Podcasts about i'm dr

The boys argue over who is more white trash, $50k NBA fines for mean DMs, and how to suck your way into becoming a billionaire

Is it safe to go to the doctor's office at this point during COVID-19? In this episode, I will discuss this issue and hear from a hypertensive expert about primary care and blood pressure control.COVID-19 Symptom Tracker App https://covid.joinzoe.com/us-2****Ask your doctor if you would benefit from vitamins:Vitamin C with rose hips, Zinc, D3 & K2, Magnesium or this one, B complex, Elderberry, Probiotic or this one, Melatonin & Quercetin, Braggs Nutritional Yeast, Apple Cider Vinegar If you enjoyed the podcast, please share and consider leaving a 5-star rating.Vitamin D Self Testing (no affiliation)****Click here to see how to use a home blood pressure monitor and log.Get a validated Omron Blood Pressure Monitor here for purchase online. Use Omron MIT Elite for pregnant women due to the altered hemodynamics.Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?****Hi, I'm Dr. Tonya, a clinical research scientist at the University of Alabama at Birmingham, Alabama, where I hold various positions and spent the past decade studying hypertension management. I am an author of six first-authored publications in scientific journals. You can read my work HERE. Connect with me on Facebook or Twitter. ****ResourcesCenter for Disease Control: Doctor Visits and Getting MedicinesCOVID19 Symptom Tracker App#officevistsafety #hypertension #COVID19SymptomTrackerApp ****Royalty-free music: Turn om My Swag 2 Intro by Mr. Willie Breaux****Disclaimer: This podcast is for educational purposes only and not intended to replace medical advice. Affiliate links support the podcast.

Let's talk about FDA's emergency use authorization. Hello, I'm Dr. Jeff Kingsley and welcome to another edition of Riding in Cars with Researchers. The FDA has the ability to get products to market faster in emergency situations. It’s called the emergency use authorization, or EUA.Normally research takes 7-10 years in human clinical trials before you would ever get FDA approval. In an era of a pandemic, this is being accelerated like I've never seen before. Sponsors are conducting what is called adaptive trial designs, where they're blending different phases of research. They are still following the normal safety protocols that we would - it's still a gated approach. But it enables faster turnaround times and faster collection of data.

Vitamin D deficiency, sufficiency, toxicity, and benefits. How would you know if you have enough vitamin D, why it's important to know, and what to do about it? I cover these topics and more in this episode referring to the vitamin D experts and other experts in their own words.While we wait on the vaccine to protect us from contracting COVID-19, new research has shown that vitamin D is likely protective against the virus and other illnesses. I tell you everything you ought to know in this episode. ****Ask your doctor if you would benefit from vitamins:Vitamin C with rose hips, Zinc, D3 & K2, Magnesium or this one, B complex, Elderberry, Probiotic or this one, Melatonin & Quercetin, Braggs Nutritional Yeast, Apple Cider Vinegar If you enjoyed the podcast, please share and consider leaving a 5-star rating.Vitamin D Self Testing (no affiliation)Butter beans give you 126 mg of magnesium per cup. Click here for how to cook butter beans in about an hour.****Click here to see how to use a home blood pressure monitor and log.Get a validated Omron Blood Pressure Monitor here for purchase online. Use Omron MIT Elite for pregnant women due to the altered hemodynamics.Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?****Hi, I'm Dr. Tonya, a clinical research scientist at the University of Alabama at Birmingham, Alabama, where I hold various positions and spent the past decade studying hypertension management. I am an author of six first-authored publications in scientific journals. You can read my work HERE. Connect with me on Facebook or Twitter. #relievestressandanxiety #drtonya #lowerhighbloodpressure #covid-19****ResourcesNational Institute of Health Vitamin D Fact Sheet for ConsumersVitamin D societyVitamin D for COVID-19: a case to answer?Adequate Levels of Vitamin D Reduces Complications, Death Among COVID-19 Patients#vitaminD #vitaminDtoxcitity****Royalty-free music: Turn om My Swag 2 Intro by Mr. Willie Breaux****Disclaimer: This podcast is for educational purposes only and not intended to replace medical advice. Affiliate links support the podcast.

Why do we need to feel like our world is falling apart to get serious in prayer? What if we prayed like our lives depended on it all the time? Because it does! This message on the prayer of Daniel in chapter 9 talks about that kind of prayer. The book of Daniel is full of amazing stories and predictions for the future so follow as we go through it together in this episode of Sermons at High Peak. I'm Dr. Kevin A. Purcell, pastor of High Peak Baptist Church in Valdese, NC. You can find us on the web, on Facebook, Instagram and Twitter. --- Send in a voice message: https://anchor.fm/high-peak/message

Hello, I'm Dr. Jeff Kingsley and welcome to another edition of Riding in Cars with Researchers. Let's talk about vaccine research! Traditional VaccinesThe vaccines that you and I have both received since childhood are derived from actual viruses or bacteria; they're derived from the actual thing that infects people. And they come in two basic forms. One is a little bit safer than the other, but they're both effective. Right now we are exploring an entirely new realm of vaccine research that is incredibly exciting, where we are in an era of genetics, the actual genetic code that could tell your body to make a very specific antibody to a very specific protein without you ever experiencing any exposure to the actual virus or bacteria. So in COVID-19 research right now, we are doing that. How does DNA Play a Part?We all remember learning about DNA in school - it's our genetic code. And we also have RNA in our bodies. RNA reads the DNA, and then it shuttles it to the machinery in your body that can generate antibodies. The vaccine research we're doing today is using messenger RNA. We are taking snippets of SARS-CoV-2, the virus that causes COVID-19, and we're taking very specific snippets of the genetic code for the spike protein so that your body will make antibodies not to the whole virus, not to random pieces of the virus, but very specifically to the piece that it uses to infect you. And so in doing so, your body, in getting the vaccine, is never exposed to the entire virus. You're never exposed to the whole thing! Fascinating area of research and super exciting! I love the research we're doing right now, including the vaccine research we're doing right now.

What if you woke up in the future and the world was falling apart with some tiny country now a world power threatening to destroy the USA? That's the vision Daniel received in chapter 8. Why does God give us prophecy of such disastrous events? The book of Daniel is full of amazing stories and predictions for the future so follow as we go through it together in this episode of Sermons at High Peak. I'm Dr. Kevin A. Purcell, pastor of High Peak Baptist Church in Valdese, NC. You can find us on the web, on Facebook, Instagram and Twitter. --- Send in a voice message: https://anchor.fm/high-peak/message

Should You Trust Office Blood Pressure Measurements? In this episode, I will discuss the new hypertension guidelines for office blood pressure measurements. I have included soundbites from the co-chair of the hypertension committee to help answer this question.****Ask your doctor if you would benefit from vitamins:Vitamin C with rose hips, Zinc, D3 & K2, Magnesium or this one, B complex, Elderberry, Probiotic or this one, Melatonin & Quercetin, Braggs Nutritional Yeast, Apple Cider Vinegar If you enjoyed the podcast, please share and consider leaving a 5-star rating.Vitamin D Self Testing (no affiliation)Butter beans give you 126 mg of magnesium per cup. Click here for how to cook butter beans in about an hour.****Click here to see how to use a home blood pressure monitor and log.Get a validated Omron Blood Pressure Monitor here for purchase online. Use Omron MIT Elite for pregnant women due to the altered hemodynamics.Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?****Hi, I'm Dr. Tonya, a clinical research scientist at the University of Alabama at Birmingham, Alabama, where I hold various positions and spent the past decade studying hypertension management. I am an author of six first-authored publications in scientific journals. You can read my work HERE. Connect with me on Facebook or Twitter. #relievestressandanxiety #drtonya #lowerhighbloodpressure #covid-19****Resources10 Year Cardiovascular Risk Calculator2017 Hypertension GuidelinesNew Guidelines for Proper Blood Pressure Measurement****Royalty-free music: Turn om My Swag 2 Intro by Mr. Willie Breaux****Disclaimer: This podcast is for educational purposes only and not intended to replace medical advice. Affiliate links support the podcast.

I'm Dr. Jeff Kingsley and welcome to another edition of Riding in Cars with Researchers. Let's discuss the difference between the treatment trials for COVID-19 and the vaccine trials for COVID-19 19. The treatment trials we're doing for COVID-19 are with monoclonal antibodies. So what we're doing is we're taking known antibodies that can bind the right receptor, bind the right protein, and give you protection from COVID-19. And we're giving you the antibody! If you've gotten infected with COVID-19, your body has not yet figured out how to defeat it. We can jumpstart you by giving you an antibody that is designed to be effective in defeating COVID-19. It's different in vaccine research where we're giving your body a chance to build its own immunity, build its own antibodies, in advance of you ever getting COVID-19. So if you get COVID-19, we're trying to give you an antibody in advance of your own body's ability to figure it out and say, “Hey, let's help you out here.” And in vaccine research, we're trying to get your body to develop that very same antibody, the right antibody in advance of you having ever randomly come in contact with COVID-19 in your community, your workplace, your household. So that if you do come in contact with it, you've already got the antibodies and the virus can't infect you because of that. That's the similarity and the slight difference between our treatment of research and our vaccine research.

I'm Dr. Jeff Kingsley and welcome to another edition of Riding in Cars with Researchers. Do you want to know how we're coming up with therapies and vaccines for treating COVID-19 with therapies?We are literally looking at patients who actually survived COVID-19. And their body made the right antibodies and got rid of it. They defeated it and beat the virus. So what scientists are doing is they're taking blood samples from patients who succeeded in defeating COVID-19, and they're looking at all of the antibodies. Anytime your body sees something that is “not you” (a bacteria is not you; a virus is not you). Your body is continuously looking for threats; things that are not you. When your body sees something that it says, “Hey, this shouldn't be here; this is not me”, your body then randomly starts making antibodies to it. Most of the antibodies you make are worthless. Your body makes an antibody to a protein on a cell surface that does nothing. That antibody successfully grabs a protein, but it doesn't make a difference because that protein wasn't actually meaningful, that protein didn't have any influence in that virus's ability to infect you. So that antibody was a waste of your time. And then as you continue to be sick, your body stumbles upon an antibody that effectively defeats the virus, it hits the right protein. So what we've done is look at patients who successfully beat the virus, looked at all of their antibodies, tested all of their antibodies against the virus, and found out which antibodies actually made a difference. And then once we're able to see one that one works, found the antibody that was really successful into feeding the virus, we can then turn that into a treatment for you. That's how we're figuring out rapidly how to defeat this virus and then cr

What Can You Do Now to Relieve Stress, Anxiety, & High Blood Pressure? There's a lot going that might be causing unnecessary stress, anxiety, and blood pressure higher than your target goal. Here are some easy solutions that are not medical advice. I will tell you exactly what to do.Never do anything without your doctor's advice especially if you have a chronic illness.****Ask your doctor if you would benefit from vitamins:Vitamin C with rose hips, Zinc, D3 & K2, Magnesium or this one, B complex, Elderberry, Probiotic or this one, Melatonin & Quercetin, Braggs Nutritional Yeast, Apple Cider Vinegar If you enjoyed the podcast, please share and consider leaving a 5-star rating.Vitamin D Self Testing (no affiliation)Butter beans give you 126 mg of magnesium per cup. Click here for how to cook butter beans in about an hour.****Click here to see how to use a home blood pressure monitor and log.You can purchase an Omron Blood Pressure Monitor from any big box store or pharmacy. Click here for purchase online. Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?****Hi, I'm Dr. Tonya, a clinical research scientist at the University of Alabama at Birmingham, Alabama, where I hold various positions and spent the past decade studying hypertension management. I am an author of six first-authored publications in scientific journals. You can read my work HERE. Connect with me on Facebook or Twitter. #relievestressandanxiety #drtonya #lowerhighbloodpressure #covid-19****Resources****Royalty-free music: Turn om My Swag 2 Intro by Mr. Willie Breaux****Disclaimer: This podcast is for educational purposes only and not intended to replace medical advice. Affiliate links support the podcast.

What happens when the beasts get out of their cage? We look at the 4 beasts prophesied in Daniel's vision in chapter 7 and what they mean, who they were and why it matters today. The book of Daniel is full of amazing stories and predictions for the future so follow as we go through it together in this episode of Sermons at High Peak. I'm Dr. Kevin A. Purcell, pastor of High Peak Baptist Church in Valdese, NC. You can find us on the web, on Facebook, Instagram and Twitter. --- Send in a voice message: https://anchor.fm/high-peak/message

What's the Best Time to Take Your Blood Pressure Medicine? In this episode, I will tell you the best time to take your blood pressure medicine and why it's important. ****I announced the winner to Fonceur's newly released book Eat to Prevent and Control Disease. It is on sale now on Amazon. ****Hypertension Resistant to Treatment podcast, website, and YouTube channel: Helping You Find Knowledge, Resources & Support for Good Blood Pressure Control to Delay Medication Treatment or Reduce & Potentially Eliminate Medication****Ask your doctor if you would benefit from vitamins:Vitamin C with rose hips, Zinc, D3 & K2, Magnesium or this one, B complex, Elderberry, Probiotic or this one, Melatonin & QuercetinIf you enjoyed the podcast, please share and consider leaving a 5-star rating.****Click here to see how to use a home blood pressure monitor and log.You can purchase an Omron Blood Pressure Monitor from any big box store or pharmacy. Click here for purchase online. Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?****Hi, I'm Dr. Tonya, a clinical research scientist at the University of Alabama at Birmingham, Alabama, where I hold various positions and spent the past decade studying hypertension management. I am an author of six first-authored publications in scientific journals. You can read my work HERE. Connect with me on Facebook or Twitter. #whentotakebloodpressuremedicine #drtonya #hypertensionresistanttotreatment****Resources****Royalty-free music: Turn om My Swag 2 Intro by Mr. Willie Breaux****Disclaimer: This podcast is for educational purposes only and not intended to replace medical advice. Affiliate links support the podcast.#besttimetotakebpmedicine #melatonin #highbloodpressuremedicine

Hello! I'm Dr. Jeff Kingsley and welcome to another edition of Riding in Cars with Researchers in the midst of a COVID-19 pandemic. I've stopped doing lots of videos because frankly, I haven't been riding in cars, but it's time. I'm actually heading into the office right now to see some COVID-19 patients. We are treating COVID-19 positive patients. We are diagnosing patients. We are trying to prevent family members from being able to get COVID-19 from other family members in the same household who are COVID-19 positive. And we are doing vaccine trials. It's insane, but this is what you do in a pandemic. This is why we do research!What most companies call a mission statement is what I call a passionate cause. Our company's passionate cause is revolutionizing research and changing lives. And in a pandemic, how do you revolutionize research and change lives? Well, you lease extra real estate, you hire as many people as you can, and you begin becoming a force to reckon within the community and in the industry. We are doing free COVID-19 testing for everyone, all commerce, in the community. And we are doing diagnostic testing trials to find better tests for diagnosing patients with COVID. We're doing antibody and antigen tests. We're doing treatment trials, prophylaxis trials, and vaccine trials. That's how you revolutionize research. This is a therapeutic area that didn't exist eight months ago and the world needs desperately needs this research. Hence, that's what we're doing. We have leased more real estate, we have rearranged our largest office by literally moving people to different floors, rearranged rooms and storage to keep our healthy patients separated from our COVID-19 positive patients and to facilitate excellence in research. We're adding technology, adding all sorts of resources. That's how you revolutionize research.

What to Eat For High Blood Pressure: Pharmacist Reveals Top Superfoods?In this episode, I interviewed La Fonceur, a pharmacist in India, who reveals top superfoods for blood pressure control to prevent and control high blood pressure. She tells us what we ought to know about superfoods and hypertension for good blood pressure control. This is more than information about the Dietary Approaches to Stop Hypertension.La Fonceur is the author of the book series Eat So What! and Secret of Healthy Hair, a dance artist, and a health blogger. She has a master's degree in Pharmacy. She specialized in Pharmaceutical Technology and worked as a research scientist in the research and development department. She is also a registered pharmacist. Being a research scientist, she has worked closely with drugs. Based on her experience, she believes that one can prevent most of the diseases with nutritious vegetarian foods and a healthy lifestyle.****Go to hypertensionresistanttotreatment.com and follow the instructions in the podcast for a chance to win La Fonceur's newly released book Eat to Prevent and Control Disease. It is on sale now on Amazon. Enter the contest for a chance to win by midnight on Tuesday 9/8/2020. ****Hypertension Resistant to Treatment podcast, website, and YouTube channel: Helping You Find Knowledge, Resources & Support for Good Blood Pressure Control to Delay Medication Treatment or Reduce & Potentially Eliminate Medication****Ask your doctor if you would benefit from vitamins:Vitamin C with rose hips, Zinc, D3 & K2, Magnesium or this one, B complex, Elderberry, Probiotic or this one, Melatonin & QuercetinIf you enjoyed the podcast, please share and consider leaving a 5-star rating.****Click here to see how to use a home blood pressure monitor and log.You can purchase an Omron Blood Pressure Monitor from any big box store or pharmacy. Click here for purchase online. Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?****Hi, I'm Dr. Tonya, a clinical research scientist at the University of Alabama at Birmingham, Alabama, where I hold various positions and spent the past decade studying hypertension management. I am an author of six first-authored publications in scientific journals. You can read my work HERE. Connect with me on Facebook or Twitter. ****Royalty-free music: Turn om My Swag 2 Intro by Mr. Willie Breaux****Disclaimer: This podcast is for educational purposes only and not intended to replace medical advice. Affiliate links support the podcast.#superfoods #diet&bloodpressure #highbloodpressurediet

Remember the story of Daniel in the Lions Den? There's so much more to that story that we think about or hear as children. You've got a king who trusts a servant, but his other servants are jealous so they plot against him. There's a servant of God who trusts God so much, he's willing to hang out with hungry lions all night. Finally, you have a God who knows it all and has a plan. Find out more about it in this message from Daniel 6. The book of Daniel is full of amazing stories and predictions for the future so follow as we go through it together in this episode of Sermons at High Peak. I'm Dr. Kevin A. Purcell, pastor of High Peak Baptist Church in Valdese, NC. You can find us on the web, on Facebook, Instagram and Twitter. --- Send in a voice message: https://anchor.fm/high-peak/message

If you play games with God and don't humble yourself before him, then you will find out that there are serious consequences. God doesn't take his glory lightly and King Belshazzar of Babylon learned that the hard way while Daniel learned how God blesses His faithful followers. The book of Daniel is full of amazing stories and predictions for the future so follow as we go through it together in this episode of Sermons at High Peak. I'm Dr. Kevin A. Purcell, pastor of High Peak Baptist Church in Valdese, NC. You can find us on the web, on Facebook, Instagram and Twitter. --- Send in a voice message: https://anchor.fm/high-peak/message

CBD & Blood Pressure Control: A Pharmacist Perspective. Cannabidiol (CBD) is a cannabis product that has been in the news lately. Famous doctors such as Dr. Oz and Dr. Sanjay Gupta have supported the use of CBD to treat various diseases. In this episode, I interviewed La Fonceur, a pharmacist in India, who gives her perspective and recommendations. In the next episode, she will be telling us what we ought to know about superfoods and hypertension for good blood pressure control.Remember, this is not medical advice, and only your doctor can tell you what you need to do for your high blood pressure. Consult your doctor or health care provider for medical advice. Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?Click here to see how to use a home blood pressure monitor and log.You can purchase an Omron Blood Pressure Monitor from any big box store or pharmacy. Click here for purchase online.Ask your doctor if you would benefit from vitamins: Vitamin C with rose hips, Zinc, D3 & K2, Magnesium or this one, B complex, Elderberry, Probiotic or this one, Melatonin, & Quercetin#cbd #cbd&bloodpressure #cbdsideeffectsIf you liked this podcast, please give it a rating and share it with anyone who would benefit.****Hi, I'm Dr. Tonya. Thank you for listening! Hypertension Resistant to Treatment podcast is for everyday people to learn what everybody ought to know about hypertension. Then, you can take action to get good blood pressure control without excessive medications; so, you can be healthier and create your happiness in life! At Hypertension Resistant to Treatment podcast, website, and YouTube channel, you will get knowledge, training, resources, and support so you can live free from high blood pressure and its complications. Visit hypertensionresistanttotreatment.com for more detailed information. After about ten years of conducting hypertension research, I realized some fascinating conclusions. I found that the average person goes through a bit of resistance when told they have high blood pressure and that perhaps we were missing essential opportunities when helping people with high blood pressure. Hypertension Resistant to Treatment website, podcast, and YouTube channel are the results of my relentless attempt to tell you everything you ought to know about high blood pressure, train you about what to do to manage your blood pressure, and support you. At the same time, you work with your health provider to obtain good blood pressure control. ****Royalty-free music: Turn om My Swag 2 ****Subscribe to this podcast to get WEEKLY transforming information, and share the website and podcast with ANYONE who could benefit from it. You can read my work HERE at this link, including my published studies from the landmarked Systolic Blood Pressure Intervention.

Hello Everyone! Welcome to Regenerate You, I'm Dr. Nirvana.Even though you've probably got the hang of your cycle by now, chances are that some menstrual mysteries remain in question. Maybe your cycle is super long or short, or it's irregular, or it comes with side effects like PMS—and you wonder if what you experience each month is normal. Or maybe new issues have cropped up, like really awful cramps or a heavier flow. It's important to pay attention to what's normal and what isn't during your cycle, because changes can provide clues to your overall health. On this episode, I discuss the basic information you need to know, to help clear up the confusion about your periods once and for all!If you're looking for additional advice, feel free to visit my blog here. You can also stay connected with me on my Facebook page @DrNirvanaHeals or on my Instagram @DrNirvana.Please remember to subscribe! And remember, when you regenerate, there's a new you every day!

Hello Everyone, welcome to Regenerate You, I'm Dr. Nirvana!On this episode, I sit down with two of my very favorite ladies from the Resting Mind. We discuss how they help women heal their anxiety through simple approaches by creating habits for sustainable change.This interview is longer than my normal episodes, but if you're ready to focus on you again, without apology, to heal your anxiety; then this Podcast is a must-listen! Jackie & Mimi will help you to bridge the gap between your conscious goals and your subconscious settings (the things that keep you stuck), so you can have the life you want! They offer easy techniques you can use every day, that result in releasing unhealthy habits!You can find out more about Jackie & Mimi on their podcast, website, or join their FB Group! They're a wealth of scientific information while incorporating emotion and environmental habits as well.If you’re looking for additional advice, feel free to visit my blog here. You can also stay connected with me on my Facebook page @DrNirvanaHeals or on my Instagram @DrNirvana.And remember, when you Regenerate, there's a new you every day!

ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer. 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. Cancer research discussed in this podcast is ongoing, so clinical trials described here may no longer be enrolling patients, and final results are not yet available.   Before any new cancer treatment can be approved for general use, it must be studied in a clinical trial in order to prove it is safe and effective. In today’s podcast, members of the Cancer.Net Editorial Board discuss 3 clinical trials that are exploring new treatment options across prostate, germ cell, and kidney cancer. This podcast will be led by Dr. Sumanta (Monty) Pal, Dr. Neeraj Agarwal, Dr. Timothy Gilligan, and Dr. Tian Zhang. Dr. Pal is co-director of City of Hope's Kidney Cancer Program and is the head of the kidney and bladder cancer disease team at the institution. He has served in a consulting or advisory role for Astellas Pharma, and Bristol-Myers Squibb. Dr. Agarwal directs the Genitourinary Oncology Program at the Huntsman Cancer Institute at the University of Utah. He has served in a consulting or advisory role for Astellas Pharma, Bristol-Myers Squibb, Nektar Therapeutics, and Merck. Dr. Gilligan is an Associate Professor and Medical Oncologist at the Cleveland Clinic Taussig Cancer Center. He has no relevant relationships to disclose. Dr. Zhang is an assistant professor of medicine at Duke University School of Medicine and is a medical oncologist at Duke Cancer Institute. She has served in a consulting or advisory role for Bristol-Myers Squibb and Merck. View full disclosures for Dr. Pal, Dr. Agarwal, Dr. Gilligan, and Dr. Zhang at Cancer.Net. Dr. Pal: Hi. I'm Dr. Monty Pal from the City of Hope. I'm joined today by Dr. Neeraj Agarwal from the Huntsman Cancer Institute and University of Utah, Dr. Timothy Gilligan from the Cleveland Clinic Taussig Cancer Institute, and Dr. Tian Zhang from Duke Cancer Institute. Today we're going to discuss 3 ongoing clinical trials in prostate, germ cell, and kidney cancer. As you may know, clinical trials are the main way that doctors are able to find better treatment for diseases like cancer. Patient participation is vital for clinical trials. By participating in a clinical trial, you can directly help researchers develop better treatment, reduce side effects, and even reduce the risk of cancer altogether. The 3 trials we'll discuss today were chosen by members of the Cancer.Net Editorial Board Genitourinary Cancers Panel from the trials in progress abstracts that were presented at ASCO's 2020 Genitourinary Cancers Symposium. Because these are ongoing clinical trials, final results from these studies are not available yet. I'd like to note that none of us have any direct involvement with any of these trials. To view our full disclosures, please visit the show notes for the episode on Cancer.Net. Now, the first trial we're going to discuss is the KEYNOTE-641 trial for prostate cancer.  [Study of Pembrolizumab (MK-3475) Plus Enzalutamide Versus Placebo Plus Enzalutamide in Participants With Metastatic Castration-resistant Prostate Cancer (mCRPC) (MK-3475-641/KEYNOTE-641)] Dr. Agarwal, can you tell us who this study is designed for? Dr. Agarwal: This trial is designed for patients with advanced prostate cancer, or metastatic prostate cancer, who are experiencing disease progression on standard androgen deprivation therapy, a state known as castrate resistant prostate cancer. Dr. Pal: And if you see these patients in your clinic right now, what is the current standard of care? Dr. Agarwal: The most commonly utilized [treatments for] these patients include drugs which block androgen signaling inside the prostate cancer cell. And one of the most commonly utilized drugs is enzalutamide followed by abiraterone. Dr. Pal: Tell us a little bit about how this particular study aims to improve or change the current standard of care. Dr. Agarwal: Early clinical data showed that adding the immunotherapy agent pembrolizumab to enzalutamide may improve survival outcomes. The response rates in that smaller study were meaningful and were very promising. Based on those earlier data, this trial has been designed and is asking two main questions. Number one, whether adding the immunotherapy agent pembrolizumab to enzalutamide will improve overall survival. And the second question is, whether adding pembrolizumab to enzalutamide will delay disease progression. Dr. Pal: Are there any risks that patients should be aware of with this regimen? Dr. Agarwal: Both agents are very commonly utilized for many years now in oncology clinics. Enzalutamide is an oral pill which blocks androgen signaling and is associated with side effects such as fatigue, muscle loss, bone loss, falls, and many others which are relatively easy to manage over time. Pembrolizumab is an intravenous therapy approved for multiple cancer types, and is associated with immune-related side effects. Many of these can be severe in 4 to 5 percent of patients receiving pembrolizumab. These can include diarrhea, abnormal liver function tests, or liver toxicity, a skin rash, lung toxicity, which can include pneumonitis [or lung inflammation]. But most of these side effects can be managed as long as they are promptly detected. So I think education and close monitoring with oncologists is the key for early prevention and management of the side effects. Dr. Pal: Those are great tenets, not just for this clinical trial but in using these agents in general. Thanks a lot. And final question for you, Dr. Agarwal. Is this trial still open right now? And if so, when do you think we might see some results from it? Dr. Agarwal: This trial is open across the United States and different parts of the world. And the primary results, early results, will be available, I'm hoping, in 2023, in the middle of 2023. Dr. Pal: Well thank you for that excellent overview, Dr. Agarwal. I'm going to turn my attention now to Dr. Gilligan to discuss a topic that we don't often have on this podcast. But this is nonetheless a critical disease space for us to discuss. Dr. Gilligan is going to tell us about the P3BEP clinical trial in testicular cancer. [Accelerated v's Standard BEP Chemotherapy for Patients With Intermediate and Poor-risk Metastatic Germ Cell Tumours (P3BEP)] Dr. Gilligan, can you tell us a little bit about who this study is designed for? Dr. Gilligan: Yes, germ cell tumors are cancers that start in the reproductive cells, most commonly in testicles of adolescent or adult men. But germ cell tumors can also start in children - typically not in the testicles but elsewhere in the body - and they can start in women in the ovaries or elsewhere. In children, we sometimes see [germ cell tumors starting in the brain]. Those are not included in this trial. But basically, everybody else with germ cell tumors are eligible for this - men, women, and children - if they have a poor or intermediate prognosis. And just to clarify one more piece about that, this is for people who have advanced stage disease. Again, men, women, or children with advanced stage metastatic germ cell tumors, as long as it didn't start in the brain. And as long as their prognosis is in the intermediate or poor risk category, not the good risk category. Dr. Pal: So glad that you pointed that out, Tim. I have to tell you that I gave this incorrect label of a testicular cancer study, but critical for our listenership to know the germ cell tumors can occur both in males and females. Can you tell us a little bit about the current standard of care for the patients that are being [included] in this study? Dr. Gilligan: Absolutely. Chemotherapy for germ cell tumors has been one of the huge success stories of modern oncology, and the cure rate is extremely high. Overall, [we cure about 96% of men with testis cancer.] However, when you start to look at advanced stage disease in intermediate and poor risk patients, the success rate goes down. It's about a 75% cure rate for patients with intermediate risk tumors and 60% for [those with] poor risk tumors. The standard of care has been the same for a long time. It's 4 cycles of chemotherapy called BEP, and that's what has produced those results. And while those results are good, we would like them to be a lot better. Dr. Pal: So Dr. Gilligan, you've used this term intermediate and poor risk in the context of patients with germ cell tumor. Can you tell us a little bit about what intermediate and poor risk [means]? Dr. Gilligan: Yes, it's based mostly on where the cancer has spread to and how high certain blood tests are. There are things called tumor markers which are proteins in the blood that are made by the cancer, and the higher those levels, the worse the prognosis. Similarly, if the cancer has spread to certain organs, such as the liver or the bones or the brain, organs other than the lungs, then patients have a poorer outcome and a poorer prognosis. The last category is men and women who have certain germ cell tumors that grow in the chest called extragonadal tumors. They also have a prognosis that's not as good as other germ cell tumors. So it's a little bit complicated, and for patients, when you see your oncologist, they can clearly tell you which prognostic category you fall into. Dr. Pal: How does this study aim to improve or change the standard of care? Dr. Gilligan: So mainly we'd like to get those numbers better. And I think the key idea in this study is that with chemotherapy, which is different than the kinds of drugs we talked about in the prior conversation, the philosophy is to basically give patients as much of a dose as they can safely tolerate. And the idea of this trial is that if we give the chemotherapy more frequently - if we kind of squeeze together the cycles so that rather than every 3 weeks we're repeating it every 2 weeks - can we get a better response in killing the cancer without having too much toxicity? Dr. Pal: So they use this term in the title “accelerated.” Is that what you're referring to there? Dr. Gilligan: Yes. So if you think of chemotherapy as something that is repeated, we're repeating it sooner. And we used to give the patient 3 weeks to recover. On this trial, they're comparing that standard approach every 3 weeks to giving it every 2 weeks. In other words, we're making it denser. You get the chemotherapy faster. And the question is, will we cure more people that way or not? Dr. Pal: And Dr. Gilligan, any known risks that patients should be aware of as they [consider] a study like this? Dr. Gilligan: Well I think the risk with this approach is that we may increase toxicity without improving outcomes. Past attempts to do better than the standard treatment have not been successful. And the current standard treatment has been the standard for a long time as a result. We are hoping the new approach will be better, but we don't know until we try it, and it's possible that it will be more toxic. Dr. Pal: When do you think we might see some results from this? Dr. Gilligan: I don't know when we will see results. My guess is that it will be within a few years. Germ cell tumors grow quickly; they're aggressive cancers, so you tend to get your results pretty quickly, but I don't know exactly. Dr. Pal: Dr. Gilligan, thank you for that excellent overview. Last, but certainly not least, we're going to turn our attention to Dr. Tian Zhang for discussion of a very important study in kidney cancer. [A Study of Bempegaldesleukin (NKTR-214: BEMPEG) in Combination With Nivolumab Compared With the Investigator's Choice of a Tyrosine Kinase Inhibitor (TKI) Therapy (Either Sunitinib or Cabozantinib Monotherapy) for Advanced Metastatic Renal Cell Carcinoma (RCC)] Tell us a little bit about this study and who it's designed for. Dr. Zhang: PIVOT-09 is a study of a combination of a [novel] immunotherapy called bempegaldesleukin in combination with nivolumab compared to investigator-selected sunitinib or cabozantinib. So these are standard blood vessel blockers. The study is designed for patients with metastatic clear cell kidney cancer who have had no prior medication treatments and also measurable disease that can be followed on subsequent scans. Dr. Pal: And when you're seeing these patients in clinic with metastatic kidney cancer, what is the current standard of care? What are you using to treat patients these days? Dr. Zhang: We've known for a long time that kidney cancer will respond to these immune activating therapies, and [it has been demonstrated that a drug called IL-2, when given in high doses,] improved the overall survival for a subset of patients with metastatic kidney cancer and [produced] really durable complete responses for a small number of patients. However, it was highly, highly toxic, and there were lots of patients who ended up in the hospital. It had significant toxicities and patients were treated in the hospital for about a week at a time. So since about 2018, our standard of care immunotherapy options [have included] agents like ipilimumab and avelumab or the combination of pembrolizumab or avelumab with a blood vessel blocking agent. This is an easier way to give immune activating treatments in a more targeted fashion. [With this study we are testing] whether the IL-2 cytokine can be modified and given more in a more safe and effective manner. Dr. Pal: This is an interesting drug. If I understand it correctly, we're taking IL-2 from yesteryear, a drug that we used more than a decade ago to treat patients with advanced kidney cancer, and we're retooling it a bit for patients to really enhance the efficacy, maybe really enhance the safety of the compound as well. Can you tell us how this compound's doing that? Dr. Zhang: Right so bempegaldesleukin is a special formulation of IL-2. It's actually a pegylated form of the IL-2 cytokine, so it includes this polyethylene glycol molecule around the IL-2. And this pegylation allows that cytokine to be released slowly [in the bloodstream] so that in itself may improve the side effect profile. And then it also activates the tumor fighting subset of immune cells, T cells and natural killer cells in the tumor microenvironment, without activating other suppressive T cells. So the thought from preclinical studies is that bempegaldesleukin, because of its pegylated form, will actually decrease the side effects while activating the tumor fighting cells in the tumor microenvironment. Dr. Pal: And in this trial, how will success be evaluated? How will we know the treatment is working, that it's positive? Dr. Zhang: So the primary objective for this particular trial is a composite of objective responses as well as overall survival, and then secondary objectives include progression free survival - so lengthening time until disease progression - as well as evaluating the safety of the combination and the quality of life for patients who are treated on this combination. Dr. Pal: Now I remember IL-2, the drug that you referred to, from more than a decade ago, giving it to patients and certainly it came with a lot of toxicity. What are some of the toxicities of patients receiving bempegaldesleukin should be aware of? Dr. Zhang: Some of the early phase 1 trials that evaluated bempegaldesleukin found that some of the toxicities included low blood pressure as well as syncope where patients would feel lightheaded [or faint,] headaches, edema, swelling in their legs and fluid buildup, as well as infusion reactions. And I think we should also think about the immunotherapy-related toxicities of nivolumab where we're giving it in combination. So diarrhea, rashes, endocrine dysfunction are pretty common. So those would be some of the expected side effects of the immunotherapy cohort. And then we shouldn't forget about the control cohort treated with standard sunitinib or cabozantinib, and those side effects would include hypertension, hand foot syndrome or other rashes, diarrhea, nausea, hypothyroidism, and loss of protein in the urine. Dr. Pal: Right. Well a final question for you Dr. Zhang. Is this trial still open to patients, and if it is, when do you think we might see some results from it? Dr. Zhang: Yes, the trial is still open. It's enrolling up to 600 patients total and it's currently open globally in the U.S., Mexico, South America, Asia, Russia, and Australia. I'm hoping we will see results from this phase 3 trial in the next 2 to 3 years. Dr. Pal: Well thank you very much, Dr. Zhang, Dr. Gilligan, Dr. Agarwal. There are many different clinical trials currently enrolling people with genitourinary cancers. If you're wondering whether participating in a clinical trial might be right for you, please talk to your health care team. Thanks so much for listening. ASCO: Thank you, Drs. Pal, Agarwal, Gilligan, and Zhang. Visit www.cancer.net/clinicaltrials to learn more about participating in clinical trials. All treatments have side effects—please talk to your health care team about possible side effects to watch out for. And if this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play. This Cancer.Net podcast is part of the ASCO Podcast Network. This collection of 9 programs offers insight into the world of cancer care, covering a range of educational, inspirational, and scientific content. You can find all 9 shows, including this one, at podcast.asco.org. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/donate.

How Would Your Doctor Know When To Take You Off Of Medication?Remember, this is not medical advice, and only your doctor can tell you what you need to do for your high blood pressure. Consult your doctor or health care provider for medical advice. Ask your doctor if you would benefit from vitamins: Vitamin C with rose hips, Zinc, D3 & K2, Magnesium or this one, B complex, Elderberry, Probiotic or this one, Melatonin, & Quercetin#comingoffbloodpressuremedicine #hypertension #tipsforcomingoffmedicineIf you enjoyed the podcast, please share and consider leaving a 5-star rating.****Click here to see how to use a home blood pressure monitor and log. You can purchase an Omron Blood Pressure Monitor from any big box store or pharmacy. Click here for purchase online. Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat? **** At Hypertension Resistant to Treatment podcast, website, and YouTube channel, you will get knowledge, training, resources, and support so you can take action to get good blood pressure control. Visit hypertensionresistanttotreatment.com for more detailed information. ****Hi, I'm Dr. Tonya, a clinical research scientist at the University of Alabama at Birmingham, Alabama, where I hold various positions. I spent the past decade studying hypertension, home blood pressure monitoring and tracking, medication adherence, and readiness and confidence to change lifestyle behaviors. I am an author of six first-authored publications in scientific journals. I have collaborated with colleagues on three published studies with the finding from the landmark study that influenced the new hypertension guidelines released in 2017 (Systolic Blood Pressure Intervention[SPRINT] Trial. You can read my work HERE at this link https://www.ncbi.nlm.nih.gov/pubmed/?term=TONYA+BREAUX-SHROPSHIRE, including my published studies from the landmarked Systolic Blood Pressure Intervention (SPRINT) Trial. I created a blog, podcast, and YouTube channel for you to learn what everybody ought to know about hypertension. Connect with me on Facebook or Twitter. If you liked this podcast, please share it with anyone who could benefit from it. Join me every week for more hypertensionresistattotreatment.com podcast, and hit subscribe to get upcoming episodes immediately when released. Disclaimer: This podcast is for educational purposes only and not intended to replace medical advice. I have provided this content based on my clinical and research knowledge. Consult your health care provider for medical advice and treatment and before starting any nutritional supplements or lifestyle practice.

Do you find yourself wondering how people can live like animals? If you're not careful you might join them. Find out how to avoid such a fate by listening to our 4th sermon on the Book of Daniel. The book of Daniel is full of amazing stories and predictions for the future so follow as we go through it together in this episode of Sermons at High Peak. I'm Dr. Kevin A. Purcell, pastor of High Peak Baptist Church in Valdese, NC. You can find us on the web, on Facebook, Instagram and Twitter. --- Send in a voice message: https://anchor.fm/high-peak/message

Hello Everyone, welcome to Regenerate You, I'm Dr. Nirvana!On today's episode, I interview Matt Schifferle who is a Personal Efficiency Specialist offering fitness advice for those with insulin resistance and PCOS. He shares his tips on what exercises are best to do for PCOS while discussing why having a weight loss plateau is actually a good thing!His approach to fitness is not like most others in his field, because he offers an intuitive approach to working out that centers around nature. Matt is a breath of fresh air when it comes to his mission to helping those who struggle with weight loss. This interview is longer than my normal episodes, but if you're ready to learn how natural principles can help you attain your best fitness goals, sit back, relax and listen to what Matt has to share. You can find out more about Matt Shifferle on his website, IG page, or YouTube channel!If you’re looking for additional advice, feel free to visit my blog here. You can also stay connected with me on my Facebook page @DrNirvanaHeals or on my Instagram @DrNirvana.And remember, when you Regenerate, there's a new you every day!

Show Notes: Speaker 1: (00:00) Hey innovators. Welcome to episode number 30 of the simplified integration podcast. Is it time to move away from the mom and pop shop? Leonardo DaVinci once said that simplicity is the ultimate sophistication, and I agree you see the problem with the way that most consulting groups approach medical integration is anything but simple. In fact, it's the exact opposite. It's expensive, it's complicated. And quite frankly, it's exhausting enough is enough. There are far too many amazing integrated clinics that are struggling. I'm on a mission to change that when I've come to find from over five years, working with integrative practices is that simplicity really is the secret deal saying of less is more, is true through a streamlined approach. I was able to create multiple successful seven-figure integrated clinics. And now I'm going to show you how you can do the same. Join me as I share with you the secrets to successful medical integration and practice growth. Join me on a journey to greater sophistication through innovation. I'm Dr. Andrew Wells and welcome to the simplified integration podcast. Speaker 1: (01:09) Hey, what's going on doc. Great to have you back here today. So I want to talk about a struggle that a lot of chiropractors are dealing with in practice and what I call running a mom and pop shop. And there's a lot of different definitions of, of running a mom and pop business. And what I mean by this in the chiropractic sense is a business that you're sort of chained to a business that relies on you personally, to make sure that it operates and chiropractors have to wear a lot of different hats. They have to be the doctor, the exam doctor, the adjusting doc, the, you know, the marketer, the business person, sometimes the front desk person. There's a lot of different hats that we wear. And because of that, it keeps us tied to our office, physically tied to our office. And one of the biggest complaints I hear from chiropractors is, you know, I would love to have a life outside my practice. Speaker 1: (01:54) I would love to be able to take a day off or to go on vacation or not to have to be completely reliant on me, physically being in my practice. And that's a tough thing to break away from as a chiropractor. Uh, for the first couple of years, I had no idea how to do that. And, um, you know, I often, you know, people always ask me like, why did, why our chiropractor is only open Monday through Thursday? Like, I don't know if you guys have noticed this, but a lot of chiropractic offices, like they're open for four days and closed for three days. And I think, I think it's because chiropractic is so dang demanding that sometimes people need a three day weekend to feel normal. Um, but on the flip side of that, as you're also losing a day of production, you're losing a day of revenue. Speaker 1: (02:34) So it can be a really tricky balance in the chiropractic profession to run a profitable, profitable business, but also have a life outside of practice. And I talked to a lot of doctors who have been in practice for 20, 30 years, and they're really like, they're worn out, they're physically worn out. They're mentally worn out. They're spiritually worn out because they've just been giving, giving, giving so much to their patients and their practice. Uh, it can be just such a demanding role on your body. And I know that, um, I had, when I first got into practice, I had some doubt about being a chiropractor because just the, the hustle and the amount of work you had to put in. I'm like, man, I can't see myself doing this for the next 30 years. And this became really clear to me when, um, the, our first full right after our first two years in practice. Speaker 1: (03:22) So my wife and I, uh, got married right after I graduated school. We were working really hard to open our new, our new clinic. And I was never able to take my wife on a honeymoon. And I felt really guilty about that. And in my mind, like I always pictured, I got married and we'd drive to the airport and fly and go somewhere, like going on vacation for two weeks. And that was like, what I had envisioned for my wedding. The problem was this part of our life. We had zero time and we had zero money. We were working six days a week. We were, um, you know, we were making money, but we were plugging it all back into our business. And that's where all of our time and money went. And so sadly, my wife and I were like dying to take this, this honeymoon at the time, we were a part of a coaching group. Speaker 1: (04:06) And I remember one of our coaches like saying like, like really strongly recommending that we didn't take a honeymoon, which made no sense me. He's like, no, you need to plug into your business. You can't take time off you're you're only two years. I would never take, take time off on vacation in my first two years in practice. And I'm like, this sounds just sounds off. Right? And so finally my wife and I were like, all right, we're, we're doing this, we're going on vacation. And we, we set up our honeymoon over Christmas vacation because number one, I felt guilty about leaving my practice behind. And I felt like if I, if I gave up a week or two weeks of actual clinic time that our business was really going to suffer and the truth is it would have suffered, but not too much, like we could have made it happen, but you know, it was important for us to go on a honeymoon and take some time off together and just have a, you know, time for my wife and I to be alone. Speaker 1: (04:58) So we set this honeymoon up over Christmas vacation because that would have the least impact on our business. And we went, we flew to the Caribbean and had an awesome 10 day vacation, 10 day honeymoon. And I remember before I left, I called one of my, one of my coaches. And he's like, what? You're taking 10 days off from your clinic. Like how, like, how can you do that? It's such a bad mistake. I'm like, dude, this is my, this is my honeymoon. Like I owe this to my wife, my wife, and I want to do this. And it's like, well, that's a bad decision. I would never do that. That was the first time I'm like I'm done with his management company. Cause they could give like two craps about me as a person, like a normal person would say, that's exciting. Enjoy your honeymoon. Speaker 1: (05:38) But that was my first. That was like, that was like, yeah, this is probably not the right management group to be a part of. So I left that group. Um, but uh, yeah, I didn't want them making me feel guilty about going on vacation, but he was also right in some degree because as a mom and pop business, it's really tough to be able to take those types of vacations. So again, we did it over Christmas vacation, had the tea, it was, we were there for 10 days. Um, and we wanted to have the least amount of impact on our business. And we were in the Caribbean. Uh, we had an awesome, awesome time. We got to slow down, we got to refocus. Uh, it was great for our relationship. You know, I got to lay in a hammock. I actually got to read a fiction book for the first time in a long time, which I never had time to do. Speaker 1: (06:21) It was really, really, really nice. And it was good in a lot of ways. It was good for our physical, mental, spiritual health. Good for our relationship. I'm really glad we did it, but I also felt guilty because I had to put it off for so long. And so I remember thinking, I remember laying in the hammock on her honeymoon thinking like, how am I ever going to make this happen again? Cause I'm going to go right back to our clinic. It's going to be the same mom and pop operation. It's going to be very tough again to pull myself away from the practice. And I'm like, I really don't want to have to take a vacation every, every Christmas or to have to plan it over these holidays like that. Speaker 2: (06:56) And so this was one of the big, Speaker 1: (06:57) Um, the big things that got me exploring other options, other types of practices, other types of businesses, because I didn't want to be tied again, tied to my business. And so if you're listening to this and that is an issue that you're having, uh, it may be time to look at a different type of business model. And this is one of the things that got me looking into medical integration because, uh, medical integration, you know, the, the big promises are you can make more money and you don't have to be necessarily tied to your practice 24 seven. So that was really attractive to me. I've also talked to hundreds and hundreds of doctors all across the country docs who are new in practice docs who have been in practice for 30 years. And that's one of the struggles a lot of people do deal with. Speaker 1: (07:40) Is that how do you, how do you break away from your practice life and be able to enjoy your life outside of practice without stress or feeling guilty about, you know, doing things on your own time or actually having a life. How about that? Having a life outside of chiropractic? And so this is one of the things that pushed me into integration. And, um, I remember, you know, integration for us when we made the transition. It was tough. It was a ton of work. It was really, really difficult. But I remember the first day that I actually left practice during a work week, this was after we integrated. And I took the day off on Friday to go to a conference. And I remember being there. I was, I showed up to the office on Friday morning and I remember feeling like really scared, really nervous and really guilty about leaving. Speaker 1: (08:24) And it was just going to be for Friday. We had, in fact, we were only open for Friday morning for the Friday morning shift. And I remember my office manager looks at me. She goes like, what's wrong? And I'm like, I'm afraid to leave the practice. And she goes, it's going to be okay. We know what we're doing. So we had everything lined up. We had prepared for it. I had spent a lot of time developing my team and my staff. And they're all like dr. Wells, like, see you later, go away. Like we don't need you here anymore. And I'm like, I'm like really? And I had all these like fears. I used to that. And so, um, I left that morning and it felt so weird to be pulling away from my practice while the clinic was seeing patients and generating income and people were being taken care of and the staff was handling problems and it was amazing. Speaker 1: (09:09) And so I went, I was able to go have a conference over the weekend. I didn't go into the PR. I didn't see patients or help patients that Friday after Friday morning and everything was fine. And so the more I built up my practice and develop my team the more time I had to pull away from the clinic to work on, on the business, not in the business. And that's what so many chiropractors are after is to be able to do that and run your business as a business and not as a mom and pop shop, because once it becomes, once you move away from the Dr. Wells show or the dr. Smith show, whatever your name is, when you get away from that, it allows you to sort of elevate yourself above your clinic to now start developing it as a real business with systems and staff that can, that can run protocols and run programs for you. Speaker 1: (09:54) And it's an incredibly rewarding, it's a lot of work, but it's incredibly rewarding. And so now, you know, I'm in a position where I can, I've opened other businesses and I help other doctors open their businesses. I can do consulting and management work because I have a team that can do a lot of work for me. So, um, I don't know if this resonates with you, uh, if it does, um, you know, if it's something that you're struggling with and want to have a life outside of practice, or just maybe work on other businesses or expanding your business, uh, integration can be an awesome vehicle to do that. Um, it comes with challenges. It comes with risks, but, um, uh, just the nature of, uh, of operating a medical clinic or an integrated clinic, uh, you have to hire people. You have to hire medical, uh, service providers to do a lot of the work for you. Speaker 1: (10:40) So it forces you into moving away from the mom and pop shop. And on the other side of that is, you know, a financial reward and time freedom. Uh, just last year in October, we took a month off and went to Italy. So we were there for over a month. I would never, ever, ever be able to do that if we are in our mom and pop chiropractic shop. So there is all kinds of benefits from moving away from that type of business model. Um, if you're, if you're of that mindset and thinking that way out, highly encourage you to do some research and figure out if it's a right fit for you. If you have any questions or want to bounce some ideas off me or need some advice, I'm happy to help out any way I can. You can always email me@infoatintegrationsecrets.com. Again, that's info@integrationsecrets.com doc. Speaker 1: (11:25) I'm so grateful that you joined me on my podcast today. Thanks for tuning in. I look forward to seeing you on the next podcast episode. Hope you have a great day. God bless. Hey innovators. Thanks for listening to the simplified integration podcast fact that you're listening tells me that you're like me, someone who loves simplicity and the truth is those who embrace simplicity are some of the greatest innovators. So hope you got a ton of value from what we covered on today's episode. Be sure subscribe and share with other docs that you feel could benefit from greater sophistication through simplification and innovation. If you've got specific questions that you'd like answered on this podcast, or you've got specific topics that you'd like me to discuss, just shoot me an email at info@integrationsecrets.com that's info@integrationsecrets.com.

It got a little hot under the color for three young men, but they knew God would be with them in the fiery furnace. Here's the sermon from Daniel 3 in our series through Daniel. Do you have Amazing Faith? We all can if we want to. The book of Daniel is full of amazing stories and predictions for the future so follow as we go through it together in this episode of Sermons at High Peak. I'm Dr. Kevin A. Purcell, pastor of High Peak Baptist Church in Valdese, NC. You can find us on the web, on Facebook, Instagram and Twitter. --- Send in a voice message: https://anchor.fm/high-peak/message

Should You Ask Health Questions In Facebook Groups? In this episode, I will tell you what I think about asking health questions in a hypertension Facebook group. Be wise about the information you share on social media including Facebook groups because the information may be shared with unintended consequences. Remember, this is not medical advice, and only your doctor can tell you what you need to do for your high blood pressure. Consult your doctor or health care provider for medical advice. Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?Click here to see how to use a home blood pressure monitor and log.You can purchase an Omron Blood Pressure Monitor from any big box store or pharmacy. Click here for purchase online.Ask your doctor if you would benefit from vitamins: Vitamin C with rose hips, Zinc, D3 & K2, Magnesium or this one, B complex, Elderberry, Probiotic or this one, Melatonin, & QuercetinIf you enjoyed the podcast, please share and consider leaving a 5-star rating.****Hi, I'm Dr. Tonya. Thank you for listening! Hypertension Resistant to Treatment podcast is for everyday people to learn what everybody ought to know about hypertension. Then, you can take action to get good blood pressure control without excessive medications; so, you can be healthier and create your happiness in life! At Hypertension Resistant to Treatment podcast, website, and YouTube channel, you will get knowledge, training, resources, and support so you can live free from high blood pressure and its complications. Visit hypertensionresistanttotreatment.com for more detailed information. Hypertension Resistant to Treatment website, podcast, and YouTube channel are the results of my relentless attempt to tell you everything you ought to know about high blood pressure, train you about what to do to manage your blood pressure, and support you while you work with your health provider to obtain good blood pressure control. ****Royalty-free music: Turn om My Swag 2****Subscribe to this podcast to get WEEKLY, transforming information, and share the website and podcast with ANYONE who could benefit from it. You can read my work HERE at this link, including my published studies from the landmarked Systolic Blood Pressure Intervention (SPRINT) Trial.

Ever had such disturbing dream that you couldn't get back to sleep or maybe even were afraid to go back to sleep? The King in Daniel 2 had one of those and asked for the impossible from his advisors, but with God all things are possible. Find out how Daniel was able to help the King and how God helped Daniel in this amazing story in our sermon series on Daniel. The book of Daniel is full of amazing stories and predictions for the future so follow as we go through it together in this episode of Sermons at High Peak. I'm Dr. Kevin A. Purcell, pastor of High Peak Baptist Church in Valdese, NC. You can find us on the web, on Facebook, Instagram and Twitter. --- Send in a voice message: https://anchor.fm/high-peak/message

We live in a selfie world and not just in the way we take vacation photos. Look around and everyone's saying, "I gotta do me!" But when we look at the book of Daniel we see a different kind of call. This week I started looking at the book of Daniel. It's full of cool stories, scary visions of the end of time and more importantly a God who wants us. Get started with me in this first miracle about how to gain weight on a vegan diet. I'm Dr. Kevin A. Purcell, pastor of High Peak Baptist Church in Valdese, NC. You can find us on the web, on Facebook, Instagram and Twitter. --- Send in a voice message: https://anchor.fm/high-peak/message

Dr. John Sweetenham, medical oncologist at the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern Medical Center and chief editor of the ASCO Daily News, and Dr. Don Dizon, head of Women’s Cancers at Lifespan Cancer Institute in Rhode Island and editor of the ASCO Educational Book, discuss the extraordinary breadth of issues in oncology that are covered in this year’s Educational Book, which is a continuing resource for the seminal ASCO20 Virtual.    Transcript Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham, a medical oncologist at the UT Southwestern Simmons Cancer Center, and chief editor of ASCO Daily News. I'm pleased to be the guest host of the podcast today and to welcome my colleague, Dr. Don Dizon. He's head of women's cancers at Lifespan Cancer Institute in Rhode Island, and editor of the ASCO Educational Book. We'll discuss some of the compelling articles that have been published in the Educational Book, some of which are also going to be featured during the ASCO20 Virtual Education Program, and I'd also like to chat about important topics that perhaps aren't being covered during the program, but certainly deserve our attention. My guest and I report no conflicts of interest relating to the issues discussed in the podcast. Full disclosures relating to all Daily News podcasts are available on our episode pages. Don, it's great to have this opportunity to speak with you today. Dr Don Dizon: I'm really happy to be here. Thanks a lot. Dr. John Sweetenham: The ASCO Educational Book covers such an extraordinary breadth of issues from health services and quality improvement to symptom control, survivorship, and more. Can you tell us a little about what ASCO members can expect in the Educational Book this year? Dr. Don Dizon: Sure. I'm always happy to speak about the Educational Book. At its most germaine, what I think we have attempted to do is really live up to our ASCO President Skip Burris' vision of the approach to oncology, which is not approaching cancer with an individual's perspective, but really to bring in the multiple voices that are seminally important in everyone's experience with cancer. So we have strived very much, and our authors were exceptionally participatory in providing multidisciplinary articles on multiple cancer topics, as you just mentioned, so that the reader, who is importantly across the globe because the ASCO Educational Book is a free resource, can get that multiple perspective view on the topic related to malignancies. Dr. John Sweetenham: Can you tell us a little about some of the issues that maybe are not going to be covered in the program, but you believe are going to be very relevant to what we experience as oncologists today? Dr. Don Dizon: I think across the Educational Book, the topics that we dealt with are pretty detailed. Some of the ones that I think are of importance is a whole aspects of antibody drug conjugates, for example, which is covered in the developmental therapeutics track of the Educational Book, and there are multiple perspectives going from the basics of ADCs, all the way up to the clinical application of, not only FDA approved ones, but others that are in development. So that's very important, I believe. Global oncology is also covered, and although most of us are practicing perhaps in the United States, we have attempted to bring in multiple voices internationally because we recognize that ASCO serves an international audience, and its members are not limited to the United States. In the area of breast oncology, we attempted to really cover multiple topics that are relevant across the continuum of breast cancer, really paying attention to what subgroups are guiding therapy these days, whether that be the hormone positive subset, triple negative, the role of the immunotherapy, but also the approaches to metastatic breast cancer. So I believe that all throughout the Educational Book, you will find topics that are relevant, not only to the specialist, for a more contemporary view of where the field is at, but also very relevant for our folks who are in practice in our communities. Dr. John Sweetenham: Great, thank you, and I think one of the real strengths of the Educational Book is that it covers many of those topics that I would say we think about some of the time, but maybe we should be thinking of a little bit more. I'm thinking specifically of adolescent and young adults with cancer, fertility problems associated with cancer and its treatments, and then some of these 'softer issues,' such as communication with our patients, and more primary palliative care. Can you comment on some of those areas that are going to be covered in the Educational Book this year? Dr. Don Dizon: Yeah, absolutely, I think you had mentioned the issues concerning adolescents and young adults (with cancer), and certainly there are topics that are relevant for folks that we are hoping to cure and potentially are going to be alive for many, many decades. And I think for those folks, we do want to question the importance of addressing issues when we first meet them, rather than saving them for end of treatment, or even four or five years later. A classic example of that is fertility preservation, but equally important is the topic of sexual health in these patients, and I am very fortunate that our AYA topics did deal with these issues that aren't routinely discussed, but hopefully, this will really push our colleagues to embrace that these are important aspects. Same thing goes with palliative care, and the role of the oncologists in the delivery of care, particularly for patients who are not dealing with curative intent illness. And so I think the Educational Book, not only summarizes the field, but with multiple people generating that manuscript really drives home an action item, which again, is one of the things we were pretty cognizant about because at that end of the day, it's nice to have a summary, but it's more important to provide guidance. Dr. John Sweetenham: One of the other aspects of the Education Program as a whole that I really like this year is that I think that you and ASCO are tackling some issues which are a little more almost edgy and controversial, and I'm thinking in particular around issues such as disparities in access to care, gender disparities in the oncology workforce, which I think is a really interesting subject to address, and then some of my own kind of pet controversies, I guess, such as the use of real world data and cancer center advertising, which I think are all intriguing subjects to be covered in the Education Program. Can you comment just a little on how you decided to include those topics this year? Dr. Don Dizon: You know I will credit the Education Committee for branching out just beyond the science of oncology and really going into the practice, as well as the art of oncology. The Educational Book and the topics we cover are only as reflective of what the society feels is important for that annual meeting. And I think in this regard, leadership really did embrace a broad range of topics and tried to achieve one important aspect across all of them, health equity and the approach to patients no matter who they are and who they love and how they identify themselves in terms of health equity, it was all about achieving balance, in terms of who was invited to speak, who wrote articles for and with us, and also the way the language of the Educational Book was structured is very deliberate. We wanted to make a stance that there is a better way to write about oncology, and there's a better way to speak with each other. And I think you'll see this reflected, not only in the Education Session virtually, but hopefully you'll see that also approach in the Educational Book. So the book is a continuing resource, I think, for this seminal Education Program that was put together for 2020. Sadly, circumstances today led to the cancellation of the in-person meeting, but I think the Education Program virtually is going to be reflective of this exceptionally all encompassing view of oncology practice. Fortunately, the Education Program will live on for 2020 within the Educational Book. Dr. John Sweetenham: All right, thank you. You mentioned this extraordinary time. The moment in August of 2020. It's difficult to talk about oncology and not bring up the issue of COVID-19 and the pandemic. Can we expect to see that addressed in the Education Program this year? Dr. Don Dizon: The answer shortly is yes. The fact that the Education Program really worked to identify and address very contemporary issues is an important aspect of how reactive the program has had to be. So there are two sessions in the Education Program which are going to be really important, I think, for all of us. One from the trainees perspective and how programs are managing COVID-19's presence as we train the next generation of oncologists in our fellowship programs, this has, I'm sure, John, you feel the same.  It did impact the program here at Brown University, as it did, I'm sure, all across the country, and it's impacting how we select fellows for the coming year. Given that not everybody is able, willing, or should travel to meet with programs. So virtual interviews are on the horizon, and I think hearing from program directors about how they are going to manage that virtual aspect of interviewing, and more importantly, advice to people who are interviewing is going to be as important. I think one of the quickest collaborations in the history of medicine, especially oncology, was around COVID-19 and cancer, and there will also be a roundtable on that specific issue that is going to be a part of the Education Sessions this year. Dr. John Sweetenham: Yeah, I guess I hadn't really thought of it so much, but I guess that virtual interviews may require a very different skill set from the ones we use for our in-person interviews, right? Dr. Don Dizon: I think it will be. I'm a big advocate for social media, for example, but people have critiqued your background. Where you are selecting to do the interview might be important for program directors to get a better sense of who you are, but it also behooves us as clinicians to appear professionally as well when we're representing our programs.  Dr. John Sweetenham: Right, absolutely. Well, it's difficult to believe, but I think that we are just coming to the end of our time. Don, thank you for your time. It's been a real pleasure listening to you, and I just want to say congratulations on what I think is an outstanding Education Program. Very, very, very broad, and I think we're all going to learn a lot this year. Dr. Don Dizon: Thank you so much, John. It's always a pleasure to speak with you. Hopefully, next year we'll be in person. Just one other shout out that for the Education Program, just for everyone who's attending, 74% of the sessions that are going to be presented have a companion Educational Book article, and I'm exceptionally proud of that. Thank you very much, John. Dr. John Sweetenham: Thank you. That's outstanding, and thanks to our listeners for joining us today. Please take a moment to rate and review us on Apple Podcasts. Thanks again, and goodbye. Disclaimer: 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.   COI Disclosures: Dr. John Sweetenham Honoraria: Seattle Genetics Dr. Don Dizon Stock and Ownership Interests: InfiniteMD, NeuHope Consulting/Advisory: i-Mab, Clovis Oncology, AstraZeneca, Regeron, Tesaro, Merck, Sharp & Dohme, Bristol-Myers Squibb, Kazia Pharmaceuticals

High Blood Pressure Treatment & Pregnancy. In this episode, I will tell you what blood pressure medication to avoid in pregnancy and what could be safely substituted for methyldopa. Everybody is different and you should check with your doctor about your options.Remember, this is not medical advice, and only your doctor can tell you what you need to do for your high blood pressure. Consult your doctor or health care provider for medical advice. Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?Click here to see how to use a home blood pressure monitor and log.You can purchase an Omron Blood Pressure Monitor from any big box store or pharmacy. Click here for purchase online for adults. Click here to purchase a monitor that has been recommended for pregnant women.Ask your doctor if you would benefit from vitamins: Vitamin C with rose hips, Zinc, D3 & K2, Magnesium or this one, B complex, Elderberry, Probiotic or this one, Melatonin, & QuercetinIf you enjoyed the podcast, please share and consider leaving a 5-star rating.****Hi, I'm Dr. Tonya. Thank you for listening! Hypertension Resistant to Treatment podcast is for everyday people to learn what everybody ought to know about hypertension. Then, you can take action to get good blood pressure control without excessive medications; so, you can be healthier and create your happiness in life! At Hypertension Resistant to Treatment podcast, website, and YouTube channel, you will get knowledge, training, resources, and support so you can live free from high blood pressure and complications. Visit hypertensionresistanttotreatment.com for more detailed information. After about ten years of conducting hypertension research, I realized some fascinating conclusions. I found that the average person goes through a bit of resistance when told they have high blood pressure and that perhaps we were missing important opportunities when helping people with high blood pressure. Hypertension Resistant to Treatment website, podcast, and YouTube channel are the results of my relentless attempt to tell you everything you ought to know about high blood pressure, train you about what to do to manage your blood pressure, and support you while you work with your health provider to obtain good blood pressure control. ****Voiceover Intro and soon to be outro done by Mr. Willie Breaux, Jr.Royalty-free music: Turn om My Swag 2****Subscribe to this podcast to get WEEKLY, transforming information, and share the website and podcast with ANYONE who could benefit from it. You can read my research work HERE at this link, including my published studies from the landmarked Systolic Blood Pressure Intervention (SPRINT) Trial.

Blood pressure: How Low Is Too Low? In this episode, I will tell you what blood pressure is considered too low, according to science. Everybody is different, and you should check with your doctor about your parameters. At the end of this episode, I will give you a tip that we use in the clinic to screen for dehydration.Remember, this is not medical advice, and only your doctor can tell you what you need to do for your high blood pressure. Consult your doctor or health care provider for medical advice. ****Click here to see how to use a home blood pressure monitor and log. You can purchase an Omron Blood Pressure Monitor from any big box store or pharmacy. Click here for purchase online. Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?****Ask your doctor if you would benefit from vitamins: Vitamin C with rose hips, Zinc, D3 & K2, Magnesium or this one, B complex, Elderberry, Probiotic or this one, Melatonin, & Quercetin **** At Hypertension Resistant to Treatment podcast, website, and YouTube channel, you will get knowledge, training, resources, and support so you can take action to get good blood pressure control. Visit hypertensionresistanttotreatment.com for more detailed information. ****Hi, I'm Dr. Tonya, a clinical research scientist at the University of Alabama at Birmingham, Alabama, where I hold various positions. I spent the past decade studying hypertension, home blood pressure monitoring and tracking, medication adherence, and readiness and confidence to change lifestyle behaviors. I am an author of six first-authored publications in scientific journals. I have collaborated with colleagues on three published studies with the finding from the landmark study that influenced the new hypertension guidelines released in 2017 (Systolic Blood Pressure Intervention[SPRINT] Trial. You can read my work HERE at this link https://www.ncbi.nlm.nih.gov/pubmed/?term=TONYA+BREAUX-SHROPSHIRE, including my published studies from the landmarked Systolic Blood Pressure Intervention (SPRINT) Trial. **** I created a blog, podcast, and YouTube channel for you to learn what everybody ought to know about hypertension. Connect with me on Facebook or Twitter. If you liked this podcast, please share it with anyone who could benefit from it. **** Join me every week for more hypertensionresistattotreatment.com podcast, and hit subscribe to get upcoming episodes immediately when released. Voiceover Intro by Mr. Willie Breaux, Jr. Song: My SwagDisclaimer: This podcast is for educational purposes only and not intended to replace medical advice. I have provided this content based on my clinical and research knowledge. Consult your health care provider for medical advice and treatment and before starting any nutritional supplements or lifestyle practice.

ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer. 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. Cancer research discussed in this podcast is ongoing, so clinical trials described here may no longer be enrolling patients, and final results are not yet available.   Before any new cancer treatment can be approved for general use, it must be studied in a clinical trial in order to prove it is safe and effective. In today’s podcast, members of the Cancer.Net Editorial Board discuss 3 clinical trials that are exploring new treatment options across prostate, bladder, and kidney cancer. This podcast will be led by Dr. Timothy Gilligan, Dr. Sumanta (Monty) Pal, Dr. Petros Grivas, and Dr. Tian Zhang. Dr. Gilligan is an Associate Professor and Medical Oncologist at the Cleveland Clinic Taussig Cancer Center. He has no relevant relationships to disclose. Dr. Pal is co-director of City of Hope's Kidney Cancer Program and is the head of the kidney and bladder cancer disease team at the institution. He has served in a consulting or advisory role for Astellas Pharma, Exelixis, and Pfizer. Dr. Grivas is the clinical director of the Genitourinary Cancers Program at University of Washington Medicine. He is also an associate member of the clinical research division at the Fred Hutchinson Cancer Research Center. He has served in a consulting or advisory role for Exelixis, Merck, and Pfizer. Dr. Zhang is an assistant professor of medicine at Duke University School of Medicine and is a medical oncologist at Duke Cancer Institute. She has served in a consulting or advisory role for Exelixis, Merck, and Pfizer. View full disclosures for Dr. Gilligan, Dr. Pal, Dr. Grivas, and Dr. Zhang at Cancer.Net. Dr. Gilligan: Hi. I'm Dr. Timothy Gilligan from the Cleveland Clinic. I'm joined today by Dr. Monty Pal from the City of Hope Cancer Center, Dr. Petros Grivas from the Fred Hutchinson Cancer Research Center and University of Washington, and Dr. Tian Zhang from Duke Cancer Institute. Today, we're going to discuss three ongoing clinical trials in prostate, bladder, and kidney cancer. As you may know, clinical trials are the main way the doctors are able to find better treatment for cancer and other diseases. Patient participation is vital for clinical trials. By participating in a clinical trial, you can directly help researchers develop better treatment, reduce side effects, or even reduce the risk of cancer all together. The three trials we'll discuss today were chosen by members of the Cancer.Net Editorial Board Genitourinary Cancers Panel from the trials and progress abstracts that were presented at ASCO's 2020 Genitourinary Cancers Symposium. Because these are ongoing clinical trials, final results from these studies are not available yet. I'd like to note that none of us have any direct involvement with any of these trials. To view our full disclosures, please visit the show notes for this episode on Cancer.Net. So to get started, the first study we'll discuss is the TALAPRO-2 trial for prostate cancer, [Talazoparib + Enzalutamide vs. Enzalutamide Monotherapy in mCRPC (TALAPRO-2)] and Dr. Pal is going to discuss this. So if we could get started, just to begin with, who is the study designed for? Dr. Pal: Thanks a lot, Dr. Gilligan. Well, this study addresses a unique disease population. It's patients with prostate cancer that's metastatic, and that implies that the cancer has migrated out of the prostate to other organs. But beyond that, it also implies that these patients have also developed some resistance to first line hormone treatment. So patients in this study [have] so-called hormone resistant or castration resistant [prostate cancer]. Dr. Gilligan: So if a patient was in this situation, and they weren't going on this trial, what would be the standard treatment for them at this time? Dr. Pal: There are several options for these patients. Hormone therapies like abiraterone and enzalutamide could be considered. Chemotherapy is also a consideration. Dr. Gilligan: And can you say a little bit more about what the patients would receive if they went on it? The subjects of the study, what they'll get? Dr. Pal: Some patients with prostate cancer may have [a deficiency in their cancer’s ability to repair damage to DNA]. This is something that we've seen in other tumor types, breast cancer perhaps being the most notable example. Pancreatic cancer being another one. In this particular trial, [the researchers] try to exploit that by using a class of drugs called PARP inhibitors. In this case, a drug called talazoparib. So patients in this study receive a standard hormone therapy called enzalutamide. And they receive that with or without this drug, talazoparib. Dr. Gilligan: So they will get either-- what you described before is the standard of care—hormonal therapy, or that combined with this new drug. Dr. Pal: That's exactly right, Dr. Gilligan. Dr. Gilligan: I wanted to make that clear because this is a trial that has placebo, and sometimes research [participants] have concern about, "Do I want to be on a trial that has a placebo?" Do you want to say anything about that? Dr. Pal: It's very important to bear in mind that every patient that enrolls in this study is going to get the standard treatment in this setting. As I've mentioned before, enzalutamide represents one of those options. And, of course, in this trial above and beyond that, they have the possibility of getting talazoparib or a placebo. So certainly patients won't be receiving placebo alone in this trial. Dr. Gilligan: Do you want to say anything more about what's kind of interesting about this new approach to treating prostate cancer? Dr. Pal: What I think is quite inventive about this study is that talazoparib, the PARP inhibitor, is being combined with hormone therapy. And I think that's the real difference in what this protocol offers versus the treatment strategies that now represent a standard option for patients. Dr. Gilligan: Right. And my understanding is that the hope is that by using this combination, we'll be able to make treatment more effective. Dr. Pal: Absolutely. When we talk about PARP inhibitors and prostate cancer currently, we're typically restricting it to patients who have these so-called DNA damage repair mutations. And that's certainly a finite group of individuals. In this particular trial, we're actually going to look not just at those patients, but all patients within this disease state. So we go beyond the 25 to 30 percent of patients who are estimated to have alterations in DNA damage repair. Dr. Gilligan: Right. I think that's an important point: to get on this trial, patients don't have to have a particular genetic profile. So how will success be evaluated? How will we know if it's working? Dr. Pal: In this case, we're going to be looking at the delay in cancer growth as the primary outcome measure. We're certainly hoping that the combination of enzalutamide with talazoparib is going to slow growth relative to enzalutamide plus placebo. The innovative endpoint that's explored in this study is also diving deeper and looking at those patients who have these DNA damage repair mutations that's going to also reflect one of the primary outcome measures in this study. And that's something quite important to bear in mind. Dr. Gilligan: So we have some experience with PARP inhibitors. Can you say something about what we know about the side effects? Dr. Pal: Fatigue is a relatively common side effect. Decreases in blood counts is another potential side effect. And in particular in my clinical experience, I've seen drops in the white blood cell counts. That of course makes patients more susceptible to infection. Diarrhea may also be one of the consequences within this class of drugs. And certainly, I would refer patients to a more comprehensive discussion of these side effects with their clinicians before entering into the study. Dr. Gilligan: Is the trial still accruing patients? And do we know when we might expect results? Dr. Pal: I think that there are many trials within this particular space. This one is ambitious in that it hopes to accrue over a thousand patients. I don't have a good finger on the pulse of when results will report. But I'm sure that'll be the subject of future podcasts for us.  Dr. Gilligan: Well, thank you very much Dr. Pal. It's a very exciting study and exciting new area of research in prostate cancer. Dr. Pal: Definitely. Dr. Gilligan: We're going to move on now to the second study we want to talk about, which is the KEYNOTE-905 study. [Perioperative Pembrolizumab (MK-3475) Plus Cystectomy or Perioperative Pembrolizumab Plus Enfortumab Vedotin Plus Cystectomy Versus Cystectomy Alone in Cisplatin-ineligible Participants With Muscle-invasive Bladder Cancer (MK-3475-905/KEYNOTE-905/EV-303)] And Dr. Grivas is going to talk to us about that. Can you orient us, Dr. Grivas, to what this study is, for which group of patients, and what it's looking at? Dr. Grivas: This clinical trial is applicable to patients with localized, meaning not spread, bladder cancer. And when the bladder cancer has invaded the muscle layer of the bladder, we call this muscle invasive bladder cancer. And these patients usually go for cystectomy, the removal of the bladder. And ideally, they get chemotherapy before, but some patients may not be fit enough for chemotherapy. So those patients go straight to cystectomy, the removal of the bladder. So this clinical trial is trying to evaluate whether immunotherapy with this drug, called pembrolizumab, helps these patients before they get the cystectomy. Dr. Gilligan: Can you tell us a little bit more about pembrolizumab and what we know about it? Where it's used currently in bladder cancer? Dr. Grivas: Pembrolizumab has three different indications for patients with bladder cancer. The first one is in an earlier stage, what we call non-muscle invasive bladder cancer, which is a very superficial cancer, when the cancer is not invading through the muscle layer. And there's a specific indication for those patients who get therapy with BCG, which is a form of immunotherapy given inside the bladder. And if the cancer is not responding well to this BCG, usually, they go for removal of the bladder. But some of them may not be able to do that or do not want that. And pembrolizumab has a track record in those specific scenarios of BCG-unresponsive tumors as we call them for those patients who cannot get cystectomy or don't want to have it. The other two indications are for patients who have metastatic, [meaning bladder cancer that has spread to other organs.] And there are two specific indications of pembrolizumab immunotherapy in that particular setting. So this trial is trying to expand upon the role of pembrolizumab in bladder cancer. Dr. Gilligan: So it's been shown to be a benefit when the disease is more advanced and now we want to see if it's helpful earlier on in the period of time around surgery. Dr. Grivas: Right. And it's interesting in a particular setting we're looking at this trial, because we have indications literally before and after in an earlier states, the non-muscle invasive disease setting. And also as you mentioned, Dr. Gilligan, in the more advanced setting. So we're trying now to see whether this middle setting of muscle invasive bladder cancer, whether there's a role of pembrolizumab by itself before removing the bladder. Dr. Gilligan: Are patients who are eligible to get chemotherapy prior to cystectomy able to go on this trial or is it only for patients who are not [well enough] to get chemotherapy? Dr. Grivas: This is for patients who are not in good condition to undergo chemotherapy. So if someone is in good condition to undergo chemotherapy, then the trial does not apply to them. This is only in those who cannot safely receive chemotherapy before the cystectomy. Dr. Gilligan: Thank you for clarifying that. What data do we have that makes us think that it may be a good idea to give immunotherapy prior to cystectomy? Because this has been looked at a little bit already, and I think it's why this trial is being done. Can you say a little bit about that? Dr. Grivas: Sure. I would like to underline that as you alluded before, the standard of care therapy for patients who undergo cystectomy, the removal of the bladder, is to undergo chemotherapy with a drug called cisplatin before cystectomy. But as we discussed before, this is the standard of care with a high evidence. However, many patients, maybe 50, maybe 55 percent of patients may not have enough condition to undergo this chemotherapy safely. And that is the population we would try to capture. And to answer your question, there have been so far, four clinical trials looking at immunotherapy before cystectomy. And all of those four clinical trials look very promising in that regard. So based on this promising information, this new trial the KEYNOTE-905 is a phase III trial trying to confirm the promising data from the previous phase II trials and help us make a final decision whether this should be the standard of care or not in patients who cannot undergo safely chemotherapy in that setting. Dr. Gilligan: What are the known side effects and risks of immunotherapy? Dr. Grivas: Immunotherapy overall is much better tolerated than chemotherapy. However, it can still cause significant side effects, especially in a small proportion of patients. So the main thing we need to keep an eye on is if the immune system gets too overstimulated, it can cause what we call immunotherapy-related adverse events or side effects. And any organ of the body could in theory be attacked by an overstimulated, overactive, immune system. So they are different forms of “-itis.” For example, if you have inflammation in the lungs, it's pneumonitis. In the liver, hepatitis. So we have to be careful and educate our patients, educate our medical providers and the teams, follow the patients and then report any new symptoms for changes in order to be able to recognize early and manage properly these side effects. As I mentioned, it's not common to have a severe reaction, but it can happen. So education helps, and I recommend to the patients to discuss with a medical provider the potential of those immunotherapy-related adverse events that usually, if they occur, can be managed with proper treatment to try to suppress, “cool down,” the immune system. So education is important. Dr. Gilligan: So just to summarize then, this is a trial for patients who would normally be treated with surgery alone, and we're looking at whether adding immunotherapy before and after surgery can improve those outcomes. Dr. Grivas: That's exactly right. Especially for those patients who cannot safely undergo chemotherapy before the surgery. Dr. Gilligan: And how are we going to measure whether it's successful? Whether that immunotherapy has improved outcomes or not? Dr. Grivas: The two measures that we're are looking at in this particular trial are the following. Number one, we tried to see how many patients--what is the proportion of patients from everybody who gets in the trial—who has no residual cancer cells at the time of the removal of the bladder, at the cystectomy. When the pathologist looks at the cystectomy sample in the lab after the bladder is removed from the body, what is the proportion of patients with no cancer inside the bladder after the immunotherapy compared to no immunotherapy at all? So we're going to compare these. We call this “complete response,” meaning no cancer is found in the bladder after its been removed, after the immunotherapy. And we're going to compare this complete response in the two groups. The other metric we use is to see how many patients have no recurrence regardless, meaning the cancer came back after the treatment. After the cystectomy, how many of those patients either had the cancer come back later or died from another cause. So we use these metrics and we compare the two metrics in the two populations in the trial with and without immunotherapy before the surgery. Dr. Gilligan: And currently, the relapse rate's roughly 50 percent, so we're hoping for a lower number than that. Dr. Grivas: Correct. We try to look for a lower number, and we try to see to compare these two populations with and without immunotherapy and see if immunotherapy adds value in that particular setting. Dr. Gilligan: Is this trial still open and do you know when we might see results from it? Dr. Grivas: The trial is open. It started recently, so I will strongly encourage the patients to discuss with their providers and look at particular locations where this trial is open. So definitely, there is room to go. And I think the trial will take a few years to complete and then report the results. So definitely an ongoing trial options for the patients. Dr. Gilligan: Great. Well, thank you very much. So an exciting trial for patients with localized bladder cancer going through surgery to see if we can improve outcomes, increase the cure rate, by adding this interesting new immunotherapy. Thank you, Dr. Grivas. Dr. Grivas: Thank you so much. Dr. Gilligan: So now we're going to move on and talk about the COSMIC-313 trial with Dr. Zhang from the Duke Cancer Institute. [Study of Cabozantinib in Combination With Nivolumab and Ipilimumab in Patients With Previously Untreated Advanced or Metastatic Renal Cell Carcinoma (COSMIC-313)] Can you tell us who this trial is designed for, or which group of patients? Dr. Zhang: Absolutely. We know that for patients with kidney cancer with a clear cell component and intermediate or poor risk by IMDC criteria, that both immunotherapy combinations with ipilimumab and nivolumab as well as the targeted therapy blocking blood vessel formation, called cabozantinib, have both demonstrated significant benefit for these patients. And these are approved treatments. So this particular trial is attempting to combine these starting as a triplet of ipilimumab, nivolumab, cabozantinib for four cycles and then maintenance nivolumab with cabozantinib. And this triplet treatment is compared to a placebo-controlled regimen of the same immunotherapies without the targeted therapy. Dr. Gilligan: So if a patient weren't going to go on this trial, what's the current standard of care? Dr. Zhang: Both the immunotherapy combination as well as having the cabozantinib by itself, are our standard of care therapies for these patients in these categories. Dr. Gilligan: Is this restricted to any particular group of kidney cancer patients? Dr. Zhang: These patients must have at least one of the IMDC criterion. So these are markers of inflammation, like high neutrophil count, low hemoglobin, or high platelet levels, high calcium levels, as well as poor performance status in less than one year from diagnosis to needing these type of treatments. Patients have to have kidney cancer that spread to other sites of their body or locally advanced disease which is not surgically resectable. And as a note, other treatments that are approved in patients who have intermediate poor risk disease include combinations of immunotherapies with targeted therapies like pembrolizumab with axitinib or avelumab with axitinib. Dr. Gilligan: So then just to be clear, these are drugs that are already being used, have already been shown to work, and we're trying to see if we combine them do we get a better result than using them by themselves. Dr. Zhang: That's right. And I think that's a main point. If two agents work on their own, can they be combined to work better? It is important to note that we must follow these patients for their side effects to make sure that the benefit of the triplet therapy would be worth the potential added toxicity of this combination. Dr. Gilligan: So as you mentioned, there's already a standard treatment that includes targeted therapies, immunotherapies, axitinib and pembrolizumab. What do you think is the interesting or different about the approach in this study? Dr. Zhang: The main difference of this triplet combination is the addition of ipilimumab which is a CTLA 4 inhibitor. This is even a bit of a stronger immunotherapy, which targets the dendritic cell interaction with cells to activate the immune cells even more. And so we know that ipilimumab in kidney cancer does drive increase the ability for us to achieve a complete response, meaning that this combination is a really active immunotherapy combination for metastatic kidney cancer. So if we can add the ipilimumab effect with a very strong targeted effect of the cabozantinib the thought is that this triplet might be even more effective than the current standard of care, pembrolizumab-axitinib or avelumab-axitinib combinations. Dr. Gilligan: Thank you for clarifying that. Just to make sure our listeners are clear on this. They're two doublets that are already approved—two kinds of immunotherapy or immunotherapy combined with targeted therapy. This will be the first triplet, if I understand correctly, that if this is shown to be more effective, it would be the first triplet therapy where we're using three different agents, our strongest immunotherapy combined with targeted therapy. Is that a fair summary? Dr. Zhang: Absolutely. I think that's a great summary. Dr. Gilligan: So how will success be evaluated? What are the endpoints for this? Dr. Zhang: Success for this particular study will be evaluated by improving time until tumor growth and the safety of the triplet combination so the primary outcome of this particular study is improving progression free survival. But one of the key secondary endpoints, of course, is to make sure that the benefit of this triplet is worth the potential combined side effects. And then also to follow patients and see if it also improves survival to make patients live longer. Dr. Gilligan: Do we have any sense of how long it'll be before we see outcomes from this? Or results? Dr. Zhang: This is an ongoing international trial enrolling in the US but also spanning Europe, Asia, South America, Australia, and New Zealand sites. It will enroll up to 676 patients, and it's open currently. And patients should discuss it with their oncologist and see if it's open in a site close to them. Dr. Gilligan: Dr. Grivas earlier told us about some of the side effects or risks with immunotherapy. This is combining immunotherapy with targeted therapy. Can you say a little bit about what we're gonna be watching for in terms of side effects or what we might expect? Dr. Zhang: Sure. I think all of the immunotherapy side effects that Dr. Grivas told us about pertain to this study as well. The rashes, the diarrhea, inflammation of the lungs or liver, and affected endocrine dysfunction. But the targeted therapies can also have high blood pressure, rashes on the hand and feet, so called hand foot syndrome, also diarrhea, and elevation of liver enzymes, as well as the loss of protein in the urine. I think the one overlapping toxicity of cabozantinib with a combination of ipilimumab and nivolumab, the immunotherapy combination, is the diarrhea. So patients who start on this trial should be careful to report any diarrhea early on so that their oncologist and their investigators on the study can get an early handle and manage their diarrhea well. Dr. Gilligan: Thank you. That's very helpful. One last question, I want to get back to that issue of eligibility. Sometimes when cancer patients want to go on a trial and they find that they are told they're not eligible to go on, this trial looking at intermediate risk patients specifically so a good risk patient might want to go on it and couldn't. Can you say a little bit about how those decisions are made and what the rationale for selecting groups of patients for trials is? Dr. Zhang: Sure. We know that the IMDC criteria were really made in the setting of targeted therapies, and they were a set of prognostic markers and markers of inflammation, for example, and of time from initial diagnosis to treatment. But now they've been used often as stratification markers in our treatment trials and as selection now for eligibility. In particular for this patient population, ipilimumab, nivolumab seem to have more benefit in this intermediate and poor risk population. And so that's why, for this particular study, they're selecting specifically those patients with intermediate poor-risk disease. Dr. Gilligan: So we want to focus on the patients who are most likely to benefit, it sounds like you're saying. Dr. Zhang: That's right. So the favorable risk patient population do have a better prognosis in general, but those patients may not have as much benefit from the immunotherapy doublet. Dr. Gilligan: All right. Thank you. Well, that brings us to the end of this podcast. Thanks for listening. There are many different clinical trials currently enrolling people with genitourinary cancers. If you're wondering whether participating in a clinical trial might be right for you, please talk to your health care team. This is Timothy Gilligan. Thank you very much. ASCO: Thank you, Drs. Gilligan, Pal, Grivas, and Zhang. Visit www.cancer.net/clinicaltrials to learn more about participating in clinical trials. All treatments have side effects—please talk to your health care team about possible side effects to watch out for. And if this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play. This Cancer.Net podcast is part of the ASCO Podcast Network. This collection of 9 programs offers insight into the world of cancer care, covering a range of educational, inspirational, and scientific content. You can find all 9 shows, including this one, at podcast.asco.org. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/donate.

Hi! I'm Dr. Lori Buckley and I am back!! In this episode I'm all alone talking about being alone. I talk about the things I'm doing and that you can do to make this pandemic a bit less difficult.If you would like to ask me a question for me to answer in a future episode, please leave me a voice message here: https://www.speakpipe.com/Drlori I will play your message in the episode, so if you prefer to remain anonymous, don't say your name on the recording!Watch my videos and follow me on social media! you tubeInstagram See acast.com/privacy for privacy and opt-out information.

American Society of Clinical Oncology (ASCO) CEO Dr. Clifford A. Hudis is joined by Dr. Piyush Srivastava, the past chair of ASCO’s Clinical Practice Committee, in the newest ASCO in Action Podcast to discuss the recently released ASCO Special Report: A Guide to Cancer Care Delivery During the COVID-19 Pandemic. Dr. Srivastava was instrumental in developing the report, which provides detailed guidance to oncology practices on the immediate and short-term steps that should be taken to protect the safety of patients and healthcare staff before resuming more routine care operations during the COVID-19 public health crisis. Subscribe to the ASCO in Action podcast through iTunes and Google Play.       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 this ASCO in Action podcast brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insights into the world of cancer care. You can find all of the shows, including this one, at podcast.asco.org.   This ASCO in Action podcast is ASCO's series where we explore the policy and practice issues that impact oncologists, the entire cancer care delivery team, and the individuals we care for, people with cancer.   I'm Dr. Clifford Hudis, CEO of ASCO. And I'm the host of the ASCO in Action podcast series. I'm really pleased to be joined today by Dr. Piyush Srivastava, the past chair of ASCO's Clinical Practice Committee. Dr. Srivastava is also a practicing gastrointestinal oncologist, the regional medical director of the End of Life Options program, and the director of Outpatient Palliative Care at Kaiser Permanente Walnut Creek Medical Center in California.   Today, we're going to talk about the recently released ASCO Special Report, A Guide To Cancer Care Delivery During The COVID-19 Pandemic.   Dr. Srivastava was instrumental in developing the report. And we'll speak today about the guidance that the report provides for oncology practices as they return to more routine care delivery. Piyush, thank you so much for joining me today.   Thank you, Dr. Hudis for taking the time to speak with me. Just before we start, I just want to say that I do not have any relationships to disclose. So thank you.   Thank you very much for joining us today. Now, just to provide some context, today as we speak, we're approaching month five of the COVID-19 public health crisis in the United States. We've had more than 2.15 million confirmed cases of the virus and well over 100,000 deaths.   In fact, as we record this today, several of the largest population states in the United States-- California, Texas, and Florida-- are just reporting their largest single-day increases in cases and the health care systems in some of their big cities are approaching the kind of near breaking point that we saw earlier in New York. So the problem is still very much with us.   When the outbreak began, oncology practices nationwide immediately began making operational changes designed to protect the safety of patients and the safety of staff. This meant adjusting to resource shortages that were unfolding and complying with national and state restrictions on elective procedures, among many other things.   Today, communities across the country are in varying states of recovery. And as I just described, some of them actually are probably pausing their recovery right now. Either way, they are facing a real transition in terms of oncology practice. And some are returning to something more like routine care while continuing to be acutely attuned to protecting the health and safety of both patients and staff.   So Dr. Srivastava, could you start us off and tell our listeners just a little bit about what's happening in your own practice and how you have been adapting to the changing circumstances?   Of course. I would be very honored to share my experiences at Kaiser Permanente in Northern California. So at the start of the pandemic, we were very fortunate to be nicely set up to provide care remotely. We've had a very strong existing telehealth structure. So we were quickly able to adapt to the pandemic situation.   Initially, we nearly went 100% remote, with doing all of our new consults and chemo checks via video visits and telephone visits. If a patient needed some more attention, to be seen by a care practitioner, many times that we would coordinate with the on-call physician on site, who would see the patient on the chemotherapy infusion chair.   We also looked as an institution which services we could provide remotely and take off site and so that we didn't need to bring the patients into the cancer center. For example, we activated our home health nursing team to be able to provide port flushes in the home setting.   We also made a very conscientious effort to see what treatments and what procedures that we could postpone or actually decrease the frequency or increase the timing in between events. For example, bisphosphonate administration and port flushes, which we increased to do every three months.   What was extremely eye opening and inspiring to me is a large organization such as Kaiser Permanente was extremely nimble and flexible and was able to respond to the outside pressures. I believe, when I speak to my colleagues across the country, that many people experienced the same things with their institutions. And their institutions responded very flexibly to the ongoing pandemic.   Thanks very much. It's really interesting, I think for me, and I'm sure for many of our listeners, to hear how you adapted but also to compare that with their own experiences. It sounds to me like some of the key features were clear eye on the safety of patients and staff but also having a structure that respected the needs of the clinicians from the beginning. And then, of course, understood that the flexibility overall was a key attribute. And I just think that's something that many people will be reflecting on.   As we hit it from that one in a sense, forgive me, but anecdote, which is how one center, one operation adapted, I wonder if you could talk a little bit about ASCO's role in providing the more general guidance that you helped to develop. Why did this society feel it was necessary to provide guidance at that level?   Yes. So as we are all extremely aware, many individual health care professionals, institutions, and health systems look to ASCO for mentorship when it comes to oncology care. So this current pandemic was no different. I believe ASCO felt a strong duty and a responsibility to partner with the oncology world to ensure the highest quality and efficiency of cancer care and delivery through this pandemic.   Also, the beginning of the pandemic, there was a lack of really clear guidance from federal and state agencies. So cancer care providers and administrators looked to ASCO to help develop their plans of providing care during the pandemic. Now, also opening and ramping up as well, they're looking to us.   I see. So as we think about staff at ASCO headquarters, it's really pretty straightforward on a daily basis. Our decisions to open headquarters, for example, or not are predicated, number one, on the safety of our staff. So when you look at the Special Report, what would you say was the one or the several overarching goals that drove the development of the Special Report?   So when constructing the report, we did very much realize that there are so many varied practices across the country, really around the world, right? For example, we have small rural practices. We have medium-sized private practices. We have academic centers, and we have hospital systems. And all these organizations look to ASCO for cancer guidance and guidance to cancer care delivery.   By no way were we going to be able to solve individual operational care delivery issues for each practice. So the Special Report is made to serve, if you will, as a starting point or a launching pad for individual institutions to develop their own policies and operational adjustments.   So what I would like to do now is maybe just dive a little bit deeper into some of the specific policies and practices that were outlined in the report. And as I look at it, it was really broken down into stages of patient care.   So for example, before a patient even arrives on site, many practices are in a sense pre-screening them or triaging them. What are some of the methods that you have seen put into place and that have been effective that we should recommend to practices just getting open?   So the Special Report lists out very clearly sequential steps to consider in safely bringing patients into cancer centers. And I'll highlight a few of them, which I feel is extremely important. The first step is to actually reach out to the patient well before their scheduled visit to the cancer center. So if we can call these patients and family members well before their visit, we can educate them as to the process that they'll experience when they come into the cancer center.   Allow them to ask questions and to give the reasoning behind or the why to we are doing this. I think that will go a long way. So transparent communication, I think, will reduce anxiety and fear.   I also believe an effective second step was to do a quick check in, anywhere from 12 to 48, 72 hours prior to the actual visit, depending on what your operations would allow, just to check in to make sure that you're screening for the COVID symptoms and the patient doesn't test positive to any of those symptoms.   I may just add also in the first step, when you reach out to the patient well before their appointment, that's also a good time to screen for COVID questions. And then a third implementation can be as a single point of entry.   So when a patient comes into the cancer center, there's one point of entry so that way a temperature could be checked, a patient could be screened again for those COVID symptom questions. And so that when that patient arrives inside the cancer center, there's been essentially three checks and balances of checking for COVID-19 symptoms.   So this provides obviously the safety to minimize the risk of bringing COVID into the cancer center. But I also think an extremely important added benefit is that the staff and providers will feel confident and safe that the institution has done these many different steps to ensure their safety as well and to minimize their risk of exposure to COVID.   I see. So that's one part of this. Now, the implication in all of this is the volume coming through the clinics is likely to be lower. And one of the ways in which it is controlled, of course, is through the reduction of less critical face-to-face encounters and arguably an increase in telemedicine. What are some of the considerations that you think oncology practices should factor into their use of telemedicine in care delivery?   Yeah. That's actually a fantastic question, because telemedicine has really-- well, telemedicine was forced upon most institutions. And the institutions had to really find an effective way to provide care remotely. So it's a very interesting and important topic. For example, I think one thing that I personally struggled with, and I think my institution struggled with is, who is the right patient for telemedicine?   So the report talks about specific patient categories that you can think of that would be easier to provide patient care remotely. So for example, those that are not requiring in-person physical exam, those who may not actually actively be getting chemo treatment, those that don't need any in-office diagnostics. So don't necessarily need lab work tied to that appointment or you don't necessarily need imaging exams at that moment.   Other visits that the report recommends to think about is follow up. So follow up could be done through telemedicine. Or those that are on oral oncolytic treatments. And so it's a quick check in just to make sure that they're taking the medication and the adherence is high could be done by video or by phone.   A couple of things to consider with telemedicine, obviously, is the audio and visual capabilities. And so even in the Bay Area in California, we do have spots that don't have the best reception. And so that can become problematic. So that's something to also think about.   The other sort of counterbalance or countermeasure to this is just to make sure that patients feel that they're being taken care of and they feel satisfied. So in my own practice, I've now adopted that when we finish a video visit or we finish a telephone visit, I let the patient know that I have felt comfortable with the interaction and that I felt that I was able to accomplish the care plan and execute the care plan as needed by the video and phone. But then I ask them, do they feel comfortable and are they OK proceeding this way or do they prefer face-to-face visit.   Yeah. I think that's an interesting observation about telemedicine. I think everybody is feeling their way right now and learning. And we want to be careful not to go too far away from the direct physical encounter since so much can be lost without those subtle cues from body language and classic physical findings as well. Now, coming back once more to the workforce, the report addresses how we maintain a healthy workforce.   And it specifically, I think, gets into questions of testing and scheduling and even dealing with stress. Can you walk through that a little more about antibody testing or saliva or nasal swabs and the frequency and exactly what facilities and practices should be thinking about for their staff.   Sure. And this is an extremely hot topic, and the interesting thing about this topic is it can vary widely just depending on what's available at that moment in your location, what the county is ordaining and what the state is ordaining as well. So there's a bit of variability.   But what the Special Report does very nicely, it lays out considerations for institutions to think about when they are caring for the workforce, both physically and emotionally. So this Special Report lays out some PPE guidelines, and really it's based on what the CDC is recommending.   And as we know, as one of the largest sort of scientific research-based organizations, it's important that we bring the CDC's sentiment forward when we talk about PPE, especially with PPE stewardship as this goes on for some time, we may have some issues with the supply chain.   The other thing the Special Report calls out is to really have institutions make sure that they are putting their health care practitioners in the forefront. So checking in with health care practitioners to make sure that they are not ill, that they're feeling OK, that they haven't been exposed to anybody outside of the medical system. And I think what's really, really special about this report is that it really talks to the practitioner's well-being. I think this is scary for any provider in the front line.   We are also worried about our own health and what we can bring back to our loved ones outside of the medical center. But also, I think all of us as oncology providers are feeling a little disillusioned and a little saddened, because we are not able to provide oncology care like we normally have been.   And so that's a huge adjustment for the oncology provider. And of course, that comes with some moral distress. So the report also calls out for institutions to check in with their health care providers to make sure that their emotional well-being is good and to also make sure that they feel that their family and loved ones are safe at home. So I think that was a really added benefit.   Yes. Really important to acknowledge the importance of all of that to the individuals. And it is not just about narrowly the safety of the surfaces and workspaces they're in, but really in a sense their holistic experience in life. I want to turn to the broad public approach to cancer care and focus on the corners that we cut, if you will, in going into this crisis, the compromises with old ways of doing things that we very quickly adopted.   The report focuses on some of those immediate short-term steps that we took. And I think looking at the effectiveness of that, I can tell you that I asked the ASCO leadership on the staff side and on the volunteer side why those adaptations couldn't just be our new permanent normal.   That is to say, if it was safe enough to do telehealth in April of 2020, why isn't it safe enough to do it forever? So that was the nidus of our Road to Recovery Task Force. And I know you sit on the group focused on care delivery. What do you think we can expect from that effort?   Yeah. And this is fantastic. I am honored to be sitting on the Road to Recovery Task Force, because I think this is an issue that's facing every oncology care provider in the country and, frankly, around the globe. And the task force is composed of a group of really active and very intelligent oncology providers who are putting their minds together collaboratively to see how we can continue to provide cancer care in an efficient and in a high-quality manner moving forward beyond the pandemic.   And as you said very nicely, Dr. Hudis, we have gained several insights through our care over the last few months, and can we harness those insights and continue to practice oncology in a very efficient and high-quality manner?   So the task force is extremely comprehensive. The group is addressing several buckets, if you will, that are very pertinent to oncology care and delivery. So they're looking at health equity. They're looking at resetting clinic and patient appointments.   They're looking at practice operations, telemedicine, home infusion. I know that's something that we've all been grappling with. Financial assistance to practices, which is extremely important when we look at the economy around us.   Quality reporting and measurements. So we want to make sure-- we want to challenge ourselves to make sure that we are practicing the highest-quality cancer care that we can. Utilization management. So that's also extremely important as we are looking at the economy around us.   Psychosocial impact on patients. So this has been obviously extremely traumatic for patients in their very vulnerable state. The task force also is looking at provider well-being, which once again, I can't reinforce how important that is as we go back into somewhat normal operations, whatever that normal may be, but looking at the sort of stress that the providers are feeling in that.   And then ongoing preparedness I think, which is extremely essential, because we just don't know what the virus will do over the next year and what might also come in the future. So the task force is extremely collaborative, extremely thorough. And it is a group of very active individuals on oncology care that are bringing their brilliant minds together to come up with some guidance.   Well, I think that's really great. As we wrap up now, I wonder if at the highest level if there's a single or several major takeaways that you want listeners and our entire community to take away from these recommendations.   Yeah. You know, I've actually had some time to reflect. It's been a very privileged experience for me to be a part of this and to be a listener and to be a learner from all these brilliant minds around me who are putting their heads together to accomplish this. I find that recommendations in the Special Report to be very thoughtful and very comprehensive.   I do hope practices remember that these are actually guidelines to help them develop and change policies at individual institutions. I also hope that oncology practitioners and administrators remember that we're all in this together. And so there is going to be an ever-changing environment.   So I hope that this report is just a start of a collaboration that can be ongoing with ASCO and with oncology providers around the world. I am fully confident that ASCO is a tremendous and a large resource for us in the oncology world to be able to accomplish collaboration and to actually uplift and maintain cancer care during and after the pandemic.   Well, that's really, I think, is nice and as great and complete a summary as one could hope to hear. So I want to thank you, Dr. Srivastava, for speaking with me today. I'm really grateful to you for your time on this whole initiative and the effort that you've put to it as well as, of course, for the time today.   I appreciate it. It has been a great honor. And so thank you very much to you, Dr. Hudis, and thank you very much to the ASCO staff, who do a tremendous job on a daily basis to make sure that we are doing the best we can.   So the Special Report, and later, ASCO's Road to Recovery, are all part of ASCO's larger commitment to providing information, guidance, and resources that will support clinicians, the cancer care delivery team, and patients with cancer, both during the COVID-19 pandemic and then well beyond it.   We invite listeners to participate in the ASCO survey on COVID-19 in Oncology Registry or ASCO registry. This is a project where we are collecting and then sharing insights on how the virus impacts cancer care and cancer-patient outcomes during the COVID-19 pandemic.   We encourage all oncology practices to participate so that we will have the largest possible data set and represent the full diversity of patients and practices across the United States.   I'll remind you that you can find all of our COVID-19 resources and much more at asco.org. And until next time, I want to thank everyone for listening to this ASCO in Action podcast.   If you enjoyed what you heard today, please don't forget to give us a rating or a review on Apple Podcasts or wherever you listen. And while you're there, be sure to subscribe so you never miss an episode. The ASCO in Action podcast is just one of ASCO's many podcasts. And you can find all of the shows at podcast.asco.org.

Does Amlodipine Cause Ankle and Leg Swelling? I this episode, I answer a question from my private FaceBook group. Hope that this brings value to you, If you like this video let me know in the comments so that I will do more videos like this. #amlodipineRemember, this is not medical advice, and only your doctor can tell you what you need to do for your high blood pressure. Consult your doctor or health care provider for medical advice. Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?Click here to see how to use a home blood pressure monitor and log.You can purchase an Omron Blood Pressure Monitor from any big box store or pharmacy. Click here for purchase online.If you enjoyed the podcast, please share and consider leaving a 5-star rating.****Hi, I'm Dr. Tonya. Thank you for listening! Hypertension Resistant to Treatment podcast is for everyday people to learn what everybody ought to know about hypertension. Then, you can take action to get good blood pressure control without excessive medications; so, you can be healthier and create your happiness in life! At Hypertension Resistant to Treatment podcast, website, and YouTube channel, you will get knowledge, training, resources, and support so you can live free from high blood pressure and complications. Visit hypertensionresistanttotreatment.com for more detailed information. After about ten years of conducting hypertension research, I realized some fascinating conclusions. I found that the average person goes through a bit of resistance when told they have high blood pressure and that perhaps we were missing important opportunities when helping people with high blood pressure. Hypertension Resistant to Treatment website, podcast, and YouTube channel are the results of my relentless attempt to tell you everything you ought to know about high blood pressure, train you about what to do to manage your blood pressure, and support you while you work with your health provider to obtain good blood pressure control. ****Royalty-free music: Turn om My Swag 2****Subscribe to this podcast to get BI-WEEKLY, transforming information, and share the website and podcast with ANYONE who could benefit from it. You can read my work HERE at this link, including my published studies from the landmarked Systolic Blood Pressure Intervention (SPRINT) Trial.

Hello Everyone and welcome to my Podcast, Regenerate You, I'm Dr. Nirvana.Insulin is one of the most misunderstood hormones in your body. There are some diet plans that say to keep it as low as possible and others that say you need more of it. If you're trying to lose weight, balance your cholesterol, or even achieve healthy thyroid levels; optimum insulin levels are necessary. But what constitutes normal insulin and what is this powerful hormone doing in your body? This is what I'll be discussing on this episode. If you’re looking for additional advice, feel free to visit my blog here. You can also stay connected with me on my Facebook page @DrNirvanaHeals or on my Instagram @DrNirvana.Please remember to subscribe and to share this Podcast!And remember, when you regenerate, there’s a new you every day

Aloha and good afternoon everyone, and welcome to the "Secret Art of Huna", I'm Dr. Jane Lewis, and I thought today I'd talk about loneliness. If you have any questions please leave me a comment, I'd love to hear from you! Blessings, Jane    Free Guided Meditation: https://SecretArtOfHuna.com Pioneers Club: https://secretartofhuna.com/pioneers-club Facebook Page: https://www.facebook.com/secretartofhuna

Can You Lower Chronically Severe Blood Pressure Naturally? In this episode, Dr. Tonya will answer a question from the Facebook group. Her answer is based on her past training and experience in hypertension management. Remember, this is not medical advice, and only your doctor can tell you what you need to do for your high blood pressure. Consult your doctor or health care provider for medical advice. Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?Click here to see how to use a home blood pressure monitor and log.You can purchase an Omron Blood Pressure Monitor from any big box store or pharmacy. Click here for purchase online.If you enjoyed the podcast, please share and consider leaving a 5-star rating.****Hi, I'm Dr. Tonya. Thank you for listening! Hypertension Resistant to Treatment podcast is for everyday people to learn what everybody ought to know about hypertension. Then, you can take action to get good blood pressure control without excessive medications; so, you can be healthier and create your happiness in life! At Hypertension Resistant to Treatment podcast, website, and YouTube channel, you will get knowledge, training, resources, and support so you can live free from high blood pressure and complications. Visit hypertensionresistanttotreatment.com for more detailed information. After about ten years of conducting hypertension research, I realized some fascinating conclusions. I found that the average person goes through a bit of resistance when told they have high blood pressure and that perhaps we were missing important opportunities when helping people with high blood pressure. Hypertension Resistant to Treatment website, podcast, and YouTube channel are the results of my relentless attempt to tell you everything you ought to know about high blood pressure, train you about what to do to manage your blood pressure, and support you while you work with your health provider to obtain good blood pressure control. ****Royal-free music: Turn om My Swag 2****Subscribe to this podcast to get BI-WEEKLY, transforming information, and share the website and podcast with ANYONE who could benefit from it. You can read my work HERE at this link, including my published studies from the landmarked Systolic Blood Pressure Intervention (SPRINT) Trial.

This is NephTalk. I’m Christopher Springmann and let’s get cooking! Hi, I'm Dr. Shusterman, The Cooking Doc. Now, you're heard me say, "Change Your Buds" in my videos, but what does Change Your Buds actually mean? It means learning to change your taste buds so they actually enjoy healthy food. But this doesn't happen quickly. It takes time. You have to teach your taste buds to like healthier things; whole grains, vegetables, fruit. And that's what The Cooking Doc is all about. It's about teaching you to make those things actually taste good. And once you make these changes, you won't have to fight as hard against your cravings for unhealthy foods. Your cravings will actually go away over time.

Hello Everyone, welcome to Regenerate You, I'm Dr. Nirvana!There are a lot of factors that can contribute to your individual experience with hormonal birth control, including your genetics, the type of hormonal contraceptive used, and how long you were using it. But on this episode, I wanted to review the top 5 common causes of post-birth control hair loss, that I see with my patients and what you can do about it.If you’re looking for additional advice, feel free to visit my blog here. You can also stay connected with me on my Facebook page @DrNirvanaHeals or on my Instagram @DrNirvana.And remember, when you regenerate, there's a new you every day!

Dr Hayes interviews Dr. Lawrence Einhorn and patient, John Cleland, on the cure for testicular cancer.     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 role of cancer care. You can find all of the shows, including this one, at podcast.asco.org. Welcome to the "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've also been privileged to be the past president of ASCO. I'll be your host for a series of podcast interviews with the founders of our field, have been, and will continue to be over the next several months. In this series of podcasts, I'm hoping to bring the appreciation of the courage and the vision and the really scientific background among the leaders who founded our field of clinical cancer care over the last 70 years. I hope that by understanding the background of how we got to what we now consider 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 guests our Dr. Larry Einhorn, who first demonstrated the cure of testicular cancer with cisplatin. And we have a special guest, Mr. John Cleland, who as far as I know was the first man to be cured of this cancer with cisplatin in the world. Dr. Einhorn is currently the Distinguished Professor of Medicine on the faculty of the section of hematology oncology at Indiana University School of Medicine. Mr. Cleland is now retired after a distinguished career as a high school teacher in track and field coach in Indiana. This interview is really particularly poignant for me. I knew John Cleland socially before I had ever heard of Larry Einhorn because our respective wives worked together while I was in med school as I began my clinical training. I then had the enormous privilege of being assigned to the oncology ward at the University Hospital for one of my rotations in internal medicine during my third year of medical school in 1977. And Dr. Einhorn was the attending. And frankly, for me, the rest is history. I had no chance. I had to become an oncologist. Dr. Einhorn received his undergraduate degree at Indiana University, went to medical school at the University of Iowa. He then returned to Indiana for his residency and fellowship. But he spent an oncology fellowship year at MD Anderson, Houston. After that you then returned back to IU in 1973 and has remained there ever since. He has won nearly every award and honor available in clinical research. And I'm not going to try to name them all, but most importantly, like me, as many people in this podcast series, he has served as president of ASCO, in his case, in the year 2000 and 2001. Dr. Einhorn and John, welcome to our program. Thank you. Thank you. Thank you. Dr. Einhorn, I'll start with you. Obviously, your greatest contribution is the cure for testicular cancer, which is pretty good. Can you kind of walk us through the history? How did you get involved with cisplatin? How did you derive the three drug regimen? What were the early obstacles? Especially with your returning back to Indiana. Can you kind of just walk us through that history? Certainly. So as you mentioned, I did a one-year fellowship in oncology at M.D. Anderson before returning to the faculty in 1973 and Indiana University. And in that time period, which was 46 years ago, the thought was that you might be able to cure adult leukemia like was cured with childhood leukemia from the wonderful studies from St. Jude's and that the studies that were ongoing in lymphomas and other hematological malignancies were very promising. But it was felt that you really don't want to do too much toxicity in a solid tumor, where you're getting a one log kill before you get progressive disease. And there was a clear pervasive atmosphere of pessimism of what can be done with solid tumors in general. So when I joined the faculty in 1973, I was the only oncologist. We had two hematologists that were there in our small faculty, which went from 2 to 3. And I wanted to be involved with both liquid tumors as well as solid tumors. But I wanted to be involved with solid tumors that were chemo sensitive. And even back in the early 1970s, testicular cancer was responsive to older drugs like actin or myosin-D and later with a two-drug combination of vinblastine plus bleomycin. And there were a small number of not just remissions but cures, and that was one of the few solid tumors that actually had a modest cure rate back at that time. And then the platinum story came around. And this is a podcast of itself with the wonderful work of a biophysicist at Michigan State, Dr. Barnett Rosenberg, who first discovered that platinum could be the first heavy metal ever to be looked at as antineoplastic agent. And when platinum entered first in human clinical trials in 1972 and 1973, it was [? selfed ?] at an NCI-sponsored phase I working group that I attended that this drug was producing minimal benefit and tremendous toxicity, especially horrendous nausea and vomiting. And the drug was pretty close to being discarded as a interesting novel mechanism of action, but not a drug that really had much of a future. But what changed the history of platinum and changed the history of testis cancer was the fact that among the phase I patients were treated with platinum, which included melanoma, lung cancer, colon cancer, breast cancer, the usual type of patients that enter phase I studies back in those older days were 11 patients that had testicular cancer who had failed actin or myosin D, failed vinblastine, plus bleomycin, and so they received single agent platinum. And when we, even today-- Actually, where were those studies done? That was done at Roswell Park actually, phase I study. And Roswell Park-- and this was an era, by the way, that there were only four NCI cancer centers in the United States, Roswell Park, M.D. Anderson, Memorial Sloan Kettering, and, of course, the NCI. So Roswell Park did a broad-based phase I study. Jim Holland was there at that time. He has unfortunately subsequently passed away. He was one of the real pioneers and also a past ASCO president. So among the patients in that phase I study were 11 patients with testes cancer. And there were three complete remissions and two partial remissions. And even in 2019, if we saw that with the phase 1 novel agent, there would be a tremendous amount of enthusiasm generated. We also looked at some of the preclinical work with platinum. And it is a drug that can cause testicular atrophy. In my youthful ignorance, I didn't realize that there are many drugs that cause testicular atrophy. So with that as a background, in 1974-- and I was on the faculty for one year at that time-- we wrote a protocol to simply add platinum, a novel experimental drug, and added it to the established two-drug regimen that I learned about when I was at M.D. Anderson, namely vinblastine and bleomycin. And the principles of combination chemotherapy aren't complicated. We want each drug to have single agent activity, different mechanism of cytotoxicity, different toxicity, and platinum as a non-mild suppressive drug, which can be given in full dosage, with vinblastine as a mild suppressive drug, and evidence of synergy. And one of the unique characteristics of platinum is it is synergistic across a panoply of cytolytic agents. So we started to study in the late summer of 1974 as a phase II study. And so we treated 47 patients when we first presented this data at the American Urological Association, later at ASCO. And I would be the first to admit that I was as startled as anyone that we were able to literally have a one logarithmic increase in the cure rate, because most progress in oncology is going from a 5% to a 10% to a 15% long-term survival rate. But all of a sudden with this three-drug combination, 60% of these patients were not only complete remission, but durable complete remission and cures. There was a lot of toxicity with platinum. And over the years, we learned, as science tends to learn, when a drug is active to mitigate the side effects as far as nephrotoxicity and nausea and vomiting. And we made modifications to the treatment regimens as the years went by, as you know, with changing the dosages have vinblastine, lowering the duration of maintenance therapy, and eliminating maintenance therapy, reducing the number of courses of platinum, substituting etoposide for vinblastine to where it's now the standard, bleomycin, etoposide, platinum, or BET. And I will make a final comment, in my long career, that this was a very exciting time in 1974. There were several chemotherapy drugs that were experimental drugs, such as doxorubicin and even a nitrosourea the first drugs to have penetration into the blood brain barrier. But the era of chemotherapy is gone and appropriately so. And science and medicine has moved forward. And now, we look at molecular targeted agents and immune checkpoint inhibitors and immunooncology. And that's what is exciting, so much more exciting about the field in 2019 than it was in 1974. But nevertheless, platinum has had legs. In 2019, it is still first line therapy in 12 different types of malignancies. Of course, testis cancer being the poster child for curable cancer. And I often mention that just as platinum has cured thousands, tens of thousands, hundreds of thousands of young men with cancer, testicular cancer saved platinum, because if it weren't for those early studies showing activity of platinum, I think I can say without fear of contradiction that the drug wouldn't be around right now because of this tremendous toxicity in the early phase I studies. Yeah, Larry, let me ask about that, because in the early 1970s when-- I wasn't around, but you didn't have antiemetics. You didn't have drug fractures. You didn't really understand the renal toxicity. Just briefly, how did you get around those? How do you get people-- I'm going to ask John the same question in a minute. What were you thinking, John? John is the recipient of our ignorance in that era. So taking it one item at a time. Platinum is a heavy metal. And we were somewhat slow in realizing that other heavy metals, like mercury, can cause acute tubular necrosis. And so when patients were getting platinum, as is true in those days, they would often just get IV pushed platinum. And so we learned that in order to prevent acute tubular necrosis, we needed to make sure that patients were well hydrated with IV saline solution before they start chemotherapy. We then give the intravenous platinum and then follow that with intravenous saline hydration, so that the drug doesn't accumulate in the proximal tubules, and we force a diuresis. And we never needed mannitol. And some people back then, in fact, perhaps even now, are doing the silly thing of mannitol diuresis, which is totally unnecessary. And so back in the early days before we had antiemetics, everyone had to be treated as an inpatient because we had to give 24-hour continuous hydration because of the [INAUDIBLE] from severe nausea, vomiting, and dehydration that would happen. Of course, today, it's all done as an outpatient with three or four hours of hydration. As far as nausea and vomiting is concerned, one of our first studies we published in The New Journal of Medicine was a cannabinoid derivative from Eli Lilly, called nabilone. And so nabilone, didn't produce a marijuana-type of high. It didn't cause euphoria. It caused some dysphoria and had a variety of side effects. But it lowered the incidence of nausea and vomiting. But what revolutionized chemotherapy induced nausea and vomiting, and ASCO recognizes this as one of the five leading advances in the past 50 years, was the discovery of the first 5-HT3 receptor antagonists. And this was a rational, selective pharmaceutical development. And this truly changed the face of how we give chemotherapy with drugs like platinum. Instead of having an average of 10 to 12 emetic episodes on day 1 of platinum, today with appropriate anti-emetics, the median number of emetic episodes is zero. People still get nausea. People still get occasional vomiting. But everything is done as an outpatient now. And it's done as an outpatient because of the discovery by others of what is the mechanism with platinum, which is not a gastrointestinal mechanism, but affects the emetic center in the medulla oblongata and the chemo receptor trigger zone and finding that patients get drugs like platinum, they get high level of 5-HT3. And developing a selective 5-HT3 receptor antagonist change the field completely. And, of course, now we also [? weigh ?] a methasone and neurokinin-1 antagonist, aprepitant or fosaprepitant. And we also have olanzapine as far as the nausea issue. And olanzapine is probably the best drug for nausea. So patients today have no concept of what patients like John went through when we had no knowledge about any of this whatsoever. And we were looking at things kind of naively by 2019 standards. I don't think I'm making this up. I recall as a medical student walking down the inpatient at University Hospital and thinking this smells just like my fraternity house. Without the fun involved. Yeah. And I got a kick now out of the so-called medical marijuana. But didn't you talk the administration into looking the other way for a while so that these guys could do that? Sort of. What had happened with nabilone, it had to be under lock and key, as if it were gold at Fort Knox. When we had an audit by the FDA and we had-- I don't know how many, I think 60 or 70 patients on nabilone, you know, we had to make sure we had every consent form and every safety guarded and everything. You know, here, we're using these incredibly toxic chemotherapy drugs and there was no regulation at all. And here we're using a pill to lessen nausea and vomiting, and it was just the hoops you had jump through were tremendous. When did you start realizing you had something big. Was it, you know, after two, three patients, or later-- Well, again, when you're young and dumb, it's easy, because you treat someone like John and you get the first chest X-ray three weeks later and things are gone and with pulmonary metastases. And you naively think, not only this cool, but, gee, that's great, it's not going to come back again. But we know even 40 years later that most epithelial malignancies that we get nice remissions with, the disease does come back again. So we had initial enthusiasm that platinum vinblastine myosin was a very active, but very toxic regimen. And we had the hope that this might be durable remission. And, Dan, I actually first presented data with testes scores, not at ASCO, but with the Annual American Urological Association meeting, and that was 99% urologists there. And so we had 20 patients that we had treated. And then that following year, I submitted an abstract to ASCO. And back then, it wasn't done online. We would send a paper abstract with a self-addressed postcard that they would send back to us whether it was accepted or not. And so when I sent in the abstract, I get the postcard back saying it was accepted as a plenary session paper. And I had no idea what plenary session even meant. It's true. And we get this postcard back in January for this June meeting. And all of a sudden my naivete went away, and I thought what, if I make a fool of myself? And I had this initial abstract with these complete remissions, and by the time June rolls around every one of them would have relapsed, which I was starting to learn happens in other tumors like small cell lung cancer, that are chemo sensitive disease. But fortunately, the time of presentation everyone was still disease free. And, of course, everyone for the most part remain disease free. So we had the first glimpse of activity with the first few patients. But it really wasn't until patients were out at a year that we really had the realization that these were not temporary remissions, but these were durable. And as it turned out, permanent remissions and cures. I wasn't there, but I understand that after you recorded that it looked like you had change the ratio of [? puranoctur ?] from 10%, 90% to 90%, 10%, that people in the audience, you had a standing ovation at the end of your presentation. Yeah, it was very heartwarming. It's literally the walk on the moon type of things is the things that you do once in your career, you know, that you never forget about. I had the opportunity to do that and not one of those four NCI cancer centers, but little Indiana University with our faculty of three. And we had one oncology nurse at that time, Becky Furness. We had no data managers. We had no compliance office or anything else. And we were giving [INAUDIBLE] back in the 1970s. I'd like now to turn briefly to your relationship with John Cleland. John, can you give us a brief history of your cancer treatment before you and Dr. Einhorn decided to go with the cisplatin. I was a student Purdue University, the fall of 1973, when I discovered I had a lump on the my left testicle. And I went to a local urologist. And he examined me on a Tuesday afternoon, in the middle of November, and told me he wanted me at the hospital the following morning. And the following day after that, they performed surgery. And I was diagnosed with testicular cancer. That was November 15, 1973. On the 29th of November then, I had a retroperitoneal node dissection. That was at the UI Cancer Center by Dr. John Donohue. And then on December 3, 1973, on a Monday morning, Larry Einhorn walked into my hospital room. And that was my first introduction to Dr. Einhorn. He talked to me a little bit and said we were going to put me on a 5-day course of a drug called mithramycin. We took mithramycin for five days. And then a couple of days after that, I was released from the hospital. So that was in the 1st of December of 1973. The middle of February of '74, I returned to IU Med Center just for a routine checkup. And I was diagnosed there again with testicular cancer had returned. And Dr. Einhorn began putting me on a three-drug regimen-- adriamycin, bleomycin, and [INAUDIBLE]. And I was on that until about July of '74. Then I was on actin myosin-D for a couple of months. And then we ultimately started in on the cisplatin in early October of '74. You have to tell us the story that you actually had to tell Dr. Einhorn about cisplatin because of a radio show you listened to. Well, by the middle of the summer, I had been pretty beat up, after all the chemotherapy and the nausea and everything. And I didn't really have a job-- or I couldn't do a job or anything. So most of the time, I just lay on the couch in our apartment and listened to the radio or watch TV. And one day-- I really like Paul Harvey-- and he came on the radio every day at noon there in Lafayette, Indiana. And one day he begins talking about researchers at Michigan State University. have maybe come up with the cure for cancer. So I begin listening much closer. And they talked about this chemotherapy called cisplatin. So I just made a mental note to myself, well, the next time I go see Dr. Einhorn, I'm going to ask him about this. Well, a couple of weeks later, I'm down at IU. And he's palpating me and listening to my chest and all this type of thing, you know. And I began asking him about that. And he said, John, just don't get too excited about that. We've heard of these cancer cures before. Probably nothing important has happened here. Don't worry about it, you know. And then two or three months later, I'm taking it. So that was my introduction, Dan, to cisplatin. Well, I can't to you-- Some of those Purdue graduates are pretty smart every now and then. We get lucky, like a blind squirrel. I just say, I can't tell you how many-- probably 100, 200 patients will told me things like this. And I've said exactly what Dr. Einhorn said to them, yeah, yeah, yeah. I wonder how many cures I've missed. OK, and the second story I want you tell us, John, is about your readmission to the hospital after your first cycle of chemotherapy. Yeah, I started this platinum October 7, 1974. I had five doses in the hospital. And then I was released. That was on October 7. October 20 rolls around, which was a Sunday, and I was violently ill. I had a fever of over 104, almost 104 and 1/2. And I was just completely almost derelict. My wife and a couple of friends, we contact Becky first, us my oncology nurse. And I guess she called Dr. Einhorn. And he said, well, come on down and check in through the emergency room at IU. And so that's what we did. We got there late at night, 9:30, 10:00 at night, something like that. And they always-- if I went to the emergency room, they always took a chest X-ray, which they did. And then in the hospital overnight and middle of the next morning, I see Dr. Einhorn and Becky getting off the elevator. My room was kind of in a corner. I could see part of the lobby out there and the elevator and the nurses station. And I could see them kind of go past the nurses station. And I could just tell that something was up. Somebody had good, let's put it that way, just by their body language, and the way they looked at each other and talked and walked. And they kept coming closer and closer and closer to my room. And finally, they walked in. And Dr. Einhorn says, John, your chest X-rays are clear. That's really good news. And, you know, I kind of interpreted that as, hey, I'm cure, you know. And ultimately, I guess I was, because from that chest X-ray the night before, my chest film was-- the weak before, my chest film was just riddled like Swiss cheese. And then the film was totally clear. You probably don't know this, but I've seen your chest x-rays, which is probably illegal now. Probably did a lot of illegal things back then. And, you know, that's when the scales fell from my eyes and I said, I'm going to be an oncologist. This is unbelievable. But, you know, I think to emphasize, it wasn't clear you were going to survive that weekend. To survive, you would be cured. But that goes back to how toxic this drug was at the start. Right. Right. It was not a lot of fun. I know that. Yeah. Well, I want to get back, Larry, to you for a moment, because there were two people in your life who were really essential to this story. One, of course, was Dr. Donohue, with whom you have published the, I think, seminal and classic paper in the annals of internal medicine. You want to say a few words about John. And the other is I'd love you to talk a little bit about Steve Williams. Steve was a fellow when I was a med student that I used to tease-- I mean, he's the only guy I ever knew who went from being a fellow to cancer center director I think in one year. I'm making that but-- he kept saying, you know, I might as well put me on faculty because he doesn't have any other fellows. Sure. So when I joined the faculty in 1973, in July of 1973, as I mentioned, I was the first oncologists. There were two hematologists there. And John Donohue is a true gentleman, one of the world leaders in urological oncology and the urological transplant with kidney transplant and many other fields. His ability to surgically cure patients with extensive retroperitoneal disease was known worldwide. And because of who John was and the fact that there were very few oncologists in the state of Indiana treating solid tumors, when he would see patients who would relapse after a retroperitoneal lymph node dissection, he would give chemotherapy himself, usually with actin myosin-D, which, by the way, causes almost as much nausea and vomiting as platinum did. And when I first got there, I knew John by reputation, but not by his interpersonal relationships with others. And with some fear and trepidation, I walked into his office because I told him I wanted to start looking at clinical trials in testes cancer. And I thought we might have a turf battle because he was treating patients with chemotherapy himself. And he just welcomed me with open arms. And he was so enthusiastic about finally having a partner and someone to collaborate with. And we had a wonderful, 30-plus years of collaboration with many important discoveries that John made equally, as I did. And, unfortunately, after John retired, he subsequently died when he was in Florida. And it's a similar sad story with Steve Williams. So Steve Williams was in my third fellowship class, which means we had one fellow a year. He was great, very humble, from Bedford, Indiana. And father was a newspaper reporter from the small town newspaper. And Steve was the eternal optimist. And to show you what an eternal optimist he was, when the Indianapolis Colts would those 14 games in a row, he always knew they going to win the next game, you know. And that's Steve. And John Cleland talking about Paul Harvey, Steve would have believed that platinum was going to be the cure too, you know. He was just a very positive person. And Steve was very gifted. He has a great relationship with patients. And there's not a person, a doctor, nurse, or patient, who has ever said anything unkind about Steve. He's one of the kindest people that we ever had the privilege of knowing. And Steve was very much involved with our testicular cancer research studies and many other pivotal studies as well. We decided to be a NCI cancer center, which is an enormous amount of work. And by then, we had about 10 faculty members in hematology, oncology. And no one wanted to do it. And so we went up to poor Steve and said, boy, Steve, this would be a great career move for you-- without telling him how much work is involved. We are cancer center today because Steve Williams made us a cancer center and everything that goes along with that. And before leaving, and fortunately, we're talking about John being cured with fourth line therapy with platinum combination chemotherapy, whereas if John had had that disease diagnosed a year earlier, quite honestly, John, you wouldn't be alive right now. And it's sort of the opposite for Steve Williams. He eventually developed metastatic melanoma before any of the marvels with immunotherapy or even the BRAF inhibitors were around. And he eventually died from these diseases that he fought so hard to palliate and prolong survival and cure with metastatic melanoma. And now there's a 30% cure rate-- 30%, 5-year survival and continuous 5-year survival with single agent PD-L1 inhibitors. And I want to make a final comment about John. And if this were 2019, rather than 1974, and you're looking at a patient who has been through mitramycin, which is used by me as adjuvant therapy briefly for adenocarcinoma, which is what John had, and then going through actin myosin-D and all the toxicity with that drug and then gone through a adriamycin combination chemotherapy, and looking at fourth line therapy. So when we started platinum combination chemotherapy, and John his fourth line therapy, yes, his chest X-ray looked like Swiss cheese, as he mentioned, but he was pretty much asymptomatic. And the courage and fortitude that it takes to go through treatment like this, because we knew what the side effects were with platinum. It had been around for about eight months, and we knew about all the horrendous side effects of the drug. We had no idea whether this would produce as fourth line therapy any prolongation of survival or any meaningful quality of life. And to go through this therapy without any idea whether it's going to help you, but to do it with truly altruistic motives and knowing that maybe this will help other patients in the future is really noble and admirable. And this is why John over the decades has been such a role model for clinical trials and for the cancer patient population. And I want to follow up. John, briefly, tell us about your history since then-- your family, your athletics, your career. I think it's inspirational, frankly. Well, I worked for the animal science industry for five years following my cure. And I decided finally I needed to give something back a little more to society than what I was actually doing. So I knew I wasn't smart enough to be a medical doctor. Male nursing wasn't exactly in vogue at that time, which might have been honestly a pretty good job for me. So I thought, well, I could be a teacher. I can teach life sciences. So background is pretty much life sciences in agriculture. So I did. I turned to teaching and teaching biology for 31 years and did a lot of coaching of track and cross country. And my wife and I have three kids. I married my college sweetheart even before I had testicular cancer. And, you know, I owe her just about everything in life. She hung in there with me when times were really dark. And I say we got three kids. And I've had great job and great career and friends. I want to emphasize you've had three children since your treatment. I also want to emphasize I know you've run one or two marathons since your treatment. Actually, Dan, I ran four marathons. So you ran four marathons since your treatment. Four full marathons, yes, sir. And I believe that your baseline creatinine is something like twice normal. And, Larry, you probably know this better than I do. But, again you've been inspirational to all of us. Well, thank you. Thank you, Dan. I'll tell you this. Every day I live is a blessing. I should have probably died 44, 45 years ago. I could drop dead at the end of this telephone conversation and have no regrets in life whatsoever. Well, John, you keep thinking that maybe one day you'll live long enough to see Purdue win the NCAA, but I wouldn't count on it. I was going to make a point, it must pain him truly to thank two guys from Indiana and also be appreciative of Michigan State, you know, for a guy from Purdue that must really be painful. Well, yeah, you know, testicular cure is basically Big 10 centered with Michigan State coming up with this cisplatin and Dr. Einhorn being on the IU you faculty. But it took a Purdue Boilermaker to be tough enough to handle all that to begin with, you know. That's true. OK, we're running out of time. I need to bring this to an end. I want to thank both of you again, both of you're inspirational, John for all the things we've talked about and Dr. Einhorn for so many of us who've gone into the field that we've trained and even the ones we've never touched directly, you touched hundreds of thousands of oncologists around the world indirectly. So thanks for all your contributions and what you've done. And thank you both for being on this podcast. I hope it opens up more inspiration for other young investigators and other young oncologists who don't really realize how we got where we are. So with that, we'll end this. And thanks a lot. And hope you have a nice weekend. OK, thanks, everyone. Have a good rest of the week. Bye, bye. 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. 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. Dr. Greg Hundley: I'm Dr. Greg Hundley, the director of the Pauley Heart Center at VCU health in Richmond, Virginia. Dr. Carolyn Lam: Oh, Greg. Today we have a special episode focused on COVID‐19 pandemic, something that has just affected us so severely worldwide, it really needs no introduction. Why are we doing a special issue? Well, I think it very quickly got recognized that patients with cardiovascular disease do seem predisposed to severe COVID‐19 syndrome, and that these patients can have an acute COVID‐19 cardiovascular syndrome, in fact. We're going to be talking all about this in a series of interviews about the syndrome, the clinical presentations, what this implies for management. Is the pulmonary embolism involved in the pathophysiology of all of it? And what are ways that we should use to monitor or even screen these patient?, For example, what's the role of troponins? Dr. Greg Hundley: Yes, Carolyn. I am excited, just as well as you, and our first paper today is from Dr. Leslie Cooper, from the Mayo Clinic. He's really done a nice review describing the disease process and the management of acute COVID‐19 and the cardiovascular syndromes. Dr. Greg Hundley: Leslie, we'd like to welcome you to Circulation on the Run and just to get started, I'm wondering, could you tell us a little bit about the genesis of your paper and then also perhaps some of the mechanism, how does this virus affect our systems and promote cardiovascular disease? Dr. Leslie Cooper: In mid‐March as the COVID, crisis was taking off in this country, I was on a telephone call with Dr. [Biykem] Bozkurt and [Dr. Mark] Drazner, from Texas. We realized that there was a terrific need for clinicians to have an overview of how to manage the COVID‐19 impact on the heart. There was also, at that point, very little clinical data about the mechanisms and what the real pathogenesis was. We set about and the rapidly put together the available world's literature. That is what was ultimately published here in Circulation about two weeks ago. Dr. Greg Hundley: Tell us a little bit about that mechanism. Dr. Leslie Cooper: It became apparent that there is not one specific mechanism. We initially thought that like the Coxsackie viruses, this could be a direct cardiac damage, but clinically as we reviewed the literature, it became clear that it's more systemic. The older patients who have preexisting cardiac disease, hypertension, coronary disease, other risk factors, such as diabetes or obesity have a much greater risk of cardiac involvement and the consequences of that cardiac involvement are very substantial. Dr. Leslie Cooper: In addition, when you get a profound cytokine storm from the systemic infection, that can depress cardiac function. A combination, in individuals, of cytokine mediated damage from systemic inflammation, stress induced cardiomyopathy, as you would see in takotsubo, as well as hypoxia and perhaps increased pressures in the lung from, as Carolyn mentioned, pulmonary emboli, and finally direct viral damage. Viruses can infect macrophages in the heart. There is a growing body of literature that there can be a direct effect independent of the systemic infection. The answer is there are multiple factors each of which may have its own therapeutic target. Dr. Carolyn Lam: Oh, I love the way you explained that so clearly Leslie, and in fact, this is really bringing back sweet memories of when I was training under you at Mayo Clinic. I won't say how many years ago, but there comes the question, you know so much about myocarditis, in general, and a different viral myocarditis. Could you maybe tell us a little bit about how this one may or may not differ and also how this impacts management? Dr. Leslie Cooper: The coronaviruses have a very different mechanism of cell entry and propagation. It does not appear that this particular infection in the heart is causing the kind of antigen specific immune reaction that you see classically with a Coxsackie virus. We're not seeing necessarily a lot of auto‐antibody, molecular mimicry. We're not seeing a lot of T‐cell infiltrate. We are seeing some infection of macrophages, and it's not yet clear how many of those were infected peripherally and then migrated to the heart. The histology is quite different and the acute damage is therefore, more subtle. You're not seeing sheets of lymphocytes and the targeted therapies would not be necessarily directed at those cells. Dr. Leslie Cooper: Having said that, inflammation more broadly, for example, anti‐IL‐6, anti‐IL‐1 type, anti‐cytokine mechanisms are currently under evaluation in clinical trials, and they may be quite meaningful. Quite meaningful in the setting of the systemic inflammation. When you compare this to a SARS and other coronavirus infections, I'd like to say, we have known that occasionally a coronavirus can cause myocarditis, for 40 years. It's simply not very common. It predisposes the individual or makes the particular virus more cardiovirulent at this point. Dr. Carolyn Lam: All listeners, you have to get ahold of this beautiful paper. As Greg was actually suggesting a little bit earlier, they're this beautiful figure that you have to refer to that shows a management pathway and considerations. Also, very lovely illustrations of potential mechanisms. Leslie, could you also let us know then, in the overall management, not just treatment, where is the place then, for things like myocardial biopsy? Dr. Leslie Cooper: I think you have to start with the clinical presentation. COVID‐19 as a syndrome, and SARS‐CoV‐2 as a virus, can present with multiple cardiac syndromes. The first would be ST segment elevation, like myocardial infarction with normal coronary arteries. In that setting, it may be microvascular obstruction, or it could be myocarditis or stress cardiomyopathy, perhaps in a younger person who doesn't have risk factors. Dr. Leslie Cooper: Can also present with a primary cardiomyopathy, a heart failure presentation, shortness of breath, systolic dysfunction. And finally it can present as a pericardial effusion, not the most common presentation, but it's important to realize that just like other viruses, this can cause an epicardial or pericardial inflammation. Dr. Leslie Cooper: Management really depends on the clinical syndrome and I'd emphasize guideline‐directed medical management. If it's an arrhythmia, a ventricular tachycardia or heart block, manage that per the current guidelines. The same is true for systolic heart failure. Dr. Leslie Cooper: In addition, I would say that since most patients with COVID infection do not have cardiac involvement, you should first treat the whole patient. First, see the clinical syndrome. What is the dominant problem? Is it a lung problem? Is it kidneys? Then, if there is a cardiac manifestation, we recommend starting with a troponin. If the troponin is elevated, proceed to a point of care echo. Dr. Leslie Cooper: We do want to minimize exposure of allied health staff and physicians to the virus. We do not recommend multimodality imaging or heart biopsy upfront. Having said that, if the patient has substantial left ventricular systolic dysfunction, and they're already in the cath lab, because you're excluding coronary disease, our paper does recommend that you consider an endomyocardial biopsy to find the mechanism of left ventricular dysfunction. Dr. Greg Hundley: Very good, Leslie. Dr. Greg Hundley: Could you close this out, a little bit about therapy when we have patients with this severe hypertension, respiratory abnormalities requiring ventilation, and then also these devastating cardiovascular effects. Are we looking at anti‐inflammation is primarily the target as opposed to antiviral therapy? Dr. Leslie Cooper: Right now, there are a couple of clinical pearls. Number one, as in all cardiogenic shock, you don't have... Sinus tachycardia is not a therapeutic target. You may need that because of low stroke volume. You want to allow when it's compensatory for the tachycardia. Once you've treated with guideline directed therapy, the arrhythmias and the cardiomyopathy appropriately, specific mechanistic interventions, such as antiviral therapy or anticytokine therapy should be given within the context of a clinical trial, wherever possible. Dr. Leslie Cooper: Our article recommends that if you have access to a clinical trial and in this country, the convalescent plasma trial, is up and running. Mayo is leading that for the country. It's available at approximately 600 sites. We would recommend, first of all, enrollment in a trial because we then will understand the mechanisms and the best treatment. If you don't have access, it really depends on the clinical syndrome and how sick the patient is. Patients who are less sick have been treated with things like hydroxychloroquine. People who are more sick, we move on to a convalescent plasma and anticytokine therapy such as tocilizumab. Dr. Greg Hundley: Very good. Well, Leslie, we want to thank you for sharing this wonderful review with us at Circulation. We feel very privileged to have the opportunity to publish this and also to share it with our readership. Again, thank you for all of your frontline work at the Mayo clinic and helping participate in trials and things of this nature to combat this terrible disease. Dr. Leslie Cooper: Thank you so much. Dr. Carolyn Lam: Greg, from acute COVID‐19 cardiovascular syndrome to now, all about troponins. I am so, so thrilled that Dr. Nicholas Mills is here with us, not only our associate editor, but also corresponding author of the next paper. He's from University of Edinburgh in UK. Nick, I love the question that you asked in your title, "Are troponins an ally or a foe in the fight against COVID?" Explain, please. Dr. Nicholas Mills: I strongly believe that they can be an ally, but I recognize amongst cardiologists and clinicians around the world that are grappling with this new condition, that the use of biomarkers can be contentious. We're still learning very much about this condition and how it affects the heart. Therefore, it's difficult to provide very clear guidelines. It's how you interpret the cardiac biomarkers in this condition. The reason I feel strongly that they can be an ally is, they're easy to measure, they're cheap, and you don't require a direct patient contact to obtain the result of the test. It gives us some fundamental information about whether the heart is involved or not. Dr. Greg Hundley: Nick, can you tell us which biomarkers do you favor and is it high sensitivity troponin? Is it regular troponin? For our listeners in many different hospitals across the world, what would you suggest? Dr. Nicholas Mills: The evidence that has that merged very rapidly over the last few weeks and months suggests that our range of cardiac markers have very, very high prediction for poor outcome. Whether that's predicting a patient that might deteriorate and require admission to an intensive care unit for ventilation, or develop complications such as acute kidney injury or death. Dr. Nicholas Mills: There are a number of biomarkers that look very useful for predicting the course of a patient. The strongest, in most studies, is cardiac troponin. I think it's because we do have such sensitive assays now. High sensitive assays are such a fabulous way of getting a barometer of your heart health. The heart of course, is a fairly fundamental organ. If this condition is going to affect to any other organ out with the lungs. If it's the heart, you're going to be in trouble. I think high sensitive troponins, in particular, give us such exquisite information about the systemic complications of this virus that they are perhaps above all other markers, the most useful for predicting outcomes. Now, that clinical question goes beyond that. We need to understand how this virus is affecting the heart and whether we can intervene in any shape or form in response to these results in order to try and improve the course for these patients. That is a more challenging question. Dr. Greg Hundley: Nick, you've got a wonderful figure and we just heard from Leslie Cooper about the different cardiovascular disorders. Once we have elevation or experience, we see elevation in a patient with a biomarker, whether that be high sensitivity, proponent, BNP, et cetera. How does that point us in a direction of where our next move is, clinically, to combat this disease process in patients? Dr. Nicholas Mills: I think the first thing to say is that biomarkers do need to be interpreted in the clinical context and to understand that the pre‐test probability of having underlying structural chronic disease in your patient who presents with COVID‐19. That will very much influence your interpretation. If you think about the spectrum of conditions that you might see, and in fact, that we are seeing, there are a number that I would highlight. In particular, we know from many years of looking after patients with bacterial or viral pneumonia, that the pro inflammatory state of those conditions in patients who are vulnerable, older, and have underlying coronary heart disease is a really powerful risk factor for acute coronary syndrome and type one myocardial infarction. Dr. Nicholas Mills: Often in ventilated patients or patients who have clearly an alternative diagnosis, these important conditions, which are treatable, are overlooked. I think in considering the potential causes of myocardial injury of these patients, we should not overlook the probability that vulnerable patients have triggered acute cornea events in the context of their illness. Dr. Nicholas Mills: The other group that I think are really important are type two myocardial infarcts. They are an increasingly well‐recognized group of patients with the use of high sensitive tests in critical care units around the world. In the context of profound hypoxia or hypotension in sepsis, it gives the clinician managing the patient an idea about the vulnerability of the patient and their susceptibility and risk. I think that is also important. Dr. Nicholas Mills: Then, I think there's a separate group of conditions that are a direct consequence of the exposure to coronavirus and the clinical syndrome of COVID‐19. We are seeing case reports and have our own experience locally, of patients who develop myocarditis in this condition. I think it is rare, but it is real. When it occurs, it can be particularly severe and associated with prothrombotic complications. The other conditions that we are seeing are stress cardiomyopathies in relation to profound breathlessness, and that is not uncommon. Dr. Nicholas Mills: We are trying to systematically scan our more critically unwell patients in the intensive care unit to look for evidence of cardiomyopathy. Dr. Nicholas Mills: The final group that I would highlight is in those that are more severely unwell. Right ventricular dysfunction as a cost of either prothrombotic changes or of ARDS itself, is a really important observation that an elevated cardiac biomarker may be the first clue that that patient is developing cardiac decompensation. Although there's a range of different, important underlying conditions and the biomarker in itself cannot differentiate between these, I think recognizing that the patient is at risk of these underlying cardiac artery disease is an important first step. Dr. Carolyn Lam: Nick, really nicely explained. I'm going to read one of the lines from, I think, one of the concluding paragraphs from your paper, because it's really interesting. "Clinicians must recognize that troponin is not a test for myocardial infarction and it never was." Now, that's very interesting. I know in many ways you've explained it in what you said earlier, but could you maybe just end by hammering home what you meant there? Dr. Nicholas Mills: Myocardial infarction is a clinical diagnosis. It is not a test, one test. It's a combination of clinical features, a variety of different tests that help you arrive at that final diagnosis. Unfortunately, when troponin was introduced into clinical practice a number of years ago, as a replacement for CKMB, it became a sort of de facto. This is the test we use to differentiate people with myocardial infarction, without it, and that has become perpetuated in our clinical practice. Dr. Nicholas Mills: As the technologies move forward and we've developed really high sensitive tests that allow us to measure proponent accurately in almost all patients, it's become abundantly clear that it is a marker of heart injury in a very wide range of clinical conditions. We need to almost unlearn that original teaching, but this was a marker used exclusively to rule in and rule out myocardial infarction and embrace it as a test that tells us about your heart health and how it is affected in a wide range of conditions. Dr. Nicholas Mills: For me, it's never really been high sensitivity troponin in any way, a test exclusively of myocardial infarction. I use it very widely. I always find it informative in the clinical setting in order to guide decisions that I make for my patients. In a patient with ischemic chest pain and an elevated troponin, the default is, this is a type one myocardial infarction until proven otherwise. In all other settings, this is evidence of acute myocardial injury. Some careful consideration is required to determine what the mechanism is that underpins that. Dr. Carolyn Lam: There, you heard it, ladies and gentlemen. That kind of wisdom is going to last beyond COVID‐19. Thank you so much, Nick, for joining us today. That was awesome. Dr. Nicholas Mills: Pleasure. Dr. Greg Hundley: Well, listeners, now we're going to switch and talk a little bit about pulmonary emboli and to introduce that topic. We have Dr. Sophie Susan from Lille, France, who has performed a study in France, looking for this disorder. Dr. Greg Hundley: Welcome Sophie. I was wondering, could you start us off, tell us a little bit about the background for your study, the hypothesis and the question you were going to address, and then what was the study population and some of your results? Dr. Sophie Susan: I work in Lille University Hospital, which is in the North of France. During the early days of March, we had the first patients with COVID‐19 and we were very surprised. High number of patients with sudden aggravation of the respiratory symptoms. We were suspecting high numbers of, I would rather say pulmonary thrombi or pulmonary embolisms. We looked back to medical records of patients admitted in our institution last year, in the same period of time, to look at the frequency of these pulmonary embolism or pulmonary thrombi. We also looked at all the patients admitted for influenza, ARDS in our institution last year. Dr. Sophie Susan: What we observed is that there was a higher frequency of pulmonary embolism during COVID‐19. We observed 22 patients. At the moment we sent the [Research] Letter to Circulation. That means 20% of patients admitted in ICU. And by comparison, there were only 6% of patients in the same period of time in ICU last year. To be sure to avoid any bias in the data collection, we looked also at the CTPA, the angiograms, of the angiography of those patients. We observed that in influenza patients, they were much more investigation with CTPA than in COVID‐19 patients. Despite this higher number of CTPA perform, they were less pulmonary embolism or thrombi identified. Our conclusion was at that moment, that there was an awareness on the new increase frequency in thrombotic pulmonary complications in COVID‐19 patients. Dr. Greg Hundley: Thank you so much, Sophie. You've got a beautiful table in your article. Were there any particular patient characteristics that you could identify in this patient population that you think may make patients predisposed to this? Dr. Sophie Susan: Yes, we were very surprised in my region. My area is a metabolic area and we were very surprised to observe the high number of obese patients in our ICU. There was a publication from our group on the subject. We looked at the BMI of those patients and on our table, you can see that almost all of them were above 25, and the large majority about 30 BMI. They were also all receiving thromboprophylaxis at baseline at the entrance in ICU. Although all the patients were at least receiving 40 milligrams of Heparin, or even more, and some of them were also on their particular levels of low molecular weight or unfractionated heparin therapy. Dr. Carolyn Lam: That is a very important point that you just made, that some of these patients, or a lot of them, had background prophylaxis already. Sophie, could you end by telling us how have these results perhaps influence your management? Or what do you think are the implications? Dr. Sophie Susan: It's a difficult question. The first issue is that regarding the population admitted in ICU, we've got a lot of weight patients and there are no current guidelines adapting thromboprophylaxis to weight. The first question was that 40 milligram of heparin is good for everyone. Do we need to increase this regimen in obese patients? Dr. Sophie Susan: There was a proposal of ESC two years ago, and we adapted these proposals for COVID‐19 patients. We do believe that 40 milligrams of heparin is not enough for patients in ICU, for overweight patients in ICU. So for a BMI above 30, we think that we should increase the regimen of low molecular weight or unfractionated heparin. That's the first point. Dr. Sophie Susan: We've got also, a disease that is random, very difficult sometimes to perform CTPA, difficult, to move patients to those exams. Sometimes we've got to give a probabilistic treatment and in case of acute worsening of the respiratory status and in particular, in case of repositioning patients, when they are under high‐positive and expiratory pressure, sometimes they get sudden aggravation. We must think about probabilistic therapeutic approach with heparin on those patients. That's the two main conclusions we made for the adaptation of protocols. Dr. Carolyn Lam: Well, thank you so much, Sophie. I really am so grateful that you published this work here at Circulation. You very, very, fairly pointed out what you found. I thought that your inclusion of the control groups was really the best that we could do, and therefore your data represent the best available evidence for a very important question that we've all been asking. Are these patients at higher risk of pulmonary embolism? Dr. Carolyn Lam: Thank you so much for sharing that with us. Dr. Sophie Susan: Thank you very much for the invitation. Dr. Carolyn Lam: What an amazing series of papers that we have on COVID‐19. Guess what? These three that we talked about today are not the only ones. We really strongly encourage you to look at ahajournals.org/coronavirus where you can see many more papers published in Circulation, relevant to COVID‐19 as well as some commentary from experts on the front lines. Dr. Carolyn Lam: Thank you very much, once again, everyone for joining us today. Dr. Greg Hundley: Have a great week. Dr. Greg Hundley: This program is copyright, the American Heart Association, 2020  

Welcome to MINDSET Mondays Podcast Series where new and provocative topics are uncovered and explored to develop our presence, raise our consciousness, and find our voice to better manage our relationships in all walks of life! I'm Dr. D. I'm delighted to have you join us at MINDSET Mondays and being a part of our community of listeners worldwide. Join me with David Corbin, a two-time Wall Street Journal Best-seller Author, returns to MINDSET Mondays to spread his message on Illumination on how to courageously face what's going on, inquisitively follow it to see the outcomes, and then enthusiastically fix it so it's not a reoccurring challenge. It's about the Law of Control and what you can take charge of. Last year he had not one.. but TWO of his books make the Wall Street Journal List- quite a feat- so take note of his ideas because they’re really catching on worldwide. Are you interested in learning more about MINDSET and making positive shifts? Visit 3 Steps to MINDSET Shift at

BiG Ideas, a podcast from the Institute for the Study of Culture and Society at Bowling Green State University, is excited to announce The Enlightenment, a bite-sized podcast, written and hosted by ICS intern Taylar Stagner. In this episode, Stagner speaks with undergrads, graduate students, and professors who share how the Covid-19 pandemic, and the campus shut down it has caused, have affected their lives.   Jolie: Hello. You're listening to the Big Ideas podcast. I'm Dr. Jolie Sheffer, associate professor of English and American culture studies and the director of the Institute for the Study of Culture and Society at Bowling Green State University. This is not a typical episode. The conversation you are about to hear was recorded during the COVID-19 crisis, so you may very well notice a difference in our sound quality. You'll also notice that we've got a different format. We wanted to capture some of the incredible challenges facing BGSU students, faculty, and staff during this world-historical event, as well as document some of the incredible creativity, resiliency, and generosity we've seen. Jolie: Now more than ever, we believe it's important to hear thought-provoking and inspiring stories about big ideas featuring members of our community. The following episode is one of several short-form stories being produced and reported by Taylar Stagner, a master student in the American culture studies program and an ICS intern. We're calling this series, The EnlightenMinute. We hope you enjoy it. Stay safe out there. Taylar: Welcome to EnlightenMinute, a bite-sized podcast from the desk of ICS. I'm Taylar Stagner with more on how students and faculty at BGSU are dealing with the drastic shift in university life. Online video applications, like WebEx, Zoom, and Skype, help peers and instructors converse with each other during the statewide shelter in place order. No unnecessary travel is permitted and all classes and projects have been moved online. In the shuffle to switch instruction online to slow the spread of COVID-19, one of our interns at ICS is missing out on her last semester of college. Renee Hopper is getting her bachelor's degree in creative writing with a minor in German. To finish her minor, she was going to go to Germany before the shutdown. Renee: And I wasn't planning on being on campus next year at all because of study abroad. And now that summer is canceled, I have to figure out a way to take German online at a different university this summer and transfer it over, which I've heard is a rough process. Taylar: After BGSU moved to online instruction, Renee moved back to her home outside of Columbus in Dublin, Ohio with her parents and older brother. I asked her how that was going. Renee: Most days, pretty good, now that we're used to it. I've established my own little space in our dining room where my mom literally took our own Snuggies and hung them in the doorways so that I have my own enclosed little office. Absolutely innovative. But when I'm in there, I can pretty much be counted on that they're not going to come in and I can work. Taylar: While Hopper can make do, she can't help but feel like her undergraduate career ended anticlimactically. She had to go and empty out her dorm room during spring break. Renee: It was really melancholy. I wasn't expecting it, especially because there are so many fun things to prod at about dorm life, like you don't have a kitchen and you really miss food. But just the fact that I hadn't been expecting to start packing up so quickly made it harder to walk in the room and be like, "Oh, all of this is coming back with me right now." And it was really strange that I couldn't even go get food and use a bit more of my Falcon dollars before we left. I had to order one of those little robots and it brought us Dunkin and we had a little moment there. But it just felt, it didn't feel permanent at the time just because it was such an odd time to do it and because there were so few people on campus. Taylar: Hopper isn't the only one having difficulties with the change. Masters student Justin Kindelt moved to Northwest Ohio from Evergreen State University in Tacoma to pursue a American Studies degree. And since the switch, his workload as a student and graduate assistant has doubled. Justin: I feel like it's exploded, gotten huge. I mean, a lot of my projects had to switch from what they were supposed to be to something I can do at home, which you can't blame anybody for. It happens. But, and then one class, three papers have been added. Taylar: And that's not mentioning the change in responsibilities as a teaching assistant for the School of Cultural and Critical Studies. Justin: Teaching, what used to be a discussion that I get to lead on Fridays is something I have to type up every Thursday night. My students, I think, are suffering from the same problem, but it's not engaging us. Hey, here's some things, hopefully you can answer some of it. Taylar: Kindelt also thinks you lose something with the transfer to discussion boards and even video conferencing. You lose some of the back and forth. Justin: Well, I like discussions. I like to hear what somebody says and then respond to it and talk about this, talk about that. And it just feels like written discussions are much more formal. Even at two classes that we still video chat into, you've got to hit a button to raise your hand. And the professor picks whether or not to call on you, and you've got to turn your mic on and off. So there's just, the flows not there as much. It's much more structured, even if it's not academically structured. It's not as easy to just engage in the conversation. There's at least button pressing between communications on every aspect of it. Taylar: Teaching online is not something new for Dr. Kim Coates, the director of the American culture studies program. I asked Coates about how some professors think keeping strict deadlines on assignments instills normalcy in this chaotic time. She says that it's okay for professors to be lenient, but communication is key. Kim: That doesn't mean that I have been less or I've expected less from them in terms of the work that they do, but what I'm letting them know is that if they need more time to do it or any other types of flexibility that I'm willing to accommodate them. Taylar: With many students and professors with tenuous access to reliable internet, a physical library and uncertain global unrest, unneeded stress can add to our likelihood of sickness, something Coates hopes to avoid by communicating with her students. Kim: Again, I think all of us are doing the very best we can right now, and to expect ourselves to do our very best work or to be performing at our peak is just unreasonable and we're only setting ourselves up for disappointment and perhaps getting sick ourselves. And we don't want that. Taylar: Truly, these are unprecedented times to be getting an education, but Coates leaves us with some encouraging words. Kim: My generation, and even your generation, Taylar, and a few before have not experienced anything like this. It's really been since World War II that something like this has affected our country as a whole, as well as the entire globe. Seeing how we all come together and get through when circumstances demand that we do so, I think we've all done a really good job. So I'm proud of my students, I'm proud of my colleagues, I'm proud of BGSU. Taylar: In our next EnlightenMinute, how do graduate students and professors produce research during COVID-19? How much can we expect of ourselves, and how do we move forward with shaken up research plans? I'm Taylar Stagner and I hope you've enjoyed reaching Enlighten Minute. Jolie: You can find the Big Ideas podcast on Apple Podcasts, Google Play, Spotify, or wherever you like to listen. This episode was written, researched and produced by Taylar Stagner with editing by Stevie Scheurich. Special thanks go out to Marco Mendoza for his extraordinary sound editing in challenging conditions.  

BiG Ideas, a podcast from the Institute for the Study of Culture and Society at Bowling Green State University, is excited to announce The Enlightenment, a bite-sized podcast, written and hosted by ICS intern Taylar Stagner. In this episode, Stagner speaks with graduate students, and professors who share how the Covid-19 pandemic, and the campus shut down it has caused, have affected their lives as researchers and working parents. Jolie: Hello, you're listening to the BiG Ideas podcast. I'm Dr. Jolie Sheffer, Associate Professor of English and American Culture Studies and the Director of the Institute for the Study of Culture and Society at Bowling Green State University. This is not a typical episode. The conversation you are about to hear was recorded during the COVID-19 crisis, so you may very well notice a difference in our sound quality. You'll also notice that we've got a different format. We wanted to capture some of the incredible challenges facing BGSU students, faculty, and staff during this world historical event, as well as document some of the incredible creativity, resiliency, and generosity we've seen. Now more than ever, we believe it's important to hear thought provoking and inspiring stories about BiG ideas featuring members of our community. The following episode is one of several short form stories being produced and reported by Taylar Stagner, a master's student in the American Culture Studies Program and an ICS intern. We're calling this series, The Enlightenminute. We hope you enjoy it. Stay safe out there. Taylar: Research, draft, edit, submit, edit again. Resubmit, publish, research. Research, draft, edit, submit, edit, resubmit, publish research. Research, draft, edit, resubmit, edit, publish research. This is how you stay relevant in academia. It's a cycle of drafting and submitting to journals for publication. Constant research is how professors argue for tenure, master's students finish theses, and graduate students finally get the letters PhD next to their name. But what if a worldwide pandemic shuts down how people actually do research? With K through 12 schools shut down, kids are at home. Many research projects require in-person observation. And how do you stay calm and go with the flow when the whole world is turned upside down? Here at ICS, our director, Dr. Jolie Sheffer, is usually very busy with her own research and service projects, sometimes up to 15 projects at a time. But now, her energy focuses more towards her students' wellbeing. Jolie: Now, there was no guarantee that our students even have housing, that they have food, that they have enough money, those bare necessities, and even internet access to be able to participate in the classes. That priority list looks really different. So in some ways, I have fewer things on my plate now, but the stakes of those things feel much higher. Taylar: With a young child and a partner who also works from home, finding time to write is a challenge. But when Sheffer finds time to write, it becomes a necessary reprieve from the current circumstances. Jolie: I am trying to still write most days between 15 minutes to 30. There are a few days I've been able to get in an hour if my husband's able to watch my son. And that's actually been really helpful for my mental health. I mean, I really like losing myself in the research and getting back into those kinds of thorny problems that help me forget about COVID-19 and all of that uncertainty. Taylar: There exists so much uncertainty, especially with kids at home. Adam Cohen is a doctoral student here at BGSU. And the last couple months have been especially challenging because he and his wife recently had twins. Adam: Which they came three months premature. They were supposed to be born at the beginning of April. And due to some complications, they were actually delivered on New Year's Eve, 2019. So we've been in Cincinnati since then, because there's a really good children's hospital out here in Cincinnati. And they've been in the NICU, which stands for neonatal intensive care unit. Taylar: So obviously, taking care of his family is the priority. But with everything up in the air, Cohen still has to think about his dissertation and how COVID-19 might disrupt his original plans. Adam: Generally speaking, my research is in media studies, particularly audience studies. And for my dissertation, I've been researching what I call electoral spectatorship. So I'm looking at debate watch parties at bars during the 2020 presidential election in the US. Taylar: And there might not be another public debate to get together for the rest of the 2020 presidential election. Cohen might be able to switch his research to online watch parties, but that pivots away from what he was really prepared to study. Adam: But it's a completely different conversation than the one that I was previously in. And it kind of unfortunately cuts out some of the stuff that I was most interested in, like the intertwining with consumerism. I'd have to say, I really don't know. So I'm still kind of hoping that it doesn't fully come to that, but it might. Taylar: Stevie Scheurich is also working on their doctorate. They study gender and feminisms, and Scheurich is in their second year. Stevie: My focus is just kind of shot because everything is so up in the air. There's just so many variables that I can't really do anything about. And I'm coping. I feel pretty calm most of the times, but sometimes just trying to get my brain to think in a straight line or to sit down and do my task for more than 10 minutes at a time, it's just not cooperating. Yeah. There's time, but I feel like I'm moving slower. Taylar: I asked Stevie about how some academics are excited to get more work done with all this newfound time at home, but Stevie doesn't see it that way. Between their responsibilities as a student and a graduate assistant for ICS, this time just feels like a practice run for more unstructured time to work on a dissertation. Stevie: I feel like it's an illusion of more time. I still have the same amount of tasks to do in a day. I just have more agency when I get to choose to do it. And for me, I feel like this is kind of a nice dry run for thinking up dissertation time, because that is unstructured time as you find. Hopefully, there's not a global crisis happening during dissertation as well. But if I can do this, then I can sort of manage that as well. Taylar: In order to cope with all the uncertainty, Stevie has taken on the mentality of a familiar aquatic creature to help remind them it's okay to go with the flow. Stevie: One time, I went to the Shedd Aquarium and they had a jellyfish exhibit, and there's just this circular tank. And I guess they don't really move on their own. So they were just circulating the water in a circle. They're just at the whim, floating in a circle. And that's sort of how I feel, if that makes any sense. I'm sort of afloat in the ocean. Don't have a lot of power myself. So I'm just letting the wave carry me where ever. As long as I'm staying afloat, I guess, that's important. Taylar: During such daunting times, we can all take notes from jellyfish. The whims of a global pandemic have shaken all of us, but now there isn't so much to do other than ride the waves with fellow jellies to more certain times. During our next episode of Enlightened Minute, we speak to administrators at BGSU who are wrestling with how next year will unfold. I'm Taylar Dawn Stagner, and I hope you've enjoyed reaching Enlightened Minute. Jolie: You can find the BiG Ideas podcast on Apple Podcasts, Google Play, Spotify, or wherever you like to listen. This episode was written, researched and produced by Taylar Stagner with editing by Stevie Scheurich. Special thanks go out to Marco Mendoza for his extraordinary sound editing in challenging conditions.  

In this special COVID-19 episode of the BG Ideas podcast, Melody Freeland, a BGSU grad student and winner of the ICS ICS Student Research Award, and Dr. Cyndi Ducar, associate professor in World Languages and Cultures at BGSU, sit down to discuss teaching strategies in application to students learning math without English as their first language.   Announcer: From Bowling Green State University and the Institute for the Study of Culture and Society, this is BG Ideas. Musical Intro: I'm going to show you this with a wonderful experiment. Jolie: Welcome to the Big Ideas podcast, a collaboration between the Institute for the Study of Culture and Society and the School of Media and Communication at Bowling Green State University. I'm Dr. Jolie Sheffer, associate professor of English and American culture studies and director of ICS. Jolie: This is a special episode of the Big Ideas podcast, which we're recording during the COVID-19 pandemic. That means we're not in studio but are recording via phone and computer. Our sound quality will differ as a result, but we thought it was important to share with you some of the amazing work being done by members of our BGSU community. Perhaps now more than ever, we want to celebrate big ideas. As always, the opinions expressed are those of the individuals involved and do not necessarily represent those of BGSU or its employees. Jolie: Today, I'm joined by two guests, Melody Freeman and Dr. Cynthia Ducar. Melody is a BGSU alum with an undergrad degree in mathematics education for ages 7 through 12 who is currently working on a master's degree in Spanish, also at BGSU. She received an ICS student research award for her project "Analyzing and assessing the preparedness of math teachers to meet the needs of students for whom English is not their native language". Her faculty mentor is Dr. Cindy Ducar who teaches graduate and undergraduate Spanish courses and topics such as applied linguistics, Hispanic socio-linguistics, and heritage language pedagogy. Welcome, Melody and Cindy. Thanks for being with me today. Melody: Hello. Cynthia: Good to see you. Jolie: Melody, could you start us off with a description of your project and what motivated you? What questions were you trying to answer? Melody: Yeah, so my project, the official title is BGSU in mathematics education graduates self-efficacy for the teaching of Hispanic English language learners. So this project kind of focuses on looking at our own program at BGSU, which I went through as an undergraduate. So it's kind of a unique thing where I can kind of look at that program for mathematics education, but specifically at those who are studying to get their degree in a 7 through 12 grade certification for teaching math and those same students who are going through the program or have just recently graduated, kind of like myself and my colleagues, who I graduated with at BGSU, and looking at and studying or investigating their levels of self-efficacy specifically for teaching students whose native language is Spanish or who are classified as English language learners. Melody: I guess I would say that where this project came from, why this question, why this project, I think part of it comes from the fact that I did go through the same exact program as an undergraduate, so I have kind of this firsthand experience and our program is one of the top in the nation. But any program still has gaps or things to work on, and so I did notice or take note of a few things as I did go through the program myself, one of those gaps in preparation, which is related to preparing our future teachers who teach math specifically, to be able to do that efficiently and effectively for this student population specifically. So I think that those are kind of the main components of what led to this project. Jolie: Cindy, how did you come to work with Melody on this research project? And how does your own research in socio-linguistics help shape your mentorship for this project? Cynthia: So I met Melody quite a few years ago and she was in my Spanish course for majors and minors, and like she said, she was majoring in mathematics education, but her Spanish was through the roof. I mean, she was a stellar student from day one. And as we got to know each other in that class, eventually she got closer to the end of her career in her senior year, she came back to me and she said, I'm thinking about working on this action research project, where I work with students who are weaker in English and have a background in Spanish and I want to do something more for these students, so how could we work together? Cynthia: So we talked about coming up with a placement for her that was going to lead her to a population in Northwest Ohio that might have more Spanish speaking students. She wound up in Fremont and things didn't quite go as expected, I would say, but she got a lot out of the experience nonetheless, and was able to implement her project there with a group of students and have stellar results. So I think that's how this now came to be. She saw the effects of putting into place changes in her teaching style and then the approach to math, and in that case, she was using manipulatives and looking at changing the wording and word problems to reach these students. And my own research looks at the flip side of this, right? It looks at these students acquisition of Spanish, but you really can't separate that from their acquisition of English, right, that push to learn the dominant language. So preparing teachers to be able to meet the needs of this population better is something that matters to me in terms of student success, in general, in helping these students reach higher levels of achievement. Cynthia: And I think often we think of this as a Spanish teacher problem or an English teacher problem in English as a second language problem. It's really no one's problem, but it is all of our business to do our best to help all of our students. And so I think Melody's project addresses that, by trying to meet the needs of these students in a mathematics curriculum, which is often overlooked, and math is often the first subject they say will be easy for you if you're limited English proficient. Jolie: And that's my followup question for Melody, which is, we often hear math talked about as a kind of universal language, that it doesn't sort of matter what language it's being spoken in because the math itself is this transparent tool for communication. Could you talk about why you think it's so important that math teachers, in particular, be able to instruct in Spanish more effectively? Melody: What you just mentioned is one of the things that I hear so often, when I talk to people, I talked to colleagues, I talked to educators and other people in the community, a lot of people say, kind of echoing what both of you just said, math is a universal language, but math in and of itself, really is its own language with its own register, and these things start to get really blurry and complicated for someone who is bilingual or is trying to learn another language, or learn mathematics in a language which is not their native language. Melody: When you look at the standardized assessments that you take for mathematics in 8th grade, in the United States, nearly 75% of native English speaking students score at or above the basic level. So that's almost three quarters. But those who are English language learners, it's only 30%. So that's a 45% gap in mathematics achievement. And this is so important. I mean, that in and of itself speaks volumes, I think. When you look at standardized testing and things like this, it gets even more complicated because 8th grade is one of the most important years of standardized testing in the United States for mathematics. And so that's right before you get into high school. Melody: So imagine these sorts of tests put you on different tracking once you get to high school, and it's been proven that data shows that when you're in lower tracked classes, the instruction is much lower quality, et cetera. So it's almost a snowball effect that is really not setting the student population up for the success that they deserve, or it were to receive equitable opportunities. Jolie: Cindy, as someone with extensive experience, what do you think educators should be doing to make their classrooms more inclusive? What particular pedagogical methods or practices do you find effective or promising? Cynthia: Melody and I have talked a lot about culturally responsive teaching and looking at the background that these students come from and just to talk about that 40% gap that she just mentioned, students are coming to math questions, there's words in those questions, right, they have to be able to understand those words. Once they are able to understand the words, the words come from a culturally loaded context, right? Not everyone is taking a trip to wherever Florida for the week, right, and then looking at airfare for that. There's a lot of cultural assumptions that are laid in, in these math problems. Cynthia: So to me it's important to address and to value the students' culture, so to include questions. I mean, there's plenty of ways to address students' cultures from students that come from a Latino background along with students that come from other backgrounds, right? We could look at something a little more neutral, right? Travel is something that's a privilege for people, whereas cooking is something that everyone does and you can still do plenty of math when you're cooking. Cynthia: So there's ways to still make math contextualized, and yet allow it to be culturally relevant across cultures rather than geared to certain contexts that are very privileged. So I think, just most important is, finding ways to bring in the students' cultures and making them feel included and valued in the classroom. And I think we can do that regardless of what the subject area is. Jolie: Melody, you're interested in the potential uses of virtual reality technology in Spanish language mathematics instruction. What do you find so interesting and promising about that tool for mathematics education in particular? Melody: So that angle, I guess I would say the project came from the grant that BGSU just got for project impact, it's focused on preparing math educators or educators in general in our education program and looking at how, for example, we've talked about how the area that we are in, our university, it's sort of hard to find these diverse student populations in order to give our students who are learning to be teachers, that experience of being able to teach a diverse student population. Melody: So one of the ways in which virtual reality for instance is kind of coming or can be used to combat that issue is having kind of like these virtual students that kind of act as this diverse population where it wouldn't otherwise be able to be reached here. And one of the reasons why that's important, I think, is I've heard from a lot of people, even people at the university, that it's not so important because the schools around here aren't so diverse, but we're training educators who are going to teach all across the country. So imagine populations, if we send students to Texas or to Florida, I mean the student population there, the Hispanic student population is much larger than it is in Northwest Ohio. So that's one of the ways that I think that virtual reality, if I do get the chance to kind of include that in this project, that's kind of the angle it comes from, I'd say. Jolie: We're going to take a quick break. Thanks for listening to the Big Ideas podcast. Announcer: If you are passionate about big ideas, consider sponsoring this program. To have your name or organization mentioned here, please contact us at ics@bgsu.edu. Jolie: Welcome back to the Big Ideas podcast. Today I'm talking with Melody Freeman and Dr. Cindy Ducar about Spanish language pedagogies. Obviously due to COVID-19 a lot has changed in the world since the beginning of the semester. We've all moved to online instruction and we're living under the governor's stay at home order. As both students and teachers and researchers, how have your work and lives changed during the current restrictions? Melody, what are you dealing with? Melody: As a researcher, first, I suppose, the good thing is that we have technology. So things like putting together my questionnaire or passing out distributing surveys, what have originally probably been done in person is still okay, it still is going to run smoothly because I can do those things on Google Forms, et cetera. So it's just a matter of having to kind of move everything onto this virtual format, then maybe jump through a few extra hoops for IRB approval and things like that. Melody: Things like recruitment or getting in contact with participants is also something I have to kind of do in this virtual manner of maybe create a screen cast or something in order to kind of pass out that recruitment or try to get people to participate in this study. So it's just a lot of being technologically efficient and being able to move things also to a virtual format. Jolie: What about for you, Cindy? How has your life been upended in this last month or so? Cynthia: I'm grateful that we had the first seven weeks of the semester with our students to get to know them. And I think that's made this transition to online teaching easier for both me and for them. I think I'm also very grateful to have already taught classes online before, and though I had not previously taught the particular classes that I'm teaching this semester online, moving them online was easier because of that experience. Cynthia: Zoom conversation hours with students are not the same as face to face conversation hours for obvious reasons, right? It's already awkward to speak to someone in a second language as it is. I would say that's twice as awkward when you're trying to do it and not step on someone else's toes because your voice will literally cut the other person off, and then everyone's silently listening to you while you speak, which is also very intimidating for students, I think. But I'm running six 30 minute Zoom sessions per class, and students can just jump in when they want to. And those smaller groups work out better for people usually then having the whole class together at once. Cynthia: And of course I'm doing all of this with children at home while I'm also trying to teach kindergarten and 5th grade, on the side, which presents a challenge in which, if I'm very honest, diminishes my time to do research. I'm hoping to pick that back up again in the summer, but right now juggling the teaching of my own classes with keeping my kids learning as well, keeps me busy enough. Jolie: And I'm curious, part of what we're talking about is pedagogy for Spanish language instruction. We're talking about technology. How has this last month's experience of being sort of forced by external circumstance to rely so heavily on technology, has it changed your thinking about best and worst cases for doing instruction in K-12 classrooms, or the kind of teaching that you are thinking about for your project, Melody, and some of your research shows, Cindy? Melody: I didn't really talk about my teaching changes, but since I, as a graduate student, I'm also teaching an introductory level Spanish class. This being my first time teaching that course at the university level and then kind of just halfway through being like, all right, let's just make it all virtual, it's been crazy, but it's also been such a good thing because it really makes you be super reflective as an educator. I feel like every time that I finish a lesson or a Zoom meeting with one of my students for office hours, I'm constantly reflecting on how could that be better next time, et cetera, because of the circumstances. Melody: And so I think that it's also a good thing because I've been experimenting with so many different types of virtual tools and things that already exist out there using things like Nearpod and Go Formative and GoReact and all of these programs, all of these tools that I've had like at my fingertips, but that I haven't really been using as much as now, I realize I could, or they could really help with face to face instruction in the future. So I think that that's been kind of a positive thing that's come out of all of this. Jolie: What about for you Cindy? Cynthia: If I were to add a few positive things that have come out with this, I would agree as well that some of these technologies have sort of opened my eyes up to giving more timid students the ability, a platform, to express their ideas that's less intimidating. So, students have jobs right now, they're working during some of these times that I'm offering those Zoom sessions, and I said, look, just send me a Marco Polo, which is a way to record themselves that doesn't get erased, as it would if it were on Snapchat or something, right? And so they're sending me Marco Polos and there are some girls in these classes who I didn't even know could put sentences together and are conversing with me. Cynthia: And it's so exciting to see how many ideas that they can actually share in Spanish orally that I wasn't aware of. It's not that I didn't know that they could produce in Spanish, it's just a lot of times you have students who are stronger in written format versus in the spoken format, and this really gives more shy or introverted students a platform where they can present what they know in a more comfortable space. And it's really been eyeopening. It's something that I'll include no matter whether I'm online or face to face in the future. We've also tried Flipgrid for recordings as well. That gives people the chance to comment on each other, and it's interesting to see the performance of those same types of students in those different venues where they're stronger, if they just think it's just me and them talking. So that's been interesting. Cynthia: Vocabulary also, I found a lot of new activities that the students have written to me of their own accord and said, you know what, this is way better than just practice or something. So we've got them looking at corpus of Spanish language, like spoken language and finding the words in context, and then I have them paying attention to collocation, so which prepositions tend to be used with that word, and then what tends to come after that, and they're like, I would have never done this before. And this is ... They're not saying they're going to retain those words, right, because they're not producing them as much, but I think in a normal classroom context, adding some of these activities that we've sort of been forced into is going to be really longterm beneficial. Cynthia: That said, we should also recognize that Melody's research focuses on, often, less privileged populations. And so all of this technology, whether it be free or not, is not always accessible. So, we need to keep things like that in mind, if this situation elongates, those gaps that we're talking about are just going to get exacerbated and research like Melody's is going to become even more important, I think. Jolie: Yeah. Melody, do you want to speak a little bit about some of the challenges you are maybe seeing from your student's perspective more clearly than you would have before we had moved to online only instruction? Has it given you a different appreciation for some of the barriers that exist? Melody: Yeah, I would definitely say so. I feel that students are a little bit more open to sharing things sometimes virtually, or maybe since it's not in front of the whole class or whatever that may be. And so I've definitely learned a lot of new things over the past couple of weeks about my students and about better ways that they are learning and things like that, just because of all this that's been happening. And it makes me do a lot more check-ins with my students individually with each one, really trying to figure out, is this working for you, and so, yeah, I've learned a lot more about their learning styles and also about those barriers of things that they're dealing with now that they have to be at home or things like that, family issues and things like this that are really kind of interrupting their learning. And that is one of the things that I started thinking about. Melody: And I do talk very often with my colleagues who are now math teachers in K through 12 settings, or 7 through 12 settings, and so many issues that they're facing, especially right now, as K through 12 educators is crazy. So I applaud all the teachers who are K through 12, who are doing this virtually right now, because things like technology are a huge issue because schools that aren't one-to-one or they don't have technology for each of their students, that creates an entire problem, because now that you can't have face to face interaction and you have a large amount of your students who don't have access to Wi-Fi or don't have access even to an electronic device, this makes things extremely complicated. And not only that, but learning virtually is very difficult for a lot of people, so. Jolie: Cindy, I wonder if you could say a little bit about how being forced to be in the position of homeschooling, right, and I'm in the same position, I've got a little one at home, has it changed your thinking about what K-12 education is like, right? So you and I are both university level instructors, but we're seeing K-12 in a new way. How has it changed your understanding or thinking about what is needed, what's working, what's not? Cynthia: It's been interesting to me to see the differences that are expected across different schools, even locally. And as someone who used to teach in the K through 12 setting as well, I'm also in touch with friends who are still teaching, my neighbors are teachers as well, the amount of time that they have that they're told that they're allowed to have the students doing work and the quantity of things that they want to cover just don't coincide, right? So the K through 12 teachers, or in general, the system, is trying to take into account what you and I are talking about, right, that we don't have as much time to dedicate to teaching our kids as our teachers do, but at the same time, we want our children to not lose or fall behind in any way. Cynthia: I think that's a real battle. I think that battle is exacerbated for populations that are not as privileged as we are. And I think it's something that we are going to need to address as a society down the line. I have no idea how we'll address it, but there's gaps, there's gaps that just cannot be taken care of. I have a former Macy student now who has been working for five years in Western New York as a migrant student tutor, and she can't reach her students. And she's driving her car out there, the district has given her a Wi-Fi hotspot thing to just be near them, but if they don't have a device to connect on, that free wireless connection does them no good. Cynthia: So, I mean, I think there's so many things for K through 12 educators to take into consideration. I know a lot of districts had followed what BGSU is doing, they're doing pass-fail grading. They're recognizing that they're not going to get through all that same amount of material. I think the teachers are doing their absolute best to give what they can, but they all recognize that some are going to get more than others. And there's no way for us to solve that issue right now, but that's something that we're going to need to solve in the future, for sure. Jolie: The experience of this semester has really revealed the vast inequalities and it has made them worse, right? I think I've talked with a lot of people about how it becomes obvious that Wi-Fi needs to be a public utility, that if this is a tool we expect people to have, it needs to be as available to people as running water, because everything, when you switch over like this, the assumption is everyone has it and everyone does it. And as you mentioned, devices too ... We've had this even on our own campus with Chromebooks not operating properly with the software that the university supports and the challenges. Cynthia: There's families that are sharing one cell phone amongst multiple children and parents, and they're all trying to do their work on that one device. That's a major challenge, and not even an ideal device to begin with to be doing that work on. Jolie: Melody, anything you want to add or advice you want to give to students who might be thinking about their own goals for doing work that really impacts communities and has a real tangible benefit? Melody: One of the things I would say is just I've realized how important it is to stay connected to the community. And remember that the position that you're in is not always reflecting the position that everyone else is in. And I think that it's important that no matter what program you might be in or institution, there's always more that can be done, or there's always ways to improve the way that things are functioning. And to always be reflecting on that and reflecting on, especially thinking about equity and thinking about these issues of social justice and not as everyone having the same opportunity, but is everyone having the opportunity that they personally need to be successful. Melody: Because I think that that's why equity is so important, more importantly the equity of opportunities, because I think that that goes and connects to not only my research, but even everything we just talked about with all this online teaching and everything that's going on in K through 12 education and university education, et cetera, is just ... To look at and make sure that everyone has equitable opportunities. Jolie: I feel that so much. I think one of the things we've been talking about is that the strangeness of this semester, where you're forced to get out of your routine, of how you're used to teaching, of how you're used to engaging, with that has brought an opportunity for more self-reflection, more engagement, more checking in, right, with students and trying to assess what's working. And maybe in our ordinary lives, if we're hitting 80% of our students, we feel, hey, that's good, that 20% gap is because they're not interested or they're not trying. And in the current 80% is just not good enough, right? Because we want to make sure we are giving everyone the tools they need, so that then they really can put in as much effort as they want to. Jolie: So I like the kind of emphasis on trying to find the positive here, which is to keep that equity mindset when we go back to something that more closely resembles ordinary life, right, even though that will be altered, to keep that focus on making sure everyone, a hundred percent, have the tools they need to succeed. Cynthia: And if I could full circle back to Melody's research, I would just say small changes can make a huge difference, right? So her undergrad action research project looked at just using manipulatives to help students with a specific facet of learning for math. And do you want to tell her about the gains that you saw in those students? I mean, I think we look at these teacher prep programs and we think they're so stacked, they're so full, how would we ever create space for addressing the need that she's discussing? But if you give teachers these tools, I think they can help to make situations more equitable with just small tweaks. Do you want to tell what you did at all, Melody? Melody: Yeah. So that project that I did as part of the action program, which is an amazing program at BGSU, was using manipulatives, which are just concrete objects that students can manipulate while they're learning mathematics, not necessarily always in mathematics, any subject, and how that helps to kind of relate the abstract mathematical concepts to something more concrete that they can literally move around with their hands. I mean, so I had learned about manipulatives during my undergraduate process and learning, but I hadn't thought about how to apply that to this specific student population and the effects that that might have, and using that as an explicit tool for intervention for these students. Melody: And so that's kind of what the project focused on and with the results that I had were great, they actually show that the gap between the pre-test and the post-tests between the English language learners and non-English language learners was closed completely. And that was in my own classroom as a math teacher, just using manipulatives. Melody: And that's one tool out of so many tools that I think is so important for math educators in particular to learn how to use them, but learn how to use them effectively as well and how to implement those into the classroom and how they can help different student populations. Because one of the things that we talk about and stress is differentiation, and how important it is, and it seems like such a daunting task, which it is, it's extremely difficult and challenging for an educator to go to a classroom and differentiate their instruction for so many different types of students. But when you have these tools and you learn how to use them for these different populations, I think, and as that research had shown, that makes huge gains. Jolie: Cindy and Melody, thank you so much for talking with me today. Melody's research was supported by the new ICS student research award, which was funded by generous donors to ICS's BGSU one day fundraising campaign. Jolie: You can find the Big Ideas podcast on Apple Podcasts, Google Play, Spotify, or wherever you find your favorite podcasts. Our producers are Chris Cavera and Marco Mendoza. Research assistance was provided by Renee Hopper, with editing by Stevie Scheurich. Special thanks go out to Marco Mendoza for his extraordinary sound editing in these challenging conditions. Thank you both so much. Melody: Thank you. Cynthia: Thank you. Jolie: It was really fun talking with you.  

In this special COVID-19 episode of the BG Ideas podcast, we talk with Dr. Lori Liggett, who researches popular images from the women's suffrage movement. Liggett is a Teaching Professor in the School of Media and Communication and a Spring 2020 Faculty Fellow.   Announcer : From Bowling Green State University and the Institute for the Study of Culture and Society, this is BG ideas. Musical Intro: I'm going to show him this with a wonderful experiment. Jolie: Welcome to the Big Ideas podcast, a collaboration between the Institute for the Study of Culture and Society, and the School of Media and Communication at Bowling Green State University. I'm Dr. Jolie Sheffer, Associate Professor of English and American Culture Studies, and the Director of ICS. This is a special episode of the podcast, which we are recording during the COVID-19 pandemic. That means we're not in the studio, but are talking via phone and computer. Our sound quality will be different as a result. Jolie: But now more than ever, I thought it was important to share with you some of the amazing work being done by members of the BGSU community. Even, or especially when conditions are challenging, we need to recognize and celebrate great ideas. As always the opinions expressed on this podcast are those of the individuals involved, and do not necessarily represent those of BGSU or its employees. Today I'm speaking with Dr. Lori Ligate, a Senior Lecturer at BGSU in the School of Media and Communication who's teaching and research focus on gender and visual culture. She's a spring of 2020 ICS faculty fellow who is doing public scholarship focused on images of womanhood in popular media during the era of women's suffrage. I'm really pleased to get to talk with you today, Lori. Thank you for being flexible and joining me, virtually. Lori: Thank you. I appreciate it. Jolie: To start off, could you tell us a little bit about how you got interested in studying the era of women's suffrage? And what have been some of the more interesting and surprising directions that this research has led you? Lori: Right. Well, basically I got involved in studying the suffrage movement about 25 years ago, and it wasn't my original intent. I was studying women's service magazines of the late 19th century. Women's service magazines are things like Godey's Ladies Book, which was one of the first one. Then you segue into things like Good Housekeeping. Lori: I was interested in motherhood, domesticity from a sociopolitical point of view. As I was doing decades of looking at literally every issue of Good Housekeeping, I started seeing this pivot from talking about new household technologies, and cooking procedures and new techniques for mothers, and into more political stuff. And immediately I was hooked. And of course, I knew a little bit about the suffrage movement, but I hadn't seen it within that context. And it shocked me, because there were actual literary essays that would appear in the service magazines. Lori: I also started seeing it in advertising, just references were popping up everywhere. And when I really got into it was probably around the, I would say, 1908, 1910 issues. When you started seeing, and remember this as Good Housekeeping, references to militarism, to women becoming militant, to radicalism. Now, this is Good Housekeeping. I guarantee you, if you were to go to the newsstand today and pick up a Good Housekeeping, you would not see anything on radicalism and militancy. I was shocked. Lori: This was largely due to what was going on in Great Britain at the time. And a leader in Great Britain, one of the leaders, is the famous or infamous Emmeline Pankhurst. And the British movement had become militant at that point. We started to see the beginnings of that in the American suffragist movement. I just never imagined I would see it in Good Housekeeping. So that's the origins of it. Jolie: And what were some of the elements of your research that surprised you most? You said that the language of militancy, but what about some of the visual iconography? Lori: Well, I expanded from there over the last 25 years, I guess I would consider myself a media scholar, but I really focus on visual culture and visual communication. I've always been attracted to the images of things. When I study media, I'm interested in mediated images. And so I was already studying advertising. Lori: This was a long way to get to the bicycling stuff that I'm doing now, but I am a fanatic about the art nouveau movement, which was late 1880s, at full steam in the 1890s, less popular, but still very prevalent up until the start of World War I. I started seeing images of women in advertising that was very much art nouveau style, but would have a political element. In a lot of those images, I noticed that they were using the bicycle. And so you would see women on bicycles, advertising everything from soap to cigars, to carpeting, to flour. Things that had nothing to do with bicycling, but you would see a woman and a bicycle. Lori: I was just fascinated by that. And I started collecting images of women on bikes. Basically, what I was doing, I was downloading JPEGs, and just keeping an archive, trying to figure out what to do with it. At some point, I would say probably in the 1970s, definitely by the eighties, and certainly the nineties and throughout, you started to see more scholarship on the suffrage movement that wasn't what we would call traditional history. Lori: I was a grad student in the nineties, and so looking at material culture and the sociopolitical angle of political culture, it sort of brought everything together for me. So we've got these visual images, we've got advertising, we've got women's politics, we've got for some reason the bicycle, which I didn't understand at that point. And really a couple of decades later, it leads me to the project that I'm working on now. Jolie: Tell us a little bit about some of that research, and what have you discovered was the role or the purpose of all of that focus on the bicycle? What is the connection to women's voting, and changing women's rights? Lori: I had to backtrack and learn a lot about bicycle history. I'm certainly not an expert, but I know a lot more about bicycle history than I did, let's say nine months ago, let's put it that way. And so the bicycle itself is just a fascinating global phenomenon. Today we would look at a bicycle and almost all of us, regardless of gender, of where you live in the world, the bicycle has been part of your life at some point. There's reason for that, which is that the bicycle represents the first device that permitted human beings to self mobilize. Lori: In the 1600's, there are images of people on these things that kind of look like a bike. People were imagining something along those lines. But it takes until about, I think the date is 1817, and you have a German guy, his name was Karl Von Drais, or Dryas probably. He developed this thing called a running machine. Now what was the running machine? They were also called hobby horses, or dandy horses. Another name based on his name was a Draisine. What it was is it was something that looked like a bicycle, two wheels. There was a plank that you would sit on. Lori: You would straddle it, sit on it. And then with your feet, almost like Fred Flinstone, you would move it along. It took decades of improvements until you get to the 1860s. And you have something that the French developed, which was called the boneshaker. The boneshaker was called that because it was incredibly hard on the cyclist's body. Lori: At the time these devices would have been made out of wood and steel. The tires, there was no tire the way we think of it. The wheels were made out of iron or steel. And so if you wrote it, it was just shaking every bone in your body, so it was called the boneshaker. And there was a woman's version, which was called the tricycle. They develop these three-wheel devices, extremely heavy, extremely expensive, not to be ridden in public. But only wealthy women who had private space, so garden space, would ride a tricycle. It said that Queen Victoria had a couple of them. And they were pretty popular amongst the wealthy. But you did not see women riding a tricycle out in public spaces. Jolie: Well, so fast forward a little bit to how does that get associated? How do these new technologies and improvements to this, get associated with ordinary middle-class and working-class women? Lori: It's interesting you say ordinary because the bicycle, the one we think of with the big wheel and the little back wheel, that was actually called the ordinary. And that was developed in the 1870s. It was called a high wheel or an ordinary, and it was considered an improvement on the boneshaker because it was light and it was fast. It was extremely difficult to maneuver. Riding schools were set up. Lori: But you actually had women, particularly in the beginning, French women who started almost performing on these high wheelers. They would come to the United States and perform as almost circus acts. And they were working women. They were women who were not from the upper classes. They tended to wear clothing that was considered back then a little scanty. And they were seen really as spectacle, as an oddity. Lori: In the late 1880s, you have something developed that's called the safety. The safety is really the progenitor of the bicycle today. And almost immediately due to a guy in American named Albert Pope, he imported the safety. He bought all the patents for it, and he started marketing like crazy. And Americans started buying the safety. Just a couple of years of the safety coming to the United States, bike manufacturers started doing something they called the drop frame so that women could get on to the bike. Lori: Women took to it like crazy. And in the 1890s, you have something that was called the bicycle craze. And it truly was this phenomenon. I don't want to bore you with details. But just to give you an example in 1885, you had six bicycle manufacturers in the United States, just six, and they were producing about 11,000 bikes a year. In 1895, there were 125 manufacturers. They were producing a half a million bikes a year. A year later, it was a million bikes. Lori: What happened is, oftentimes the bike is seen as this great democratic equalizer of the classes and gender. We had all these social reform movements. By the 1890s, the women's suffrage movement had been pretty much in full swing for almost 50 years, with peaks and valleys, of course. But things were different. Lori: There were new technologies. Technologies in communication, transportation, mass media. Newspapers were the most popular form of communication, and the price of a newspaper had dropped. The relationship there is that the ability to find out about these devices was available to almost everyone, whether you were in an urban area or a rural area. And bikes became prevalent in the streets. Lori: Now, not everyone liked them. A lot of cities imposed bans, and there were bands against women riding bikes. One of the things that ties to the suffrage movement is that during the 1890s, so you have the bicycle craze, but you also have probably the, I don't know if I'm would say the height, but the beginning of the strength of the suffrage press. Lori: And as there were mainstream and regional, national newspapers all across country, suffrage leaders started publishing their own works. And there were many. I think in the 1890s, there were something like 30 different suffrage publications. And these acted... Of course, they were political, but they were also quite social. And they serve the purpose of creating community amongst women who are geographically separated, and also maybe not have the same political mindset. Lori: A lot of women probably had not heard about the details of a lot of political organizing that was going on. Or perhaps it had always been treated as this anomaly, this strange thing on the side that was going on. But the way we do social media today, it's very difficult to think about, that someone would take the time to write a letter to the editor, then wait for a month, and get the response. But it was really the way that women communicated. Lori: They would write in a question to the editor and then people would respond with helpful tips in. It was really sort of an exchange of ideas. And you had things that within the suffrage press that certainly were talking about the issue of suffrage, and other social reform issues, but bicycling, or cycling in the 1890s became one of the major topics of conversation. Lori: That's what women wanted to know about. They wanted to know things like how do you ride a bike? How do I get a bike? How much do they cost? What do you do when people harass you, and jeer at you and throw things at you and call you names? Which were all things that happen with great frequency. And the suffrage press played this incredible role in bringing women together in a political way, in a community way. Lori: And also the specific thing, which was the bicycle. Jolie: 2020 marks, the hundredth anniversary of the passing of the 19th amendment, which granted women the right to vote. What are some of the things we might take for granted now that back then really posed major obstacles to the women fighting for suffrage? Lori: If we look at... The marker for the women's suffrage movement is 1848, the Seneca Falls convention, out of which Elizabeth Cady Stanton and Lucretia Mott, and a hundred other people created something called the Declaration of Sentiments. The purpose of that conference, or convention, initially was not for women to gain the right to vote, or even to advocate for the right to vote. It ended up, they discussed that. But it was really the whole women's rights in general. Things we take for granted. Lori: Women during that time period could not serve on a jury. They had no legal rights. They could not own property. They did not have the right to their own children. They did not have the right to divorce. And all of that is based on the United States, adopting a legal system which was based on the English common law system, which is called coverture. And basically what that says is when a man and a woman marry, they become one person and that one person is the male. Lori: The woman's identity was figuratively, but legally and economically merged into with the male. She really was the property if she was single, of her father, if she was married, her husband. And it was really that, that the women's rights movement began to address. And out of that, then the very soon realization was if you don't have the right to vote and you don't have any means to influence lawmakers. You don't have access. Without access you have nothing. Lori: And I think today we are still fighting for so many rights to access, but we don't realize that the most fundamental rights were not ours, except for the people who are part of the suffrage movement for 72 years. And of course today, again, it's people all over the world and people who identify all different ways, who are still fighting for access. Access to self-governance to a voice in governance, to the financial systems, economic systems. So there are a lot of parallels to today. It just seems very diffused today. You know, it's much more diffused and, but yeah, we owe them a lot. Jolie: Many of us have learned some of those major figures from the suffrage movement, but there are many more that are less well known. Do you have any particular figures or key moments in history that you'd like to draw our attention to that maybe don't get covered in the one chapter or that one paragraph in a given textbook? Lori: Right. There is a lot of work going on today to look at individual stories that have not been told about the suffrage movement, and to look at particular demographics within the suffrage movement that before this have not been discussed. Of course, African American women, Native American women, and women of color in general, Asian Americans, immigrants, people who were not fully Americans were part of the movement from its very inception. Lori: We know some of those famous names. We know Harriet Tubman. In fact, there was a movie that was just out about Harriet Tubman. A lot of the black women who were involved in the movement in the early years, came out of the abolitionist movement, as did almost all of the early white women came out out of the abolitionist movement. Elizabeth Cady Stanton, Lucretia Mott who's my ancestor, by the way, Susan B, Anthony. Lori: Those are the names that we know. They all started as abolitionists. They were anti-slavery reformers. Sojourner Truth, who gave the famous speech, "ain't I a woman," in Akron, Ohio. And she was really talking about rights in general. And I don't want to pare down what she said too much, but I encourage anyone to watch some of the reenactments that have been done. I think Alfre Woodard does one. There are quite a few famous black female actors who have reenacted, not necessarily in dress, but the voice, the speech of Sojourner Truth, it is powerful. Lori: You also have so many women who are involved that are much lesser-known, but not during the time period. Ida B Wells, she was a famous person, anti-lynching activist, and journalist. Mary Church Terrell who I believe got her degree at Oberlin College, and was an educator and very well known in the movement. Lori: And then there are all the women that you would see them as the set actors in a movie, in a documentary where you don't know their names, you don't know who they are. But the movement took just thousands and thousands and thousands of people. I mean the movement was 72 years long. It was multigenerational. The two of us, we would have been in the middle of those generations. We would have had mothers and grandmothers, and daughters, and nieces. It was multigenerational. The earliest women in the movement never lived to see the 19th amendment. That always makes me very sad. Lori: But Lucretia Mott died, I think, in 1893, I think that's the date. Elizabeth Cady Stanton, I want to say about 1904, something. Susan B. Anthony, a couple of years after that. Sojourner Truth, Harriet Tubman, all these people, they didn't actually... And this was their life work. This was their job. Lori: And so I think that we... I teach a narrative structure in scriptwriting for television and film. One of the principles that I always try to explain to my students is we never want to look at a movie and say, "Well, it's not as good as the book." The movie is a snapshot, and those snapshots are typically, they become engaging when we have what we call a representative character. And so what's happened is the most well known white women of the suffrage movement have become our representative characters that have taken us through the movement. And now in the last 20 years, it's been about expanding that snapshot. Let's go down all these different avenues. And I think when you study visual culture, you study material culture, you look at visual communication. You start to see that the snapshot is a very, very, very... It can be a very full portrait of all of the people who were involved, including men. of course. Jolie: We're going to take a quick break. Thanks for listening to the big ideas podcast. Announcer : If you are passionate about big ideas, consider sponsoring this program. To have your name or organization mentioned here, please contact ICS at ics@bgsu.edu. Jolie: Hello and welcome back to the Big Ideas podcast today. I'm talking to Dr. Lori Ligate about the Centenary of women's suffrage. Lori, we've been talking a lot about the past and about rediscovering this history. What relevance do you think this story has for our own times? Are there particular points of struggle that today really signify the challenges to women's participation in US politics and governance? Lori: Well, I want to answer that probably two ways. And I'll start with something that is on everyone's mind today, which is that the women's suffrage movement at its endpoint in 1918 was the great flu influenza pandemic. I'm not an expert in that by any means, but of course I've been reading about it recently with regards to the women's suffrage movement. It was sort of a light bulb one day when I realized, I'm doing all this work and I've got all this timeline in my head. And someone mentioned the 1918 influenza pandemic, which I knew that was the year, I was aware of that. I'd never put the two together and thought, "Wow, what did this do to the suffrage movement?" I mean, we have to remember that was a catastrophic global event. In United States, alone, 675000 people died, worldwide 50 million. Lori: And so I look to see what other scholars and journalists have written about this, and actually, Google it, there's some really interesting information to be learned about the women's suffrage movement, and the 1918 flu pandemic. It almost derailed the movement. I don't think it's too far fetched to say that we here in 2020, a hundred years ago, we are very lucky that somehow these women and men were so organized, and had such a machine in place that somehow they were able to overcome this catastrophic world event. And just two years later, less than two years later, 18 months, really the 36th state, Tennessee ratified the 19th amendment. But it almost derailed it. Lori: I read something recently. What it said is that one of the things that happened, we know that during World War I, just like World War II, many women moved into the workforce because the men were away. What I didn't realize was that because the flu pandemic, that also contributed women going into the workforce. Now that need seems antithetical to what we think. But so many men were away during World War II, and then you've got this pandemic. Lori: Women were working as nurses, even if they weren't nurses, they were doing nursing type work, moving into the workforce in a way that had never happened before. Soldiers were coming back from the battlefield and bringing the influenza with them. The death amongst American soldiers was higher than any other population. And so there's all this interconnection between this political movement that had been going on for 70 years and this global pandemic. I think about today when everything has stopped, it seems like. In reality it hasn't. There is still activism that's happening. Right now we're talking probably more than decades about the Equal Rights Amendment. The Equal Rights Amendment grew directly out of the women's suffrage movement. Lori: The sad thing about that now is that we have now surpassed the number of years that it took for women to gain the right to vote. We have not yet attained the Equal Rights Amendment. I think that's sort of a great parallel for today is that, we have so many more mechanisms in place. I mean, what we're doing today, looking at each other awkwardly, in real-time and using several devices to hopefully record this. Now we have devices, technology, means to communicate, and to have a voice that the women and the men back then did not. And the activism that's happening in terms of equal pay, equal access, and I guess just generally equal rights is continuing must continue. And however long this pandemic takes, we can't be derailed by it. Jolie: Talking about the current pandemic. You were on fellowship with ICS this semester, so you were already released from teaching and service, but how has your life changed? Granted, what was already supposed to be a restful, and research focused semester? What has happened to you? Lori: Anticipating that you might ask that question, I've run through many scenarios of how I would answer it in my head. Because the first thing I want to say from a very sincere and genuine place is how much I have appreciated being given this opportunity to do this fellowship. I started really last summer. I forget when it was announced that I got it. I think it was a semester before that. But really last summer I started putting the wheels in motion. I taught a class last semester on the women's suffrage movement. And I went at this full steam. Lori: This semester with not having to teach, and not doing service, the goal was to get out into some archives. I love doing archival research. I wanted to see the bicycle museum, which is located in New Bremen, Ohio. There are quite a few archives that are within driving distance. And so I think that was the first thing was the realization, and I'll be honest, it took me probably like a lot of this, quite a few weeks to realize that probably wasn't going to happen this semester. A lot of archival materials today, thank goodness, are digitized. When you really start looking at things specifically, you realize that a lot of things still are not digitized. So that's been difficult. Lori: As you know, the two primary requirements of the fellowship are the public community presentation, which for me was a scheduled for March 28th. And I would have been doing a very visual, public-friendly, community-friendly talk on the suffrage movement and the impact of the bicycle, and vice versa. Of course, that was canceled. Lori: And then the other thing that just breaks my heart is the Ohio Humanities for the last, I don't know how many years have sponsored a series of Chautauqua programs in Ohio. This was meant to be the last year of Ohio Chautauqua. And this year there were two planned, and one of them was in Rossford, Ohio, which of course is very close to us. And pure coincidence, the theme was Voting in America. I found out about this, I thought I was dreaming, I contacted them and basically forced myself upon them, and met with various people. So we started meeting, I was on the Chautauqua planning committee. I forget how many meetings we had. I think I had a preliminary meeting to meet the director. And then the committee met at least two times. Lori: And it was this great group of people. There were two of us educational types, or educator types on it. But we had the parks and rec guy, and we had the woman who is the local historian, and we had librarians, librarians are good for everything, librarians. Lori: And so this committee of about 10 people, and the Chautauqua was planned for, I think it was the second week, was a five-day event planned for the second week in June. We had five, I study documentaries, so we call them social actors. But I guess in the Chautauqua world, they are a re-enactors. They are the actors that play certain characters from history, coming from different parts of the country. I was working with the League of Women voters and they were going to... And I think I was going to do it too, I was sort of getting my nerve up to dress as suffragists, and to have a parade. And we were going to have voter education materials, and end of the story, it was canceled. Lori: So there is some hope that it could happen in the fall, but I don't know how much that's hope and how much that's reality. That's the way it is. And so I've had to pivot in the work that I'm doing, and go back to doing more secondary source staff, sort of get my wind back a little bit. And I'm going back and looking at some of the 1890s poster art that I love. I'm looking at that from perhaps a 19th-century taxonomy of women. There's still so much interesting work to be done, but it's been disappointing. But I've got a good compared to a lot of people. So I can't be overly disappointed. Jolie: We've talked about this a bit, but about how this movement overlapped with a world war, a different pandemic. As last thoughts for our conversation, is there any kind of lessons we can take, that you would want us to take away from the suffrage movement, managing to persevere in the face of long odds, and many internal and external challenges? Lori: I guess what I would say is that what history teaches us is that the reform movements, social and political, economic, whatever I'm using reform sort of broadly, they succeed if people don't give up. And we have to remember that there are always going to be ebbs and flows to everything. I try to tell myself this personally. There are ebbs and flows to everything, but if you keep going and your commitment is there, the success will eventually come. Lori: Now, whether or not the people who begin the movement live to see it, that's another thing that seems very sad. But what becomes most important is the work itself. And I have experience in labor organizing and that sort of thing, and what I will say is, and this is contrary to what we're taught from a self improvement, that every individual makes a difference. Lori: I think when we look at history, it is always the collective. It is always the collective. We see individuals who stand up, and they become our representative figures in that part of the history. But if you explore further, it's usually a collective that may come after that individual, who takes up the cause and keeps it going. And so power in numbers, I guess, is what I would say. And we will get through this pandemic. When you look at the numbers from 1918, you look at things going back to the black plague, bubonic plague, all those, they wiped out huge numbers in the population, and you wonder how the human race survived. We will get through this, hopefully with not the catastrophic events or the effects of 1918. And so the work has to continue. The activism has to continue, and we've got the tools and mechanisms to make that happen. Jolie: Thank you so much, Lori. It was really great to talk to you. Lori: It was nice to talk to too. Thanks. It was good to see you, too. Jolie: I know, lovely to see you. Yes, we can't be there in person, but this is as close as we can get. Lori: Yes, absolutely. Jolie: You can find the Big Ideas podcast on Apple podcasts, Google play Spotify, or wherever you like to listen. Our producers are Chris Cavera, and Marco Mendoza. Research assistance was provided by Rex Light with editing by Stevie Scheurich. Special thanks go out to Marco for his extraordinary sound editing in challenging conditions.  

About Krista Ellow:Hi. I'm Dr. Krista Ellow. I'm a clinical pharmacist turned diabetes health coach who's on a mission to make the world of medications makes sense again! It can be done and I'm here to show you how.Why me?First, in addition to having the science background required, I also host my own podcast called, “The Angry Pharmacist” where I share my experiences in the world of healthcare and share with you where I think there's been mistakes, especially in the treatment and management of diabetes. I'm a board certified expert in chronic disease, and I spent years applying the traditional methods of diabetes management. I realized that those older methods no longer work. Today, I use food and other techniques to help patients heal, recover and overcome diabetes. Join me on this adventure and learn to get your diabetes under control and your life back on track!On This Episode:Learn the role medication plays in diabetes.Discover how scientific research affects how we view medicine.Be reminded the importance of viewing your clients as actual people and not as projects.Krista gives her definition of success.Krista Ellow:stophighsugars.comConnect with other incredible people looking to break out of the corporate mindset by joining the More Than Corporate Facebook group: http://bit.ly/2MuWn53 See acast.com/privacy for privacy and opt-out information.

Download my free thyroid resources here (including hypothyroid symptoms checklist, the complete list of thyroid lab tests + optimal ranges, foods you should avoid if you have thyroid disease, and more): https://www.restartmed.com/start-here/ Just about every day I get questions about alternative options for thyroid medications. Is there anything else that you can use? Do they actually work? We are going to discuss that today. BEFORE I DO! Make sure you understand that you should not stop your thyroid medication without first consulting your doctor. There are some people who must be on thyroid medication forever and you must know if you fit into that category. Stopping your thyroid medications abruptly without the assistance of a physician can be dangerous. On the other hand, there are many people with thyroid disease who may be able to decrease their medication with the right therapies. And these are the people I am talking to now! These therapies may be able to hep you improve your thyroid function naturally. They can be used with all types of thyroid medications and may help your thyroid function on its own. Recommended thyroid supplements to enhance thyroid function: - For thyroid hormone production and conversion: https://www.restartmed.com/product/th... + https://www.restartmed.com/product/t3... - For hair loss: https://www.restartmed.com/product/th... - For weight management: https://www.restartmed.com/product/gu... + https://www.restartmed.com/product/fu... - For gut health: https://www.restartmed.com/product/ul... - For energy and adrenal health: https://www.restartmed.com/product/th... + https://www.restartmed.com/product/po... I'm Dr. Westin Childs and I focus on thyroid health, hormone balance, and weight loss. I write about thyroid disorders, weight loss, insulin resistance, estrogen/progesterone balance on my blog. I truly believe that hormone balance is the key to managing your weight, your mood and your quality of life which is why I'm so passionate about it. If you enjoyed this video please subscribe on youtube or leave a comment on my podcast here: https://itunes.apple.com/us/podcast/d... This video is not intended to be used as medical advice. If you have questions about your health please consult your physician or primary care provider. Dr. Westin Childs goes to great lengths to produce high-quality content but this is NOT a substitute for medical care.