes this phenomenon makes working in this field feel a little bit like the "Wild West." However, he and others are actively helping to bring guidelines up to speed in order to make this technology as safe as it can be, while also leveraging that same flexibility in order to maximize his creativity in finding solutions for the hospital's patients. When it comes to that creativity, Dr. Ryan also draws upon his background as a classically trained artist, and surprisingly, he sees many similarities between his work as a biomedical engineer and the artistic process. Join me as we talk with the team from the 3D Innovation Print Lab, and explore this exciting and rapidly growing technology and its increasingly significant impact on the world of medicine.EPISODE GUESTSDr. Justin Ryan – Dr. Ryan is a research scientist and Director of the Helen & Will Webster Foundation 3D Innovations Lab at Rady Children's Hospital in San Diego, CA. With a background both in art and biomedical engineering, Dr. Ryan brings a unique skill set to his work with the 3D Innovations Lab.Dr. Sanjeet Hegde - Dr. Hegde is a pediatric cardiologist, research scientist, and the Director of Research at the Heart Institute at Rady Children's Hospital in San Diego, CA. He was a founding member of the 3D Innovations Lab, and helped pioneer Rady Children's Hospital's first 3D printing program.Kathryn Matthews - Kathryn is a parent of a child with complex congenital heart disease (CHD), and she is an active CHD advocate through her work and leadership with a family advisory council at her local children's hospital. Her advocacy, and courage to ask her medical team for what she thought her child needed, were a major catalyst in the integration of 3D printing into the medical care at Rady Children's Hospital.SUPPORTPlease consider supporting the important and innovative work of the Helen & Will Webster Foundation 3D Innovations Lab - you can find more information about how to do that HERE.*Episode Note - since initially producing this episode, the roles/titles of both Dr. Ryan and Dr. Hegde have changed. As a result, there is some discrepancy between their guest bios and how they are introduced in the episode. The titles included on this page are the most current.Also, the audio clip at 1:46 is Frank Muller performing the opening lines from "A Tale of Two Cities" by Charles Dickens.

Portia M. Wood, Esq.woodlegalgroup.com Portia M. Wood, Esq. is founder of the Los Angeles law firm, Wood Legal Group, LLP. where she oversees a practice devoted to providing clients with the best in estate planning. From working at the prestigious Richardson Ober law firm as a civil litigator to opening her own practice, Portia has seen the challenges families face when a proper estate plan is not in place. Wood Legal Group is a firm focusing on estate planning, probate, trust administration and elder law issues. https://www.woodlegalgroup.com/Dr. Ernst von Schwarz, author of the new book, The Secret World of Stem Cell Therapy: What YOU Need to Know About the Health, Beauty, and Anti-Aging Breakthroughhttps://www.drvonschwarz.comDr. Ernst von Schwarz is a world-renowned cardiologist and stem cell research pioneer and author of the new book, The Secret World of Stem Cell Therapy: What YOU Need to Know About the Health, Beauty, and Anti-Aging Breakthrough. Dr. Schwarz serves as the Director of Cardiology and Director of the Heart Institute of the Southern California Hospital in Los Angeles, as well as Director and President of the Pacific Heart Medical Group in Murrieta, CEO of Dr. Schwarz Medical Institute of California, Medical Media Lab, and Medical Director of HeartStem, Inc. https://www.drvonschwarz.comMark DowdBOOK: My Tsunami Journey: The Quest for God in a Broken Worldwww.markdowd.ukMark Dowd studied with the Dominican Order at Blackfriars, Oxford in 1981 intending to become a priest, but then switched careers to journalism and began working with The Times newspaper. Since 1987, he has worked in TV with Weekend World, Newsnight and Panorama. Mark's fact-finding mission chronicled in his new book, My Tsunami Journey: The Quest for God in a Broken World, began after his father, during the TV news broadcast of the tsunami, remarked on the destruction: “God could have stopped that.” https://markdowd.uk/

This episode features Dr. Helaine Kwong, Clinical Cardiologist at Queen's Heart Institute. Here, she discusses cardiovascular disease in women, what got her interested in this field, preventative health, and more.

Dr. Albert E. “Bo” Rivera is a licensed physician and surgeon in Alabama, board-certified diplomat of the American Osteopathic College of Dermatology, a fellowship-trained member of the American College of Mohs Surgeons as well as member of several dermatology and medical specialty organizations such as the American Society for Dermatologic Surgery, American Society for Mohs Surgery, American Academy of Dermatology, Skin Cancer Foundation and the Madison County Medical Society. He was born and grew up in nearby Haleyville, Alabama, graduating from Haleyville High School. Afterward, he completed his undergraduate education at Auburn University, earning a degree in Premedicine and Zoology while also a letter-winning member of its' nationally ranked track and field teams. Following his hometown friend and primary care doctor's footsteps, he completed his medical training at Kansas City University of Medicine and Biosciences in Kansas City, Missouri. His internship in General Surgery was done at the University of Kentucky, in Lexington, Kentucky, followed by an Internal Medicine residency at Northside Hospital and Heart Institute in Saint Petersburg, Florida. At Northeast Regional Medical Center in Kirksville, Missouri, he completed both a Dermatology residency as well as a Dermatology research and laser fellowship under the direction of Lloyd J. Cleaver, DO. Upon completion of his residency, Dr. Rivera was nationally awarded the James Bernard, D.O. Residency Leadership Award based on integrity, respect, empowerment and initiative. The final honor in his training was completing a Mohs Micrographic Surgery subspecialty fellowship under the direction of Roger I Ceilley, MD and Andrew K. Bean, MD in West Des Moines, Iowa. Over the years he has had the opportunity to publish several articles in national and international medical journals as well as authoring chapters in medical textbooks and online. Dr. Rivera serves on the editorial boad for the Jounral of Clinical and Aesthtic Dermatology and the Journal of the American Ostepathic College of Dermatolgy as well as serving on the AOCD Editorial/Public Relations Committee and as an American Academy of Dermatolgy Liason. He has also given presentations at local, national and international venues to both non-medical and medical professionals throughout his medical career.

The Heart Institute of the Caribbean (HIC) is on a massive drive to fight heart disease in Jamaica and the rest of the region.Located in Kingston, the institution, under the leadership of the highly respected and highly qualified Dr Ernest Madu, has engineered initiatives to make cardiovascular care affordable to all.He explained that many locals, including young doctors, have been trained by the Institute, hence making more professionals available across the country. Centres have been established in Mandeville and Ocho Rios to improve access to care and cut the need to travel into the capital Kingston.Additionally, there is a low-cost membership scheme for a fee of J$100, as part of the drive to make care available to as many people as possible. This gives members free consultation for an entire year.“Our key objective is still to provide accessible and high-quality cardiovascular care in the Caribbean, and to make such level of care available to all citizens,” declared Dr Madu.He noted that in Jamaica 40 per cent of deaths each year are from heart disease; and estimated that 7,500 Jamaicans have heart attacks annually. The Heart Institute of the Caribbean was opened for business in April 2005 and since then has provided life-saving cardiovascular care to more than 200,000 Jamaicans.Its head, Dr Madu, is an internationally recognised authority in cardiovascular medicine and innovative healthcare systems and solutions. He holds the academic rank of Professor of Cardiovascular Medicine and Advanced Imaging Technologies. Hosted on Acast. See acast.com/privacy for more information.

NOTE: Lowell will be away until further notice for health reasons. We will post updates at www.BlastTheRadio.com/lowellgreen Today, Lowell discusses former Ontario Premiere Kathleen Wynne's admission that her green energy polices are bad for Ontario. It's a disaster that has cost us dearly... And yet, the liberal party is still laser focused on climate and NOT health care. And, Lowell addresses yet another issue that he sees coming down the pipe regarding the new Civic Hospital - the fact that currently he can be wheeled to/from the Heart Institute and Civic, but the new location will require ambulance or shuttle service. We hear from you, of course! Lowell is back soon on www.BlastTheRadio.com

Dr. Miles Nichols is a functional medicine doctor specializing in Lyme, mold illness, gut, thyroid, and autoimmunity. After Dr Miles personally struggled with chronic fatigue in his early 20's, Dr Miles dedicated himself to figure out the root causes. Dr Miles spent many years seeing every specialist he could think of: naturopaths, acupuncturists, chiropractors, integrative MDs, energy healers, and more. Eventually, Dr Miles discovered a functional medicine mentor and was able to test himself for underlying root cause issues. He found a subclinical thyroid issue, autoimmune antibody, multisusceptible mold illness genetics with exposure to black mold, gut infections, sleep apnea, and chronic Lyme co-infections Babesia and Bartonella. Dr Miles was able to recover his energy after treating these main root cause issues through functional medicine protocols. It was a difficult journey, and Dr Miles has now made it his mission to help other have something he never had: a step-by-step guided process through identifying root causes and reversing them, naturally when possible. Dr Miles and his wife Dr Diane Mueller co-authored “How to Use Your Mind to Heal Your Mold and Lyme” and “Stress Resilience”. They founded the Medicine with Heart functional medicine clinic in Colorado and also the Medicine with Heart Institute that trains other doctors in functional medicine. Dr Miles has been a featured speaker at national conferences and professional associations. Connect with Dr. Miles: https://medicinewithheart.com Join Dr Miles for a weekly meditation and brain retraining webinar free of charge: https://medicinewithheart.com/registermeditation Connect with Dr. Aaron Tressler: www.in8life.com Facebook & Instagram: @in8life

Dr. Diane Mueller believes there needs to be a holistic mind and body approach in order to heal from Lyme. This belief led her to co-found the Medicine with Heart Institute and Training School; an institute that focuses on healing chronically ill patients as well as certifying practitioners in advanced functional medicine testing. As a survivor of mold illness, Lyme disease, and chronic IBS symptoms, she is passionate about helping others restore their health and passion for life.Her most recent project is the publishing of her book, Use Your Mind to Heal Your Mold and Lyme.  Her book delves deeper into her approach to Lyme treatment and connecting the heart, body, and mind.Tune in to hear how Dr. Diane founded the Heart Institute with her husband,her approach to functional medicine and testing, as well as her own personal journey and lessons from Lyme and co-infections.

Habits & Health episode 39 with Dr. Miles Nichols, a functional medicine doctor specializing in Lyme, mould illness, gut, thyroid, and autoimmunity. He personally struggled with chronic fatigue in his early 20's, and then dedicated himself to figure out the root causes. He suffered with and recovered from thyroid dysfunction, autoimmunity, a gut infection, Lyme co-infections, and mould illness. Dr Miles and Dr Diane Mueller co-authored “How to Use Your Mind to Heal Your Mold and Lyme” and “Stress Resilience”. They founded the Medicine with Heart functional medicine clinic in Colorado and also the Medicine with Heart Institute that trains other doctors in functional medicine. Links: https://medicinewithheart.com   https://facebook.com/medicinewithheart   https://instagram.com/medicinewithheart   Practitioner Training Institute - https://mindbodyfunctionalmedicine.com   Books: "Use Your Mind to Heal Your Mold and Lyme" https://amzn.to/3oueo55   "Stress Resilience" book - https://www.amazon.com/Stress-Resilience-Overwhelm-Challenge-Resolving/dp/0997301805   Favorite quote - "Within the depths of the human heart lies a paradise waiting to be revealed" by Teacher Li Junfeng   Recommended book: "The Universe is a Green Dragon" by Brian Swimme https://amzn.to/3wBsu8b   Don't forget, there is a transcript of every episode at tonywinyard.com Habits & Health links: Website - tonywinyard.com Facebook Page - facebook.com/TonyWinyard.HabitsAndHealth Facebook Group - facebook.com/groups/habitshealth Twitter - @TonyWinyard Instagram - @tony.winyard LinkedIn - uk.linkedin.com/in/tonywinyard YouTube How to leave a podcast review - tonywinyard.com/how-to-leave-a-podcast-review/ Details of online workshops to create habits for health - tonywinyard.com/training/ Are you in control of your habits or are they in control of you? Take my quiz to find out - tonywinyard.com/quiz Take part in Tony's free 5-day-programme - tonywinyard.com/tinyhabits Full shownotes including transcription available at: https://tonywinyard.com/dr-miles-nichols/

In this episode of the Thyroid Answers podcast I get into a deep and lengthy discussion with Dr. Miles Nichols to discuss the connection between Anti-Parietal Cell antibodies, Chronic Inflammatory Response Syndrome (CIRS), thyroid physiology, thyroid autoimmunity, and the cell danger response. This is my longest podcast to date. I really like the longer format as it provides more time to get in-depth on the topics. Let me know your opinion on the longer format. Do you like it? Not like it? Let me know. We discuss: What are anti-parietal cell antibodies (APCA) Role of parietal cells in the Stomach The connection between parietal cells, APCA, and B12 status The connection between B12, APCA, and thyroid physiology Evaluating B12 status What is CIRS What causes CIRS The connection between CIRS, the CDR, and thyroid physiology and so much more ... Dr. Miles Nichols is a functional medicine doctor specializing in Lyme, mold illness, gut, thyroid, and autoimmunity. After Dr. Miles personally struggled with chronic fatigue in his early 20's, Dr. Miles dedicated himself to figuring out the root causes. He suffered with and recovered from thyroid dysfunction, autoimmunity, a gut infection, Lyme co-infections, and mold illness. Dr. Miles and his wife Dr. Diane Mueller co-authored “How to Use Your Mind to Heal Your Mold and Lyme” and “Stress Resilience”. They founded the Medicine with Heart functional medicine clinic in Colorado and also the Medicine with Heart Institute that trains other doctors in functional medicine. Social: https://facebook.com/medicinewithheart https://instagram.com/medicinewithheart https://www.linkedin.com/in/drmilesnichols/ Contact: https://MedicineWithHeart.com (clinic) https://MindBodyFunctionalMedicine.com (practitioner training program) Medicine with Heart Functional Medicine Clinic 720-722-1143 service@medicinewithheart.com

You always hear that taking aspirin has good health benefits to it, but a new study shows that it may not be the case! Dr. Noelle Mann, Co-Director of the Women's Heart Program at Stony Brook University Heart Institute joins us to give us all the details you may have missed! Check out the podcast to find out what has changed!

Dr. William Gray, System Chief of Cardiovascular Services at Maine Line Health and Co-Director of the Lankenau Heart Institute, joined the podcast to share big trends in cardiology and thoughts on evolving payment structures.

This episode features Dr. Ronald Freudenberger, Physician in Chief of the Heart Institute at Lehigh Valley Health Network in Allentown, Pa. Here, he joined the podcast to talk about the big trends in cardiology as demand for outpatient services grows and new technologies emerge.

Our Summer 2021 Series features the rebroadcast of some of our most listened-to episodes from the last 4 seasons of Charting Pediatrics. Do you have a guest or topic suggestion for Season 5? Let us know, chartingpediatrics@childrenscolorado.org Safety and teamwork are second nature for pediatric providers. In medicine, we have long looked to the airline industry as a leader in the application of crisis response and as the ideal of high reliability. Coming from a shared reality that even the most experienced professionals are vulnerable to human error, both aviation and medical professionals rely on problem-solving strategies to optimize responses to critical incidents. In this episode we discuss the collaborative work of physicians at Children's Colorado's Heart Institute and Human Factors and Pilot Development leaders at United Airlines. Our guests are Robby Bishop, MD, Director of the Simulation Lab at the Children's Hospital Colorado Heart Institute; Rob Strickland, Senior Manager of Human Factors and Pilot Development at United Airlines; and Carlos Porges, Psy.D, Neuropsychologist, Boeing 757/767 Pilot and member of the Human Factors and Development Team at United Airlines. Paper: Crisis Resource Management in Medicine: A Clarion Call for Change Video: Crisis Resource Management in Medicine: A Clarion Call for Change Do you have thoughts about today's episode or suggestions for a future topic? Write to us, chartingpediatrics@childrenscolorado.org 

Dr. Jeffrey Carstens, Executive Medical Director of CHI Health Heart Institute, joined the podcast to discuss the physician and staff pipeline for heart care, new industry trends and best advice for physician leaders.

Aaron Kinney, Executive Director of Herma Heart Institute at Children's Wisconsin, joined the podcast to discuss the big trends in pediatric heart care, research and innovation.

Chronic fatigue in his early 20's was threatening Dr. Nichol's ability to finish school. He was also confused as to why he was having a hard time "getting out of bed in the morning." While his tests at multiple doctors were "within range" the way he felt was less than optimal and not sustainable.Talking Points:-Using breathing techniques to regulate the nervous system-Buteyko and Win Hof breathing methods-Cold exposure therapy-Peptide therapies to stimulate tissue repair-Resetting your chronic stress responses-Understanding mitochondrial diseasesDr. Miles Nichols is a functional medicine doctor specializing in Lyme, mold illness, gut, thyroid, and autoimmunity. After Dr Miles personally struggled with chronic fatigue in his early 20's, Dr Miles dedicated himself to figure out the root causes. He suffered with and recovered from thyroid dysfunction, autoimmunity, a gut infection, Lyme co-infections, and mold illness.Dr. Miles and his wife Dr Diane Mueller co-authored “How to Use Your Mind to Heal Your Mold and Lyme” and “Stress Resilience”. They founded the Medicine with Heart functional medicine clinic in Colorado and also the Medicine with Heart Institute that trains other doctors in functional medicine. With a doctorate in oriental medicine, he has extensive training and expertise around herbal medicines and has developed formulations used by functional medicine doctors across the country.Connect with my Guest:Clinic: https://MedicineWithHeart.comPractitioner Training Program: https://MindBodyFunctionalMedicine.comFacebook: https://facebook.com/medicinewithheartTwitter:medicinewheartInstagram: https://instagram.com/medicinewithheartComplimentary discovery call with clinic:Free Discovery Consultation From Medicine With Heart Sponsors:Envita Medical Center: Envita Medical Center: A Center of Excellence for Personalized Oncology and Lyme Disease Treatment located in Scottsdale, AZ. What defines Envita is the undeniable truth that every patient who has the courage to come to Envita and walk through our doors, discovers the incredible healing and compassionate care that can only exist in a clinic that is radically focused on patient outcomes;... they provide a focused team of people with an exceptional heart for serving our patients. At Envita they have discovered a revolutionary solution for patients to help improve their quality of life. Call to speak with one of their patient care coordinators today. (Ep. #80 for more info)Envita Medical Center Medical Bill Gurus The experts at Medical Bill Gurus are dedicated to innovative solutions for any medical billing scenario. Their patient advocates are available to help reduce medical bills and assist patients with navigating a dynamic health landscape. They take pride in speaking with patients every day and helping them find guidance on how to navigate our broken healthcare system. (Ep.#111 for more info)Medical Bill Gurus | Redefining The Role Of Medical Billing To Move Healthcare Forward Lyme Laser Center Finally, a proven and comprehensive Lyme protocol with no antibiotics, no potentially harmful therapies, and no outrageous prices or hidden ongoing costs. Lyme Laser Centers uses their unique, technologically advanced laser systems and their numerous other supportive technologies to help you gain control of your Lyme disease and overcome the often debilitating effects that it has on your body and your life. With a completely free in-house consultation with a Lyme Laser Specialist, it's easy to learn more about the Lyme Laser Protocol™ and how it can help you overcome your Lyme. Start healing your body, naturally.Link: www.LymeLaser.com/HomeProtocol/Urbane Medical A boutique ketamine infusion center located in Scottsdale, AZ. Who specializes in a "hospitable" environment rather than a hospital environment. Ketamine can promote a sense of wellbeing, decreases brain fog, and reduce chronic nerve pain.Home Connect with Lyme Voice:Lyme VoiceInstagram: @LymeVoiceSarah Schlichte Sanchez: Sanchezsmile@gmail.com 

Dr. Maryanne Chrisant, Director of Pediatric Cardiac Transplant, Heart Failure and Cardiomyopathy at The Heart Institute at Joe DiMaggio Children's Hospital in Hollywood, FL., joined the podcast to talk about the biggest challenges in cardiology and advice for emerging physician leaders.

This week on the podcast, we discuss kids and sugar! Our guests, Catherine Anthony and Delaney Elam, are Registered Dietitians in the Heart Institute and they joined us to share helpful information and useful tips. In this episode, we discuss added sugar versus natural sugars in foods kids like, popular drinks and foods with a lot of added sugar, picky eaters, sports and energy drinks; and so much more! 

- Masking - Help for homeless - Heart Institute - Free Sundays ** Please check out the show notes for the links to our sources. Donate: https://www.berlinbriefing.de/donate/ Twitter: @berlinbriefing Facebook: https://www.facebook.com/BerlinBriefing/ Mail: berlinbriefing@gmail.com

Law of Attraction Mastery Course- the ONLY time it will be live http://jjflizanes.com/mastery   Mold and Lyme Summit http://jjflizanes.com/mold   Early Bird Pricing Ends on May 31st for Manifestation Bootcamp in Los Angeles in October http://jjflizanes.com/bootcamp   As a survivor of IBS, Lyme Disease and Mold Illness, Dr. Mueller is passionate about bringing research, understanding and compassion to those with these diseases. She has co-authored with her husband, Dr. Miles Nichols, a book which is to be released in May 2021 called Use Your Mind to Heal Your Mold and Lyme. Her practice, the Medicine with Heart Clinic, treats those around the country. She also co-owns an online functional medicine school the Medicine with Heart Institute, where she trains clinicians around the world in functional medicine.   Book: Use Your Mind to Heal Your Mold and Lyme https://mwh.thrivecart.com/book/   14 Day Happiness Challenge: https://medicinewithheart.com/14-day-happiness-challenge   Functional Medicine Training Institute (Medicine With Heart Institute): https://mindbodyfunctionalmedicine.com/   Gut Resolve Course: https://mwh.thrivecart.com/gut-resolve/   JJ Flizanes is an Empowerment Strategist and the host of several podcasts including People’s Choice Awards nominee Spirit, Purpose & Energy. She is the Director of Invisible Fitness, a best-selling author of Fit 2 Love: How to Get Physically, Emotionally, and Spiritually Fit to Attract the Love of Your Life and The Invisible Fitness Formula: 5 Secrets to Release Weight and End Body Shame. Named Best Personal Trainer in Los Angeles for 2007 by Elite Traveler Magazine, JJ has been featured in many national magazines, including Shape, Fitness, and Women’s Health as well as appeared on NBC, CBS, Fox, the CW and KTLA. Grab a free copy of the Invisible Fitness Formula at http://jjflizanes.com/book      

Law of Attraction Mastery Course- the ONLY time it will be live http://jjflizanes.com/mastery   Mold and Lyme Summit http://jjflizanes.com/mold   Early Bird Pricing Ends on May 31st for Manifestation Bootcamp in Los Angeles in October http://jjflizanes.com/bootcamp   As a survivor of IBS, Lyme Disease and Mold Illness, Dr. Mueller is passionate about bringing research, understanding and compassion to those with these diseases. She has co-authored with her husband, Dr. Miles Nichols, a book which is to be released in May 2021 called Use Your Mind to Heal Your Mold and Lyme. Her practice, the Medicine with Heart Clinic, treats those around the country. She also co-owns an online functional medicine school the Medicine with Heart Institute, where she trains clinicians around the world in functional medicine.   Book: Use Your Mind to Heal Your Mold and Lyme https://mwh.thrivecart.com/book/   14 Day Happiness Challenge: https://medicinewithheart.com/14-day-happiness-challenge   Functional Medicine Training Institute (Medicine With Heart Institute): https://mindbodyfunctionalmedicine.com/   Gut Resolve Course: https://mwh.thrivecart.com/gut-resolve/   JJ Flizanes is an Empowerment Strategist and the host of several podcasts including People’s Choice Awards nominee Spirit, Purpose & Energy. She is the Director of Invisible Fitness, a best-selling author of Fit 2 Love: How to Get Physically, Emotionally, and Spiritually Fit to Attract the Love of Your Life and The Invisible Fitness Formula: 5 Secrets to Release Weight and End Body Shame. Named Best Personal Trainer in Los Angeles for 2007 by Elite Traveler Magazine, JJ has been featured in many national magazines, including Shape, Fitness, and Women’s Health as well as appeared on NBC, CBS, Fox, the CW and KTLA. Grab a free copy of the Invisible Fitness Formula at http://jjflizanes.com/book      

Law of Attraction Mastery Course- the ONLY time it will be live http://jjflizanes.com/mastery   Mold and Lyme Summit http://jjflizanes.com/mold   Early Bird Pricing Ends on May 31st for Manifestation Bootcamp in Los Angeles in October http://jjflizanes.com/bootcamp   As a survivor of IBS, Lyme Disease and Mold Illness, Dr. Mueller is passionate about bringing research, understanding and compassion to those with these diseases. She has co-authored with her husband, Dr. Miles Nichols, a book which is to be released in May 2021 called Use Your Mind to Heal Your Mold and Lyme. Her practice, the Medicine with Heart Clinic, treats those around the country. She also co-owns an online functional medicine school the Medicine with Heart Institute, where she trains clinicians around the world in functional medicine.   Book: Use Your Mind to Heal Your Mold and Lyme https://mwh.thrivecart.com/book/   14 Day Happiness Challenge: https://medicinewithheart.com/14-day-happiness-challenge   Functional Medicine Training Institute (Medicine With Heart Institute): https://mindbodyfunctionalmedicine.com/   Gut Resolve Course: https://mwh.thrivecart.com/gut-resolve/   JJ Flizanes is an Empowerment Strategist and the host of several podcasts including People’s Choice Awards nominee Spirit, Purpose & Energy. She is the Director of Invisible Fitness, a best-selling author of Fit 2 Love: How to Get Physically, Emotionally, and Spiritually Fit to Attract the Love of Your Life and The Invisible Fitness Formula: 5 Secrets to Release Weight and End Body Shame. Named Best Personal Trainer in Los Angeles for 2007 by Elite Traveler Magazine, JJ has been featured in many national magazines, including Shape, Fitness, and Women’s Health as well as appeared on NBC, CBS, Fox, the CW and KTLA. Grab a free copy of the Invisible Fitness Formula at http://jjflizanes.com/book      

Law of Attraction Mastery Course- the ONLY time it will be live http://jjflizanes.com/mastery   Mold and Lyme Summit http://jjflizanes.com/mold   Early Bird Pricing Ends on May 31st for Manifestation Bootcamp in Los Angeles in October http://jjflizanes.com/bootcamp   As a survivor of IBS, Lyme Disease and Mold Illness, Dr. Mueller is passionate about bringing research, understanding and compassion to those with these diseases. She has co-authored with her husband, Dr. Miles Nichols, a book which is to be released in May 2021 called Use Your Mind to Heal Your Mold and Lyme. Her practice, the Medicine with Heart Clinic, treats those around the country. She also co-owns an online functional medicine school the Medicine with Heart Institute, where she trains clinicians around the world in functional medicine.   Book: Use Your Mind to Heal Your Mold and Lyme https://mwh.thrivecart.com/book/   14 Day Happiness Challenge: https://medicinewithheart.com/14-day-happiness-challenge   Functional Medicine Training Institute (Medicine With Heart Institute): https://mindbodyfunctionalmedicine.com/   Gut Resolve Course: https://mwh.thrivecart.com/gut-resolve/   JJ Flizanes is an Empowerment Strategist and the host of several podcasts including People’s Choice Awards nominee Spirit, Purpose & Energy. She is the Director of Invisible Fitness, a best-selling author of Fit 2 Love: How to Get Physically, Emotionally, and Spiritually Fit to Attract the Love of Your Life and The Invisible Fitness Formula: 5 Secrets to Release Weight and End Body Shame. Named Best Personal Trainer in Los Angeles for 2007 by Elite Traveler Magazine, JJ has been featured in many national magazines, including Shape, Fitness, and Women’s Health as well as appeared on NBC, CBS, Fox, the CW and KTLA. Grab a free copy of the Invisible Fitness Formula at http://jjflizanes.com/book      

Law of Attraction Mastery Course- the ONLY time it will be live http://jjflizanes.com/mastery   Mold and Lyme Summit http://jjflizanes.com/mold   Early Bird Pricing Ends on May 31st for Manifestation Bootcamp in Los Angeles in October http://jjflizanes.com/bootcamp   As a survivor of IBS, Lyme Disease and Mold Illness, Dr. Mueller is passionate about bringing research, understanding and compassion to those with these diseases. She has co-authored with her husband, Dr. Miles Nichols, a book which is to be released in May 2021 called Use Your Mind to Heal Your Mold and Lyme. Her practice, the Medicine with Heart Clinic, treats those around the country. She also co-owns an online functional medicine school the Medicine with Heart Institute, where she trains clinicians around the world in functional medicine.   Book: Use Your Mind to Heal Your Mold and Lyme https://mwh.thrivecart.com/book/   14 Day Happiness Challenge: https://medicinewithheart.com/14-day-happiness-challenge   Functional Medicine Training Institute (Medicine With Heart Institute): https://mindbodyfunctionalmedicine.com/   Gut Resolve Course: https://mwh.thrivecart.com/gut-resolve/   JJ Flizanes is an Empowerment Strategist and the host of several podcasts including People’s Choice Awards nominee Spirit, Purpose & Energy. She is the Director of Invisible Fitness, a best-selling author of Fit 2 Love: How to Get Physically, Emotionally, and Spiritually Fit to Attract the Love of Your Life and The Invisible Fitness Formula: 5 Secrets to Release Weight and End Body Shame. Named Best Personal Trainer in Los Angeles for 2007 by Elite Traveler Magazine, JJ has been featured in many national magazines, including Shape, Fitness, and Women’s Health as well as appeared on NBC, CBS, Fox, the CW and KTLA. Grab a free copy of the Invisible Fitness Formula at http://jjflizanes.com/book      

Dr. Ronald Freudenberger, Physician in Chief of the Heart Institute at Lehigh Valley Health Network in Allentown, Pa., joined the podcast to talk about the big trends in cardiology as demand for outpatient services grows and new technologies emerge.

In this interview, Dr. Diane Mueller turns the microphone on Sarah for an energetic and experiential conversation about (seemingly teeny-tiny) ways to stack your daily habits towards hope, recovery, and transformation.This episode is just one of the 30+ interviews by speakers and international experts for this FREE...Body, Mind, Mold, and Lyme Summit May 17-21. A whole BODY, whole MIND training, and support SUMMIT for practitioners and survivors.Link: https://lyme-disease-and-mold-illness-summit.heysummit.com/?sc=TanZIQ3S&ac=V83fdhnSTalking Points:~Choosing to ACT when you have zero motivation.~What can I do with what I currently have?~How can you create some level of FREEDOM within the constraints that you have?~A bed that is made, is a bed that doesn't intend to be laid in...~If you are stuck watching Netflix all day, how can you get something out of it?~NO negative self-talk (be alert to what you say to yourself internally)~Persistence vs. Perfection~If you are operating at 60%, congratulate yourself on the 60%.~Set your alarm differently...it's one step in the right direction.Dr. Diane Mueller ND, DAOM, LAcAs a survivor of IBS, Lyme Disease and Mold Illness, Dr. Mueller is passionate about bringing research, understanding and compassion to those with these diseases. She has co-authored a book which is to be released in May 2021 called Use Your Mind to Heal Your Mold and Lyme. In addition, she is co-hosting a Summit this Spring called, "Use Your Mind to Heal Your Mold and Lyme."Her practice, the Medicine with Heart Clinic, treats those around the country. She also co-owns an online functional medicine school the Medicine with Heart Institute, where she trains and certifies clinicians around the world in functional medicine. https://mindfulness-medicine.comSponsors:Envita Medical Center: Envita Medical Center: A Center of Excellence for Personalized Oncology and Lyme Disease Treatment located in Scottsdale, AZ. What defines Envita is the undeniable truth that every patient who has the courage to come to Envita and walk through our doors, discovers the incredible healing and compassionate care that can only exist in a clinic that is radically focused on patient outcomes;... they provide a focused team of people with an exceptional heart for serving our patients. At Envita they have discovered a revolutionary solution for patients to help improve their quality of life. Call to speak with one of their patient care coordinators today. (Ep. #80 for more info)Link: https://www.envita.com/?utm_source=lymevoice&utm_medium=cpc&utm_campaign=lymevoice-cpc-blog&utm_content=blogMedical Bill Gurus The experts at Medical Bill Gurus are dedicated to innovative solutions for any medical billing scenario. Their patient advocates are available to help reduce medical bills and assist patients with navigating a dynamic health landscape. They take pride in speaking with patients every day and helping them find guidance on how to navigate our broken healthcare system. (Ep.#111 for more info)Link: (link)https://www.medicalbillgurus.com/Lyme Laser Center Finally, a proven and comprehensive Lyme protocol with no antibiotics, no potentially harmful therapies, and no outrageous prices or hidden ongoing costs. Lyme Laser Centers uses their unique, technologically advanced laser systems and their numerous other supportive technologies to help you gain control of your Lyme disease and overcome the often debilitating effects that it has on your body and your life. With a completely free in-house consultation with a Lyme Laser Specialist, it's easy to learn more about the Lyme Laser Protocol™ and how it can help you overcome your Lyme. Start healing your body, naturally.Link: www.LymeLaser.com/HomeProtocol/Urbane Medical A boutique ketamine infusion center located in Scottsdale, AZ. Who specializes in a "hospitable" environment rather than a hospital environment. Ketamine can promote a sense of wellbeing, decreases brain fog, and reduce chronic nerve pain.Link: https://urbanemedical.com/Connect with Lyme Voice:Link: https://lymevoice.com/Instagram: @LymeVoiceSarah Schlichte Sanchez: Sanchezsmile@gmail.com

What do we do when life hits us hard, and unimaginable tragedy becomes our new reality? While few of us can fathom the loss of a child, this is exactly what happened to Dana Vavalle and her husband John. On this episode we hear their story and how they navigated their grief after the loss of their young son Francesco and their founding of their non-profit Cesco’s Heart to honor the memory of their son. Learn more about Cesco's Heart here!Cesco's Heart was founded by John and Dana Vavalle in 2012 when their first-born son, Francesco lost his battle with his heart defect. They began this non-for-profit organization to support the research and advancements in treatments for children with heart disease.  Cesco’s Heart donates 100% of their proceeds to Advocate Children’s Hospital’s Heart Institute.  John and Dana Vavalle are members of Advocate Children’s Hospital’s Presidents Society and often visit the patients and their families bringing them special items during the holidays and other occasions.  Cesco’s Heart holds their annual fundraiser every fall to raise money and raise awareness for this important cause they hold dear to their heart.

Why You Should Listen: In this episode, you will learn about healing from mold and Lyme disease. About My Guests: My guest for this episode is Dr. Diane Mueller. Diane Mueller, ND, DAOM, LAc is a survivor of IBS, Lyme disease, and mold illness. Dr. Diane's journey to heal herself led her to complete two doctorate degrees in holistic health care. She has a Doctorate degree in Naturopathic Medicine as well as a Doctorate degree in Acupuncture and Oriental Medicine. She is passionate about bringing research, understanding, and compassion to those with these conditions. She has co-authored the book "Use Your Mind to Heal Your Mold and Lyme: A Survivor's Guide". Her practice, the Medicine with Heart Clinic, treats people from around the country. She co-owns an online functional medicine school, the Medicine with Heart Institute, where she trains clinicians around the world in functional medicine. Her recent book “Use Your Mind to Heal Your Mold and Lyme: A Survivor's Guide” shares many of the strategies that she used to recover her own health and the health of many of her patients. Key Takeaways: - Should mold be treated before Lyme disease? - Is killing the bug important for recovering health? - How can pulsing antimicrobials be part of a protocol? - What are persisters, and how are they addressed? - Can mycotoxins lead to leaky gut? - Does fungal colonization occur after exposure to water-damaged buildings? - How does Bartonella impact the lymphatics? - How do Ehrlichia and Anaplasma negatively impact our mitochondria? - What is the role of viruses and retroviruses in chronic illness? - Can medicine mushrooms be used in those with mold illness or fungal overgrowth? - What is the role of bile transporters in detoxification? - How might manganese or hyaluronic acid be used as "feeders"? - How might pulsing be used to avoid sensitization to therapeutic interventions? - What properties does cistus have that make it a useful tool? - Why is it important to approach biofilm treatment with caution? - What is the role of autophagy in cleansing? - What can negative thoughts do to the physical body? - Where can patients find support? Connect With My Guest: http://MedicineWithHeart.com Related Resources: Book - Use Your Mind to Heal Your Mold and Lyme: A Survivor's Guide Body, Mind, Mold and Lyme Summit Interview Date: April 6, 2021 Transcript: To review a transcript of this show, visit http://BetterHealthGuy.com/Episode143 Additional Information: To learn more, visit http://BetterHealthGuy.com. Disclosure: BetterHealthGuy.com is an affiliate of Amazon.com and HeySummit.com Disclaimer: The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.

Janïs Petit from the University of Ottawa talks to Dan Pak who is a passionate runner, heart health advocate, and an Atrial Fibrillation patient at the University of Ottawa Heart Institute. Dan with us lessons on how important is for everyone to be conscious that Heart diseases can affect even those physically active and how research at the Heart Institute has benefited his recovery.Learn more about Dan’s inspiring journey www.ottpak.blogspot.com and follow Dan on Twitter @OttPak

#003: Sheila got married at twenty and entered the metaphysical world after growing up in the corporate restaurant world. She and her husband worked in his family's McDonald's for fifteen years and then owned three themselves for five years in Anchorage, Alaska. After selling the restaurants, they moved to the interior of Alaska and built their own house. They then helped 200 families in Alaska build their own homes.While living that life, Sheila became a Reiki Master teacher and healer for 23 years, an Intuitive Reader/Guide, and a practitioner of many healing modalities, including massage therapy, cranio sacral work, essential oils, reflexology and she founded the Healing Arts Institute or The HEART Institute for six years, prior to owning Aura Borealis Bed & Breakfast in the Wrangell National Park with her husband. They had 6000 guests visit their final six years of living in Alaska.  She's lived on Maui for a year and a half now and is passionate about sharing with other people the techniques that can help to remove blocks and obstacles in their lives. She loves to help facilitate Past Life Sessions (you'll hear her conduct one for me in this episode) and says they allow people to rescind and shift past soul level contracts made eons ago that still haunt them today. That was certainly my experience. TAKEAWAYS FROM THIS EPISODE:All souls create soul-level contractsTrauma from your past lives can create issues in your current life.Good news! You can heal trauma from your past lives.MENTIONED IN THIS EPISODE:www.crystaldragonhealing.comhttps://www.instagram.com/crystaldragonhealing/www.facebook.com/groups/thecrystaldragon1Sheila's Crystal Dragon Rune Eggs of Orgonite: https://www.crystaldragonhealing.com/dragoneggsBecoming Infinite Website: https://coopergillespie.com/becominginfiniteSONGS IN THIS EPISODE:Mad Planet - Two of UsLANDROID - Yellow SeaThank you so much for listening!

Wheeling Hospital Medical Director Dr Michael Campsey On COVID And Heart Institute 11 25 20 by The Watchdog

I spoke with Connie Cunningham on Oct 21, 2020. We spoke about how she went from thinking about intuition was for other people to living from her intuition on a daily basis. How things have shown up in her life and transformed it from nutrition to the Way of the Heart and the Halo. We also spoke about how her daughter interestingly enough created the first situation that made her start to realize that she has the ability to listen. BioI would describe myself as a truth seeker. The shift in my journey began when my daughter had repeated ear infections and a constant runny nose. After 7 bouts of antibiotics and surgery to remove her “faulty” adenoids(which a red me was my daughters problem), three weeks after surgery we were dealing with yet again an ear infection. I was asking all the right questions to the wrong people.Heather and I worked together for a brief period when at the time she shared that my daughter’s problem might be dairy. It took me 6 months to get my head wrapped around the fact that NO WHERE or NO ONE in our medical system even hinted the food my daughter loved the most was what was causing her issues. From that time on I knew I had to take that nutrition course and help to share the same info that Heather shared with me. My intuition at that time came in the form of asking questions. I used to think that being intuitive or having intuition was something everyone else had. I know now that intuition is from God. A voice, an image, a connection, a knowing, a wisdom that doesn’t come from us. A calling for a relationship with a source so much bigger than ourselves. As a Naturopath, we talk about healing the Mind Body and Spirit. From a voice calling me to “Go buy a book” at a time when it just didn’t make sense, I met the founder of The Rediscovery of the Heart Institute and will forever be learning about The Spiritual Heart and sharing with others. Guard your Heart with all diligence for from it flows ALL the issues of Life- King Solomon Here’s how people may identify me asNutritionist, Naturopath and Yoga teacherI also promote products using quantum technology www.halomultiverse.com (Main website for Halo)Halo Light Therapy/ Water Therapy Purchase light therapy sessions or Halo charged water Q3 Frequency Bracelets (Coming soon for pets) Improves Blood flow Increases energy, strength and vitality Promotes Cell Rejuvenation 5G/EMF Protection 24/76 Hologram chips of High-Quality Natural Frequencies www.thequantumdifference.com/conniec My site to purchase Halo and Q3 Bands Contact me, Connie by text or phone (506) 850-9728Email clearlynutrition@gmail.com

Javed Butler, MD, is a Professor and Chairman of The Department of Medicine at The University of Mississippi. Prior to joining the University of Mississippi, he was the Director of the Division of Cardiovascular Medicine and the Co-Director of the Heart Institute at Stony Brook University in New York. Dr. Butler served as the Director for Heart Failure Research at Emory University and Director of the Heart and Heart-Lung transplant programs at Vanderbilt University prior to that. After completing his medical school in Pakistan, Dr. Butler completed his residency from Yale University and fellowships from Vanderbilt University and Harvard University. He also completed his Masters in Public Health degree from Harvard University and an MBA from Emory University. He serves on several national committees for the American College of Cardiology, the American Heart Association and the National Institutes of Health, and was recently elected as a member of the prestigious Association of University Cardiologists. Dr. Butler is the recipient of the Simon Dack Award by the American College of Cardiology and the Time, Feeling and Focus Award by the American Heart Association. What if we told you the world was, indeed, flat? Okay, fine. It's round. However: Dr. Javed Butler encourages us to adopt a mindset that everyone is equal, regardless of where they fall in the institutional hierarchy, and that we have a duty to treat every person with dignity and respect. Today, he offers sage advice as we continue on this path in medicine: Align our best opportunity with our best interest, and though it's important to recognize what we enjoy, it's even more critical we identify and avoid what we don't enjoy doing. Lastly, he encourages us to be truthful with our mentors and think about helping our mentors achieve their mission as we learn from them. Pearls of Wisdom: 1. View the world as flat. No one is above anyone else and we need to treat every person with dignity and respect. We are all equal. 2. Use the “meaningfulness equation” to align the best opportunity in the market with your best interest. 3. Do not be afraid to reach out to mentors. We should enter into these relationships with the mindset of helping them achieve their mission and learning in that process.

Dr. Hayes interviews Dr. Canellos on his involvement with CHOP, MOPP and CMF as well as his role as Chief of Division of Med Onc at SFCI/DFCI for 25 years. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Welcome to JCO's Cancer Stories, The Art of Oncology, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all of the shows, including this one, at podcast.asco.org. Hello. Today my guest on the podcast is Dr. George Canellos. Dr. Canellos was instrumental in early treatments for breast cancer, lymphomas, -- and chronic leukemias, and he's generally considered one of the so-called Gang of Five with the National Cancer Institute in the 1970s, along with Drs. Vince DeVita, Robert Young, Bruce Chabner, and Philip Schein, who ultimately demonstrated that chemotherapy could be used to cure a fraction of patients with Hodgkin's and non-Hodgkin's lymphomas. Dr. Canellos was raised in Boston, and he attended Boston Latin School. He then received his undergraduate degree at Harvard and his medical degree at Columbia in New York City. But he remained a Red Sox fan, so he returned to Boston for his residency in internal medicine at Massachusetts General Hospital. But he then trained in oncology at the National Cancer Institute where he stayed until 1974 when he once again returned to Boston to join the faculty of the then Sidney Farber Cancer Institute where he served as the Chief of Medical Oncology until 1995. He is currently the William Rosenberg Chair at Medicine at the now Dana Farber Cancer Institute and a Professor of Medicine at Harvard Medical School. Dr. Canellos has authored over 300 peer-reviewed papers and too many reviews and chapters to name. Most importantly, he served as the Second Editor in Chief of the Journal of Clinical Oncology, a role he filled from 1987 until 2001. And during that time, he directed the Journal to become the leading journal in our field. Perhaps even more importantly, he served as ASCO President in 1993 and 1994, and he's been recognized as an ASCO Oncology Luminary, and he's been recognized with the Statesman Award and the Distinguished Service Award for Scientific Achievement from our society. Dr. Canellos, welcome to our program. Good to talk to you. Great to talk to you. You know, I spent a lot of time with you at the Sidney Farber and then Dana Farber Cancer Institute, and I've heard you say, and I've also read, that you originally seriously considered becoming a surgeon because of the work you did with Dr. Oliver Cope, one of the leaders in surgery of our last century and especially related to thyroid and other cancers. So what led you to get away from surgery and become a medical oncologist? Well, I served as a surgical intern at Mass General at that time, which was a lot of exposure to serious illness and surgery. But it dawned on me. Two things dawned on me. One is that if one was interested at all in malignancy that surgery really wasn't the answer, certainly, in any way. And in those days, of course, even radiotherapy was not the answer. And so the other thing I realized, that I had the manual dexterity of a California fur seal. I didn't really feel, being left-handed, I didn't feel that I really had the dexterity required to do some of the complicated surgery that was going on in those days because I held retractors as an intern for some very long operations that really didn't achieve more than taking out a gallbladder. It took three hours. Now, we can do it with a laparoscope in a half an hour, probably. So I switched into medicine at Mass General and stayed in medicine at Mass General. And being inspired to really think about other treatments for malignancy in those days, there were very few really textbooks available that talked about chemo. There was some. I would nip up to the library of the hospital rarely and try to read about them. There were new drugs coming out at that time, but there was very little really known about the action of the drugs and the potential of the drugs that might have existed at that time. Then I went to NCI, as one had to because there was a doctor draft. And two years of residency in medicine, I actually went to the medicine branch of the NCI. And there, under Emil Frei III, another investigator named Freireich, Jay Freireich, who were around at that time and running the program, such as it was, we first were experience-- I was thinking that I would do research there, and I did. But at the same time, the Clinical Associate Program entailed a year of clinical exposure, of clinical care, and I had several colleagues. The first major colleague was Vincent DeVita who really, at that time, decided to approach a treatable more solid malignancy, as acute leukemia of childhood was being approached, with combination chemotherapy. However, there weren't many drugs that were very active at that time. There were some. An alkylating agent, nitrogen mustard, steroids, a vinca alkaloid that had just been relatively new introduced for adult disease. And there was no procarbazine. Of course, it hadn't been invented yet, but methotrexate. And so the first combination regimen that came out of that program was MOMP, M-O-M-P, and that had some activity, but it was only given for a relatively short period of time. Eventually, the tolerance of patients to these drugs was considerable, a considerable issue, because we didn't really have granulocyte support. There were a lot of things that we'd take for granted now that were not available then. So the toxicity of some of these programs, such as the M-O-P-P Program when procarbazine came along, the MOPP program was considerable. But the interesting thing is the patients that we had were generally on the younger side, younger than 45, let's say, and they could tolerate the therapy. And I found that, honestly and subsequently, with testes cancer, that younger people who get a lot of toxicity from these drugs, despite that, if they think there may be a cure around the corner, will tolerate it. And you don't hear a great deal of complaints about it, about the toxicity, interestingly. But the older patients, of course, are far more vulnerable. Their bone marrow reserve not being great, these regimens were quite toxic. But, fortunately, the first targeted disease was Hodgkin's disease, and it's generally a disease confined to younger people, in general. About 20% of them are in the older group. But we first tested the aggressive chemotherapy, known as MOPP, in the younger patients, actually. But what was surprising to us, and surprising to everybody, was the fact that they failed to relapse as they were all expected to do at that time. In the single drug agent era, of course, Hodgkin's disease would relapse eventually. As house officers, we just expected that to happen. Now, the training in the major academic hospitals in those days, oncology was not an important part, or even a desired part, of the program, if you will. And so most who arrived at a place like NIH really didn't have much background at all in the treatment of cancer because they probably didn't see it all that much. I know I didn't. As a surgeon, yes, but not as internal medicine. I was going to ask you that. When you were at Mass General and you said you noticed that surgery wasn't curing people, there couldn't have been anybody around that was mentoring you or said, why don't you-- how did you even hear about-- No, no, there wasn't. There were some docs there who really cut their teeth on giving hormones to breast cancer patients, and that was about it. But very few people were giving-- I couldn't think of anybody who was giving-- one person who was giving chemotherapy, a lady, a fine lady, fine physician actually, but on the private side, but nobody on the academic side that amounted-- So what made you-- What made you say, I'm going to go to the NCI and learn how to do this? I mean, that seems like that was completely out of the blue. Well, you weren't given much choice. Of the two institutes, I applied at the Heart Institute and the Cancer Institute. The Cancer Institute accepted me, and the same with Vince DeVita. He applied to the Heart Institute but got into the Cancer Institute. And we were both there, probably you could say, as our second choice at the time. Because-- Yeah, that's interesting. Yeah. Very little was known about oncology as a field, and there we were. On the other hand, seeing these patients at least respond to these drugs in the way they did, and seemingly not relapsing, made you wonder whether or not, in time-- when I went back to the NIH, I came back to the MGH to be a senior medical resident. I can tell you what was interesting, because there was no oncology Fellow, per se. They would ask me to see a patient if the patient had a malignancy. And I remember going in and seeing a patient with ovarian cancer. She had a huge belly full of ascites, malignant ascites, and I said that the drug for this disease is thiotepa, an alkylating agent. I wrote out the recipe, if you will, how many milligrams, et cetera. And I wrote in the note, and I will give the first dose, which I did. The intern covering the service, a surgical intern covering the GYN service, obviously read part of my note but not all of it, or decided he was going to give another dose as well, but somehow the woman was double-dosed. And there was a certain panic by the nursing staff, et cetera. She tolerated the drug surprisingly well. But more surprising, everything went away. She had this dramatic response to therapy. The ascites went away. The abdominal masses went away. And she was discharged. And I said to myself, at that time, this is a precedent for something, and that era will arrive once-- if it's not the right drug, we'll find the right drug for the disease. But I can tell you, it was very uplifting to me. I had already been to NIH. That's a great story. When you guys were at the NCI, a similar question is, when did the light bulb come on that it looked like you were actually curing Hodgkin's disease? Well, you're talking about a two-year appointment. At the end of the two years there, the remissions were already clear. That is to say, the disease had not come back, and the people were being followed. But two years is just two years. I mean, it's not a long time. And when I went back on the faculty-- see, I went for a year in England to become a hematologist because everybody had to be a hematologist in those days if you were interested in cancer. Anyway, that's what I did. And when I got back, they recruited me to the faculty, and the patients were still in remission, and that was great. And then we put our attention to the non-Hodgkin's lymphomas and modified the MOP regimen by putting cyclophosphamide instead of nitrogen mustard, which was a horrific drug by the way, nitrogen mustard in the doses that we gave. But like it or not, we put Cytoxan into it and we called it CMOP. It was like MOP but it was with C instead of the M. So we called it CMOP. And early in the 1970s, we did a randomized trial with the radiotherapists who were throwing radiation at everything that walked in with a non-Hodgkin's lymphomas, and we did a prospective randomized trial stage by stage, histology by histology. And I remember looking at the data for the large cell lymphomas with the CMOP and I said, Vince, you know, if we judged everything by median, the median survival of our patients was what you'd expect historically. But just below the median, the line straightened up, flattened out, and was going out now several years, at least four or five years, flat in a disease that usually recurred very quickly and killed everybody who was affected by it. And I remember when the Board of Internal Medicine decided to create a specialty called Medical Oncology and have an exam, et cetera, Vince thought it was because of Hodgkin's. And I'm sure it contributed, but I said it must be also the non-Hodgkin's because it's far more common. It's far more common. We helped far more people. And indeed, it probably is. Can I interrupt you for a moment? I interviewed Saul Rosenberg for this series, and he told me just [INAUDIBLE] the radiation psychologist. So Dr. Kaplan had referred to him from Memorial to come to Stanford and do radiation, and Dr. Rosenberg told Dr. Kaplan, I think we need to give these people chemotherapy, and Kaplan agree. But the Chair of Medicine did not and would not let Rosenberg see patients in his own clinic and give chemotherapy. So he wrangled a room from a hematologist, and he told me he would see patients in the room. He had a chair in the hallway. If the patient needed chemotherapy, he'd have the patient go sit in the chair in the hallway. Get an IV pole. He'd start the IV himself and then mix up the chemotherapy himself, hang it up. While the patient was getting chemotherapy in the hallway, he'd see the next patient in the room. Those are the kinds of obstacles he had to do. And the other thing I have to say, I didn't get to interview Dr. Holland before he passed away, but relative to your looking at the Kaplan-Meier curves, I'll never forget his yelling at me one time that, if you need a statistician to see what you've done, you probably haven't done much. I said that, 'cause I remember saying that as well, but anyway. Let me ask you another question. Yeah. You're know for lymphoma and chronic leukemias but also for breast cancer, and generally you're credited for coming up with the so-called CMF regimen. Vince and I were called into the director's office. At that time, the director of NCI was [INAUDIBLE]. And they said, all this lymphoma stuff is wonderful, but we want you to do solids. Now, we didn't have a referral pattern for solids at all. The only breast patients we saw were relatives of employees of the NCI. So Vince wanted to do ovarian, and I said ovarian is a good disease because they have malignant cells floating around, and we can do stuff on those. And Vince really wanted to do ovarian. I chose breast. And, again, we had no mastectomy surgical group or anything. And so what we did was make deals with medical oncologists in the community, two of them who actually trained-- one of them trained at the Brigham Hospital, actually, and they lived in the area. And they liked to come to our conferences and things. They would refer patients. And what we specified, initially, was that we have patients without isolated bone lesions only, that they had to have measurable lumpy, bumpy disease. And so to design a therapeutic treatment for them, we had to use the principles that we learned from the lymphoma experience. And that's where CMF came. CMFP, we used to have prednisone in some circumstance. And so that was the regimen that-- if you notice, the design of it would be like the MOP program. Anyway, so we started treating people like that. Suddenly, they did respond and some responded quite well. They had some toxicity, of course. And the very first paper we wrote was on the toxicity of CMFP. It was hard to get things published in medical oncology areas, and the Lancet was wonderful for us. The Lancet was very helpful, and we published a lot of stuff in the Lancet. But the first one was in the British Medical Journal, the toxicity of CMF program in patients, and we especially cautioned patients who had compromised liver function because they seemed to get worse toxicity at that time in our imagination. But it worked. It did work. We published it in the Annals of Internal Medicine eventually. But the important thing was, our friend Johnny Bonadonna would come over periodically to find out what we were doing. And he came over with an offer. He said he had all these patients who would get mastectomies and then nothing. Let me interrupt you for a moment 'cause I was going to ask you about Dr. Bonadonna. Yeah. Would you, just for the audience, a lot of them may not know who he is. Oh. Well, Johnny Bona-- Do you want me to describe him? Well, at that time, he was a young investigator working in Milan at the major hospital there in oncology, and he trained at Memorial before and then went but back to Italy. So he came and he wanted to know what we were doing. We showed him the protocol that we were doing for breast, and he was interested. And what he offered was the opportunity of doing a randomized trial on patients with a higher risk, if you will, breast cancer, node-positive patients. And he said that in Italy that nothing was done for them and that he could randomize them nothing to chemotherapy, and we offered him a contract. He required money. We gave him a contract. We gave him our protocol, at least the chemotherapy protocol. He went back to Italy and did that trial. And he left the prednisone out. He made sure it was of just CMF. And the patients, apparently, I guess, knew what they were getting, but I don't know whether they had strict requirements or informed consent and things like that. We didn't ask. We didn't ask. All we wanted was randomized data, and he certainly had it. And I remember being at the ASCO meeting in 1976, I think it was, '75 or '76, in Toronto when the first data was presented by Bonadonna. And the media people were there. People were barely hanging from the rafters to hear. The room wasn't big enough, really. None of the rooms were big enough because they never expected the attendance, that there were that many young oncologists around or people interested in oncology. And so he gave that first data, and that was a shot in the arm for adjuvant therapy, certainly for breast cancer, but for other things as well. I think, in general, he and Dr. Fisher, who sadly passed away before I had a chance to interview him, are responsible for thousands and thousands of people. Yeah. Absolutely. Absolutely. Absolutely. But I'm giving you the NCI side, my personal side of it, and you're right. Bernie was a real pioneer because he had so much opposition from the surgical establishment at the time. I can tell you that. From a surgeon's point of view, they really thought he was the Antichrist. I mean, it was terrible. I saw him and Jerry Urban get into a verbal argument at a meeting. I thought it was going to be a fistfight, actually, over-- Really? Yes, yes. Yes, they're severe. But anyway, let me go-- let me go to my next question, which has tended to change gears for a moment. You may or may not remember this, but when you were ASCO President, in your presidential address, I was in the audience and you said something to the effect that the greatest clinical experiment you have conducted are the Fellows you have trained, or something like that. Yes. Yeah. And I was in tears, of course. But you certainly can claim success on that. The division chiefs, department chairs, cancer center directors, most recently a Nobel Laureate, [INAUDIBLE], all of them came out of the program. But when you returned to Boston, you could not have envisioned all of this. What was the atmosphere, and what was Dr. Farber's vision? Well, Dr. Farber had died by the time I got there. Oh, he was already gone? OK. He was already gone. And when I was leaving, when Tom Frei recruited me, Vince thought I was mad because they made me Clinical Director. At least have a go at acting job as clinical director of the NCI. But really, down the line, it was a bureaucratic evolution. And I said, I don't really want to be an oncocrat at this age, anyway. What I said was, Vince, I said, the doctor draft is over. The best and the brightest and the youngest and the cheapest are all going to be in these hospitals, and there are a lot of them in Boston because I happen to know Boston, including house staff at the Brigham, house staff at the BI and Mass General. And I said, that's the future, or at least the future challenge. And I think he accepted it, but he didn't like it. I mean, he thought-- well, we were great buddies and we worked well together, and that goes for Bob Young and Bruce Chabner too. They thought I was very-- Where else-- at that time, there must have only been two or three places to train in oncology in the whole country, I would imagine. Yes, yes, yes. And people were just starting to set up cancer centers, sometimes without funding. And then there were all these, not many, but job requests for me to go and look at the job at Wisconsin or you name it, but I didn't want to do that. I really wanted to do medical oncology and not be a bureaucrat in any way. And many of the places, Dan, would say come and be a head of our cancer program, and it was also translated in parentheses, come and write a CORE grant. A lot of places who didn't deserve a CORE grant were asking me for people to come and write a CORE grant. You knew forever they would never get one because they really didn't have the makeup for it, yet. So what were the hurdles in Boston when you got there? Well, the hurdles in Boston were twofold. One is the fact that oncology had a very slow start in Boston, and that goes at the Brigham and at the MGH. The MGH was even disinterested in oncology at that time, actively disinterested. They didn't think it had any academic merit and therefore didn't put any effort into it. I have to say that Gene Braunwald, who was Chief of Medicine at the Brigham at the time, was interested because he had been at NIH at the Heart Institute, he knew Tom Frei, and he wasn't sure about it yet because he couldn't swallow it, I guess. And the fact was that it was growing a bit, and one of his very close associates developed large cell lymphoma and he got chemotherapy, he got to see MOP. And he was long-term remission. And I remember telling Braunwald, he was shocked that it was so successful. And I kept telling him, I said, this is not a rare event. This is happening. But the big challenge, Dan, at Dana Farber was that there was no oncology known, and we had to build the program from the bottom up. We hospitalized our patients at the Brigham before we opened the beds at the Dana Farber, but we needed the volume of patients. And we had all these beds, I think 59 beds, licensed beds, open. And I kept saying, we don't have the patients. But Tom Frei opened the beds. The next thing you know, I was talking to trustees because Tom said, we'll bring George up and we'll grow. The clinical program will grow. So the trustees thought the program would probably grow the next day. It didn't. It took a lot of effort without the [? scare ?] and myself going around giving talks in every little hospital that existed. And one of the big things I had my mind, because the house staff looked after our patients as well, was to show them what we could do. Now, in those days, other than the large cell lymphomas, of which we did not have many because they were in the hands of hematologists, was testes cancer. And the head of urology at the Brigham Hospital used to have these Saturday morning urology rounds inviting all of the practicing urologists around to come and they'd present their problem cases, et cetera. But he asked me to come along and give a talk about this new drug called cisplatin, which was having a big effect in testes cancer in other places. And I did. And I would come and talk about the early results in other places in testes cancer and that we were interested in actually starting a program. Then, they would-- of course, urologists are anything but chemotherapists, and so they would refer the patients in because, A, they couldn't give any chemotherapy. There was nothing oral that would work. What we would do is, if they sent patients in, we would do an early trial and we would publish the series in a, let's say, not spectacular journal and get reprints. We would send them reprints. And in some instances, I put the name of the referring doctor, if he'd sent us more than one patient, on the paper for, let's say, testing some antineoplastic thing. And we would put their names on the papers and send them reprints. And there's nothing a urologist loves more than to see his name on a scientific paper, a medical paper. And we started getting a ton of testes cases eventually and did trials and wrote papers about them. And I remember, when we recruited Phil Kantoff, a Fellow of mine, and I thought he was going to go back to the NIH and do gene therapy. And he walked in one day and he said, I'd like to apply for the GU job, and I said, it's yours. And he wrote quite a few papers based on the accumulated testicular data and the [INAUDIBLE]. Oh yeah. Yeah. And he was wonderful. He's Chief of Medicine now at Memorial. He's Chief of Medicine at Memorial, yes. I want to bring up one more thing that this segues into, though, and I believe now almost every medical oncologist who has trained in the last 10 years thinks that multispecialty tumor boards have always existed. But I believe that another of your trainees, Dr. Craig Henderson, who was my mentor, frankly, and you really started the first multispecialty clinic perhaps in all of oncology in this country. Do you agree with that? We called it the BEC, the Breast Evaluation Center. Yes, and we got cooperation but from surgeons. There were surgeons around, more nihilistic surgeons, if you will, not wanting to do radical surgery and radiotherapists, like Sam Hillman. And they were all around and doing those things. And we brought them into this BEC, the Breast Evaluation Center, and your mentor, Craig, was a little rough on the Fellows, I can tell you, in those days. Just his demands. Anyway, whatever it was. And so I would go to that clinic as well and see breast patients just to calm things down a bit at times. Anyway, it worked. And I know that the breast people elsewhere were recognizing that Craig had a nice thing going there with the multidisciplinary aspects. You know, it was so awful that breast cancer was treated so badly. I mean, they'd have a radical operation. And God knows, if there was some disease, that they would then get radical radiotherapy to their chest. And they were walking around sort of mutilated. And we had a part-time psychiatrist when I first arrived to see these patients because many of them had body image problems. So the idea of not doing radical mastectomy was revolutionary at that time. And I remember being called by the local Blue Cross to serve on a committee to decide whether or not Blue Cross should pay for breast reconstruction on these poor patients, and we voted. There was a committee of medical oncologists from MGH, me, and a plastic surgeon, and we voted 3 to 3 to they should pay, and they didn't. Then they said, thank you for serving on this advisory committee, but we're not paying. We've decided not to pay. Then, I can tell you, a women's agitation group got a hold of the facts. And one of them called me up and she said, I heard you were on this committee that voted not to pay. And I said, absolutely we voted to pay. They told us, thanks very much but we're not going to pay. So within two weeks then the insurance company changed its opinion because they went bananas at the insurance company. Yeah. The strength of advocacy, that's been something. Anyway, we're running out of time. I'd like to thank you for taking your time with us. Not at all, Dan. Not at all. It's a pleasure. And as I have done for every other interview in this series, I want to thank you not just for taking time with us but for all you've done for the field, for those of us who trained with you or are in the field, and most importantly for all the patients who have benefited. You look back over the-- Yeah, I know. I still follow them. My clinic has follow-ups of cured patients. You become the primary care doc for cured patients. Well, you think of the 60 years of your career and other fine folks that you were with at the NCI and then beyond, and the thousands or millions of people who have benefited, it's pretty remarkable. Yeah, well. Thanks again. I appreciate you being on. Not at all. And enjoy the rest of the day. Thank you very much, Dan. Until next time, thank you for listening to this JCO's Cancer Stories, The Art of Oncology podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories, The Art of Oncology podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.asco.org.

Dr. Paresh Goel has been in practice since 2010 and is the founder of Desert Mobile Medical Concierge Physicians. He grew up in the New York Metro area and completed his B.S. & M.B.A. in Finance & Economics at St John’s University in NY. He attended his medical school at M.S. Ramaiah Medical College in India, and he completed both his Internship & Residency programs at Brookdale University Medical Center in NY.Dr. Goel is board-certified by the American Board of Internal Medicine. He has worked in Hospital Medicine at the Lake Havasu Regional Medical Center, Banner Thunderbird, and at HonorHealth Shea & Osborn campuses, as well as Banner Baywood & The Heart Institute. He has honed his skills as a Primary Care Physician, Geriatrician & Internist in private practice & being employed at Geriatric Solutions. He has served as a Hospice Director for Hospice of the Valley in the recent past as well.He is currently the Medical Director for Modern Recovery Services & Springboard Recovery, as well as sitting on the board for some non-profit organizations. Continually striving to provide superior patient care along with the bleeding edge, state of the art medical technology, Dr. Goel started Desert Mobile Medical | Concierge Physicians in 2018 aiming to provide comfort, convenience, and transparency in a healthcare industry that is stifled with poor customer service and opaqueness.Dr. Goel is also a National Speaker on Health & Wellness, a published author, and is fond of teaching the up and coming generation of future doctors. He has a wonderfully cute daughter of 2 years of age whom he loves to spend time with. He loves to read up on world history and has a passion for cooking.Highlights:How the current state of Covid19 in Arizona affects his practiceFell in love with medicine in spite despising the practice because of what he witnessed with his dad growing upBeing inquisitive, always a problem solver and other characteristics Dr. Goel possesses in order for him to enjoy Internal MedicineUnderstanding your patient’s needs by putting yourself in their shoeBeing prepared by having a blueprint of your vision, creating a roadmap where you are goingDr. Goel’s residency journey and the challenges he had to conquerWhy Dr. Goel is against the insurance-based system HealthcareThe hindrances in coping up in an insurance-based system that persuaded him to expand on his ownOverhauling the system; giving attention to stress and anxiety, that leads to depression and suicide in the medical practitionersStepping back and finding a good niche, Dr. Goel’s advice on new physiciansWhat would Dr. Goel be if he didn't become a physicianLinks:https://desertmobilemedical.com/IG Handles:@ desert_mobile_medical

Leveraging data-driven solutions to improve health care and decrease costs at a population level https://outcomesrocket.health/ebinger/2020/03/

an you diagnose heart disease from 7000 miles away? Dr. Andrea Z. Beaton, physician and Associate Professor of Pediatrics at the Heart Institute, Cincinnati Children's Hospital Medical Center speaks about the use of telemedicine to diagnose rheumatic heart disease in children living in underserved regions of Uganda. This is a recording of her talk entitled 'Telemedicine and Task-Shifting in Sub-Saharan Africa: Applications in Rheumatic Heart Disease' given at Bellarmine University in Louisville, KY on Feb. 11, 2020. The rest of this talk will be broadcast on our March 16th episode. Bench Talk is a weekly program that airs on WFMP Louisville FORward Radio 106.5 FM (forwardradio.org) every Monday at 7:30 pm, Tuesday at 11:30 am, and Wednesday at 7:30 am. Visit our Facebook page for links to the articles discussed in this episode: https://www.facebook.com/pg/BenchTalkRadio/ Bench Talk: The Week in Science | Telemedicine in Uganda (Andrea Beaton MD) | March 9, 2020 by Forward Radio is licensed under a Creative Commons License.

Can you diagnose heart disease from 7000 miles away? Dr. Andrea Z. Beaton, physician and Associate Professor of Pediatrics at the Heart Institute, Cincinnati Children's Hospital Medical Center speaks about the use of telemedicine to diagnose rheumatic heart disease in children living in underserved regions of Uganda. This is a recording of her talk entitled 'Telemedicine and Task-Shifting in Sub-Saharan Africa: Applications in Rheumatic Heart Disease' given at Bellarmine University in Louisville, KY on Feb. 11, 2020. The rest of this talk will be broadcast on our March 16th episode. Bench Talk is a weekly program that airs on WFMP Louisville FORward Radio 106.5 FM (forwardradio.org) every Monday at 7:30 pm, Tuesday at 11:30 am, and Wednesday at 7:30 am. Visit our Facebook page for links to the articles discussed in this episode: https://www.facebook.com/pg/BenchTalkRadio/posts/?ref=page_internal

Today my guest is Dr. Laudito, the Medical Director of The Heart Institute at Palmetto General Hospital.   In this conversation, we discuss why he chose to pursue a career in Cardiothoracic Surgery. We also really dive deep into the double mammary heart bypass surgery technique, both what is it and it’s benefits for younger bypass patients. Enjoy the conversation Learn more about the show and the people that make it at: https://checkingthevitals.com/

Dr. Hayes interviews Dr. DeVita about his role as Director of NCI and his time with CHOP and MOPP.   TRANSCRIPT [MUSIC PLAYING] The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. [MUSIC PLAYING] Welcome to JCO's Cancer Stories, The Art of Oncology, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the role of cancer care. You can find all of the shows, including this one, at podcast.asco.org. Welcome to Cancer Stories. I'm Dr. Daniel Hayes. I'm a medical oncologist and a translational researcher at the University of Michigan Rogel Cancer Center. And I'm the past president of ASCO. I'm really privileged to be your host for a series of podcast interviews with the founders of our field. In this series of podcasts, I hope to bring appreciation of the courage and the vision and most importantly the scientific background among the leaders who founded our field of clinical cancer care over the last 70 years. I hope by understanding the background of how we got to what we now considered normal in oncology, we can all work together towards a better future for our patients and their families during and after cancer treatment. Today, my guest on this podcast is Dr. Vincent T. DeVita, best known as Vince. Dr. DeVita is generally considered one of the so-called Gang of Five, including Doctors Canellos, Young, Chabner, and Schein, who I've been trying to get on for this podcast in the future, all at the NCI, and who brought many of the concepts we now accept as standard into the clinic in the 1960s and '70s. Dr. DeVita is currently a Professor of Medicine and Epidemiology and Public Health at the Yale School of Medicine. I think it's also fair to say, Dr. DeVita was instrumental in the passage of the 1971 National Cancer Act. And I want to hear more about that as we get into this. He was director of the NCI and the National Cancer Program from 1980 to 1988 and then moved to Memorial Sloan Kettering Cancer Center as Physician in Chief and subsequently became the Director of the Yale Cancer Center in 1993. Among his many honors-- and I don't have time to go through them all-- but he has served as President of the American Cancer Society. And I think most dear to me, he was President of ASCO in 1977 and 1978. Dr. DeVita, welcome to our program. Nice to be here, Dan. I've done a little background. I know you grew up in the Bronx. And I know you went to William and Mary for undergrad and George Washington Medical School. And I also read what I didn't know, which is that you did your internship and residency at the University of Michigan. We're recording this just before the NCAA basketball tourney. And I have to say, go blue. We're all excited here in Ann Arbor about our basketball team. [LAUGHTER] What I'm really interested in is, were your parents physicians? Or what made you choose medicine out of the Bronx? Well, no, my father was a banker. And my mother was an interior decorator. So it was kind of a funny mix. But I think it's kind of peculiar. I was growing up, and my mother-- I tell this story in my book. My mother was kind of frightened by the fact that I really, as a seven- or eight-year-old kid, really thought the guy who delivered the ice-- in those days, we had ice boxes-- was terrific. And I wanted to be like Nunzi the iceman. And she panicked and said, no, no. You're going to be a doctor. And every time someone asked me what I was going to be, I just said I was going to be a doctor. And when I went to school, I decided I'd be a doctor. It was sort of Mama driving me in that direction. So you had a choice of being an iceman or a doctor [LAUGHS]. Right. I like-- I mean, biology was always a favorite subject of mine. So it was a good fit. And tell me about how you ended up going to the NIH and choosing oncology. Was that serendipitous? I talked to Bob Young the other day. And he said, fundamentally, he hadn't planned to be an oncologist and got to the NIH and liked it. Was that your role, or did you know you wanted to do cancer from the start? No, I was going to be a cardiologist. In fact, when I was a first-year resident, I did cardiac catheterizations and was a co-author on a paper that for a long time was well-cited in the field. So I applied to both the Heart and Lung Institute and the Cancer Institute. And those are very competitive positions. And I had an interview with Robert Berliner, which didn't go well [LAUGHS]. So I didn't get invited to the Heart Institute. And I went to the Cancer Institute. And when I walked in, Dr. David Rall was the chief of the pharmacology branch. And I asked him if I could work on the pharmacology of digoxin. And he, wise person that he was, said, sure. Go ahead if that's what you want to do. And I was surrounded by people who were working on anti-cancer drugs. And I actually became fascinated with them. And it was only a few months, because I was also on the wards at the time, that I said, oncology is the way to go. It was an exciting new field. It was kind of a funny field in those days. But I found it exciting, so I switched. So just to give you a plug here, I think many of us know that you wrote a book, The Death of Cancer, published a couple of years ago, co-written with your daughter Elizabeth by the way. But in it, you described a number of things. And one of those that I loved were your stories about Gordon Zubrod. And I trained with Dr. Frei at the Dana-Farber. He always had great things to say about Dr. Zubrod. And I wonder if you could tell the folks listening in who he was-- I think most people don't even know that-- and the impact he had on our field. Yeah, I used to call him the great umbrella. The field was very controversial at the time. And so the people who were doing things like saying, I'm going to try to cure this cancer-- leukemia in Frei's case and Hodgkin's in our case-- were considered just a little bit this side of insane. He was somebody who was distinguished. Now, Frei had-- Zubrod had been at St. Louis as a professor and also at Johns Hopkins. And he was a very distinguished-looking man and a very polite, careful man. And so he used to provide sort of the umbrella for all of us, so that [INAUDIBLE] he'd take the heat. And we could go on and do our work. So he was-- he did enormous number of things. I mean, the whole clinical trial structure was established by Gordon Zubrod. The phase I, II, III trials was all done in a paper by Gordon Zubrod in the late 1950s. So I think he was just a guy who had foresight and was a great leader. I ultimately took his job. He got tired of bucking the bureaucracy and retired and went to Florida as the director of their cancer center there. So I got to know him pretty well. And like Frei, I have great admiration with him. I mean, it's interesting how we take phase I, II, and III for granted. And when he came in, and not too long before you came in, those things weren't-- nobody really knew how to do this stuff. Doctors Frei and Freireich were already at the NCI when you got there, correct? Yes, indeed. Yeah, they were. Yeah. And so they must have been inspirational. They were, and especially Freireich. Freireich was always on the wards. And Tom didn't come over to the wards very much. He was sort of the direct-- he was chief of medicine. And Freireich was the chief of the leukemia service. So we saw Freireich all the time. Tom came over once in a while. And Jay was a super doctor. And it was very hard to stay ahead of him. You'd get an x-ray on a patient. And he'd call you up 20 minutes later and tell you what it was. He was already down looking at it. So you had to stay on your toes with Jay. And of course he was, as everybody knows-- Jay-- he was a bold guy, who-- I mean, he looked like he could walk through a wall. So he frightened a lot of people. But he was an inspiration. So I'm always grateful for what Jay Freireich taught me. There's a great story in your book, that Dr. Frei has told me as well, about the first platelet transfusion at the NCI. Can you elaborate on that? I think most folks don't know about that story. Platelet transfusion was, again, one of those radical departures. But Freireich reasoned that we were losing more people from bleeding than we were from leukemia. So he worked out a way of plasma pheresing people and collecting platelets. And we didn't have a lot of the expertise we have now. And they came in quart bags. I mean, they were plasma bags that were huge. And we were treating little kids. So they were-- throwing them into heart failure was a problem. So it was pretty radical. And he was told to stop doing it by the clinical director at that time. And in fact, he was told that if he didn't stop doing it, he was going to be fired. And he told me-- he said, I went back to my office, sat down, and thought about it. And I decided I didn't want to work at a place where I couldn't do that. So I just kept on doing it. And the person who said he was going to fire him never did. But that was Jay Freireich. [LAUGHS] He believed so strongly in it. And when I went to Yale right after I left the Cancer Institute-- I finished my residency up there. And I told them-- when I saw leukemia patients who were bleeding-- and I said, what you should do is platelet transfusions. And they said, they don't work. And I said, I used them. And I saw them work. So I think we're losing patients unnecessarily. It was just very controversial. So eventually I left the program. I was going to take a residency and then a fellowship in hematology there. And I decided to go back to the Cancer Institute where these adventurous things were going on. Times are different now, of course. Dr. Frei once told me a story that he-- you may have been with him-- that he was making rounds in the clinical center. And in those days, apparently, the adults and the kids were in the same ward. And there was a child with essentially no white cells, who'd been induced for leukemia, and a man next to him with CML. And so-- and actually, when Dr. Frei told me this, I kind of said, I don't think I want to hear this story, because he said, well, you know, the kid didn't have any white cells. And the guy next to him had way too many white cells. So [LAUGHS] I said, tell me you didn't do this. He said, yeah, we took platelets out from the guy and gave them to the kid. And the kid got better for a while. It was really exciting. I thought, boy, you don't see that anymore. Yeah, I mean, it was a very reasonable thing to do, because the white cells in a chronic myelogenous leukemia patient work very well in terms of fighting infection. Yeah. So there was no reason. And the kids, otherwise, wouldn't survive. And so, yeah, I was there when we got these-- we gave these. I mean, they weren't easy to give, because they stuck in the lungs. And we didn't have HLA matching at the time. So they were-- a lot of them were mismatched. But for a while, they were effective. And then we went to collecting white cells from normal people. But the white cells had not worked as well as platelets had worked. Platelets have been a lifesaver. Now it's a couple of hundred million dollar business each year now. So it's routinely done, as many things that Jay started are routinely done now. Of the many things for which you are credited, I think it's the use of combination chemotherapy for Hodgkin's and then subsequently non-Hodgkin's that is one of your lasting legacies. There must have been a lot of drama around doing that. I mean, I think we all just assume you're going to start protocol. You write the protocol. You get funding for it. And you go forward. But can you give us some stories about sitting around at night and thinking about how to do this? Or how did you choose those drugs and why and how to give them and the obstacles that were involved? Yeah, actually, it was a very complicated process. And we didn't have the information we have now. What we had was-- I was doing this with Jack Moxley, who left active medicine and became a dean after he left the Cancer Institute. But we're still in touch. And Jack was working with [? Sy ?] [? Perry ?] using the new isotope, tritiated thymidine, looking at the bone marrow of CML patients and also of mice. And I was doing the same thing with the leukemia 1210, which was a model that we used for chemotherapy all the time. And what we were trying to do was figure out the kinetics of human versus mouse marrow, so we could develop schedules that humans would survive. We quickly found out that you can't use the mouse as a model, because their blood cells went through a kinetic phase about half the length of humans. So you had to schedule in a different way. So we worked that out. And then we looked at very simple-- something that people really ignored is that when you give a chemotherapy agent that is toxic to the marrow, you don't get abnormal blood counts right away. For a week, you'll have a normal white cell. And then on day seven or eight, it begins to fall, because the storage compartment in the marrow works well for about a week. And then there's no replenishment. And the white count falls. So between the two, looking at the marrow and looking at the white cells in the periphery, we came up with a schedule for MOPP. And then the other things were simple. We just decided that you'd have to have three or four drugs that worked by themselves. There had been people doing combination chemotherapy before-- Tom Hall in Boston and [? Alan ?] [INAUDIBLE] at Yale. And their rationale was they're looking at a sequential biochemical blockade. But they ignored whether the drugs actually worked against the tumor, assuming that if you gave them together, that the biochemical blockade would dominate. And it didn't work. In fact, it was very discouraging. But we decided the way to do it was take drugs that had some activity in the disease and use them together and use them in full doses in the schedules that we worked out because of the prior work I was telling you about. So it took a while to put that together. And then Jack Moxley and I used to do this at a bar in Georgetown called the Lehigh Grill, where we used to-- my cardiology desire-- I used to go to Georgetown where there was a wonderful cardiologist Proctor Harvey, who used to hold Thursday night sessions. You had an auditorium that was wired. So you could hear heart sounds. And after that, we'd go to the Lehigh Grill. And we sort of put together the protocol. When we presented it to Tom, he thought it was a good idea. But the other people around him thought it was insane and really tried to stop it. Tom Frei? Yeah. Tom Frei, yeah, yeah. Well, Tom was supportive. Yeah, Emil Frei was his real name. But everybody called him Tom. Yeah, he was supportive. But the people around him and my immediate boss was very much against it, because he thought it would interfere with the protocol that they were doing and so forth. So Tom worked out a solution worthy of Solomon. He said, OK, we could do-- the magic number for phase I trials in those days was 14. If you got nothing in 14 patients, then you didn't go any further. So we could do 14 patients with the first protocol, which was called MOMP-- M-O-M-P. And we had to do the workups ourselves. We couldn't use other colleagues to work up the patients. And we had to go get the patients ourselves. So Jack Moxley and I did all those things. And the results were very encouraging. And then Jack left. And I sat down and decided that we'd put procarbazine. I was working on procarbazine. It was then called [INAUDIBLE]. And I was working on it and doing the pharmacology in the phase I study with it in Hodgkin's disease. It was a promising candidate. So we put it in. And that became MOPP. Also in those days, six weeks of therapy was it. They didn't get more than six weeks. We reasoned that the marrow problems would be acute. But you'd have to give it probably for a long period of time to affect the tumor. So we gave it for at least six months or to a complete remission plus two months. And we assumed that there were cells left after we couldn't see them. So it was a lot of good thinking that went into it that turned out to be correct, because most of the-- since then, a lot of protocols follow the same sort of routine. And it really works for a lot of cancers. But it was controversial. I went to the AACR meeting. This was before ASCO. And I presented it as an abstract. And David Karnofsky, who was sort of a god at that time at Memorial Sloan Kettering, just tore me apart. And what was I doing using the term complete remission for a solid tumor. He said, that was a term that was used in leukemia. Now, I didn't say it. But I'm thinking, the reason you use them is you can get complete remission. So we had complete remissions. And I was kind of shaking with the microphone in my hand at the time. So it was a scary but it was a good experience. I have to say-- So it just gives you an idea that people were not receptive [INAUDIBLE]. Those of us who are junior to you can't imagine that you were intimidated by somebody else [LAUGHS]. Well, I was a youngster, then. I was-- Jack Moxley and I, I would say, thinking back, we were cocky. But the big guys in the field could scare me. And Zubrod was a-- I mean, Karnofsky was a big guy in the field. Yeah. He just had a hard time getting out of the leukemia mind frame. And so of course, we've used complete remission since then in any kind of solid tumor where you can get one. In your book, you have a great quote that you presented somewhere. And Dr. Frei was there. And Wayne Rundles was there. Wayne, of course, has been at Duke for 100 years. And he said, do your patients speak with you after you're done? Well, Wayne Rundles-- when he first saw the MOPP protocol, Wayne Rundles said, that's nonsense. He said, I get the same thing with nitrogen mustard by myself. Well, nobody had ever got that with nitrogen mustard. So we actually had to set up a controlled trial and do it and prove that MOPP was better. So when I presented it when we were first starting it-- at a meeting. Tom had arranged this meeting with all the bigwigs in the field. And when I presented it at that, everybody was sort of quiet. And then Wayne Rundles raised his hand. He looked pale. He raised his hand and said to me, Dr. DeVita, do your patients speak to you after you do this? [LAUGHS] So he-- a few years later when we were obviously getting good results, he invited me to grand rounds. And by then, we were good friends. And I was up on the podium. And after I gave the talk, he was sitting down below smiling at me. And I said, Dr. Rundles, if you remember, you asked me if your patients speak to you when you do this. And I can tell you that they do for a lot longer. So it was fun. But it was fun. He was a good friend by then. And I had great respect for him. Actually, he was a very nice man. He was. When did you start thinking that you had a success? Was it during those first 13 patients or 14 patients that you treated? I mean, was it obvious right away, or did you start [INAUDIBLE]-- Well, it was obvious-- --you were in the wrong place? We put-- no. We thought it pretty early, because we were worried. We put patients in reverse isolation. Nobody knew whether you were going to kill them if you gave them all these drugs together. And it turned out the first surprise was, yeah, they had the usual toxicity. But it really wasn't that bad. So it was doable. And the second was-- we had a small number. But we had-- something like 80% of the patients went into a complete remission. And I think nobody had seen that. Now, the question was, how long were they going to last? So we were optimistic. And when we put patients on it, there was no cure for them at that time. And we said, we're optimistic that this is going to be something that will last. But we don't know. And then by three years, it looked pretty good. And I think I presented the first abstract four years after we started. And by that time, we had relapse-free survival curves. And again, nobody before that time had presented relapse-free survival curves in any of the lymphomas. So by then, by four years, I think we felt we had probably cured some patients with the disease. I asked Bob Young this same question. Did you feel a sense of history at the time, that this was really historical? Or did that come later when you looked backwards? I think what people don't realize about those days is neither Freireich nor ourselves were treating leukemia and Hodgkin's disease. In other words, we weren't out to develop a treatment for those diseases. We were out to prove you could cure cancer with drugs, because nobody believed it. If you said that, they really thought you had gone balmy. So we were out to look-- so we knew if we could do it, it would be historic. So we were excited when we looked like maybe it was going to happen. By that time, when we had first reported it, the VAMP program that Freireich did, which was an historic program-- he only had 17 patients. And they actually never published a paper on VAMP. And I asked Jay why they never did that. And he said because he didn't think they would accept it anywhere. So but by that time, they were getting about a 50% complete remission rate going four or five years. And they were thinking they're curing leukemia. And we were getting 80% complete remission rates. So I think everybody felt that we were going to prove that you could cure cancer with the drugs. And we did. So yes, in a sense, we set out to do something that would be historic. And so when it happened, I think, it is. It was a sort of a door opener for medical oncology in Hodgkin's disease. I'd like to turn now for just a minute to your role in politics. You were pretty instrumental, I think, when the National Cancer Act was signed in 1971. And that also sounds like a TV drama to me. It sounds like-- and I know this anyway, but in reading your book, it was not clear that was going to get through. Can you give us some of the playground behind that and Mary Lasker's role and how that happened? Well, Mary Lasker played a big role. The MOPP program actually played a big role, because Mary Lasker was sort of working in the background. Cancer was always a cause for her. But when we did the MOPP program, there was a guy named Luke Quinn, who she had hired to be a lobbyist, who was sort of hidden in the American Cancer Society so they wouldn't realize it was Mary Laskers' lobbyist. And he was referred to me by Sidney Farber. And I didn't want to take him at first, because he was diagnosed as having gall bladder cancer. And I said to them, you know-- I said to Sidney Farber, I don't really treat patients with gall bladder cancer. And there was silence on the phone. And he said, (SOMBER, COMMANDING VOICE) you will take this patient. [LAUGHS] So I took the patient. And when I examined him, when he came down and I examined him, he had adenopathy in both axillae. And gall bladder cancer just doesn't do that. So I had to do another biopsy. He was not a pleasant guy. So it was not easy to do these things. I had to get another biopsy. And it turned out that my pathologist at the time, Costan Berard, when he compared the biopsy, he said, it's a lymphoma, clearly. It was a diffuse, large cell lymphoma. What they had done is, because Claude Welch did the surgery-- a very famous abdominal surgeon-- and he said it was gall bladder cancer, that the pathologist sort of assumed it was. And it was a compression artifact. Long story short, he went into remission. And Mary Lasker went gaga. Wait a minute. We got something here. And that was what pushed her to get her friend, Senator Ralph Yarborough, to put up a committee on cancer to come up with the Cancer Act. And-- So it must have been quite a day when President Nixon signed that. Yeah, well, it was-- I wasn't at the signing. I wasn't high enough up in the chain to be invited to the signing. But yeah, I have all the photos of him signing it. And later when I met him-- I have a picture in the book of he and I shaking hands and him looking like he's having a roaring laugh. People ask me what I said that was funny. And I have no idea. But when I asked him, I said what is your greatest achievement as a president? He said two-- opening up China and signing the Cancer Act. So he was-- Really? Yeah, so I think he was proud that he did that. That's a great story. Actually, the other story I had not heard, but read in your book-- I'd like you to tell me about your lunch with Mr. Featherstone. [LAUGHS] Featherstone Reid, his name was. Well, this was a very-- this was a regular occurrence. Mary Lasker, when she came to town, would stay with Deeda Blair, Mrs. William McCormick Blair, who was a Washington socialite and had a lovely house on Foxhall Road. And they would have lunches and dinners. And they always arranged it so that people-- the scientists sat next to somebody with influence. And this is how they influenced the Congress to put more money into the cancer program. So one time, I got a call in the morning from Deeda Blair, saying, I'm having a lunch. We'd like to have you there. And I said, gee, I-- it's too short notice. I can't do it. And she said, well, Mary really wants you to be there. Mary was hard to say no to. So I rearranged my schedule, drove down to Deeda's house. And there was a big black limo sitting in the front of the house. I went in, and they introduced me to Featherstone Reid. I had no idea who he was. And every time Mary would say, we want more money for research with leukemias and lymphomas. Vince, tell him about what's going on. And I would tell him about. At the end of the lunch, he left. And Mary and I sat down on the couch to have a cup of coffee. And I said, Mary, who is Featherstone Reid? And she said, he's Warren Magnuson's driver. And when she saw the shock on my face-- Senator Warren Magnuson was the chairman of the appropriations committee of the Senate. When she saw the shock on my face, she said, wait a minute. When Mrs. Maggie-- he takes Mrs. Maggie shopping during the day. And Mrs. Maggie-- he fills her with all this information we're giving him. And then Mrs. Maggie is the last person to put her head down on the pillow next to Warren Magnuson. This is the way she worked. She would take someone like Magnuson, who was a good friend, but she would surround him with extraneous people who would say the same thing. So it was sort of like subliminal stimulation for him. He was always hearing these positive things. And then he supported the program. She was a piece of work. I never got to meet her. But it sounds like she was a force of nature. She was. And of course, the Lasker Award is now named for her and her husband and sort of the American Nobel Prize. She's had such [INAUDIBLE]. Yeah, and our crew won it in 1972-- Frei, Freireich, myself, and other people for other things. So I'm very fond of Mary Lasker, obviously. It's just a wonderful story. And I got to know her pretty well, so. I have one other question. And I'm not sure you'll want-- if you don't want to go off on it, we can edit it out. But in your book, you talked about Howard Skipper and Frank Schabel. And Dr. Frei used to talk about them all the time. And I think it's worthwhile to bring them into the history of what we do. Did you actually work with them or collaborate with them, or just base some of your ideas on what they had in mind? When I was starting at the Cancer Institute, I thought Schabel worked at the Cancer Institute-- I mean, Skipper worked at the Cancer Institute, because I would be working in the lab. I was doing the tritiated thymidine studies on L1210 mice. And he would be looking over my shoulder. He was doing the similar studies, but he was just doing it with cell counts in the abdomen of the mice. And he thought that was good enough. And he was there at a weekly meeting we had, which George Canellos named the Society of Jabbering Idiots. It was a great, great meeting, actually. [LAUGHS] And he was there all the time. And my view and Tom's view differ a little bit on Skipper. I think he was a real driving force, that he did the studies in mice that we were doing in the clinic with people. And he actually-- in 1964, he wrote a paper showing that you could cure L1210 leukemia. It was the first example of curing a mouse with leukemia. And I think-- so it was sort of a feedback mechanism between the Cancer Institute and the Southern Research Institute. So and he did-- he used to do these booklets. And I think he published hundreds of these booklets. Some of them, we convinced him to actually publish as papers. But I have the collection. There may be 100 booklets he wrote. And he would take a concept that we were working on and then work through it in mice. It was very, very important. And he was a wonderful person. His only problem was he smoked like a chimney. But he was-- I liked Frank and Howard. Yeah, Dr. Frei had the entire set of monographs on his bookshelf in his office and would encourage us to come in and borrow them and read them and come back. And frankly, he basically predicted what you've done with combination therapy. He predicted adjuvant therapy working. There were just a number of things he saw in these mice that we've gone on to apply in the clinic. It's pretty remarkable, I think, so. Yeah, I mean, it's not only he predicted it. But he actually showed the concept worked in mice. So as we know, mice and human are very different [INAUDIBLE]. There was a guy in Boston, Stuart Schlossman, a very fine scientist. And he didn't like mouse models. And when asked what he would do when he saw a tumor-bearing mouse, he would say, I would step on it, because he didn't believe mouse models. And but Frank and Howard did experiments and made allowances for the difference between humans and mice. So it was always good to know. I mean, I have the summary he wrote on Hodgkin's disease after he saw the MOPP program. So I think they're very instructive booklets. So I kept them. Like Tom, I think that we sort of live by them. Well, thanks for discussing them. I think our listeners need to remember these two guys. They were great. We're running out of time. I've really just touched the surface of what you've done and contributed to the field. And the people you've trained is sort of a who's who of oncology, frankly. But at the end of the day, what's your-- I'll ask you the same question you asked President Nixon. And that is, what is your legacy? What do you want people to remember that Vince DeVita did? I get asked that question a lot. And I don't have one thing that I can say. I mean, I've been lucky in my career that I've had a chance to do many things. Being the Director of the Cancer Institute was wonderful. You could sit on top of the whole field and just sort of scan it and see what's going on. And it was very important, because you've become the spokesman of practicing physicians at the same time. MOPP, of course, was important. Putting out the first comprehensive textbook in the field and watching it-- we just came out with the 11th edition-- is also very exciting. So there-- we were the first to successfully treat Pneumocystis carinii pneumonia. And we reported it in a paper in the New England Journal. I mean, there were a lot of things. I'm best known, I think, for MOPP, probably, and the principles of MOP, which I'm very proud of. But there's so many that I have a hard time. I like opera. And people ask me, what's my favorite opera? And I usually say, it's the one I just saw. It's very hard for me to pick one opera. There's so many that I like. So I'm not dodging it. But I just never can say, well, it's this. That's very fair. Frankly, I think, without your contributions, I probably wouldn't be sitting here doing what I do. And I think there are thousands of us who would say that. So we're-- Well, that's very flattering. Well, not only are we appreciative, more importantly, there are a lot of people who are alive who wouldn't have been without what you and your colleagues did at the NCI that so many years ago, so-- [INTERPOSING VOICES] I was involved in the training of 93 medical oncologist. At one time, something like 40% of all the [INAUDIBLE] directors were our graduates. So they have gotten around. And that was good for the field. They went out with the same principles we were developing at the Cancer Institute, so that's very gratifying. Have you kept in touch with any of the patients that you're treated back at the NCI? I talked to Saul Rosenberg. And he told me he still sees people that he treated 30 or 40 years ago when he first moved to Stanford. We're writing a paper on the 45-year follow-up of the first 188 patients. Again, nobody has 45-year follow-ups. And we called every one of the survivors. And there's something like 60% or so of the complete remissions are alive. So I talked to some of them. But we had a nurse talk to a lot of them. And I got messages from them after the call. And some of them still contact me, after sort of an anniversary of their treatment. So yeah, I've kept up with them. The gratifying thing is most of them are suffering from the same illness as most people who are getting into their 70s or some of them 80s. They have hip problems and so on and prostate cancer. But there doesn't seem to be any really major increase in anything in these long survivors. Now, mind you, these were patients who got MOPP as their only treatment. And so when you see second tumors in these kinds of patients, it's usually patients who got radiation therapy plus MOPP. So these patients who are 45 years had just got MOPP. And they seem to be perfectly fine. That's remarkable. I love your comment that they are getting the same illness as the rest of us get as they get older. That's great. Yeah, we don't cure bad hips and bad knees and-- Yeah, we can't cure old age. When I was at the Dana-Farber, I had a patient who had been one of Sydney Farbor's original patients from the early '50s. And by this time he was obviously an adult. He was older than I was. And he was fine, as you've said. Although he said Dr. Farber kept treating him and treating him and treating him. And then finally, when Dr. Farber passed away, someone else picked up his chair. And they said, why are you still getting this? And they stopped it. Yeah. So he got a lot of treatment. I had one of Freireich's VAMP patients. She was a girl in her early teens. And she was a wildcat. But she had had something else, and it failed. And she was one of the first patients on VAMP. And she went into remission. And she stayed in remission. And I followed her for many years. She went to college. She got married. She had children. She brought her children in to see me. And last time I had any follow-up with her, she was in her 60s. And she was one of the really first long survivors of that particular program. So it's really neat to see these patients. And it's not rare for me to go to a meeting and have people walk up to me and say they got MOPP 25 years ago. Someone else gave it to them. And they're alive and well. So that's one of the great gifts of having a chance to do this kind of work. What a privilege. Well, I think we need to end. Again, I want to thank you for being on with us today and filling us in with some of these stories. Had really good feedback for my podcast series. And it's because of the people I've had on it. So thank you very much for all you've done. It's really good talking to you. And I look forward to listening to all your podcasts. [MUSIC PLAYING] Until next time, thank you for listening to this JCO's Cancer Stories, The Art of Oncology podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcast or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories, The Art of Oncology podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.asco.org. [MUSIC PLAYING]

Dr. Decker is a pediatric cardiologist specializing in electrophysiology, cardiac arrhythmias, cardiomyopathies and heart failure. He offers innovative and minimally invasive techniques to benefit patients at the Johns Hopkins All Children’s Heart Institute. Before joining All Children’s, Dr. Decker was an assistant professor of pediatrics at Baylor College of Medicine and Texas Children’s Hospital in Houston, where he completed a fellowship in pediatric cardiology, an advanced fellowship in heart failure/transplantation, and an advanced fellowship in pediatric electrophysiology at Baylor College of Medicine. A graduate of Robert Wood Johnson Medical School in Camden, New Jersey, Dr. Decker did his pediatric residency training at Children’s National Medical Center in Washington, D.C. You can see his full bio at https://www.hopkinsallchildrens.org/Find-A-Doctor/Practitioner-Details/Jamie--Andrew--Decker White Coat Story is a podcast series for school students to gain first-person insights into the practice of medicine, and what it takes to get there.

In this edition of Essential Partners, Ron Freudenberger, MD, discusses the journey that led to his current role as Physician-in-Chief of Lehigh Valley Heart Institute. Plus, learn about the importance of care teams, research and education in the delivery of quality heart care.

This podcast interview features integrative health expert Russell Jaffe, MD, PhD, CCN, who shares his philosophy about addressing men's health issues in clinical practice. Jaffe discusses hormonal balance, prostate health, gastrointestinal health, cardiovascular health, and inflammation. About the Expert Russell M. Jaffe, MD, PhD, is CEO and Chairman of PERQUE Integrative Health (PIH). He is considered one of the pioneers of integrative and regenerative medicine. Since inventing the world’s first single step amplified (ELISA) procedure in 1984, a process for measuring and monitoring all delayed allergies, Jaffe has continually sought new ways to help speed the transition from our current healthcare system’s symptom reactive model to a more functionally integrated, effective, and compassionate system. PIH is the outcome of years of Dr Jaffe’s scientific research. It brings to market 3 decades of rethinking safer, more effective, novel, and proprietary dietary supplements, supplement delivery systems, diagnostic testing, and validation studies. About the Sponsor PERQUE Integrative Health (PIH) is dedicated to speeding the transition from sickness care to healthful caring. Delivering novel, personalized health solutions, PIH gives physicians and their patients the tools needed to achieve sustained optimal wellness. Combining the best in functional, evidence-based testing with premium professional supplements and healthful lifestyle guides, PIH solutions deliver successful outcomes in even the toughest cases. If you are interested in delving more deeply into this and other integrative health topics, we invite you to join the PIH Academy. Transcript Karolyn Gazella: Hello, I'm Karolyn Gazella, the publisher of the Natural Medicine Journal. Thank you for joining me today. Our topic is men's health, and my guest is integrative health expert, Dr Russell Jaffe. Before we begin, I'd like to thank the sponsor of this topic, who is Perque Integrative Health. Dr Jaffe, thank you so much for joining me. Russell Jaffe, MD, PhD, CCN: Thanks for the invitation. Gazella: Well, before we dig into the specific health issues that men face, you believe in a philosophy first approach. I'm sorry, physiology first approach. What do you mean by- Jaffe: The philosophy is physiology. Gazella: Exactly. Jaffe: So, that was appropriate. Yeah- Gazella: So, what do you mean by that? Jaffe: Right. It's a high level, brief, 2 words, physiology first. What we mean is, physiology before pharmacology. We mean physiology first because it seeks an upstream assessment of the causes of risk or symptoms, in contrast to most conventional care today, even holistic or not, that remains rooted in downstream symptom management. Physiology first uses global evidence to reduce risks and prevent people from falling into the river of disease. Physiology first uses nature's nutrients in supplements, with enhanced uptake and chaperone delivery, for safer, more effective, essential replenishments, items we must take in since our body doesn't make them. Physiology first urges organic or biodynamic or locally grown sources of nutrient-dense whole foods, as minimally contaminated as possible. Physiology first focuses on underlying causes. For example, too little of essential needs being met, which are eating, drinking, thinking, doing—those are the 4 headline categories—rather than working back from symptom-reactive case management. And finally, physiology first uses predictive biomarkers interpreted to their best outcome goal values. Now, this is a paradigm shift for many colleagues but we now can impersonalize predicted, proactive, primary prevention practices, save individuals probably a million a year just by applying physiology first. Gazella: Yeah. Well, that's exciting so I'm glad that we went over that. Now in general, what should be on the radar of clinicians when it comes to addressing the special health needs of their male patients? Jaffe: Yes, and here again, now that we've kind of gotten the hundred thousand–foot level, we start and recommend colleagues start with self assessment. This includes transit time, urine pH after rest, hydration, and a sea-cleans as overall global self assessments, very inexpensive. The individual does much of it themselves, brings it to the expert who interprets it so that we get a snapshot of the metabolic or metabolon/microbiome, the digestion and metabolism. You interpret that to best outcome goal values. You use that to inform and inspire and motivate people to put it in effort for the 6 to 7 weeks that it takes to change a habit of daily living and you can add years to life, years of quality life and life to years. In people with chronic symptoms, well. Take a careful family history although family history is highly relevant if you have the same behavior and environmental factors. If you change your behavior, your habits, your environment, then your family history to a very large extent disappears into the midst of history. If there have been prior treatments and treatment failures, it's important to assess that. We use the predictive biomarkers to help people celebrate when they are at their best outcome goal value and take action when their risks increase. Now, men and women at all ages need activity, at least 45 minutes a day of walking or equivalent. Sitting is the new smoking. Weight-bearing exercise or cardio exercise 2 or 3 days a week and knowing about it or preaching about it is one thing. It's when you actually do it. I'm glad to tell you that I had just enough glimpse of the consequences of not doing that I do what I'm recommending. Now we want to teach men to prepare for sleep, achieve restorative sleep, using physiology before pharmacology, using salt and soda baths, Epsom salts and baking soda, plus or minus aroma oil, essential oil. The baking soda alkalinizes and relaxes muscles in the pores of the skin, and the Epsom salts, which is magnesium sulfate, allows the magnesium to come in and that's often very helpful. We recommend that teaching people, particularly men who have sleep issues, about abdominal breathing and active meditation and green dichromatic light, along with nature's sources of serotonin and melatonin, which is tryptophan. We ask about changes in urine stream flow and quality after urination. Is there any dribbling? How many times do they get up at night to urinate? And we make lifestyle suggestions tailored to the individual at their phase of life. We want to be proactive with prostate support nutrients, such as micellized soft gel that contains all of active saw palmetto, [inaudible 00:06:03], lycopene. Free lycopene, not just some ketchup. Hygeium, with 14 or 15% beta sitosterols. Urtica dioica, also known as stinging nettles. Zinc, in the picolinate form. And selenomethionine, selenium in the selenomethionine, healthier, safer form. And all of this micellized in pure pumpkin seed oil to enhance uptake in retention, to improve function. And we think people can be pleasantly surprised at how effective and synergistic the above prostate health support is, available in a single, easy-to-swallow soft gel. Ask about adult beverages. If they consume more than 5 a week, provide comprehensive liver support and recommend a glass of water above the four quarts or four liters a day that humans need to avoid marginal dehydration—1 or 2 or 3 percent dehydrated is a big stress on every organ in your body. So this is, again, at a headline level, how our comprehensive approach actually works. Gazella: Perfect. Now I'd like to kind of narrow our conversation and I want to stay on the prostate because you mentioned the prostate. So, what are the roles that testosterone plays when it comes to prostate health and men's health in general? Jaffe: Right. Both men and women need testosterone. They need a balance of free and bound testosterone. They need good and not bad testosterone. Now, what does that mean? Well, you can measure in saliva or in plasma. The free and the bound, free and total testosterone. You can measure the dihydrotestosterone. You don't want much of that, maybe zero. You can measure oxidized testosterone. You want zero of that. And you want to enhance the good T, the good testosterone and reduce the bad T based on testing results because testosterone is needed for brain and muscle and organ and joint and bowel renewal and many other functions beyond just being a male hormone. You want to enhance healthy testosterone production through healthy microbiome and metabolon functions, especially the family of the central antioxidants. Vitamins, minerals, and cofactors that along with good hydration optimize your healthy testosterone, which is one of the vitality factors in the body and minimize the bad testosterone that causes everything from hair loss to loss of erections. Gazella: Okay, perfect. So before we leave the prostate, remind us what the significance is of the PSA test. Jaffe: That's a very important question and I think we're finally, after half a century in laboratory medicine and I've been following the issue all of that time. The PSA test is a measure of prostate repair. So, the PSA goes up if you have prostatitis. For example, if you just sit in your car too long and hold your urine in too long. And the PSA goes up in some but not all prostate cancers, and you can fractionate the PSA, free and bound, and that usually but not always helps distinguish the prostatitis from the cancer risk. If you had concern about the prostate and about PSA levels and have a biopsy, after a single biopsy—often there are multiple biopsies—the future PSA has no interpretable value that I know of except for population, but we're talking about 1 man at a time. And so many review articles that I have seen in the last few years say do other tests of prostate health and don't even do the PSA because if you don't need the test, you wouldn't do the test. If it's a question, it's a gray zone, that's exactly what the test is not very sensitive or specific. Gazella: What about enlarged prostate? Jaffe: The first thing I would do and have recommended for many years for enlarged prostate is to take that combination of prostate vitality factors and we have had men whose prostate was double or triple than usual size come back to that of a 40-year-old by following for about 6 months a program that includes the supplements that I recommended just a few minutes ago, along with eating foods that the man can digest, assimilate, and eliminate without immune burden, and that means the lymphocyte response assay test that measures T and B cell function and that then says eat this and don't eat that, take the supplement and don't take that, follow this mental and physical plan because in the 80,000 cases that we put in our database, we've evolved a very personalized approach to, say, prostate size. Gazella: Okay, perfect. So, let's move on. What does it mean when a man wakes up with an erection or doesn't have an erection? Is that significant? Jaffe: Oh, absolutely. The headline is that every healthy man should wake up in the morning with an erection. In essence, it's the quality control check of the distinctive male. Too often and very commonly, when a man does not wake up with an erection, that's a sign that they have pregnenolone steal, that they have high stress cortisol levels and low DHEA, which is the antistress hormone, usually with low free healthy testosterone, often with a sluggish thyroid and an exhausted adrenal gland, due to lack of adequate intake of the essential antioxidants, minerals, cofactors that are necessary. In addition to prostate health nutrients, I would recommend checking the thyroid, TSH, 3T3, 3T4. That can be done on a blood spot or in many different ways. But you must, by my recommendation, get the 3T3, 3T4, TSH all at the same time, and the healthy range for TSH is .5 to 2.5, not above. The usual range has too many unwell people. (Usual lab range.) You want to check adrenal stress hormones, cortisol and DHEA at four times during one day. And at the same time, in the same saliva or plasma specimen, you can measure male and female hormones and their sources, their precursors to see if the body has learned a distress response that steals the healthy progesterone and pregnenolone and produces too much distress hormone cortisol and too little healthy male and female hormones. They come from the same source. You want to get both and in balance. Now in regard to male sexual performance, there are natural solutions to erectile dysfunction. The following vitamins, minerals, and amino acids work as a team to improve the quality and duration of erections B complex. One phrase is 'B complex is for boners'. Keep the urine sunshine yellow and feel the difference comprehensive B complex means. C, it is ascorbate vitamin C, always fully buffered, fully reduced and we recommend based on the C cleanse, taking that amount is associated with healthier and the more robust erections. Vitamin D is really a neuro hormone and it does a lot of things, including improving cell function and providing cell energy to sustain the generally sixfold increase in blood retention during an erection. Then magnesium choline citrate. Magnesium is essential for a lot of different things, including a healthy sexual function, and choline citrate at the same time, say 220 mg of magnesium solves and a teaspoon of choline citrate. That enhances the uptake dramatically. It enhances the retention because it is an alkalinizing, rather than an acidifying source. Most magnesium solves and magnesium products have very low bioavailability and are in the acid form, which makes the magnesium run out almost as soon as it comes in. And then last is L-citrulline and L-arginine, and these are 2 amino acids. They both enhance nitric oxide production inside cells, and when you take about a gram of L-citrulline and 500 mg of L-arginine 30 minutes before adult activities, most men notice the difference, especially men over 40. Foods that are rich in these amino acids include nuts, seeds, chickpeas, and other legumes, also known as garbanzos, and meats. Making an avocado and chickpea hummus with some mustard seeds or black and white sesame seeds added plus or minus some toasted pine nuts with fresh ground black peppers and your favored high-quality salt, that can blend into a nutritious, delicious, amorous and traditional food. Gazella: That's great and it sounds yummy as well. Jaffe: It is. It should be nutritious and delicious. Gazella: Exactly, exactly. Well, let's now move onto the gastrointestinal tract. What should practitioners focus here when it comes to their male patients? Jaffe: Well, in the 21st century it is a pretty fair assumption that the person sitting across a professional has mild digestion dysbiosis, some degree of atrophy known as enteropathy, a long transit time. Transit time should be 12 to 18 hours. We recommend doing that with charcoal. We have an online instruction if folks are interested because you want to assess what's called the microbiome, which is the digestive tract in its fullness, or the GNS, known as the gut nervous system, which is in constant conversation and communion with the reigning central nervous system. And so we recommend focusing on a full complement of personalized native antioxidant, minerals, and cofactors in their safer higher uptake forms based on the assessments and the predictive biomarker tests that we recommend. We want to pay attention to hydration because even a little bit 1, 2, 3% dehydrated puts a stress on every part of the body. We want to have prebiotics. That is unprocessed fiber from diet or supplements, 40 to 100 grams a day. That's what Dennis Burkitt taught me and the most knowledgeable nutritionists that I know recommend that much fiber a day. Probiotics, 40 to 100 billion healthy by a mixed bacteria, bugs. Then synbiotics, which is really recycled glutamine to energize and repair the lining of the digestive tract. Then you want to eat what you can digest, assimilate, and eliminate without immune burden. So, you've done some functional immunology testing like LRA, lymphocyte response assay. Take in no empty calories. You are sweet enough as you are. If you feed parasites and pathogens, fungi and yeast, they will grow. Improve the digestion, the microbiome and metabolon, the innate biological detoxification competencies and enhance your digestion by eating what you can digest, assimilate, and eliminate without activating your immune responses. We teach people to stop feeding the pathogens and they disappear as digestion improves, repairs improve, resilience is restored, and habits of daily living are improved. Then you want to look at the secretory IgA if you're concerned about the interface between digestion and the body. It's called SIgA, secretory IgA. You can measure that in saliva. There should be protected mucins so that if partially digestive materials get near the wall of the body, they don't become foreign invaders if you have healthy mucins and healthy secretory IgA. And there are other elected protected digestive functions that healthy people have that are lost when people lack the essential nutrients or the essential minerals when their cellular metabolism becomes acidic, when their body is reaching out, calling out, actually crying out for repair enhancement essentials, things you have to take in that you can't make in the body. So, we wanna taper or possibly discontinue medications that impair digestion. We want to use prebiotics, probiotics, and synbiotics, especially in people who have had antibiotics and other digestive-interfering medicines. We want to check transit time, should be 12 to 18 hours. When I have roast beets as a main part of my dinner, I expect to see red in the commode in the morning. But I can tell you after all these years when I see that red, my first thought is never, "Oh, I had beets last night" so that's why we use charcoal. Now, avoid fat-binding medications and supplements that reduce essential fat-soluble vitamin uptake. That's vitamins A, D, E and K. And you need bile from the liver to do that and for that you need phosphatidylcholine-rich foods and/or supplements, and we happen to micellize all of our soft gels with this PC, with this—not politically correct—phosphatidylcholine. Now, many men have atrophy of their intestinal lining because of stress and toxin exposure and it's the 21st century, and maybe less than perfect eating, breathing, and drinking. So, getting the essential needed nutrients restored may mean intensive supplementation for a few months, followed by maintenance supplementation for a long, healthy life, and I personally plan to be dancing at 120 and I would like you to join me. Gazella: That sounds perfect. So, you mentioned tests to assess the microbiome and you also mentioned secretory IgA. Are there other tests that you recommend in terms of assessing the microbiome? Jaffe: Right. So, the transit time we talked about, it's one of the self-assessments, 1 of the 4. Then this SIgA, the secretory IgA, in saliva or serum, with the comprehensive lymphocyte response assay, if there's any indication that the person has shifted from elected protected mode into survival mode, which means all the protective and repair functions are down regulated, that's called chronic illness to happen, or hormone tests that include cortisol and DHEA at 4 different time points, male and female hormones can be measured in their precursors on the same saliva specimen. You can use plasma if you wish. Adrenal and thyroid adaptogenic supplementation is recommended either based on clinical history or these test results. By all means include some way of determining how much ascorbate that person needs because ascorbate is the maternal antioxidant that sacrifices yourself that all others may be presode. And then the magnesium with enhanced uptake choline citrate. The choline helps build acetylcholine, an important neurotransmitter and neurochemical. It also helps build the choline-rich biosalts that are more soluble and help get the thicker bile out of the gallbladder and into the digestive tract, where that helps emulsify fat to be taken up into the body. And then based on the urine pH, we would adjust how many doses of the magnesium choline citrate you take. Do a regular hydration assessment and when in doubt, what I recommend is that you have a carafe of water in front of you and a glass. If the glass is full you drink it and if it's empty you fill it, and you just keep doing that. And personally my goal is to go to the bathroom at least every couple of hours and then I cut down the amount of liquid I take in after 7 or 8 PM so then I'm not overhydrated when I go to bed. But underhydration is a much more common and unappreciated problem. Monitor the breadth of our little chemicals, and this can give very interesting insights that are both diagnosis-specific of mild digestion dysbiosis enteropathies and so forth. But in addition that information often makes it very clear to the individual that this is true for them and not in general. And the last is a zinc taste test. Developed by Harry Henken, you drop a zinc solution on the tongue. The people who need zinc can't taste it. The people who say the zinc tastes strong have enough. And it's a pretty good one-dollar type assessment of a critical mineral and specifically for men, men need lots of minerals but especially zinc. You lose about 25 mg per every ejaculation. Gazella: Yeah, that's good. That makes a lot of sense. So, now it's time to discuss inflammation. Is inflammation really repair deficit and how does that change clinical practice? Remind us why that's such a big deal. Jaffe: Right. Well, we started with the physiology-first concept. Now I'm a doubly board-certified pathologist. I know the 5 aspects of inflammation. I know it's taught as a fire to be fought, something that has to be suppressed with anti-inflammatories. And now I pause and say: Anything that starts with 'anti' is using pharmacology before physiology. Inflammation is repair deficit. What my pathology colleagues see as inflammation is the cumulative lack of repair when your immune defense and repair system is doing too much defensive work because of foreign invaders from the breath or the skin or the gut, and if you enhance the innate immune system's ability to repair, your infrastructure is reborn, your bones get rebuilt, your joints are renewed, your mood is better. Your ability to get restorative sleep and meaningful relationships all are improved when you recognize that repair deficit is an opportunity. You use the hsCRP test as a predictive and validated biomarker. It's also an all-cause mortality, morbidity marker. The healthy goal value—and this is, again, where we have the reframing. I don't even look at the lab range because that includes too many unwell people. You know the goal value for this test, hsCRP, and it's less than 0.5. Ignore statistical lab ranges unless you're treating statistics, and knowing the best outcome goal value we add ascorbate based on the [inaudible 26:350, magnesium choline citrate based on the urine pH, and other similar kinds of monitoring so that the person gets more safely the forms that are more effective because of their enhanced uptake and retention and therefore the deficits get corrected more quickly. I mentioned hydration. I keep mentioning it only because every part of your body is healthier and more resilient and more able to repair when you take in healthy water, 4 liters a day or more of either mineral-rich, I happen to have well water but some mineral-rich water that's not contaminated and/or sparkling water. I happen to like Pellegrino but there's also Gerolsteiner and Apollinaris and actually every culture has a mineral-rich water known as a therapeutic or beneficial or health-promoting mineral water. So, you want to drink hard water, so water softeners are not recommended, at least not total home water softeners. If you want to soften the water in the pipes, I don't care, but your blood vessels are not pipes and now I care about the quality of the water that you take in. Gazella: Perfect. So, I love your perspective about looking at repair deficit as an opportunity. Are there other ways to kind of take advantage of that opportunity to reduce oxidative stress and reign in inflammation? Jaffe: Yes. And again, in a physiology-first point-of-view in regard to, say, blood fats. Cholesterol and triglycerides and blood fats and [inaudible 00:28:14]. If you keep the oxidation of those fats, if you keep oxidized cholesterol to zero, if you keep oxidized LDL to zero, because you're taking enough antioxidants and especially ascorbate. Now, the fat-related cardiovascular risks just went away. What remains is understanding your hemoglobin A1C, your hsCRP, your homocysteine, your LRA (lymphocyte response assay immune responses), your vitamin D, your first morning urine pH, your omega-3 index, and [inaudible 00:28:51]. Those are the eight predictive biomarker tests and we have online for folks to peruse and/or download or watch on YouTube discussions of why these eight predictive biomarkers cover all of that genetics, which is 92% of your lifetime quality of life and health. And yes, you can blame mom and dad for the other 8%, and yes transgenerational influences on RNA are a big scientific field but not yet ready to measure clinically. Live in the moment, do one thing at a time, practice gratitude and random acts of kindness, breathe abdominally for at least 5 minutes a day, and make enhance repair your practice and banish inflammation. Gazella: That's perfect. It's a very integrative approach that includes lifestyle as well. I'd like to end with heart disease because heart disease remains the leading cause of death for men in the United States. So, what do you recommend when it comes to protecting heart health for male patients? Jaffe: Yes, and as I think you know part of my primary research when I was in government service at the National Institutes of Health Clinical Center was collaborating with the Heart Institute on animal models of heart disease. Now, Paul Dudley White in the 1930s was a famous cardiologist. He helped invent the electrocardiogram. He taught when I was a young student that in the 1930s at Mass General Hospital in Boston, Massachusetts if they had 1 heart attack a year, they published the case. And yet 40 years after that, cardiovascular disease was the major killer of Western civilization. That's not a genetic change. It's too quick for genetics. A lot has to do with smoking and sitting, sedentary lifestyle, processing of foods, and all that goes with that. Jaffe: So, cardiovascular disease. If your heart attacks you, if you have a clog in a blood vessel, an artery, if you have a stroke, you didn't pay attention to the upstream warnings that you would know about if you did the self-assessment, if you did the predictive biomarker tests because these change. Your risk goes up dramatically decades before catastrophe. And if you change your consumption and attitude, if you change the environmental toxin exposures and by the way 80% of the toxins that people have in their body are of recent exposure, and you can dramatically reduce that by certain simple lifestyle changes. Include 1 to 300 mg a day of micellized CoQ10 in 100% rice-brand oil, and no glycose. No antifreeze in your CoQ10. Keep the 8 predictive biomarkers at their best outcome goal value and when they are, when those 8 tests are at their best outcome goal value, you have a 99% chance of living 10+ years, even if you're 100 at that point, and my main teacher Buntey was 110 when he passed and as I mentioned before I plan to be dancing at 120 by following this lifestyle, and I urge anyone who is willing and interested to join me. Gazella: That's perfect. Well, Dr Jaffe, we covered a lot today. Before I let you go, I'm just wondering if there's any final thoughts or anything else that you'd like to share with our listeners today. Jaffe: Yes. In essence, the physiology-first, the epigenetics is 92% of your life quality has to do with consumption, which you eat and drink and how you think and what you do. Now whatever season of your life is as a man, that may be different. When you're young and immortal, that's one thing. As soon as you're beyond young and immortal, be prudent. Cardiovascular disease starts in teenage years. Cancer risks goes up dramatically when your innate anti-cancer mechanism is turned down because you're eating foods that are causing too much defense burden in your immune defense and repair system. So, just follow through on this physiology-first approach looking at your individual needs for personalized health promotion and put pay to chronic ill health. Gazella: Perfect. Well, once again I'd like to thank today's sponsor, Perque Integrative Health, and Dr Jaffe I'd like to thank you for taking the time and sharing so much information with us today. Jaffe: Well, thanks for inviting me and for making it such an enjoyable time. I hope the listeners will take away much that will be of value, and it's my pleasure. Gazella: Well, thank you and I hope you have a great day. Jaffe: You the same, Karolyn. Always a pleasure. Gazella: Yes, it is. Bye-bye.

Tune in to hear EIG Director of Community Outreach, Jill Economou talk with healthcare professionals about Children's Hospital of Wisconsin and the pediatric cardiac programs available nationwide. Guests this week include: Dr. Peter Frommelt and Maryanne Kessel, RN Children's Herma Heart Institute Dr. Anoop Singh and Alli Thompson Children's Project ADAM

Tune in to hear EIG Director of Community Outreach, Jill Economou talk with healthcare professionals about Children's Hospital of Wisconsin and the pediatric cardiac programs available nationwide. Guests this week include: Dr. Peter Frommelt and Maryanne Kessel, RN Children's Herma Heart Institute Dr. Anoop Singh and Alli Thompson Children's Project ADAM

Tune in to hear EIG Director of Community Outreach, Jill Economou talk with healthcare professionals about Children's Hospital of Wisconsin and the pediatric cardiac programs available nationwide. Guests this week include: Dr. Peter Frommelt and Maryanne Kessel, RN Children's Herma Heart Institute Dr. Anoop Singh and Alli Thompson Children's Project ADAM

During this interview Russell Jaffe, MD, PhD, CCN, will share his thoughts on how to safely and effectively enhance and protect bone health. Listeners will learn how acid-alkaline balance impacts bone health, as well as key nutrients that can help support bone density.  About the Expert Russell M. Jaffe, MD, PhD, is CEO and Chairman of PERQUE Integrative Health (PIH). He is considered one of the pioneers of integrative and regenerative medicine. Since inventing the world’s first single step amplified (ELISA) procedure in 1984, a process for measuring and monitoring all delayed allergies, Jaffe has continually sought new ways to help speed the transition from our current healthcare system’s symptom reactive model to a more functionally integrated, effective, and compassionate system. PIH is the outcome of years of Dr. Jaffe’s scientific research. It brings to market 3 decades of rethinking safer, more effective, novel, and proprietary dietary supplements, supplement delivery systems, diagnostic testing, and validation studies. About the Sponsor PERQUE Integrative Health (PIH) is dedicated to speeding the transition from sickness care to healthful caring. Delivering novel, personalized health solutions, PIH gives physicians and their patients the tools needed to achieve sustained optimal wellness. Combining the best in functional, evidence-based testing with premium professional supplements and healthful lifestyle guides, PIH solutions deliver successful outcomes in even the toughest cases. Transcript Karolyn Gazella: Hello, I'm Karolyn Gazella, the publisher of the Natural Medicine Journal. Thank you for joining me. Today, we're talking about bone health with pioneering integrative health expert, Dr. Russell Jaffe. Before we being, I'd like to thank the sponsor of this podcast who is Perk Integrative Health. Dr. Jaffe, thank you so much for joining me today. Russell M. Jaffe, MD, PhD: Thanks for the invitation. Gazella: Well you know when we think of our bones, we often think of osteoporosis. Let's start there. How common is osteoporosis in particular? Jaffe: Oh, far too common. Depending on how you make the measurements, somewhere between 50 and 100 million Americans are at risk. One in 4 women over the age of 40 will have a fracture of their bones due to the osteoporosis or osteopenia. Maybe 1 in 5 or 1 in 4 men, maybe more, the precision of diagnosis probably understates the issue. The point is that bones, whatever your birth date might be, your bones should be young. Bones turn over every 10 years, which means no part of any bone that you or I have is more than 10 years old. Remember when we were 10 years old, we could jump around, we could leap around. I don't recommend behaving like a 10-year-old. What I'm saying is, your bones should be resilient, and flexible, and not brittle, and not being leeched by the stress and dietary choices of modern living. Gazella: Yes. It's hard for me to even imagine a 10-year-old, but it would be fun to have bones like a 10-year-old, for sure. Now is the DEXA scan still the gold standard for measuring bone density? Jaffe: Yes. D-E-X-A, DEXA is the "gold standard" reference standard. There are other measures that are coming along. There's N-telopeptides which are a little hard to interpret. There are other measures, but to the best of my understanding, the expert experts in bone say that you can measure DEXA changes over 2years. My colleague, Susan Brown and I did an anecdotal prospective study with 11 people, 10 of whom had between 2% and 10% or 11% new bone growth, unprecedented new bone growth by following this approach to Alkaline Way bone health. Gazella: Yes. How often do you recommend that patients get a DEXA scan? Jaffe: Well, let me come at it 2 or 3 different ways. In regard to the usual and customary use of the DEXA scan, it's a 2-year waiting period. Now many doctors will do a DEXA after one year and try to compare, and interpolate, God bless. Other people will use other measures, including bone mineral protein and how much of that there is in say the urine. You asked the right question, which is what is does the measure that almost everyone agrees, or that about which there is reasonable agreement and consensus. The answer there, DEXA. Until something better is really validated and yes, new things come along all the time, but I'm seeing a lot of them go 'cause as you know, my PhD was in collagen and elastin cross-linking, and how you regulate that. That was half a century ago and learned a lot since then. But collagen has a lot to do with bone health and bone turnover. Then there's certain other unique characteristics contributed by the liver that allow the minerals, not just calcium, but all of the minerals that are necessary to align properly to form what we call a bone. Gazella: When it comes to bone health, what do you mean when you say physiology before pharmacology? Jaffe: Well I mean the fact that bone is piezoelectric, which means when you walk, when you move, actually stimulating tiny electrical flows that say to the bone rebuilding cells, the osteoblast and osteoclast, "Do your job." Moving is a good thing, at least 45 minutes a day of walking. Yes, sitting is the new smoking, but if you get up at least 5 minutes an hour, you can undo most of the adverse effects of cutting off your circulation when you sit in most chairs. Now if you happen to have one of these recliner chairs or something like that, more power to you, but you still have to get up out of the chair. Walk for at 45 minutes a day. [inaudible 00:05:24], to the extent that he had a doctor was me, and [inaudible 00:05:29] very active now, they both agree. Now walking is a terrific way of human beings stimulating bone growth because of this "piezoelectric" or tiny electrical flow that nurtures and nourishes the bone. That's an example of physiology before pharmacology. Gazella: A great example. When it comes to your integrative approach, I want to dig into certain aspects of how we can enhance or protect bone health. You often talk about the acid alkaline balance. How does acid alkaline balance impact bone health? Jaffe: Well in essence when your diet or your environment contributes acid, your bones melt slowly away and sometimes not so slowly. On the other hand, when you have a mineral rich environment that bathes the cells and renews the cell's mineral buffering abilities, now you build new bone. We want to build new bone. We don't want to melt the existing bone. Gazella: Right. That makes a lot of sense. Let's stay on this topic for a bit because I know that most of our listeners understand how to support the acid alkaline balance, but what are some of your foundational aspects when it comes to supporting proper acid alkaline balance? Jaffe: Well as you know, we start with the self-assessments. The assessment we want to start with measuring the pH, that means how much acid or how much mineral is in your urine after 6 or more hours of rest. It's the one time of day when you get a meaningful measure in a non-evasive way of the cellular mineral status, 'cause after 6 hours, the fluid in the bladder equilibrates with the lining cells, and lining cells, if they need magnesium then they put the extra acid into the urine. If it's below a pH value of 6.5, then you're too acid. You're deficient in minerals, particularly magnesium at the cellular level. You should take 2, 3, 4 more doses a day of magnesium, but enhanced uptake magnesium with choline citrate. It must be choline citrate, it cannot be choline bitartrate. Try to fool mother nature and she'll come back and slap you on the tush. You want to enhance the uptake and chaperone delivery of magnesium based on [inaudible 00:08:14] chemistry, and for your listeners who are technical, these are inverted [inaudible 00:08:20] droplets. I really am a biochemist. What that means is tiny little droplets that are taken up by [inaudible 00:08:28], that easily enhance the uptake. In recent studies near 100% comes in and then goes to the cells that are [inaudible 00:08:37]. Gazella: You know it seems like bone broth has been the rage for a while now. What are your thoughts on bone broth as a way to boost bone nutrition? Jaffe: Well I'm a big advocate for broth, but not bone broth. Why not bone broth? Bone broth turns out to be far too rich in glutamate, and why is it rich in glutamate? You wouldn't think there's much glutamate in bone, it's glycine, and proline, and something else. No. What the industry calls bone broth includes skin, it includes things that have no other commercial value that are left after you "render" the animal, or the chicken, or the whatever, [inaudible 00:09:27] bone. Bone broth, no. But meat broth, vegetable broth, fish broth, broth you make at home, or broth that's organic or biodynamic, yes, yes, yes. Broth is a very good source of minerals, and I mean vegetable broth, fish broth, meat broth if you want, but real meat made into a broth, which means you very slowly simmer it until it falls apart, and then you have more or less a broth, especially if you either whisk it or put it in a blender. Broth, yes. Bone broth, no. Gazella: Okay, good. That's a good distinguishing factor. Now we also hear about MSM and hyaluronic acid for bones and joints. I'm wondering what you think about these 2 ingredients when it comes to bone health. Jaffe: Well MSM is a sulfur source. Sulfur sources are very important in protecting and enhancing bone vitality and renewal. Now we recommend that physiology before pharmacology approach, which we use garlic, ginger, onions, brassica sprouts and eggs. G-G-O-B-E, garlic, ginger, onions, brassica sprouts. All sprouts are good, but broccoli sprouts, brassica sprouts especially, and eggs. Why not MSM? 'Cause it's pharmacology. It is water soluble DMSO. DMSO makes you smell like a fish. Not a very healthy fish or a decomposing fish actually. MSM is a supplement that's been around for 20 plus years. It has a certain [inaudible 00:11:04] that comes and goes, but it's pharmacology. We want to start the physiology, the G-G-O-B-E, garlic, ginger, onions, brassica sprouts and eggs. Then if a particular practitioner feels that additional MSM is helpful, I think they make the final decision along with their client. As you can hear from my comments, we want to use nature's pharmacy, which means you generally have to cook the food the way it's traditionally done. If you just chop up an onion, the cell walls will prevent you from getting the good stuff. But if you sauteed the union until it's clear, now you have a nutritious and delicious detoxifying physiologically helpful bone joint and vitality enhancing material that you can make into any broth you want. However, you want to eat the foods you can digest, assimilate and eliminate without immune burden. If your body reacts to one or more of the G-G-O-B-E foods, then substitute with the other 4. Thomas Jefferson said they should be stables in the diet, not condiments. I'm a Jeffersonian democrat, which means I'm a grieving optimist. I believe that we should make these staples in our diet again. Gazella: Yeah, that makes a lot of sense. What about hyaluronic acid? Jaffe: I'm glad you asked that too. Hyaluronic acid is different. It is physiologic, so when you take ... I'm a pathologist, [inaudible 00:12:40] certified pathologist. When you look under a microscope at a joint, more than at bone, but at the joints you do see what are called water absorbing compression-friendly molecules, hyaluronic acid among them. Hyaluronic acid goes back to the early '80s, when a Canadian company thought that this was going to be the answer to joint erosion, to the kind of bone-on-bone pain that very commonly occurs to people who haven't walked enough, and have sat too much, or have been on planes too much, as I have been from time to time. Hyaluronic acid has a medical application. It's an injection. I think after you use nature's pharmacy, after you engage, when you eat and think, drink and do in a comprehensive and holistic way, that injections in hyaluronic acid in the right hands, in experienced hands, are an option. It does provide relief to some people for a period of time while other renewal should be engaged in. Gazella: Okay, that makes a lot of sense. Now let's dig into some of your other go-to nutrients for healthy brains. I'm sorry, health ... Jaffe: Bones. Gazella: Bones. Yeah. Jaffe: That applies to brains too. Gazella: Yeah, yeah. That's good. When it comes to bones, what are some of the nutrients that you like to recommend? Jaffe: Well in regard to the nutrients, there are over a dozen and a half. You can divide these into vitamins, minerals and co-factors. It's mostly about a family or a symphony of minerals. Remember a symphony has many different instruments, each of whom plays a slightly different tune. We recommend, in addition to vitamin K1 and K2, in addition to vitamin D3, we recommend biotin necessary for healthy bone. We recommend half a dozen forms of calcium, half a dozen forms of magnesium. Specialized bio available forms, low contaminant forms of zinc and magnesium, and chromium and selenium, methionine. Copper is the sebacate, iodine and iodide, you need both. Boron, acid citrate, vanadium, which balances out blood sugar and chromium. Silica, but from horsetail. Stable strontium is the gluconate, and fiber, croscarmellose fiber to enhance the easing digestibility making it food-like. Those are the over 18, 19, 20 essential bone building nutrients. Now vitamin D should be the D3. There should be some vitamin C to keep everything reduced and happy. Gazella: 'Cause this does seem like a big list. These all work synergistically? Jaffe: And they're all essential. If you lack any one, your bones won't renew properly. It's amazing how many co-factors, how many minerals and necessary nutrients that allow for bone health. But Dr. Susan Brown and I published an article a decade ago, we're working on an update now, which basically says the more tonic, or soda, or acid beverage you consume, the more quickly your bones will dissolve, the more quickly your bones will melt away. Then on the other hand, when you have a healthy traditional diet, rich in minerals, the Alkaline Way, the joy of living the Alkaline Way, documented by morning urine pH, keeping it in the 6 ½ to 7 ½ range, that's green rather than sandy color which is acid, or blue which is too alkaline, you want to keep it in the green zone. It's Goldilocks scenario. Not too much, not too little. Just right is just right. Gazella: Now before I move on, I want to talk about this combination of vitamins, minerals and co-factors. Are these in one product? What will be ... Jaffe: Oh, yes. This is what Dr. Brown and I used in our prospective study. When I say gaining 2% to 11% new bone, by DEXA in just 2 years, I'm saying people taking this formula and also following a healthy lifestyle of foods they can digest, assimilate and eliminate. Gazella: Okay, great. What's the name of this product and what's the recommended dosage of this product? Jaffe: Well the recommended dosage is 4 tabsules a day to build, 2 tabsules a day to maintain, 6 tabsules a day if you have osteopenia or osteoporosis. Gazella: Okay, so 4 per day, 2 per day. Then, I'm sorry, that was 6 per day if there is osteoporosis or osteopenia? Dr. Jaffe? Jaffe: Oh, I'm back. Sorry. Gazella: Okay, perfect. The dose for osteoporosis or osteopenia is 6 per day. Jaffe: Yes, that would be 6 per day. What I would say would be 3 in the morning, 3 in the evening, so a twice a day dose of 3 tabsules, these are fully active, fully available, and they contain all of these different nutrients, each one of which is necessary, and together they form a symphony or a bone building team. Gazella: Okay, perfect. Great. Now I want to switch gears a little bit. What's your view of bone morphogenic proteins and the long-term effect on bone status? Jaffe: Well you're absolutely up to the minute. Bone morphogenic protein is being studied as we speak. It's promising, but we really don't, in my opinion yet, have enough information. What we know is it's built upon something called 2-Beta Coxatene, for those of you who are technical. This is bone mineral protein precursor. Dr. Brown and I are, at this moment in time, encouraged by what we have heard about this. She and I are collecting information as we speak, and stay tuned for bone [inaudible 00:19:21], as they say. Gazella: If we were going to look into the future when it comes to integrative health and bone support, bone building, is this where we're headed with the morphogenic proteins? Is this an exciting area? Jaffe: Well yes, definitely an exciting area. The question is, how much do you need for each person because, as you can imagine, given that you started with a really healthy organic or biodynamic bone, and then you somehow got out of it, this magic complex, how much do you need, and how much does it cost, and how long will it take before you really confirm what is asserted by some clinicians based on their observations? The observations are encouraging, but stay tuned for the bulletin. Gazella: Okay. Perfect. Now I want to dig into diet and lifestyle. I want to circle back with your G-G-O-B-E, the garlic, ginger, onions, brassica vegetables and eggs. Explain it again or in more detail as to why these 5 dietary items are foundational for you. Jaffe: Right. They're foundational because in traditional societies they are sulfur rich. You can think of sulfur as a fire that burns away bad stuff and toxins. That's a metaphor, but biochemically it's not far from the case. For those of you who are technical, they form thioethers. This makes compounds that would otherwise be free radical generating harmful compounds more water soluble and less harmful, so once they're complex, what these sulfur rich foods, or the sulfur in the foods, then they can be treated in urine, sweat and stool more safely and effectively, and it's been used for millennia in traditional societies. We just have rediscovered it in recent times. Gazella: Perfect. Well I want to stay a little bit with eggs because I've done a lot of writing about eggs, and I had the belief that eggs have gotten a bad rap. I personally eat eggs almost every morning. Explain to us about why eggs got the bad rap, and why eggs are actually good for us. Just remind us of that. Jaffe: Yes, eggs got a bad rap because Levy and Fredrickson had the idea of the diet-heart hypothesis that the amount of fat or cholesterol you ate was determinative or it actually determined how much blood fat you have. Now it turned out to not be the case, but Levy ran the Heart Institute and Fredrickson ran the NIH. They had the dominant ... in their time. At that time, there was a man named Olson, and he pointed out that eggs are the perfect food when you combined the white and the yolk, when you make a gently coddled or gently cooked egg you have a near perfect food in regard to easy to digest, assimilate and eliminate for people that have healthy digestion. Now implied in what you said, I think, is getting a healthy egg. My preference today are goose and duck eggs, or quail eggs because they haven't been messed with very much. If you put in front of me a biodynamic chicken egg, or a home harvested fresh egg, I'll be delighted. Commercial eggs I'm not so sure of. I'm concerned about what the chicken ate the got into the egg and that's what she wrote, as they say. Gazella: I would have that same feeling as well. Let's talk a little bit about what we should not eat if we're trying to protect and enhance bone health. What do you tell your patients not to do from a dietary standpoint? Jaffe: Well as you know, I don't have a private practice. I get to influence other doctors and their probable cases, but what I do recommend is stay alkaline. Stay alkaline means eat foods that are mineral rich, eat foods that are antioxidant rich, eat foods that are nutrient dense and rich, and you are sweet enough as you are, do not add sugar to your diet, do not use edible oils. I think edible oils is an oxymoron. What I mean by that is you avoid packaged goods, shipped foods, crisp foods, extruded foods, things that have been processed because processed means you lost the good stuff and you gained the bad stuff. Do a makeover in your kitchen, eat the foods that are whole, eat more fruits and vegetables that are vying ripe. If you want to have healthy fat in your diet, have an avocado, a whole one. Once you separate the oil from the seed, you know, like the olive oil, once you separate the oil from the seed the protective material is now gone and what you have are dense calories. Fat are dense calories, but those fats, those edible oils are easily oxidized, damaged and rancid. Then they get masking agents to make sure that your tongue and your brain get addicted to wanting those rancid processed fats. I don't think that's a good idea. I can tell you lots of reasons why [inaudible 00:25:15], who taught me about this in the early '80s, late '70, [inaudible 00:25:19], why Patty Deuster is so correct about these issues, but slowly we turned in regard to nutrition [inaudible 00:25:26]. Gazella: Let's talk a little bit about lifestyle factors. Now you mentioned movement and exercise in a scientific literature is so clear that that's protective of bone health. What about other lifestyle factors, like if we're looking at stress, or sleep, or just other things that we do? What do you tell your doctors to tell their patients? Jaffe: Well what I learned from [inaudible 00:25:52] and the Dalai Lama was that afflictive responses, that is the traumas of early life or the traumas of daily living that contribute stress hormones, afflict us, they erode us, they reduce new bone formation. By the way, no one gains from any of that. In the famous words of Bobby McFerrin, "Don't worry, be happy." I don't mean live by denial. What I mean is practice relaxation response. Know that your breath is a refuge and know that stress hormones only come out when you feel under attack. You may have heard about fight or flight, but there's also fortitude, there's also gaining the resilience to know that when you go to your breath, you can stay at ease even if everyone around you is hysterical. I can tell you from personal experience, in my family, if you didn't shout, no one paid any attention to you because everyone else was shouting. They just didn't know it. Gazella: Yeah, that's true. The relaxation ... Stress is a big deal. What about sleep? I know often times, sleep and stress go hand in hand, and one can lead to the other, and vice versa. What's your philosophy on sleep? Jaffe: Yes, my philosophy on sleep is that it's really important, restorative sleep, and how do I prepare for restorative sleep? Well I take a salt and soda bath. I put half to a cup of baking soda and Epsom salts in a warm tub of water, and get in for 20 minutes. First 5 minutes I breathe like a baby into my abdomen, the next 15 minutes I pray that my heart won't attack me, and whatever active mediation you want to do, then I get out and I dry off before I get into bed, and I stretch when I'm in bed before I fall asleep. Then I might even ask myself a question that I would like my dreams to answer if I'm inclined to do that. [inaudible 00:28:03] dreaming myself. In the morning I wake up and I stretch. I got to bed early enough that I get up early enough that I don't need an alarm clock. There is no screen, there is no clock, there's no unnatural sound. Occasionally I'm woken up by a wind chime or by a bird, but that's a nice thing to get woken up by. Then I stretch before I get out of bed, and then I get in the shower and I stretch when I'm in the shower, 'cause if you're not stretching a lot, you'll contract. Look at most old people, they slow down and contract. I am how you say old, but not that old, and I'm not yet contracted. Gazella: That's a good thing. Jaffe: That's a good thing. I'm working on it. Gazella: It's perfect. What would you like to be the most important bone health message that our listeners of health care professionals receive today? What's the most important thing that you want to get across? Jaffe: Most important is that bone health is a choice. It is about what you eat and drink, think and do. When you put it together in this proactive way, you have healthy bones for life. If you follow the "Conventions of modern living and pharmaceutical pill-based solutions," you end up slowing the loss but creating brittle, more fragile bones. In the famous words of Mel Brooks, the 2,000 Year Old Man, "Don't do that." Gazella: Right. Yeah, the physiology before pharmacology, I think, is such an important message. Well this has been very interesting, Dr. Jaffe. Once again, I would like to thank the sponsor of this topic, who is Perk Integrative Health. Dr. Jaffe, once again I'd like to thank you for joining me today. Jaffe: Pleasure to be with you as always. Gazella: Yes. Have a great day. Jaffe: You have the same.

Ted Lindner sits down with the doctors from Stonybrook Heart Institute. Heart disease and stroke are the leading global cause of death each year. Learn some tips on cardiovascular health from these doctors.

Thomas Diacovo, MD, is chief of the UPMC Newborn Medicine Program and director of Neonatal Cardiovascular Research at the Heart Institute. Dr. Diacovo discusses how he became interested in Thrombosis research, his journey to Pittsburgh, and his research testing new drugs for neonatal intensive care patients, particularly those with congenital heart disease who are at high risk for forming blood clots. Dr. Diacovo also credits the parents of our patients for the success of his clinical trials.

In this podcast episode, I’m going to talk about an organization created to provide support to the patients and families of the Heart Institute at Le Bonheur Children’s Hospital. This organization is called Big Heart Fund and we created to honor the memory of Kellen Austin Dorse.

Chest pain, shortness of breath and swollen feet are just some of the symptoms of heart valve disease. Dr. Vinod Thourani discusses how we diagnose and treat malfunctioning heart valves.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thank you for joining us today. We’re talking with Dr. Vinod Thourani, Chairman of Cardiac Surgery at MedStar Heart and Vascular Institute and MedStar Washington Hospital Center. Welcome, Dr. Thourani.   Dr. Vinod Thourani: Thank you so much. Host: Today, we’re talking about options to treat heart valve disease. The heart has four valves that control the flow of blood through the heart into the rest of the body. When a valve is damaged or diseased, the flow is disrupted, which can lead to serious health implications. Valve disease risk increases with age and it’s estimated that more than half of people ages 70 and older have some heart valve function issues. As more people in the U.S. live longer, a growing population of people will require heart valve treatment. Dr. Thourani, what symptoms might a patient experience that would indicate a valvular disease? Dr. Thourani: It’s a little bit different for the different valves that we have. For instance, the aortic valve has three common symptoms. You can get chest pain, which is similar to coronary artery disease, but it’s really due to the valve. You can also have shortness of breath, where you get winded when you walk up the stairs. Maybe you used to be able to walk up the stairs without getting winded, now you start to get winded. Aortic stenosis can have that symptom, also. And the third is you actually have something called syncope, where you get lightheaded. All of us, when we get up in the mornings, sometimes when we get up quickly out of bed, we get a little lightheaded - that’s not really aortic stenosis. But you can, with aortic stenosis, if you stand up or do activities, you can actually pass out or get lightheaded. So, for the aortic valve, those are the three main symptoms--chest pain, shortness of breath, or syncope. The mitral valve, which is another commonly diseased valve, really shortness of breath is the main symptom that you have, and so you have to be cognizant that you’re not able to do the activities that you were before, six months or a year ago.  It has the potential of being a mitral valve issue because now the blood is going back into the lungs, and so really your lungs get overloaded with fluid and you get short of breath. Host: How long would those symptoms have to present before a patient would maybe worry that they had something wrong with the heart? Dr. Thourani: So, unlike coronary artery disease, which is sometimes, all of us have heard of--you have a heart attack, or myocardial infarction, and that can occur acutely. Aortic stenosis, mitral regurgitation--it usually takes a much longer time period, so it’s over the years or months that this occurs, and so it’s not nearly as acute of symptomatology as you would with coronary artery disease. I do want to mention the tricuspid valve - sometimes in our societies we call it, it’s called the forgotten valve. And you can get what we call tricuspid regurgitation, or leakage, and the big symptom for that is pedal edema, so your feet swell more than before. There are a lot of reasons to have your feet swell, but of course the tricuspid valve is also one reason where you can have liver congestion or pedal edema.       Host: Why do they call it the forgotten valve? Dr. Thourani: Because, since the aortic valve and the mitral valve are so prevalent as far as disease pathologies, and that’s really what we are looking for, sometimes the tricuspid valve is not what we are looking for. So, I think that it’s very important for your physician, and we have a lot of them at MedStar Washington Hospital Center and in the Heart Institute, that specialize in valve disease, so it’s really important for everybody to look at all four valves by the diagnostic modalities that we have here. Host: Could you walk us through the diagnosis process for a patient if they’re concerned that they have a heart issue--how do they get to you and how do you progress that to develop a treatment plan? Dr. Thourani: So, as a cardiac surgeon, there’ve been multiple people who have seen the patient before they come to me.  The first place is an internist who usually sees the patient, and the easiest way to diagnose somebody is just examination. A stethoscope—you can actually hear the murmurs within the heart by listening to various parts of the chest. If the internist does have murmurs, then it’s commonly sent to a cardiologist. A cardiologist will also listen to the heart. They are specialized in heart disease and valve disease, but they’ll also most likely order a transthoracic echocardiogram, and that’s a sonogram just like you do if you’re looking at the baby in a pregnant woman. It goes over the heart and this TTE is what it is commonly called, transthoracic echocardiogram, it’s an ultrasound that specifically can look at the valves. If the transthoracic echocardiogram shows disease, then really you need to be seen by a valve specialist, and they will take you to the next step of more advanced imaging or options for the patient.  Host: How often do valve disease patients require surgery, or is it something that often can be handled medicinally? Dr. Thourani: So, the way that all valvular disease is really graded is mild, moderate or severe. So, those patients who are clearly mild or moderate do not require any surgical therapies at the time. However, it’s very important for a cardiologist--specifically, here at the Heart Institute we have cardiologists who are specifically interested in valve disease, and it’s really important for them to manage the patient with proper medications. And that pharmacologic treatment is really what’s the best, and sometimes you can keep that mild to moderate valve problem for life, if you’re on the proper medications. However, if it does go to the severe aspect of any valvular disease problem, then really it should be seen by an interventional cardiologist and a cardiac surgeon. And here, we have a valve team that is dedicated who just concentrate on valvular disease, and so I really think you have to hone in on specialists. This is not something for just everybody to treat. I think it’s very important for the heart team to evaluate patients with valve disease, and the reason is is that over the last 10 years there’s been a dramatic change in the management and the treatment of these patients with severe valve problems. Before, it was just surgery. And now, we have a multitude of options, which a lot of them now are less invasive, or quite simply a needle stick instead of opening the chest up, so we have so many different options compared to 15 years ago. A dedicated valve team will be able to really look at the patient in totality. We have an entire team of almost 30 to 40 people who just deal with a valve patient. We’re able to look at them from a frailty point of view, and then we’re able to, as a team, huddle together with CT personnel, with echocardiographers, with surgeons, with interventional cardiologists, and we sit down and we decide what our recommendation is, looking at a lot of the different pathways that we have. So, the patient gets phenomenal equipoise because we now have a dedicated team that has spent a lot of time and energy finding the best treatment modality for them.         Host: So, this is an excellent center of care for heart and vascular diseases, for valve diseases. Is there any way that a patient can reduce their risk of having this happen to them in the first place? Dr. Thourani: I think that’s a great question. So just like there have been a lot of changes and advancement for interventional procedures for valve disease, they’re also making strides in the management of these patients. The earlier that patients are evaluated and diagnosed with a valve problem, they can be treated with antihypertensives and sometimes anti-lipid medications, and a bevy of different medical therapies to try to keep them at that mild to moderate valve disease pathway. So, our goal eventually is really to see patients earlier in their course, and maybe we can prevent them from having a procedure. If they need a procedure, then we have a heart team dedicated to helping them, but wouldn’t it be nice to try to have them live longer without a procedure. Host: Is that level of education something that the cardiologists are working with, the general cardiologists, before they even get to you? Dr. Thourani: Yes, they are, and we again at the Heart Institute have this phenomenal bevy of noninvasive general cardiologists who can help manage that, and that’s what we are concentrating on. But, I think it also go to internists. I think that a majority of patients around are seen by internists, not necessarily a cardiologist.  So, I think our education has been within cardiology and cardiac surgery. My opinion is is that we need to really branch that out and diversify that out into the community of internists, also, because a lot of them are doing transthoracic echocardiograms in their offices. Host: What are some of the more advanced technologies or techniques that patients can find at MedStar Heart and Vascular Institute that they maybe they couldn’t find elsewhere in the community? Dr. Thourani: That’s something that we are very proud to note, that we have all the newest technologies to treat valvular heart disease. So, for example, when a patient comes in, we evaluate them for a regular surgery, for a sternotomy where we do go through the front of the chest, but on top of that we are now offering minimally invasive surgery, so we don’t have to go through the entire chest in order to fix their valve problems, and sometimes we don’t even need to go through the front of the chest at all. We do it minimally invasive through the side. So, that’s surgically that’s advances we’ve made and we have all of those available to us. The rapid growth of what we call transcatheter valve technologies has really exploded and we’re fortunate at the institute to have all of that technology available to us. We’re the only site in the surrounding 50 miles or so in the greater DC area that can provide all the new technologies for aortic valve, for the mitral valve and the tricuspid valve. So, quite honestly, we’re in a position to treat all the valves, sometimes without ever opening the patient up, and they can go home the next day or within two days. So, we do have a lot of technology that we’re also leading, and we’re the national investigators for many of the new technologies coming out, so we’d like to provide all the services for this area, and we believe that we can do that.    Host: What has you excited right now, either in looking forward in heart and vascular care, or in any research that you’re conducting with your colleagues? Dr. Thourani: So, the thing that excites me the most are the people here. I think that we have put together a team of highly knowledgeable, very caring physicians who really have the patient as our primary focus. That’s really what I’m the most proud of, and to be one person within this large team is personally very gratifying for me. What we are leading is incisions or the lack of incisions for mitral valve disease and aortic valve disease. We’re actually the national leaders for two or three new trials in which there are only four or five centers in the entire United States who actually have this new technology. So we’re very fortunate to be able to have that here and we’re very fortunate to be able to bring that to the patients in the surrounding 7 million of us in the Northern Virginia, Maryland and DC area. Host: Could you share any patient treatment success stories? Any outstanding care that was provided or outcomes you didn’t expect? Dr. Thourani: So, recently, we had a patient who was in her 80s, very pleasant, literally like the grandmother that we wish we had. Very high risk, someone that was not a surgical candidate, and really was mentally as sharp as can be, so we really wanted to help her. And what we were able to do is after all of our testing, we thought that she would actually be benefitted by repairing her mitral valve with never opening her up. So, with a little needle stick in the femoral vein-- it’s a very easy procedure as far as getting access to. Through the femoral vein, we were able to repair her mitral valve, and she went home the next day.  So, here’s someone who had lost all hope and wanted to spend more time with her grandkids, and we wanted her to do that, and she was completely depressed by this and kind of now bound at home. And we were able to give her another lease on life, so someone who had given to our community for over 80 years--now we were giving her back a little bit to let her enjoy the remaining parts of her life with her kids and grandkids. So, to me, that was just, it’s a fabulous story because it does show that we do have technology sometimes that somebody doesn’t know about until they come and see us, and I think that that’s something that we want to educate more people on. Host: Could you describe that surgery in lay terms? Maybe start with where the femoral artery is? Dr. Thourani: So, this procedure for the mitral valve, is done actually through the femoral vein, and so even a less risky procedure. So, we perform this in the cardiac cath lab. The patient is asleep, and we do put probes down their throat so that we can monitor the heart the whole time. And the femoral vein is actually located right in your groin area. If you feel your groin area, there’s a pulse. Just next to that is your vein. And we’re able to have a little needle stick there with local lidocaine and we’re able to perform the entire procedure. And so, when you’re completed with the procedure, which takes about an hour to hour and a half, there’s actually zero incision, and so you walk away with valve surgery with no incision. I think that’s pretty remarkable.   Host: I’d say. So, you can replace the entire valve via catheter? Dr. Thourani:  Yeah, you can replace it and you can repair it. And so, I think it’s something that has really grown within the last decade, and we’re fortunate that the institute was one of the earliest sites, within the first five sites in the United States, to have this technology, and so we’ve really perfected it in the last 12 years of having the technology.   Host: Thank you for coming today, Dr. Thourani. Dr. Thourani: Absolutely. Thank you for the invitation. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Unwarranted clinical variation was the #1 concern of 54% of healthcare executives in a recent industry survey. Is data the answer? Two cardiovascular leaders share their groups' journeys and how they foresee the future of data in this value-based system. Amy Frye-Anderson, RN, MSN is Assistant Vice President of Government Programs and Clinical Reporting for HCA Physician Services Group. Samuel Hanke, MD, is a pediatric cardiologist and an assistant professor in the Heart Institute at Cincinnati Children's Medical Center. Lori Walsh is Vice President of Membership and Senior Consultant for MedAxiom.Contact: HeartTalk@medaxiom.com For more information: https://www.medaxiom.com

Dr Carolyn Lam:                Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. This week's journal features two papers that deal with genetic testing in young athletes and for sudden arrhythmic death, and with findings that may surprise you. They really show the complexities of this era of genetic testing and cardiovascular medicine, and in fact are discussed as growing pains in cardiovascular genetics. You must listen to our feature discussion, which is coming right up after these summaries.                                                 The first original paper this week suggests that targeting fibronectin polymerization may be a new therapeutic strategy for treating cardiac fibrosis. Fibronectin polymerization is necessary for collagen matrix deposition and is a key contributor to increased abundance of cardiac myofibroblast following cardiac injury. In today's paper, first author Dr Valiente-Alandi, corresponding author Dr Blaxall from University of Cincinnati College of Medicine and Heart Institute, and their colleagues hypothesized that interfering with fibronectin polymerization, or its genetic ablation and fibroblasts, would attenuate myocardial fibrosis and improve cardiac function following ischemia reperfusion injury. Using mouse and human cardiac myofibroblasts, authors found that the fibronectin polymerization inhibitor pUR4 attenuated the pathological phenotype exhibited by mouse and human myofibroblasts by decreasing fibronectin polymerization and collagen deposition into the extracellular matrix as well as by myofibroblast proliferation and migration.                                                 Inhibiting fibronectin matrix deposition by pUR4 treatment or by deleting fibronectin gene expression in cardiac fibroblasts confirmed cardioprotection against ischemia reperfusion-induced injury by attenuating at first left ventricular remodeling and cardiac fibrosis, thus preserving cardiac function. In summary, interfering with fibronectin polymerization may be a new therapeutic strategy for treating cardiac fibrosis and heart failure.                                                 The Insulin Resistance Intervention after Stroke, or IRIS trial, demonstrated that pioglitazone reduced the risk of both cardiovascular events and diabetes in insulin-resistant patients. However, concern remains that pioglitazone may increase the risk of heart failure in susceptible individuals. To address this, Dr Young from Yale Cardiovascular Research Center and the IRIS investigators performed a secondary analysis of the IRIS trial. They found that older age, atrial fibrillation, hypertension, obesity, edema, high CRP, and smoking were risk factors for heart failure.                                                 Pioglitazone did not increase the risk of incident heart failure, and the effect of pioglitazone did not differ across levels of baseline risk. It should however be noted that in the IRIS trial, the study drug dose could be reduced for symptoms of edema or excessive weight gain, which occurred more often in the pioglitazone arm. Overall, pioglitazone reduced the composite outcome of stroke, MI, or hospitalized heart failure in the IRIS trial.                                                 The next study highlights the importance of genetic variation in cardiac fibrosis and suggests that while fibroblast activation is a response that parallels the extent of scar formation, proliferation may not necessarily correlate with levels of fibrosis. In this paper from co-first authors Dr Park and Ranjbarvaziri, corresponding author Dr Ardehali, from David Geffen School of Medicine, University of California, Los Angeles, the authors utilized a novel multiple-strain approach known as the Hybrid Mouse Diversity Panel to characterize the contributions of cardiac fibroblasts to the formation of isoproterenol-induced cardiac fibrosis in three strains of mice.                                                 They found that isolated cardiac fibroblasts treated with isoproterenol exhibited strain-specific increases in the levels of activation, but showed comparable levels of proliferation. Similar results were found in vivo with fibroblast activation but not proliferation correlating with the differential levels of cardiac fibrosis after isoproterenol treatment. RNA sequencing revealed that cardiac fibroblasts from each strain exhibited unique gene expression changes in response to isoproterenol.                                                 The authors further identified LTBP2 as a commonly upregulated gene after isoproterenol treatment. Expression of LTBP2 was elevated and specifically localized in the fibrotic regions of the myocardium after injury in mice and in human heart failure, suggesting that it may be a potential therapeutic target. That brings us to the end of our summaries. Now for our feature discussion.                                                 We all know that t-wave inversion is common in patients with cardiomyopathy, however up to a quarter of athletes of African descent, and five percent of white athletes also have t-wave inversion on ECG, but with unclear clinical significance despite comprehensive clinical evaluation. Now, what is the role in diagnostic use of genetic testing beyond clinical evaluation when we investigate these athletes with t-wave inversion? Well we're about to get some answers in today's feature paper, and I'm so pleased to have the corresponding author of the paper, Dr Sanjay Sharma from St. George's University of London, as well as our associate editor Dr Mark Link from UT Southwestern.                                                 Sanjay, please let us know what you did and what you found. Dr Sanjay Sharma:            Well as you rightly say, that up to 25% of black athletes have t-wave inversion, as do three to five percent of white athletes. And these t-wave inversions often overlap with the sort of patterns that you see in patients with hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy. For example, 80% of people with hypertrophic cardiomyopathy have t-wave inversion as do 60% of patients with ARVC. Now we know that some ECG patterns, t-wave inversions in V1 to V4 are benign in black patients, but the significance of other ECG patterns is unknown. Cascade screening in family members with cardiomyopathy have shown that t-wave inversion may be the only manifestation of gene inheritance, and there are reports to suggest that some athletes with t-wave inversion do go on to develop overt cardiomyopathy. Now when we investigate the vast majority of our patients with t-wave inversion, these are our athlete patients, we don't actually find anything. But over the past decade, also, these has been major advance in next generation sequencing that allows us to perform genetic testing in a large number of genes that can cause diseases, capable of causing sudden death.                                                 And so, we thought we'd investigate the role of this gene testing in athletes with t-wave inversion. We looked at a hundred, 50 black athletes and 50 white athletes who had t-wave inversion, and we investigated them comprehensively with clinical tests. But we also added in a gene panel looking at 311 genes implicated in six cardiac diseases, notably hypertrophic cardiac myopathy, arrhythmogenic cardiomyopathy, dilated cardiomyopathy, left ventricular non-compaction, long QT syndrome, and the brugada syndrome. We found that 21% of our athletes were then diagnosed with a cardiac disorder capable of causing sudden death, and the vast majority of these people had hypertrophic cardiomyopathy. And this diagnosis was based on clinical evaluation. When we looked at gene testing, we found that gene testing only picked up a problem in 10%. So, the diagnostic yield of gene testing was half that of comprehensive clinical investigation.                                                 When we actually looked at athletes who had nothing wrong with them in clinical investigation, and actually had a gene mutation, we found that only 2.5% of athletes who had t-wave inversion but clinically normal tests, actually had something wrong with them. And our conclusions were that gene testing picks up only half the athletes that clinical testing does, and gene testing is only responsible for identifying 2.5% of athletes with t-wave inversion, where clinical tests are negative. That was the summary of our study in short. We did find that black athletes were less likely to have a positive diagnosis of cardiac myopathy than white athletes, and black athletes are also less likely to have a genetic mutation capable of causing a cardiomyopathy than white athletes. Dr Carolyn Lam:                First and foremost, congratulations on such a beautiful paper, and so wonderfully summarized as well. It really seems to fly in the face, doesn't it? Of the way we've been discussing personalized medicine and saying that we're going to start whole genome sequencing everyone and that's going to provide all the answers for future disease risks. I mean, if I'm not wrong, what your paper is trying to tell us is that at this moment we don't have good examples where genetic testing may trump clinical diagnoses, and in fact we should be still focusing on a comprehensive clinical evaluation of patients and in the absence of a genotype we should learn to question what we're doing in genetic testing. Do you agree with that? Dr Sanjay Sharma:            You couldn't have said that more precisely. As I've said, the diagnostic yield of clinical testing was 21% versus only 10% with genetic testing. The diagnostic yield of pure genetic testing in people with otherwise completely normal findings clinically was only 2.5%. And the other thing that I forgot to tell you was that genetic testing, if we included genetic testing in addition to comprehensive assessment, cost us three times as much as clinical investigation on its own, and had we relied solely on genetics, and nothing else, it would have cost us ten times more than clinical testing. So our cost per making a diagnosis using genetics only would have amounted to $30,000 per condition. Dr Carolyn Lam:                Wow, what a great wake up call. Mark, you've thought a lot about this and in fact there was another paper in this week’s journal that has very complimentary messages. In fact you invited an editorial by Dan Roden, and I really loved his title of it, "Growing Pains in Cardiovascular Genetics." Would you maybe add your thoughts in relation to the other paper, as well as overall? Dr Mark Link:                     Sure. Circulation was very interested in these papers. These are really  ... Now, as Dan Roden says, "Growing pains." Twenty years ago when genetics came out it was looked upon as it was going to completely change our clinical medicine and precision medicine is really relying a lot on genetics. And while ultimately that may be the case, we are in a stage now where the honeymoon is over. And the other paper that was in this same issue was a paper by Hosseini  and colleagues, and it was the Clin Gen paper looking at the Brugada Syndrome abnormalities. Now the Clin Gen is an NIH sponsored group that takes individuals from a number of different institutions and actually gene testing, and tries to provide an independent assessment of the abnormality of genes. Previously is was companies that did this. A company would gene test ... They would look for gene abnormalities, try to link it with clinical disease, and they could basically then do just on their patients. But Clin Gen now is trying to tie all those companies together to get a broad consortion and to look at genetic abnormalities and whether they're truly pathologic, where there's areas of unknown significance, or whether they're truly not pathologic.                                                 So as an example, they took Brugada Syndrome, and they took the different gene abnormalities that have been described from basically different companies and different labs and different institutions, and they looked at the evidence behind the fact that they were truly pathologic, 'cause all 21 genes were defined as pathologic. They found in their independent assessment that only one ended up to be truly pathologic, and the others ones were disputed. And sort of another wakeup call that just because a single company calls a gene pathologic or Brugada Syndrome, does not make it pathologic necessarily. So we all thought these were two very important papers that looked at some of the limitations of genetic testing. We asked Dan Roden, who is really a very accomplished scholar in this field, to provide perspective on this. And I agree, I loved his title, "Growing Pains in Cardiovascular Genetics." And what he did is reviewed the history of genetic testing, and he actually starts before genetic testing and starts with Mendelian genetics, and [inaudible] genetics. And then 23 years ago they started linking that Mendelian genetics to gene abnormalities, especially in diseases such as long QT syndrome and hypertrophic cardiomyopathy.                                                 We've come a tremendous way in diagnosing gene abnormalities and associating them with these underlying cardiac myopathies and hind channel abnormalities. So no one doubts we've come a tremendous way, but there's a long way to go in terms of getting better diagnostic accuracy and really defining where these genetic testing are ultimately going to play out in clinical medicine. So everyone's excited about it, but I think these two papers are two cautionary tales that we do have to remember that genetic testing in 2018 is not the end all and be all. Dr Carolyn Lam:                I love that, cautionary tales. So important. But where do we go from here? What's the take home message for clinicians listening to this today in 2018? I mean is it that perhaps when we do these things we now need to include medical geneticists and genetic counselors as vital partners as we look at this all? Perhaps we need to not forget the primacy of clinical evaluation. What do you think, Sanjay? Dr Sanjay Shar:                  Well, there are guidelines from the American Medical Genetics side as to what one defines as a disease-causing mutation. But I agree that we need to be using certified laboratories that can actually interpret the genetic mutations. For example, in our study of athletes, 63% actually had variance of undetermined significance. So they had spinning mistakes in their genes which probably didn't account to anything at all, but had these mutations, or these so called variance of undetermined mutations been interpreted by someone who didn't really know much about this, these could have resulted in false positive results which could cause absolute chaos for an athletes career. So I do think this type of testing has to be governed very, very carefully and needs to be performed in very specialized and certified laboratories. Dr Carolyn Lam:                Indeed. Not just to the athlete, but to their families too, isn't it? Mark, what do you think is the take home message [inaudible 00:16:18]? Dr Mark Link:                     I think one of the big take home messages that I took away from these papers is that clinical medicine is not dead. In fact, clinical medicine in this day and age is still the prime way of taking care of patients. Genetic testing is still in its infancy. It doesn't help clinically in too many situations yet. It will in the future. It helps in the diagnosis, it's not as useful in the treatment. So we have a long ways to go with genetics. I like your comment that going forward we're going to need more genetic counselors to make sense of these results. Clinicians are going to have a hard time making sense of these results. I do think that there is plenty of role once a disease causing mutation has been defined, and in that situation it's invaluable in cascade screening in identifying other family members who may be affected, but outside that I do believe and I agree completely with both of you, that clinical medicine is not dead. And clinical evaluation should be number one and should enjoy it's prime time because that's where we still are at. And genetics is still in its infancy and so is cardiology. Dr Carolyn Lam:                Perhaps in selective settings ... We're not talking here about, for example, hypercholesteremia variance, we're not talking about cancer gene variance for which screening may be a little bit more advanced, and we may understand the gene phenotype associations that are perhaps- Dr Mark Link:                     I think that understanding gene phenotype associations are going to be critically important in the future. I think, as Sanjay said, the real use of genetic screening now is cascade screening for the family, and there it's invaluable. That you can tell if you've got a co-band with the disease, and with a defined pathological mutation. You can test siblings, sons and daughters, parents to see if any of them have the gene. I think that's where it should be used for sure in 2018. Dr Carolyn Lam:                Thank you so much Mark and Sanjay. So some precautions, some hope. Very, very balanced discussion. So much more we could discuss, so I really want to highly encourage our audience. Pick up this issue. You have to read these amazing papers and the editorials. Dr Carolyn Lam:                So, here's a podcast with all your colleagues, and don't forget to tune in next week.  

HLHS care poses a unique challenge for pediatric primary care providers. Pediatric cardiothoracic surgeon James (Jim) Jaggers, MD joins us today to discuss the primary care, treatment and future for patients with hypoplastic left heart syndrome (HLHS). Dr. Jaggers is Co-Director of the Heart Institute and the Barton-Elliman Chair in Pediatric Cardiothoracic Surgery at Children's Colorado. In this episode: Dr. Jaggers' approach to surgical intervention for HLHS How pediatricians and family doctors can support their patients and families confronting an HLHS diagnosis Ongoing and follow-up care for HLHS patients in the pediatricians' office The long-term prognosis for HLHS patients How the nation's leading pediatric hospitals are collaborating to provide solutions for patients with HLHS in a groundbreaking consortium Future innovation and care for HLHS patients  

Understanding yourself and the way the human system actually works with GP Walsh… GP Walsh, Founder of Master HEART Institute, speaker, author, leader, spiritual teacher, meditation master, EFT expert and composer, joins Julie Chan at the MouthMedia Network studios powered by Sennheiser.A gloomy cloud, one fateful night on a bridge, and hearing a voice Walsh discusses his tough childhood with a missing father and mentally ill mother, being under a gloomy cloud, joining a rock band, became darker and more cynical, and how 45 years ago at 19 his closest friend ended their relationship. How Walsh was a horrible person, played rock and “got wasted”, and was going nowhere. One night with hashish that was filled with terror when he thought he was going to die and was happy about it, standing on a bridge looking down at polluted river, and hearing a voice saying “Look closer” and “all the light”.The myth of getting rid of the negative, showing the brain the war is over, and the power of the ego The disconnect between our life and wanting to contribute, the things that get in the way of it, trying to get rid of all that stuff and getting rid of the negative. Everything has a purpose, everything is generated from the nervous system, how the natural expression of who you are runs into something in the environment that says that’s not OK, and how most self help is that there is something wrong with you and you need to be fixed—instead Walsh does the opposite. There’s nothing wrong with you, show the brain that the war is over, a transformation is quickly made, the independent power of the ego that is manufactured by the mind. And who you are vs. a momentary reality.The future, transformation, and an incoming mass shift The future of holistic wellness, how the nervous system’s whole purpose is to stay safe and stay whole. The reality of transformation, how we’re waking up the reality of who we are. And what science should show for another mass shift, and how the influence of love and acceptance will be demonstrated to be physiological.

Please join us this Wednesday, November 22, 2017 at 4:00 p.m. PST and 7:00 p.m. EST for a live show with host Denise Messenger.  Her special guest is Dr. Ernst R von Schwarz, MD, PhD.  He is a triple board certified internist, cardiologist and heart transplant cardiologist in Los Angeles. He is Professor of Medicine at Cedars Sinai Medical Center and Clinical Professor at the David Geffen School of Medicine at UCLA. Dr Schwarz is world renowned as a clinical and academic heart specialist and serves as the Director of Cardiology and Director of the Heart Institute of the Southern California Hospital in Los Angeles, as well as Director and President of the Pacific Heart Medical Group in Murrieta, CEO of Dr Schwarz Medical Institute of California, and Medical Director of HeartStem, Inc. Dr. Schwarz has published over 150 scientific articles in international peer-reviewed journals, several book chapters and books in Cardiology and Sexual Medicine, and is a highly sought-after speaker at international scientific conferences worldwide. Dr. Schwarz is one of the thought leaders in modern future technologies including stem cell therapies for chronic diseases for the heart and other organs. Students from Universities from all over the world seek internships with Dr. Schwarz on an ongoing basis. You asked for it and we deliver.  

Welcome! My guest today is Dr. Vincent Bufalino from Illinois. He is board certified in Internal Medicine and Cardiovascular Disease. He is the Senior Vice President of the Advocate Heart Institute and the Senior Medical Director of Cardiology of Advanced Medical Group (AMG). AMG is ranked as one of the top five health systems in the US and has 140 physicians in cardiology practice! Let’s hear more from Dr. Bufalino! Tell us what you do at AMG. “We care for patients in 12 hospitals in the Chicago area. Last year, over 20,000 cardiac procedures were performed at AMG. We provide expert medical care to those with high blood pressure, high cholesterol, and diabetes. Our surgical program provides the latest in technology to provide the highest level of quality health care.”   Do you treat patients from all around the US? “We service most of northern Illinois and have outreach clinics even in the rural communities. Most of our patients are from this area, but some continue to access our care for follow-ups, even after they’ve moved to other states.”   What is meant by the term “heart disease”? “We look at risk factors, which are not managed as well as they should be. High cholesterol is very common, and we have many tools to treat it although not everyone needs to be on medications. Some people can be treated with diet and exercise, but those over age 35-40 with family risk factors should be evaluated. Those that are experiencing symptoms should be evaluated. The death rate from heart attacks has decreased from about 20% a few decades ago to just 2% today. Unfortunately, some patients develop heart failure and require advanced care, but there are still many treatment options available.”   What are some common signs and symptoms of heart attacks? “Exertion-related symptoms are common, like discomfort, pressure, tightness, and burning. The two most common symptoms are chest discomfort and shortness of breath. You should also pay attention to rapid heartbeat and fluttering in the chest. Acid indigestion CAN be a symptom, especially if it doesn’t subside when you take an antacid.”   What is a stroke? “Essentially, a stroke is damage to the brain, usually from a blood clot or a ruptured blood vessel. Sometimes a “warning” occurs, known as a TIA (transient ischemic attack). It is accompanied by numbness/weakness on one side, vision loss, and slurred speech. Time is critical since permanent damage can be done. Within the first 60-90 minutes, we can intervene and dissolve the clot.”   What are some procedures that Medicare allows to detect heart disease? “For those over age 65, an ultrasound is allowed to assess the risk of Abdominal Aortic Aneurysm (AAA), which is the ballooning of the main artery going down into the abdomen. The ultrasound detects any enlargement of the aorta. Those with a family history of aneurysm, men with high blood pressure, and smokers have an increased risk.”   Can you explain the Cardiac Disease Screening under Medicare? “There is a ‘Welcome to Medicare’ physical exam that is allowed during the 12-month period after you turn 65. There are also nutritional therapy services available, and most people don’t even know about them or take advantage of them. The purpose is to try to give people tips that can make a difference and help them live healthier lifestyles.”   How is salt tied to heart disease? “Salt is tied to high blood pressure, and this isn’t just from the salt shaker! Sodium is packed into processed foods, so it’s important to read labels.”   You were president of the American Heart Association in Illinois. How can the AHA help people? “The AHA supports the work we do at AMG with patient education and research. Their website offers resources and even cookbooks. Find them at www.heart.org.”    Do you have any tips that people can follow RIGHT NOW to prevent heart disease? “The two most important things are to eat better and exercise more.” Resources: www.heart.org www.advocatehealthcare.com www.meetup.com  (Find walking groups all around the country.)   Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)       Find out more information about Medicare on Diane Daniel’s website!  www.CallSamm.com    

Guest: Dr. Ilan Wittstein. Cardiologist and Assistant Professor of Medicine at The Johns Hopkins University School of Medicine and its Heart Institute. Lead author of a study on Broken Heart Syndrome. See omnystudio.com/listener for privacy information.