Podcasts about internists

Medicine has traditionally been practiced “in silos”. But compartmentalization of medical practice/interventions can leave gaps in patient care. Patients win when they have increased access to a variety of medical therapies or contraceptive options. In this episode, we will review a brand new publication (released ahead of print) from the AJOG. We've decided to call this episode, “Internists, IUDs, and Inspiration”. Listen in for details.

In this episode of the Bendy Bodies Podcast, Dr. Linda Bluestein speaks with Dr. Matthew Watto, an internist and co-host of The Curbsiders podcast, about how patients can work effectively with their internist to get the best care. They discuss how internists think, why appointment times are limited, and strategies for getting the most out of every visit. Dr. Watto shares behind-the-scenes insights on primary care challenges, chronic pain management, and the medical system's limitations, while also offering practical tips for improving doctor-patient communication. If you've ever felt frustrated navigating the healthcare system, this episode provides game-changing strategies to help you get the care you need. Takeaways: Internists Have Limited Training in EDS & Hypermobility – Many internists receive little to no education on hypermobility-related conditions, making patient education and advocacy essential. Appointment Time is Short—Be Prepared – Most internists have at the very most 15-20 minutes for follow-ups and 30-40 minutes for new patients, so bringing a prioritized list of concerns helps maximize the visit. Ask for a Collaborative Approach – Internists are generalists, meaning they oversee a wide range of conditions. Patients with complex conditions should request coordination between specialists for better care. Concierge & Academic Medicine May Offer More Time – Patients who need longer appointments or more personalized care may benefit from concierge medicine, academic medical centers, or direct primary care models. Doctors Want to Help, But the System is Broken – Many doctors feel frustrated by short appointment times, insurance barriers, and administrative burdens. Patient-doctor teamwork is key to navigating these challenges. Connect with YOUR Hypermobility Specialist, Dr. Linda Bluestein, MD at https://www.hypermobilitymd.com/. Find the transcript for this episode here. Thank YOU so much for tuning in. We hope you found this episode informative, inspiring, useful, validating, and enjoyable. Join us on the next episode for YOUR time to level up your knowledge about hypermobility disorders and the people who have them. Join YOUR Bendy Bodies community at https://www.bendybodiespodcast.com/. Learn more about Human Content at http://www.human-content.com Podcast Advertising/Business Inquiries: sales@human-content.com YOUR bendy body is our highest priority! Learn about Dr. Matthew Watto YT: @TheCurbsiders IG: @thecurbsiders Twitter: @/thecurbsiders & @doctorwatto Keep up to date with the HypermobilityMD: YouTube: youtube.com/@bendybodiespodcast Twitter: twitter.com/BluesteinLinda LinkedIn: linkedin.com/in/hypermobilitymd Facebook: facebook.com/BendyBodiesPodcast Blog: hypermobilitymd.com/blog Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of the Bendy Bodies Podcast, Dr. Linda Bluestein speaks with Dr. Matthew Watto, an internist and co-host of The Curbsiders podcast, about how patients can work effectively with their internist to get the best care. They discuss how internists think, why appointment times are limited, and strategies for getting the most out of every visit. Dr. Watto shares behind-the-scenes insights on primary care challenges, chronic pain management, and the medical system's limitations, while also offering practical tips for improving doctor-patient communication. If you've ever felt frustrated navigating the healthcare system, this episode provides game-changing strategies to help you get the care you need. Takeaways: Internists Have Limited Training in EDS & Hypermobility – Many internists receive little to no education on hypermobility-related conditions, making patient education and advocacy essential. Appointment Time is Short—Be Prepared – Most internists have at the very most 15-20 minutes for follow-ups and 30-40 minutes for new patients, so bringing a prioritized list of concerns helps maximize the visit. Ask for a Collaborative Approach – Internists are generalists, meaning they oversee a wide range of conditions. Patients with complex conditions should request coordination between specialists for better care. Concierge & Academic Medicine May Offer More Time – Patients who need longer appointments or more personalized care may benefit from concierge medicine, academic medical centers, or direct primary care models. Doctors Want to Help, But the System is Broken – Many doctors feel frustrated by short appointment times, insurance barriers, and administrative burdens. Patient-doctor teamwork is key to navigating these challenges. Connect with YOUR Hypermobility Specialist, Dr. Linda Bluestein, MD at https://www.hypermobilitymd.com/. Find the transcript for this episode here. Thank YOU so much for tuning in. We hope you found this episode informative, inspiring, useful, validating, and enjoyable. Join us on the next episode for YOUR time to level up your knowledge about hypermobility disorders and the people who have them. Join YOUR Bendy Bodies community at https://www.bendybodiespodcast.com/. Learn more about Human Content at http://www.human-content.com Podcast Advertising/Business Inquiries: sales@human-content.com YOUR bendy body is our highest priority! Learn about Dr. Matthew Watto YT: @TheCurbsiders IG: @thecurbsiders Twitter: @/thecurbsiders & @doctorwatto Keep up to date with the HypermobilityMD: YouTube: youtube.com/@bendybodiespodcast Twitter: twitter.com/BluesteinLinda LinkedIn: linkedin.com/in/hypermobilitymd Facebook: facebook.com/BendyBodiesPodcast Blog: hypermobilitymd.com/blog Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

Send us a textUp to 30% of all healthcare offers no clinical value to patients. Reducing this care has the co-benefit of decreasing healthcare's carbon footprint. In this special CSIM episode, host Dr. Zahra Merali sits down with guests Dr. Billy Silverstein @WKSilverstein (General Internist, University of Toronto) and Dr. Owen Luo @OwenLuo5 (Internal Medicine Resident, McGill University) to discuss 4 of the Choosing Wisely Canada's climate-conscious recommendations (https://choosingwiselycanada.org/climate/).  They were integral in creating these recommendations, and have a wealth of practical tips about how we can implement them into our own practice! Infographic by Julia Simone (medical student). If you have not heard Part 1- make sure to go back and listen to other Canada-wide experts in this area.Support the show

Up to 30% of all healthcare offers no clinical value to patients. Reducing this care has the co-benefit of decreasing healthcare's carbon footprint. In this special CSIM episode, host Dr. Zahra Merali sits down with guests Dr. Billy Silverstein @WKSilverstein (General Internist, University of Toronto) and Dr. Owen Luv @OwenLuo5 (Internal Medicine Resident, McGill University) to discuss 4 of the Choosing Wisely Canada's climate-conscious recommendations (https://choosingwiselycanada.org/climate/).  They were integral in creating these recommendations, and have a wealth of practical tips about how we can implement them into our own practice! Infographic by Julia Simone (medical student). If you have not heard Part 1 - make sure to go back and listen to other Canada-wide experts in this area.Questions? Comments? Feedback? We'd love to hear from you! @roundstable @InternAtWork @MedicinePods

Send us a textThere are everyday practices we can stop or reduce that don't add value to patient care and harm the environment.In this special CSIM episode, host Dr. Zahra Merali sits down with guests Dr. Mathilde Gaudreau @MathildeGSimard (General Internist, University of Ottawa), Dr. Nabha Shetty (General Internist, Dalhousie University) and Dr. Valeria Stoynova (General Internist, Island Health/UBC Island Medical Program) to discuss 4 of the Choosing Wisely Canada's climate-conscious recommendations (https://choosingwiselycanada.org/climate/).  They were integral in creating these recommendations, and have a wealth of practical tips about how we can implement them into our own practice!Infographic by Julia Simone (medical student).  Keep tuning in to hear the rest of our CSIM special episodes and join us & the Planetary Health team as they present at CSIM! @CSIMSCMISupport the show

There are everyday practices we can stop or reduce that don't add value to patient care and harm the environment. In this special CSIM episode, host Dr. Zahra Merali sits down with guests Dr. Mathilde Gaudreau @MathildeGSimard (General Internist, University of Ottawa), Dr. Nabha Shetty (General Internist, Dalhousie University) and Dr. Valeria Stoynova (General Internist, Island Health/UBC Island Medical Program) to discuss 4 of the Choosing Wisely Canada's climate-conscious recommendations (https://choosingwiselycanada.org/climate/).  They were integral in creating these recommendations, and have a wealth of practical tips about how we can implement them into our own practice! Infographic by Julia Simone (medical student). Questions? Comments? Feedback? We'd love to hear from you! @roundstable @InternAtWork @MedicinePods

The Curbsiders (Dr. Matthew Watto and Dr. Paul Williams) join the Glaucomcfleckens to talk about the quirks and challenges of internal medicine, from hilarious training anecdotes to the importance of guideline-directed medical therapy. Learn about the evolution of medical education, the role of AI in healthcare, and the fascinating history behind some medical practices. Tune in for an engaging conversation filled with humor, insights, and practical tips for aspiring doctors. — Want to Learn About The Curbsiders: Twitter: @doctorwatto / @paulnwilliamz / @thecurbsiders Instagram @thecurbsiders — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! – http://www.patreon.com/glaucomflecken  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you like the scrubs I'm wearing, here's a link and discount code to get some Jaanuu Scrubs link: https://bit.ly/4cAvXbs code: DRG20 for 20% off first-time purchases* *This code works on full-price items only excluding embroidery!  -- A friendly reminder from the G's and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit http://www.EyelidCheck.com for more information.  Today's episode is brought to you by the Nuance Dragon Ambient Experience (DAX). It's like having a virtual Jonathan in your pocket. If you would like to learn more about DAX Copilot check out http://nuance.com/discoverDAX and ask your provider for the DAX Copilot experience. Produced by Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Dustin Jones // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult division leader Dustin Jones discusses helping patients better understand their osteoporosis diagnosis, including learning to read a DEXA scan. Dustin also shares tips on discussing prognosis with patients as well as using the data supporting their osteoporosis diagnosis to inform your treatment choices & plan of care development. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTIONHey everybody, Alan here, Chief Operating Officer at ICE. Thanks for listening to the PT on ICE Daily Show. Before we jump into today's episode, let's give a big shout out to our show sponsor, Jane, an online clinic management software and EMR. The Jane team understands that getting started with new software can be overwhelming, but they want you to know that you're not alone. To ensure the onboarding process goes smoothly, Jane offers free data imports, personalized calls to set up your account, and unlimited phone, email, and chat support. With a transparent monthly subscription, you'll never be locked into a contract with Jane. If you're interested in learning more about Jane, or you want to book a personalized demo, head on over to jane.app.switch. And if you do decide to make the switch, don't forget to use our code ICEPT1MO at sign up to receive a one month free grace period on your new Jane account. DUSTIN JONESWhat's up team? Dustin Jones here. You are listening to the PT on Ice daily show brought to you by the Institute of Clinical Excellence. Today we're talking about osteoporosis diagnosis, prognosis, and treatment. This is a big topic that so many of the folks, older adults that we work with, they will receive this diagnosis or have this discussed with them. And a lot of times it's not given a lot of context or they don't have full understanding of what this really means for them and what they can do about it. Most importantly, what they can do about it. All right, so let's get into this. OSTEOPOROSIS: DIAGNOSIS We'll start with the diagnosis piece, just really defining what is osteoporosis and then spend a little bit more time on the prognosis side of things and the treatment because I feel like that's where we have a lot of opportunity to really serve our folks well. So osteoporosis, we're going to review, go all the way back to your formal training when you learn some of these numbers. that we may have forgotten, all right? So when someone is, when that conversation of bone mineral density starts to come into play, usually it's for postmenopausal women or males over 50 years old, start to look at bone mineral density. And the way that we can measure, objectively measure bone mineral density is through a DEXA scan. You'll see that D-X-A or D-E-X-A, that's Dual Energy X-Ray Absorbed Geometry or DEXA. This is the reason why everyone calls it that. So you're basically looking at bone mineral density. And if for individuals that are over that kind of 65 year range, you're going to get a score. That score is going to be a T score. And so we're taking the measurement of the minerals in the bone in a certain area and comparing that to same sex and race norms for a younger population. So we're comparing it to a younger cohort, and that's where you'll get those T-scores. And so based on those T-scores, you will get maybe something from 0 to negative 1, and that is considered to be normal and healthy. Then that negative 1 to negative 2.5 is that osteopenic range or osteopenia which means the bones are a little bit weaker but not full-blown osteoporosis just yet and then below negative 2.5 and below they will receive that osteoporosis diagnosis. Typically, along with the DEXA scan, a physician is doing a FRAX screen. This measures the 10-year risk of having a fracture. There's some different lifestyle questions and it'll basically spit out a percentage of likelihood that that individual is going to have a fracture within the next 10 years. And so those two pieces of information really formulate the, or someone giving a diagnosis, but then also the treatment that follows. And then based on those T-score readings, as well as the FRAC score, the pathways are typically, there's gonna be some pharmacology involved, right? Whether we're preventing bone resorption or really encouraging more bone formation and remodeling. And then they're typically going to give some blanket generic recommendation of exercise of weight bearing exercise. All right. Now, the tough part about this diagnosis, it can come from a whole host of different providers. So you can see primary care physicians, you know, kind of leading the charge of, you know, looking into bone mineral density. Internists can as well. Orthopedic physicians can as well. And so there will be different doctors that will be kind of looking into bone mineral density. And then they will often refer out to someone like an endocrinologist, for example, for further treatment and so there's a lot of people kind of involved talking about this and what at least I have seen is that this has been a topic that has been brought up and a lot of fear has been revolving around this topic but not a ton of guidance of what it really means day to day to really influence bone mineral density beyond taking that pill and you know quote-unquote weight-bearing activities. I've just worked with so many people that did not understand that diagnosis and what it actually meant. So just understand that. I'm not saying that always happens, but in a lot of the folks that I work with, that is typically the case. OSTEOPOROSIS: DIAGNOSIS So they're given this diagnosis and now let's talk about the prognosis. In particular, what I want to speak to is the opportunity to really dive in to the DEXA scan that our patients receive. And I'm not saying it is our place to kind of give a medical prognosis per se. Well, I guess when I'm saying prognosis is what can they expect going forward and to give them context of that diagnosis. So I'm mainly working the context of fitness now at Stronger Life in Lexington, Kentucky, and it's a gym for folks only over 55. And we're about four years old now, and so over the past four years, we've had a lot of members that have had at least a couple DEXA scans at this point. And so I'll put a field out for folks to send me some of their DEXA scans, and this is something that, these are conversations I'll typically have with folks anyway, once they get their DEXA scan. This is something I want you all to do. I want you to ask some of your folks that have osteoporosis on their, you know, their chart, their diagnosis list. Say, Hey, can I see your DEXA scan? Or, you know, if you're in a medical system, look up their DEXA scan, because it's really interesting. And you start to look at a lot of these reports and you'll have some of them that are more kind of narrative based, um, that, you know, are basically just several paragraphs kind of outlining, um, you know, what to expect, what they found, something more along the lines of, a bunch of words if you're not watching I'm just holding up some of these DEXA scans but more narrative but then a lot of them will actually have graphs of T-scores when they had that DEXA scan and where. So the most common areas are going to be the lumbar spine, the neck of both femurs, bilateral femurs, and then they'll kind of zoom out a little bit and look at the total hip as well. And so get those DEXA scans and look at some of those numbers. And when you start to look, what you're often going to find is variation amongst the different sites. So you can have individuals that may have that negative below negative 2.5, negative 2.5 or below, let's say at the neck of the left femur, for example. And then the neck of the right femur may be negative 1.7, osteopenic. The lumbar spine may be negative 1.5, for example, osteopenic. And so technically that person has osteoporosis on the left, on the left side, right? The right and the lumbar spine does not have osteoporosis, osteopenic, still a concern, right? But not as bad as that left side. That message is often missed by many of our patients. Now, I believe they're getting that message, you know, when they are getting these reports and having conversations with some of the physicians, but they're probably getting all kinds of recommendations. They're getting that diagnosed and all kinds of things that, you know, we only may only hear half of what is actually being said. But a lot of folks I work with, they will receive that diagnosis of osteoporosis that in reality is only in their lumbar spine, for example. and they will take that and own it as if every single bone in their body is brittle and about to combust under any type of pressure or load. They embrace that diagnosis as it's this global systemic osteoporosis. Every single bone I have is tremendously weak without acknowledging that there's some variability in different areas of the body. That piece of information for folks can be really eye-opening and very empowering. Oh my gosh, are you saying that I only really have this in this particular area of my body and not everywhere else? That's a sense of relief for a lot of folks. A lot of folks will take this diagnosis and view it as almost like a death sentence. everything. I am so weak. I'm so fragile. I need to be very careful. I'm going to break something, any bone I need to be very, very concerned about. Right. And that's not necessarily what's happening. It's usually in kind of one, maybe two areas that are a concern, particularly folks that are initially receiving these DEXA scans. And the cool thing about where I'm at now, working with folks for over four years, this individual, she's had a DEXA scan every two years. She was on a negative slope, negative three in 2017, negative 3.1 in 2019, negative 3.4 in 2022, and her most recent scan a couple months ago was negative 2.8. This is at her lumbar spine. and when you are able to give context to the diagnosis but then also be able to see over time you'll be able to spot trends and then hopefully be able to potentially reverse trends or slow down trends and we're seeing this at Stronger Life and I know many of y'all don't have the luxury of working with folks consistently you know three times a week over the course of several years but man if we can apply some of the interventions I'm going to talk about here in a second over the course of years you can have a significant influence in a lot of these DEXA scan readings and we're definitely seeing that and you can too. But I think that conversation, the prognosis, them understanding the diagnosis, where in particular that may be, that they understand every single bone in my body is not going to combust under pressure. This particular area may be more concerned, but I'm doing okay in these other areas. It's really good for them to hear that and that can be a more empowering message. OSTEOPOROSIS: TREATMENT Now the most important thing I think is that we take the information from this DEXA scan and then we use it in our plans of care. And so if I have someone that has maybe normal osteopenic in terms of the DEXA scan in their bilateral femurs, neck of their femurs, but then they're kind of borderline osteoporosis in their lumbar spine, for example, as a physical therapist, That gives me something that I can focus on, that I can give targeted interventions to give specific forces and stressors to that area in a very progressive manner, keep in mind, to stimulate a change in that bone mineral density or increase the odds that we can see change in their bone mineral density. So we take that information, use it for our plan of care. Some folks, you may be focused, all right, this left hip, let's load up this left hip a little bit more, do some unilateral stuff, staggered stance type things, not neglecting the other side per se, but if there's a big difference, we may want to give preference to one side or the other. If it's a spine, lots of loaded carries, deadlifts, those types of things where we're getting that axial compression, getting those forces through the spine. We can give target interventions. that's gonna encourage those bones to remodel, to get stronger, or potentially slow down, decline. So we take that information and take it into our intervention piece. Now for the intervention piece, you know, this is a 15, 20 minute podcast. We have a whole week on this in our NYA Level 2 course. But what you need to know is there are three things that are really, really important if osteoporosis is on board. One is balance training. This doesn't directly impact bone mineral density, but if we're able to improve people's balance capacity, I would even go as far to say their fall capacity as well. Do they know how to land? Do they have the balance capacity to even prevent the fall? That whole conversation of falls prevention and falls preparedness that we speak to, particularly in our live course, is really helpful for these individuals. Because if we can prevent a fall or even teach people how to fall in a more efficient or safer manner, you can potentially prevent an injurious fall or an osteoporotic-related fracture. So that's the first thing. Second thing is progressive resistance training. Bones really like progressive resistance training, where we're working up to relatively higher percentages of a one rep max, 70, 80, 85%. We're not going to come out the gate hitting that, but it'll take some time. But there's some really promising studies showing that, man, if people are able to regularly train at those higher intensities, they get really strong. They improve in a lot of the functional outcome measures that we care a lot about, but also their bone mineral density as well. Lyftmore trial is a great example of one group that's been able to show that. And then probably one of the more neglected things that we can definitely implement that can be intimidating for a lot of folks, but I found a lot very empowering for patients once they're able to do these things, and that is impact training. Weight-bearing as well. Loading the bones, but really thinking about the rate of loading. Progressive resistance training puts a ton of force, a bunch of load through that skeletal system that gets really good results. But bone can also respond really well to rapid loading. So think like plyometrics, stomping, heel stomps. step-ups, maybe a plyometric push-up, for example, or a quick bearing of weight through the upper extremities, something along those lines, where we're getting those increased ground reaction forces, we're getting those impact that can give the bones a signal to remodel. You take balance training, you take falls preparedness, sprinkle in some progressive resistance training, and then sprinkle in some of that impact training, and you stretch that out over years, And I will put my money that you're going to see some solid results when your patient comes back and says, Oh my gosh, Alan, look at my DEXA scan I just got. Remember the previous year, about a couple of years ago is like right when we started working together. And then man, I just had this DEXA scan and I've reversed my osteoporosis. We've seen that. Not to say it's going to happen every time, but people have the capacity to change and we often don't perceive that with this particular diagnosis. It is not a death sentence. There's a lot we can do. So understand the diagnosis, but then also understand that prognosis and give your patients context. Get that DEXA scan, look at it, analyze it. It's going to give you a lot of helpful information that they may not have comprehended and it can ease their mind of a lot of concern and worry, but it can also give them, something that they know they can do. And we can take that information and give a targeted intervention to a particular area that may be more troublesome than others. But man, if we combine that balance training, falls preparedness, progressive resistance training, and impact training with folks over a long duration of time, we can see some really significant results. All right, y'all. I appreciate y'all taking the time to listen. Let me know if you have any thoughts, questions, or your experiences working with folks. I do want to make sure I'm not saying everyone's going to get better. Everyone's going to improve their bone metal density. That is not the case. But man, if we can try without causing more harm, I think that's a good thing to pursue. And oftentimes, we can see some improvement. SUMMARY Before I go, I do want to mention our MMOA courses. I already mentioned that level 2 where we talk a lot about osteoporosis. Our online level 1 course is starting May 15th. Our level 2 course is starting May 16th. These are both 8 weeks long, about 2 hours a week, so you'll get 16 CEUs for PT, OT. and we equip you all to be the go-to clinician to best serve older adults in your community. It's likely gonna make you a very, very busy clinician serving these folks. And then our live course, we're gonna be in Bismarck, North Dakota, in Richmond, Virginia on May 18th and 19th. I'm gonna be in Scottsdale, Arizona, the beginning of June 1st and 2nd, and then we'll be in Spring, Texas, June 8th and 9th. We'd love to see y'all on the road or see y'all online. Y'all have a lovely rest of your Wednesday and go check out those Texas games. See y'all! OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

In this episode of the Medicine Grand Rounders, Dr. Ali Mehdi takes a deep dive into the world of Glomerulopathies.

It's our annual infamous Holiday Episode, where we find the quirkiest papers in health professions education!These are the papers that we couldn't resist talking about, even if they're not the most rigorous or relevant to our practice. These are the papers that will make you say “Wow, I can't believe this got into the literature!” We like to have some fun and celebrate the diversity and creativity of our field. And who knows, maybe you'll learn something new or get inspired by some of these quirky papers. So, without further ado, let's turn to our elves and see what do they have for us!What are the oddest papers you have noticed in the last year? Here are the hosts' choice: Lara found a paper that addresses an age-old superstition in medicine…Don't be that learner that says this word!Linda found a paper that asks if all the walking her fellow Internists do on the wards makes them better doctors??Jason found a paper that totally justifies how he watches educational videos!Jon found a clever paper that looked a scrub colours and competence!Jason had a surprise bonus paper just for Jon…Episode webpageEpisode Elfs: Lara Varpio, Jason Frank, Jonathan Sherbino, Linda SnellTechnical Producer: Samuel LundbergExecutive Producer: Teresa SöröProduction of Unit for teaching and learning at Karolinska Institutet

In this episode, we will be focusing on the mental aspect of weight loss. Our medical specialist guest, Dr. Sasha High, will be exploring the connection between mindset and obesity medical treatments such as Ozempic, Wegovy, Saxenda, Victoza, and Mounjaro. We are excited to have Cory as our guest to share his community story! He shares his personal journey of growing up as a larger child and eventually developing obesity and type 2 diabetes. Cory bravely opens up about how emotional eating contributed to his weight gain over the years. He also shares his thoughts on how the medication could have potentially helped his mother battle obesity and possibly extended her life. Follow Cory @midlifecrisison8earthsTo hear some of Cory's music see links below  Lightfoils https://open.spotify.com/artist/25pI4r8Ip65oUonf92oUb3?si=1tn7chEdTVSukeyQJ19gAAPanda Riot https://open.spotify.com/artist/3l65Zubp9XQv2SDSL3DhTi?si=VVgb3FrLSpauqeLeOa1lSQFollow Dr. High on TikTok and YouTube @thepsychdoctormd  Dr. High's BioDr. Sasha High is an Internist and Obesity Medicine Physician, mom of 3, kitesurfer, and entrepreneur. She completed a Bachelor of Science at the University of Ottawa, then medical school and residency at the University of Toronto. Dr. High is board-certified in Obesity Medicine and is a certified Life Coach. She has also received additional training in nutrition, CBT and ACT.Dr. High is the Founder of Best Weight and the High Metabolic Clinic, Canada's leading medical weight loss coaching program for women. Her team consists of Endocrinologists, Internists, Psychiatrists, Psychotherapists, Registered Dietitians and Certified Life Coaches. Their evidence-based approach involves cognitive behavioral coaching, lifestyle counseling and medical treatment to help women lose weight sustainably, stop emotional eating, and learn to love their bodies.Support the showKim Carlos @DMFKimonMounjaro on TikTokJernine Trott @TheeJernine on TikTokKat Carter @KatCarter7 on TikTokLydia Roberts @mounjaro_GLP_Help on TikTok

Today Jon is talking about M G M A data. Feel free to reach out to Jon Appino and his team for more a copy of the MGMA data. Link: www.ContractDiagnostics.com

Let's Connect: Instagram TikTok Lunch and Learn Patreon Family In this episode of the Real Physician Reacts series we will be having a discussion on the long-running issues between doctors and nurse practitioners. This particular episode was based on a recent controversial video of a nurse Practioner lambasting doctors in particular Internists. Subsequently as expected several reactionary videos/posts from doctors came out and just like that another episode of Doctors vs Nurse Practitioners. Click here to watch the full video on YouTube Several discussion points today; Scope of Practice Nurse Practitioners & Physician Assistants What is the beef between Doctors and Nurse Practitioners? How can we all just get along What is Creep Scope? Links Video Rep

To receive up to 1.0 CME/CE credit please complete the evaluation and request form here: https://www.ceconcepts.com/navigating-ckd-podcast#group-tabs-node-course-default1To facilitate timely diagnosis and rapid treatment initiation for anemia in CKD, the multidisciplinary and interprofessional CKD-anemia treatment team should be aware of the significant impact of anemia on patient quality of life, progression of CKD, and cardiovascular events. Erythropoietin-stimulating agents (ESAs) are associated with significant cardiovascular safety-related concerns, but the emergence of the oral hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) may improve erythropoiesis without the undesirable downstream effects of ESAs. However, HIF-PHIs place in therapy has not yet been fully elucidated. Here, join the interprofessional team of Dr. Ajay Singh, Dr. Jane Davis, and Dr. Calvin Meaney as they explore an incisive review of current CKD-anemia treatment and diagnostic challenges, as well as the evidentiary base for HIF-PHI utilization in CKD-anemia that establishes context for the future of these agents. In conclusion, a practical discussion of real-world patient case scenarios will be presented, to provide learners with context of the multiple comorbidities, complexities, diagnostic challenges, and barriers to appropriate treatment of CKD-anemia.

Marked pregnancy-induced insulin resistance may require that patient receive high-dose large-volume insulin injections. However, these types of injections may reduce the therapeutic effectiveness of the insulin.In this episode of the Better Edge podcast, Grazia Aleppo, MD, and Emily D. Szmuilowicz, MD, discuss their recent research published in Postgraduate Medicine. Their research proposes a new treatment regimen for pregnancy-induced insulin resistance that is guided by continuous glucose monitoring (CGM). This aims to give internists and family medicine physicians a simplified and consistent approach to CGM interpretation that can be easily implemented in a brief office visit.

Internal Medicine residency programs aren't the most competitive residencies but year after year they remain the most popular by a wide margin. And for good reason: Internists are perpetually in demand and enjoy a career oriented around the prevention and treatment of a wide variety of diseases. They're in many ways pillars of their community, working in tandem with family physicians to diagnose and treat adults over long periods of time. Despite this overlap though, Internal Medicine residency programs differ widely in focus and training compared to those of family medicine residency. In this guide, we'll go over the basics of Internal Medicine residency in the US and Canada, and provide tips on how to strengthen your application materials to match well when the big day arrives. 

In today's episode, we have Tassia Pfefferkorn MD from ReBalance Integrative Health ReBalance Integrative Health is an Internal medicine clinic that practices primary care but also specializes in weight loss and integrative health. Integrative health is a combination of functional medicine and traditional medicine. We also offer some cosmetic procedures. At ReBalance Integrative Health, Dr. Pfefferkorn and Dr. Vayntrub offer Primary Care services. Their mission is to treat each patient as a whole. There are many contributing factors when dealing with health, including physical, mental, and spiritual. Although both doctors are trained Internists, they believe in integrating different methods for the management and prevention of chronic illness. This starts with an in-depth understanding of the human body and implementing changes that are unique to each individual. Each patient gets individualized care that is specific to their needs. RIH is more than just a medical practice, it is a close-knit group of doctors that treat their patients like family. Call us to schedule your appointment today, we look forward to meeting you! LINKS: FACEBOOK: facebook.com/ReBalanceIntegrativeHealth/ INSTAGRAM: instagram.com/rebalanceih/ TIKTOK: tiktok.com/@rebalanceih WEBSITE: rebalanceintegrativehealth.com/ PHONE: Phone 248-719-7271 #keepingupwiththechaldeans #chaldeanDetroitMichigan #kuwtc #chaldean #michigan #doctor #rebalanceintegrativehealth Keeping Up With The Chaldeans is a weekly Podcast show based on Chaldean Entrepreneurs. We showcase your work in hopes that we can share the business amongst the community. Strength in numbers. That is our goal with the show! To learn more about "The Chaldean Community in Detroit" please visit:

A VIDEO RECORDING OF THIS ROUNDTABLE IS AVAILABLE HERE. Your host is old enough to remember when hospital corridors featured physicians with little black bags, scurrying around to see their patients. That's no longer true, of course. Most of the physicians seen in those corridors these days are white-coated employees. The Annals of Internal Medicine reported a few […] The post Podcast 296: A roundtable on the question, Why are young internists flocking to the hospitalist practice style? first appeared on Clinical Conversations.

On this episode of Investors & Operators, Jordan sits down with Luke Redman, CEO of Hospital Internists of Texas. Together, they discuss: The transformation of the operations, structures, and strategies at Hospital Internists of Texas The challenges Luke had undergone over the past 5 years of being the CEO at HIT The key equity investment dynamics across the healthcare industry ...and so much more. Luke Redman, CEO of Hospital Internists of Texas, and Jordan had an interesting discussion about healthcare and recent investment dynamics in the PE and M&A community. Luke, who comes from a military background, shared his thoughts on problem-solving and leadership styles in the healthcare industry. They also discussed topics such as leadership development, industry dynamics, the outlooks of healthcare and its subsectors, and the career path of transitioning into different industries. While investment opportunities in areas such as the emergency room and anesthesia are drying up, Luke saw significant upside potential in some other areas. Tune in to find out! Luke Redman's Bio: Luke Redman has substantial experience in healthcare strategy as a provider and payer consultant in insurance group business strategy and accountable care. and now as the CEO of an MSO physician group serving acute and post-acute patients throughout the Austin metropolitan region. Luke's professional experience includes payer contracting, BPCI, ACO, DCE, I-SNP/D-SNP, Medicare Advantage, risk adjustment, revenue cycle, SNF, home health, health policy, and healthcare informatics. In addition to his professional accomplishments, Luke is also committed to serving underserved populations and veterans, having served two tours in Baghdad in support of Operation Iraqi Freedom.

In this episode, Dr. Sheliza Halani interviews Dr. Andrew Ha, cardiac electrophysiologist at the University Health Network whose interest and clinical focus is in atrial fibrillation.They discuss the CCS/CHRS Comprehensive Guidelines for the Management of Atrial Fibrillation, released in 2020.Host: Dr. Sheliza HalaniGuest: Dr. Andrew Ha Sound Editing: We would like to thank Krzysztof Kowalik for producing this episode and editing the audio.Support the show

Show Notes Episode 20: Thinking through relationships with heart and mind (part 1 0f 3) The following story typifies one aspect of thinking through relationships with heart and mind. It also sets the stage for the next two episodes: Yesterday a third-year medical student came to my office to work with me. The first two years of medical school are in the classroom. Students learn about the body, in health and disease. They spend the second two years with patients, learning to apply what they'd learned. Pediatrics was his first clinical rotation, and this was his first day. “Do you know what you want to do in medicine?” I asked “I think I want to be a surgeon.” ‘How did you decide to go to medical school?” “The idea occurred to me late in college. I was a psychology major. One day I realized that I was going to be a psychologist because my mom is a psychologist. I respect her so much that I wanted to be like her. After appreciating that, I thought about what interested me. Biology was my real interest, and I knew I wanted to go to medical school.” “Surgeons can be very impersonal, pompous, even conceited,” I said. Their work, to them, is almost art. They see what needs to be done, and they apply their skill and ability to the task. When I was in medical school, a surgeon's comment highlighted this attitude. “Internists,” he said, “stand around and talk about problems. Surgeons fix them.” “You can avoid developing this standoffish attitude,” I went on. “by bringing the warmth and goodness you revere in your mom into your practice. If you become a surgeon with this ideal, you will be a different doctor. You'll be true to yourself and to what you value most.”      

What is a primary care provider, why do I need one, and how the hell do I find one?Contacting a primary care provider (PCP) or a primary medical doctor (PMD) is a great first move when you need a new health issue addressed or if you want preventative care and guidance. These are the professionals you want to have a great relationship with. You should not settle for seeing an absolute jerk of a doctor, regardless of how great he or she may be. Getting effective medical care from a professional should not be like a fast-food drive thru or vending machine. You cannot hit a button related to your problem and expect a bag of magic pills, at least most of the time. So why should you invest in your relationship with a PCP? The answer would be continuity! Just like how your social media apps get better at reading your mind based on your activity, your medical care tends to improve when a professional follows you for enough time.So what kinds of primary care providers are out there? Internists usually see patients above 18 y/o and pediatricians below 18 y/o. Family medicine docs see patients of all ages and are the true jack-of-all-trades in the medical field. Ladies can designate a gynecologist as a PCP, but in some cases insurance plans may place restrictions on doing that. Check if your health plan makes you pick an internist or other traditional PCP instead. Older patients with chronic and/or several complex issues may also consider a geriatrician as a PMD.Even though you will hear me say that you need a doc for this and a doc for that, the patients considering themselves to be perfectly healthy may find a better match with a different healthcare professional like an FNP instead where the patient can have various primary needs addressed but can still get referred to a specialist when needed. It is more important to strike a balance: make sure to have a medical provider who has both expertise and professional courtesy.According the Kaiser Family Foundation, there are around 495k active PMDs in the US as of September 2021. In our country of over 330 million people, it should be no surprise that low supply makes it hard to get scheduled with any doctor, let alone a good one. About 25% of those PMDs are in CA, NY, and TX alone.So how can you find a reasonable PMD? Most websites and forums will tell you to seek out friends/family or use your insurance plan's directory. While these sources are nice, not everyone is fortunate to have family in good medical hands already and health plan directories themselves may not be up to date (plug BCBS, UHC, Healthline source here).Let me make this easy: crack open google maps and type ‘internist/pediatrician near me' or write ‘internist/pediatrician in [insert your town here].' Convenience to medical care should matter just as much as how solid a professional's advice may be. Even when your insurance company requires you to designate a PCP, you can seek out whatever prospects are reachable. Go check out the map listings, scroll past the ads, and certainly read some reviews. But don't stop there! If you want another sophisticated tool to complement your impeccable google search, see Medicare's physician comparison site, which is also linked on my Substack's resource page (at rushinagalla.substack.com).Now for the good part: it is better to hear things from the horse's mouth and actually contact the prospective medical offices you see on your computer screen. Good offices want to have nice conversations with new patients and are usually willing to go over all the nuances with you. There is no reason to be shy. Let me give you a few basic questions to ask for improving your screening process.Here's the first thing to open up with: do you take new patients? If you get a ‘yes' then you should follow up with asking what to expect with the first consultation. Given that you are new, there is more history for the PCP to collect. Some physicians give new patients more time for the opening visit or change the overall structure of the appointment. The office's response to describing how new patients are treated should matter in your screening process.The next thing to cover is this: does your physician have experience treating the condition I have? Your expectations here would vary based on your social, personal, and family history, but understanding if a prospective doc has been treating patients with certain conditions for X number of years is a great thing to know regardless. We know already that PCPs treat you for a wide variety of conditions—that being said, we all know what an iPhone does but we still check what the features and specialties are for each new generation. This is why it is helpful to know what kind of tilt a prospective doctor has.Now it would be reasonable to ask another necessary question now rather than later: does your doctor and facility take my insurance? Although you should expect a yes or no answer to this, you should remember that there are a gazillion variations of plans under each insurance network. This is why it is best to have your insurance card handy when you ask that question to clarify what specific health plan you have. You are now making the office staff's job and your screening process easier.The last effective question to ask, which tends to be overlooked, is: Can I get labs and tests performed at the clinic itself? When your new PCP gives you some orders to fill you do not want to realize right then that you need to go to another facility to get additional medical care taken care of. Some primary care facilities are fully equipped to have a test drawn on site but it is easy to know for sure when you ask about their setup over the phone. If all of the aforementioned questions are answered to your satisfaction, it is worth scheduling a visit. Now you have made it through the first major hoop in screening your PMD prospects. It is important to do your research here because you are, ideally, going to see your PCP once a year to stay on top of things. If you wait until a busy season like the end of the year to squeeze in a physical, you will not get to the clinic in a timely manner. Leaving a 6-month calendar reminder on your phone to schedule a visit later makes this part easier.Let's say you make it to the clinic in a reasonable time frame, like within a month or two of your initial phone call, for a regular physical and you are chilling in the waiting room. At this moment you are more likely to check your crypto wallet or social media newsfeed than to think up some questions for your doc. In the next episode, I'll fill you in on simple tips and tricks to get the most of your routine visit even if you're fit as a fiddle.Stay tuned and subscribe to Friendly Neighborhood Patient for more wonderful and practical guidance! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

My guest this week is Dr. Frank Tortorice of Bay Area Wellness Center. In this episode, Dr. Frank Tortorice and I discuss diabetes (or diabesity) and his comprehensive approach to addressing the chronic diseases that face people today. Learn more about  Dr. Tortorice at his website http://www.diabesitydoc.com/ Follow Nat Facebook Facebook Group  Instagram Work with Nat: Book Your 20 MInute Optimization Consult   [10:00] About Dr. Tortorice and what brought him to where he is now… [18:00] Insulin resistance.. Is it at the base of most every major disease? What is causing this epidemic?.. [23:00] What role does genetics play in your overall health?.. What is the best diet? [26:25] How important is early detection of insulin resistance? What tests should we be running?.. [32:30] Are “normal” lab numbers really what we should be striving for?.. [37:21] How do you treat a patient that won't make changes? How do you treat the patient that has tried everything and still can not regain control of their health?.. [41:00] Chronic infections and insulin resistance… [49:15] Should you treat men and women differently? What about post menopausal women vs premenopausal?.. [51:30] Is fasting helpful for insulin resistance?.. [55:55] Covid longhaulers and blood sugar issues… [65:00] Alcohol and its impact on overall health… [67:30] Dr. Tortorice's future book with Joel Green…   Frank's passion is helping people take control of their own health by having a collaborative relationship with their doctor. He works closely with other providers to help patients acquire the tools to understand and treat these conditions. His sweet spot is helping patients previously on prescription medications, reduce or eliminate safely these medications under a board-certified Internists watchful eye.  Follow Frank at http://www.diabesitydoc.com/ https://www.facebook.com/BurlingameFunctionalMedicine/ https://www.instagram.com/burlingamefunctionalmedicine/?hl=en https://www.linkedin.com/in/frank-tortorice-md-abim-ifmcp-04b76520/

What does it mean to be taking care of patients with end stage illnesses, an internist knows this better than anyone else. We are entrusted with these decisions everyday in a hospital, yet how many times has someone walked us through what we should truly be doing and saying? While Palliative care offers that solace of help, as Internists we are the first line of communication with the patients and their families. This expects an understanding of Palliative care which I decided to explore through HemOnc for the Internist. With Dr Nagpal and Nancy McCool we introduce the challenges and concepts of Palliative care in this episode.

Listen to this eCW Podcast to learn how Internists Associates of Ridley Park, Pennsylvania has used healow TeleVisits™, healow CHECK-IN™, eClinicalMessenger® campaigns, and healow Pay to maintain continuity of care throughout the COVID-19 pandemic while enhancing safety and meeting the expectations of their 8,800 patients.

Colon cancer and its management is one of the most heavily tested areas of Oncology in the Internal Medicine boards. Additionally, as Internists, we face the challenge of contributing to the diagnosis of colon cancers at every level, which demands an in-depth understanding of "WHY" screening for colon cancers is one of the success stories of modern medicine.  Lets dive right into what molecular pathways are implicated in colon cancer and the hereditary syndromes with one of the most phenomenal teachers and Oncologist- Dr Venu Bathini.

In today's episode we discuss: —Climate: A systematic review by an international team of researchers highlights the significant underrepresentation of geriatric patients in published COVID-19 randomized control trials (RCTs). In the 12 RCTs included in the review, patients had mean age of 56.3 years, and were on average 20 years younger than patients from large observational trials. One explanation for this discrepancy is the strict exclusion criteria used for RCTs, which commonly exclude patients with cognitive impairment and multiple comorbidities frequently seen in the elderly population. The authors strongly advocate for future RCTs to include this vulnerable population that has been disproportionately affected by the COVID-19 pandemic. —Epidemiology: Pediatric ischemic stroke is an infrequent complication of SARS-CoV-2. Physician members of the International Pediatric Stroke Study Group surveyed 61 international sites to assess the prevalence of SARS-CoV-2 infection in pediatric stroke patients. They found 3.6% (6/166) of pediatric arterial ischemic stroke, 0.9% (1/108) of neonatal arterial ischemic stroke, 1.9% (1/54) of pediatric cerebral sinovenous thrombosis, and zero (0/33) neonatal cerebral sinovenous thrombosis patients were positive for SARS-CoV-2. Authors suggest these results indicate that SARS-CoV-2 does not appear to increase the risk of stroke in neonatal and pediatric populations but acknowledge that more robust testing is needed to determine any role the virus has in pediatric stroke. —Transmission & Prevention: Dry heat incubation and ambient temperature fail to consistently inactivate SARS-CoV-2 on N95 respirators. Internists and microbiologists from University of New Mexico assessed whether dry heat incubation could decontaminate N95 respirators and found SARS-CoV-2 was not inactivated when N95 coupons inoculated with the virus were heated to 60-75 degrees Celsius for either 30 or 60 minutes when placed on parchment paper but was inactivated when placed on tissue culture plates. When intact 3M 1860 N95 respirators were incubated at 70-75 degrees Celsius for 60 minutes, SARS-CoV-2 was not inactivated. Authors suggests that dry heat incubation is not a consistently effective method for deactivating SARS-CoV-2 on N95 respirators. —R&D: Diagnosis & Treatments: Efficacy of lopinavir/ritonavir in the treatment of COVID-19 was not found to be considerable according to a systematic review. An international research team from Nested Knowledge, Inc conducted a systematic review of 16 studies assessing the effectiveness and safety of lopinavir/ritonavir (LPV/r) in the treatment of COVID-19 and found the majority of included studies showed no significant improvement in clinical outcomes (RT-PCR negativity, chest-CT findings, mortality, adverse events) following LPV/r treatment, though they could not perform meta-analysis due to the high heterogeneity of the comparison groups. Though their review suggests little survival or clinical benefit of LPV/r in COVID-19, authors recommend larger clinical trials are needed to more definitively explore its potential benefits due to the limitations of currently available data. —Mental Health & Resilience Needs: Experiences of New Zealand registered nurses of Chinese ethnicity during the COVID-19 pandemic are brought to light in one study. --- Support this podcast: https://anchor.fm/covid19lst/support

In today's episode we discuss: —Climate: What are the COVID-19 vaccine trial ethics once we have efficacious vaccines? An expert opinion penned by bioethicists from the National Institutes of Health and Fogarty International Center in Bethesda, MD explore the ethics of continuing blinded, placebo-controlled trials for COVID-19 vaccines in the wake of a safe and efficacious vaccine being approved for widespread use. Authors argue it is ethical to continue trials if participants consent and the risk-benefit profile of the trial remains acceptable, because continuing trials could lead to the discovery of longer lasting vaccines, better immunity, or greater efficacy in subpopulations. However, the authors emphasize trial participants in blinded, placebo-controlled trials should be informed of the availability of the vaccine and allowed to leave the trial if they desire. —Understanding the Pathology: The L37F mutation may be critical to asymptomatic COVID-19 infection and transmission. Computer scientists from the University of Illinois analyzed 75,775 SARS-CoV-2 complete genome isolates to explore virological characteristics in asymptomatic COVID-19. They found patients with asymptomatic COVID-19 were significantly more likely to have the SARS-CoV-2 single nucleotide mutation 11083G>T-(L37F) on Non-Structural Protein 6 (NSP 6)(r=0.61, p=5.42×10^-56) and countries with the highest L37F mutation ratio had lower death ratio. Artificial intelligence (AI), topological data analysis (TDA), and network analysis revealed L37F destabilized NSP6's structure in a way that impeded viral assembly and replication. Authors suggest L37F mutation as a possible explanation for asymptomatic COVID-19 and encourage further research on therapies targeting NSP6. —Transmission & Prevention: Transmissibility of COVID-19 depends on the viral load around onset in adult and symptomatic patients. Infectious disease specialists and microbiologists from the Toyama University Graduate School of Medicine and Pharmaceutical Sciences in Japan conducted a case-control study comparing patients with 14 COVID-19 who did ("index patients") and 14 who did not transmit SARS-CoV-2 to another patient. They found index patients showed higher viral loads at onset compared to non-index patients (6.6 [5.2 to 8.2] log copies/μL vs. 3.1 [1.5 to 4.8]) and that, in general, symptomatic patients had a higher initial viral load (2.8 log copies/μL) than asymptomatic patients (0.9 log copies/μL, p

Why You Should Listen: In this episode, you will learn about the impact of oxalates on health and how oxalates may be a secondary mycotoxin. About My Guest: My guest for this episode is Emily Givler. Emily Givler is a Functional Genomic Nutrition Consultant, researcher, and lecturer with a thriving clinical practice at Tree of Life Health in Lancaster County, Pennsylvania. She holds advanced certifications in Nutrition, Herbalism, and Nutrigenomics from the Holt Institute of Medicine, PanAmerican University of Natural Health, and Functional Genomic Analysis where she now serves as an adviser and supplement formulator. In her practice, she utilizes personalized lifestyle changes, dietary, and nutritional protocols based on genetic predispositions, environmental and epigenetic influences, and functional lab testing to help her clients regain their health. In addition to her clinical work, she lectures on behalf of Functional Genomic Analysis, teaching weekend intensives on advanced interpretation of SNP data to practitioners ranging from Acupuncturists, Chiropractors and Naturopaths to Psychologists, Internists, and Anesthesiologists. She offers practitioner mentoring through the BeyondProtocols.org platform, helping colleagues navigate the complex web of genetic polymorphisms to develop more efficacious protocols for their chronically ill or complex cases. She sits on the advisory board for the Nutrigenomic Research Institute as well as lending her services as an independent researcher. Key Takeaways: - What are oxalates? - What are the symptoms and conditions associated with oxalates? - What is the role of oxalates in hypermobility or Ehlers Danlos Syndrome? - What is the role of oxalates in autism? - Do oxalates trigger Mast Cell Activation Syndrome? - How are oxalates tested for? - What is the role of genetics in hyperoxaluria? - Why are sulfate levels important in hyperoxaluria? - How can Oxalobacter be supported in our microbiome? - How might oxalates be considered a secondary mycotoxin? - What type of diet may be appropriate in hyperoxaluria? - How might oxalates be treated? - Can glycine or Vitamin C be problematic in those with oxalate issues? Connect With My Guest: http://TOLHealth.com http://BeyondProtocols.org Interview Date: November 18, 2020 Transcript: To review a transcript of this show, visit http://BetterHealthGuy.com/Episode131 Additional Information: To learn more, visit http://BetterHealthGuy.com. Disclaimer: The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.

Dr. Mohan Cooray is a specialist in internal medicine, gastroenterology, hepatology, and advanced endoscopy. After graduating from the University of Toronto's Life Sciences program with the highest distinction, he was accepted into the prestigious Michael G. DeGroote School of Medicine at McMaster University and was recognized for his achievements with the Outstanding Gastroenterology Resident Award in 2015. Dr. Cooray was quickly recruited for a highly coveted position at the Michael Garron Hospital in Toronto, where he worked with patients undergoing treatment for digestive diseases. Internists are doctor's doctors; they are all about the evidence. And Dr. Cooray did not start out believing cannabis was a reasonable treatment for his patients. What changed his mind so much he helped found a company, Cannalogue, that aims to get cannabis and cannabis education out to medical patients? You gotta listen! Music by: Leo Moracchioli Covers Hello by Adele - https://www.youtube.com/watch?v=LtQUJMBH8uE (Yes we got a SOCAN membership to use this song all legal and proper like) Additional Music: Desiree Dorion www.desireedorion.com/ Marc Clement http://marcclementmusic.com/ Links: Cannalogue - https://cannalogue.ca/

Dr. Hayes interviews Dr. Young about his time with CHOP and MOPP TRANSCRIPT   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. Dr. Hayes: Welcome to JCO's Cancer Stories, The Art of Oncology, brought to you by the ASCO Podcast Network, a collection of nine programs, covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all of the shows, including this one, at podcast.asco.org. Welcome to Cancer Stories. I'm Dr. Daniel Hayes. I'm a medical oncologist and translational researcher at the University of Michigan, Rogel Cancer Center. And I've also had the pleasure of being past president of the American Society of Clinical Oncology. I'm privileged to be your host for a series of podcast interviews with people I consider the founders of our field. Over the last 40 years, I've really been fortunate to have been trained and mentored and inspired by many of these pioneers. It's my hope that through these conversations we can all be equally inspired by gaining an appreciation of the courage, the vision, and also the scientific understanding that led these men and women to establish the field of clinical cancer care over the last 70 years. By understanding how we got to the present and what we now consider normal in oncology, we can also imagine and we can work together towards a better future for our patients and their families during and after cancer treatment. Today, my guest on this podcast is Dr. Robert Young. Among many designations he has, my favorite I think for Dr. Young is that he was considered one of the, quote, "gang of five," end of quote, I think self-named, who were responsible for developing the first curative chemotherapy regimen for Hodgkin's disease and non-Hodgkin's lymphomas at the National Cancer Institute in the early 1970s. Dr. Young is currently president of RCY Medicine, a private consulting firm based in Philadelphia. He was raised in Columbus, Ohio, where he couldn't get into the University of Michigan. So he went to a second-rate community college in Columbus called Ohio State. My bosses made me say it that way, Bob, here at the University of Michigan. Dr. Young: Not the correct way, The Ohio State University. Dr. Hayes: So he received his MD then at Cornell in 1965, followed by an internship at the New York Hospital. He spent the next two years as a clinical associate in the medicine branch at the National Cancer Institute. And then he completed his residency in medicine at Yale New Haven Medical Center. In 1970, he returned to the NCI, where he stayed for the next 18 years, serving during most of that as the chief of the medicine branch. Dr. Young accepted the role as president of the Fox Chase Cancer Center in Philadelphia and served in that role and then chancellor in 2009. Dr. Young has authored over 400 peer reviewed papers regarding a broad range of both scientific and policy issues in oncology. But in addition to the I consider astonishing and precedent-setting reports of cures in Hodgkin's disease and non-Hodgkin's lymphoma, perhaps most importantly with his longtime colleague and friend Dr. Robert Ozols, he led many of the early and groundbreaking studies in ovarian cancer diagnosis and treatment that I think still guide our care today for patients with this disease. He's won too many awards and honors for me to go through. But of the major ones, he won the prestigious Bristol-Myers Squibb award, which he shared with Dr. Ozols in 2002, the Margaret Foley Award for Leadership and Extraordinary Achievements in Cancer Research from the American Association of Cancer Research, and ASCO's Distinguished Service Award, one of our highest awards, for Scientific Leadership in 2004. Of note and close to my own heart, Bob served as the ASCO president 1989/1990, which I consider a really critical time in the evolution of our society. Dr. Young, welcome to our program. Dr. Young: Thank you. Dr. Hayes: So as I noted, you grew up in Columbus, Ohio, or again, as we say in Ann Arbor, that town down south, but more importantly that your father was a surgeon. And I've heard you tell the stories as a boy you went on rounds with him and that inspired it. Was he academic or was he a really community physician or both? Dr. Young: Well he was a little of both. He was primarily a community physician. But he did, particularly at the time of the Second World War, because he was a very skilled hand surgeon, he got involved with a lot of hand surgery related to a company called North American Aviation that produced a lot of World War II planes. And there were a lot of injuries in that setting. And so he became quite a skilled hand surgeon and actually taught at Ohio State's Medical Center. So he had both an academic and community-based practice. But primarily he was a practicing community surgeon. Dr. Hayes: And did you actually go into the OR with him as a boy? Dr. Young: Oh, yeah. Oh, sure. Dr. Hayes: Wow. Dr. Young: You know, in those days, there weren't any rules and regulations about that. And so I went in and watched surgery and held retractors and participated, you know, when I was a youngster. Dr. Hayes: Wow. What a privilege. You're right, that would not be allowed now. That's a good story. What did you see, bad and good, compared to medicine now then. I mean, if you had to say here are a couple things that we've lost that you regret. Dr. Young: Well, I think that it was more under the control of the physician than it is in this day and age in so many ways. For instance, my father practiced in three different hospitals. And he admitted patients depending upon what kind of surgical support and nursing support they needed. If they were complex, he went to a bigger hospital. If they were very straightforward cases, he put them into a smaller hospital. And so he had a lot more control over how his patients were dealt with and the circumstances under which they were cared for. And, of course, most of his practice was before Medicare and all of the insurance sort of thing, so that people paid what they could pay. And so it was a much simpler and much more physician-driven practice than it is today. Dr. Hayes: Just as an aside, there's a wonderful book called The Brothers Mayo, written by a woman named Clapesattle in the 1930s after both Charlie and Will died. And it's a history of the Mayo Clinic. But in it, she says that Will basically charged people what they could afford to pay. So if you were wealthy, he charged you a lot. And if you were poor, he gave it to you for free and everything in between. And he sort started made up the billing schedule the way he wanted it to happen. And one of his more wealthy patients challenged him on this, and he said, go somewhere else. Dr. Young: Yeah, well, that's exactly the kind of practice my father ran. Dr. Hayes: Yeah. Anyway, I'm intrigued by year two-year stint at the NCI in the late '60s before you then went back and finished at Yale. And hopefully this is not insulting and I know you're considered one of the so-called yellow berets. But tell me, tell us all about your choice to interrupt your residency and go to the NIH. I don't think our young listeners really understand the political climate and the circumstances of the time that led so many of you to go there. Dr. Young: Well, I think that's a great question, because it will lead to some of the other discussions we have later. But essentially, I graduated from medical school in 1965 at the height of the Vietnam War. And in those days, there was not only a general draft, there was a physicians draft. So graduating in medical school in those days, you had one of three choices. You could either take your chances-- and again, the numbers, your priority scores at the time, didn't really have anything to do with it, because they took as many doctors of whatever kind of type they wanted for whatever purpose they wanted. So that you couldn't be sure if you had a low number that you'd not be drafted. But you could take your chance. And in those days, a lot of people did. And a lot of people got drafted. Or you could join the Berry Plan, which was at the time an opportunity to continue your specialty training until you were finished. But then you owed back the military the number of years that you had been in specialty training. Or you could do a much less well-known track and that is with the US Public Health Service. And amongst the opportunities for the US Public Health Service were things like the Indian Health Service and the Coast Guard Service and those sorts of things, or the National Institutes of Health, about which at the time I knew almost nothing except that it existed. And I owe it to some of the folks that I worked with at Cornell, primarily a hematologist oncologist by the name of Dick Silver, Richard Silver, who's still at practice at New York Hospital, who when I was working in the labs there, because I was doing some research when I was at Cornell, and they were telling me about the fact that you could actually apply for a position at the NIH. And you would be in the US Public Health Service. So it took me about 3 milliseconds to figure out that for me that was clearly a track that I wanted to explore. And I had done some research in platelet function and platelet kinetics and so forth. And there was a guy by the Raphael Schulman who is at the NIH at the time. And I said, that would be a miracle if I could get this. So the way it worked was that you applied. And then you actually interviewed with a whole bunch of different people. And as it turned out, I didn't get a position with Dr. Schulman. But I was introduced to the National Cancer Institute and both the leukemia service and the then called the solid tumor service. And I applied to various things like that. And I actually got in on the leukemia service. So I walked in after I signed up and was taking care of little kids with acute leukemia, having never been a pediatrician or knowing anything about leukemia. But it was a baptism of fire and a very exciting place even then. Dr. Hayes: I want to get back to that in a second because that's a critical part of this. But, again, going back to the political climate, my opinion, this entire issue and your personal journey and many others had a profound effect on both the scientific and medical community of this country as a whole. I think it was an unintended effect. But because of the Vietnam War and because the NIH was such a great place to train in those days. Do you agree with me? Dr. Young: You are absolutely correct. I mean, one of the things that needs to be said is that this was a transformational phenomenon for cancer research. But it also took place in every other field. And the NIH at the time was just swarming with people of all medical disciplines who were coming to take advantage of the opportunities that existed within the NIH, but also to serve in this capacity as opposed to some of the alternatives that were around. And I think I heard a figure one time, which I'm sure is true, and that is at one point in time, 30% of the chairmen of medicine in the United States had done training at the NIH before they ended up being chairmen of medicine. So that gives you an idea of the impact of this. And you're absolutely right, it was a totally unintended consequence. Nobody ever designed it that way. Nobody ever planned for it to happen that way. But in retrospect, when looked at it and you can see exactly why what happened happened. Dr. Hayes: Yeah. And I interrupted you, but I did it on purpose, because it didn't sound to me like you really had a plan to go into cancer treatment, but sort of landed there serendipitously. Is that true? I mean how do you end up there? Dr. Young: Oh yeah, oh, yeah, I mean I did get very interested in hematology when I was in medical school. I first went to medical school, of course, thinking I was going to be a surgeon, because my father had a great practice and he had a wonderful experience with surgery and it was really cool. But I just found that I just wasn't designed just the same way. And it was increasingly clear that cancer was not my not my goal-- I mean, surgery was not my goal. And so, you know, I knew I wanted to stay in internal medicine. And I got interested in the research. And I had done some significant research and in platelet function, as I said. I knew that's what I wanted to do, some sort of clinically-related research in medicine. If I'd had my choices, of course, I would have gone into a sort of pure hematology track. And, of course, it's worth saying that it's difficult for oncologists nowadays to understand how big an outlier oncology was. There was no subspecialty in oncology at the time I went to train down there. There was a subspecialty in hematology. And, of course, all of us, the Gang of Five that you mentioned, all of us took hematology boards. And that's because it wasn't clear that there was going to be oncology. When oncology came along we all took the first oncology boards ever given. So that gives you an idea of how early in the history of oncology we were in the late '60s, early 1970s. Dr. Hayes: So we're talking 1970 or so right when you started? Dr. Young: Well, 1967 to '69, I was a clinical associate. Then I was at Yale for a year. And then in 1970, I came back on the senior staff. Dr. Hayes: And who were the characters above you when you came in? I know Doctors Frei and Freireich had been there before. Dr. Young: Yes. Frei and Freireich had just left the year before. One went off to MD Anderson, the other went off to the Memorial. And George and Vince-- George Cannellos, Vince DeVita-- had stayed on, with Vince as the head of the medicine branch. And then when we came back, Vince sort of brought two of us back that he'd had before, Bruce Chabner and I. He'd sort of sent us off to Yale and said they could buff us up a little bit. And he didn't offer us a job coming back. But we went off, and we were training up there. And he called us both up and says, why don't you to come back and join the senior staff. He recruited Phil Schein as well. And so that was the Gang of Five that we started out. Four of us ended up being president of ASCO at one time or another. And I suspect the only one who didn't, Bruce Chabner, probably would have except for the fact that he was the director of the Division of Cancer Treatment of the NCI for a long time. And the NCI and the NIH changed its attitude toward allowing people to participate in major leadership positions nationally, a tragedy as far as I'm concerned, which has I think affected the morale of the NIH and a lot of other things and deprived a lot of good people of opportunities to serve nationally. But that was the way it was, otherwise we would all ended up at some point leading-- Dr. Hayes: So the Gang of Five was you Bruce Chabner, George Cannellos, Phil Schein, and Vince DeVita, right? Dr. Young: Right, exactly. Dr. Hayes: And what were the dynamics among you? I mean, so were you and-- Dr. Young: Well, I mean, it was an incredible time. You know, there was enormous talent that had poured into the NIH, as we talked before. And an enormous amount of talent was present and was recruited in during this period of time. I mean, you know, Paul Carbone was still there. John Minna was recruited. Harman Ayer, who was the longtime chief medical officer of the American Cancer Society. Tom Waldman was a world class hematologist. Max Wicha was a part of this group. Sam Broder, Allen Lichter, an other ASCO president, Steve Rosenberg, Phil Pizzo was the head of the pediatric oncology branch, now dean at Stanford. And it goes on and on and on. And so there's a massive amount of talent and a lot of freedom. And so Vince was clearly the leader, he had a lot of ideas and a lot of creativity. But he let out a lot of people do whatever they wanted at the same time. And it was sort of a situation in which we all participated, because we were all attending at the same time. So Vince and George did a lot of the lymphoma and Hodgkin's disease stuff. We all participated. I got interested in ovarian cancer. And you talked about that. Bruce Chabner and Phil Schein were always very pharmacologically oriented. And so they did a lot of the phase 1 and phase 2 trials and a lot of the laboratory backup associated with the studies we did. And everybody shared. And so there was really not a lot of competition in that sense. Everybody was I think very competitive. Because it was all sort of shared, it worked out so that everybody felt that they were getting a substantial part of the recognition that was going on in the group. Another thing that was unusual about the NIH, but it had unintended, but important consequences is that nobody had anything to do with what they got paid. So that you could go to events and say, well, you know, I deserve to be paid more, but it didn't have anything to do with what you got paid. We had no control over anybody's salary. So that I don't think the whole time I was there, the whole 14 years I was chief of the medicine branch, I don't think I ever had a conversation with anybody about money, because I didn't have anything to do with what people got paid. Let me tell you, that's a big change. It actually has a remarkable, remarkable effect on the way people work. Because if for some reason somebody wanted to make more money, they just had to leave. There wasn't any way to do it. So you either had to accept that this is what everybody got paid and that you were rewarded by the opportunities to do the kinds of research that were done. Or you said, look, I need to go on and go somewhere else. Dr. Hayes: Now, just between you and me, and maybe a few thousand other people who are listening to this, who is the first guy to say let's give combination chemotherapy to Hodgkin's disease? Dr. Young: Well, actually, I don't know the answer to that. I think if I had to guess, I would say Vince, because Vince and George had been around in the Frei and Freireich days. And of course, you know, they'd already had experience with the impact of combination chemotherapy in leukemia. And so the concept was you took drugs that were active in the disease and put them together if they had different kinds of toxicity. And you were then able to utilize the combined impact on the tumor and sort of spread around the toxicity. So it was more tolerable. And that was the concept. And I think that because Vince and George were treating chronic leukemias and treating Hodgkin's disease, the notion of combining it with combinations was pretty straightforward evolution from the experience in leukemia. There are other people who claim that. I think from time to time both Jay Freireich and Tom Frei have claimed it. I think that there was a dust up between Vince and Paul Carbone and George because there was some suggestion by somebody that Paul was the one who originated the idea or Gordon Zubrod. And quite frankly, I don't know. If I knew, I would tell you. But I don't actually know. I can tell you this, that the emotional and passionate driver of the concept of combination chemotherapy as a successful modality in Hodgkin's disease and lymphoma was Vincent. Dr. Hayes: Your answer is very consistent with what other people have said the same thing. It must have been somewhere along the line that all of you began to see that there really were cures. And did you realize, as a group, that you were making history? Or was it just day to day-- Dr. Young: Well, you know, it's interesting. I can tell you one of the most transformational experiences that I had in the early days is, of course, we were following all these patients who had started on MOP. And so to do that you had to sort of go back and pull out the charts and all this kind of stuff. You know, we didn't have electronic systems that had all the stuff recorded. You just had to go down and pull off the charts. And what struck me so tremendously was the attitude of the physicians that had first started some of these patients on this therapy, because the notes made it very clear that they were sort of flabbergasted when these people came back after the first couple of months and they were watching their disease disappear, and that they really didn't anticipate at all, initially, that they were going to see these people after a couple of weeks. And it was very clear in the notes. By the time we had gotten there, of course, there were a significant number of people already on the trial. And it was already clear that we were seeing things that nobody had ever seen before. And I think that's when it first began to dawn on everybody. And as soon as we saw it in Hodgkin's disease based on the experience that we'd seen with non-Hodgkin's lymphoma, we had a suspicion that it would likely be the case as well there. Dr. Hayes: So you already bounced across it, but as I was looking through your CV I knew this anyway, you really mentored a who's who of oncology-- Rich Schilsky, Dan Longo, Max Whishaw, Dan Van Hoff-- and you noted already that oncology training has evolved. I mean BJ Kennedy pushed through boards I think in '74 or '75, something around there. What have you seen in the evolution on oncology training that you think is good or bad? Dr. Young: Oh, I think in general, it's much better. And I think it's much better because, of course, there's a lot of success that's been built into what's been accomplished. And that makes it a lot easier to teach people about how to treat Hodgkin's disease well, than we ever could at the time we were doing it because nobody knew the answer to those things. And I think there's also a lot more of it. You know, I think at the time we were at the NIH, you know, I think credibly you could count on both hands the number of really established academic oncology programs in the United States. And now, there are probably 100. And so the quality of training and the quality of mentoring is dramatically better than it was in those days. In those days, you know, hematologist we're doing most of the treatment of cancers. And they were all sort of in the Sidney Farber mode. You take one drug, and you give it as long as it works. And then you switch to another drug and use that as long as it works. And that was pretty much the way hematologists approached the disease. And by all means, you don't cause any toxicity. Dr. Hayes: I picked up several adults who had been Sidney Farber's patient when I was at the Dana-- Sidney Farber Cancer Institute in those days in the early '80s. So I had his handwritten notes. And sadly, I did not photocopy them. I would have love to have had it. But he had a very different mindset in terms of the way-- Dr. Young: Oh, absolutely, absolutely. And as far as I can tell, this is just my own personal reaction, is that I don't think either George or Vince at the time we got here shared any of that attitude. George is a little more cautious than Vince, as everybody knows. But neither one of them for a minute ever suggested that we were being too aggressive, that it was unfair and immoral to treat people with these kinds of toxicities, not that they desired to make people sick. But they were absolutely convinced that aggressive therapy could make a dramatic difference in the natural history of these diseases. Dr. Hayes: Yeah, certainly, Dr. Frei felt that way too. Dr. Young: Yes. And well, they were his mentors. I mean, you know, all these guys were there at the same time. And they were all influencing one another. Dr. Hayes: You know, it's amazing, I think all of us-- there are 44,000 members of ASCO now-- basically are derived from about 10 people in the 1950s and '60s, most of the DNA, not completely-- Karnofsky and some others around, but-- Dr. Young: Oh, yeah. Dr. Hayes: Well, the other thing is actually, you were talking about the safety, what are the war stories? I mean, how did you give chemotherapy? Were you guys mixing it up and giving it yourself? You know, we got all these bells and whistles. Dr. Young: Well, I mean, for instance, you know this is the first time really protocols were written. And the reason that we wrote protocols was simply because we were working with fellows. And they literally needed the recipe of what it was they were supposed to give and when. And so we wrote up these what were the first of the clinical trial protocols. There was no formal informed consent at the time of these studies. We had, of course, informed consent, the same way you do informed consent now, really. And that is you talk to the patient. You explain to the patient what the treatment is and what your expectations for the treatment are. And the patient understands the disease they face and decide that they can do it or not do it. And it's actually still the same today. The only difference is we now have 14, 17-page informed consent documents that make lawyers happy, but don't really impact, at least in my view, whether patients decide to participate or not. But we didn't have those. So I think that was the other one of the great things about the setting at the NIH, not that I'm anti-informed consent, but it was simpler. It was easier to get something done. You could do unconventional treatment and nobody looked at you and said, "you can't do that, that's never been done before, you're not allowed to do that." We didn't have academic constraints. One of the things that always surprised me is when, you know, we would develop a particular technique, like peritoneoscopy or laparoscopy for ovarian cancer staging, and when guys left the program having been well-trained to do this, they couldn't do it when they went to their new institutions because gastroenterologists did this. That was the sort of thing that the constraint wasn't here. There were also very easy-- I mean, all you had to do was to get an idea and write it up. I took a look at ovarian cancer and said, you know, "It seems to me, here's a disease that's now being managed by gynecologic oncologist. Internists never see these patients. They're all treated with the melphalan. And those that happen to live a long time develop acute leukemia from that treatment. They ought to be something better than what we're doing." And so we just decided that we would begin to take patients with advanced ovarian cancer into the NIH. And the rest sort of is history. But you couldn't do that in another hospital. You know, the biggest treaters of ovarian cancer probably program-wise was MD Anderson. But all his patients were treated by gynecologic oncologists. You couldn't have gone into the MD Anderson and said, "OK, we're going to take over the treatment of advanced ovarian cancer." They would have laughed in your face. Dr. Hayes: Actually, you just segued into my next question. And again, you and Dr. Ozols, in my opinion, completely changed the course of ovarian cancer treatment. Did you get a lot of pushback from the gynecologic community? Dr. Young: Well, no, actually. It's interesting. Now I don't know what we got behind the lines, you know when they were all sitting around the bar after the meetings. We really didn't. First of all, one of the other advantages of being at the NIH is that when you said something, people listened. And the other thing is, of course, when we got really going with ovarian cancer-- this was after the passage of the National Cancer Act-- and there was money at the NIH. So one of the things we did, for instance, was to put on a series of symposia about ovarian cancer treatment, what was going on, what wasn't going on, and brought the movers and shakers of this field together in meetings and talked about what was being done and what should be done and what information we didn't have that we needed. And we actually got funded for a period of time, a group called the Ovarian Cancer Study Group, which eventually evolved into the Gynecologic Oncology Cooperative Group, National Cooperative Group. So we had some other tools that we could bring to bear to drum up an interest in new research in ovarian cancer. And, of course, gynecologic oncologists couldn't prevent us from taking patients that were referred to us. And our surgeons, for instance, none of whom were gynecologic oncologists, were happy to help and to operate on them when they needed to be operated on. And Steve Rosenberg's group has fantastic surgeons. So we didn't have any problem getting state of the art surgery done on these people. And, in fact, they are general surgeons learned some gynecologic oncology at the same time. Dr. Hayes: Yeah, you know, it's been interesting to me that the surgeons, the general surgeons, willingly gave a systemic therapy. But that still in this country, there are very few medical oncologist who do GYN oncology. It's still mostly done by GYN oncologists. Dr. Young: Yes. Dr. Hayes: And there are very few trained medical oncologist in this. And I think it's gotten too complicated for a surgeon to do both. I don't really see why that hasn't happened based on, especially your model and Bob's model, that's my own soapbox. Dr. Young: Yeah, that's an interesting point, because at the NIH, when we were there, Steve Rosenberg and Eli Gladstein in radiation therapy, there were no rules that said that they couldn't do chemotherapy. And, in fact, they did it sometimes. And we didn't say anything about it. Usually, they called on us and said, hey, look, you know, we need you to help us or participate with us or whatever. But there were no rules that said that they couldn't. And sometimes they did. But for the most part they said, "look, this is not the business we're in. We want you guys to do the chemotherapy." And so for the most part we were able to do that. Dr. Hayes: The entire NSABP, those guys were all given their own surgery, their own chemotherapy. And they ultimately handed most of it over to medical oncology through the years. But that's not happened so much in GYN. OK, I want to go into your role in ASCO at the end here. And as I noted, I think you were president during a really critical turning point for the society. And just a few things, you already mentioned that I think you were already at Fox Chase when you ran. So you'd left NCI. And what made you run? But more importantly, tell us about your role in the evolution at that time of the society. Dr. Young: I think actually they recruited me to run just at the time that I was looking to leave. And so I left in December of 1988. And I was president of ASCO 1989 to 1990. At the time, I had moved from the medicine branch and ran the cancer center's program for a year. And I decided that I liked it. I thought, well, maybe I'll just stay here for the rest of my life, the way Steve Rosenberg did and others have done very successfully. But I said, well, you know, it's either sort of now or never. And so I decided that I would make the jump. But when I got into the sort of ladder, if you will, of ASCO through the board and so forth, it became clear that there were a couple of things that were a real challenge for the society. The society had at the time for the most part been essentially run on contract, that there was no organization of ASCO at all. It was it was all run by a contract organization. And it was clear that we had grown to a size such that we really needed to begin to recruit our own leadership staff. And so my year as president was actually the first year we hired a full-time employee. And she was based in a law firm that we used for ASCO legal business. But that was the first employee ever hired by ASCO. And that was in 1990, or 1989, I don't remember which, put in that year anyway. The other thing that was going on, which was critical for the society, is that, of course, there's always been a 'town gown' challenge in all aspects of medicine. And medical oncology was no different. So it had originally been the province of academic oncologists. But the numbers began to change dramatically. And it became clear that there was an enormous number of community-based oncologists, who looked at the challenges that face the organization somewhat differently than the academics. And this is one of the things that I think I benefited from growing up with a father that had both his feet in the community-based practice and the academic practice. And I realized how private practicing physicians view academics and view academic control of organizations. And I realized-- and others did too. I wasn't alone on this-- that we really needed to build up the recognition of community-based oncology as a first class citizen in the society. And so we began to create and bring in all of these state society organizations. And we began to get leadership roles who were based in community oncology, rather than just academics. And Joe Bailes was our first head of the Public Relations Committee of the society and grew this into a national presence and became the first community-based president of ASCO. So I think I think those are the two things that I saw that hopefully I made an impact on. And it always amazes me to realize that the society was really that young. I mean, people can't believe that it's just, what, 30 years ago when we had our first employee. Dr. Hayes: Yeah, that's why I'm doing these podcasts. We make sure we get this history. You know, it's interesting, I often give you credit for the ladder. As president myself, it was made very clear to me that 90% of the patients in this country with cancer are treated by community oncologists, maybe 85% or so. And about 2/3 of our membership are community oncologists. So we now have designated seats on the board of directors. We started a Department of Clinical Affairs that Steve Grubbs is running. That's just a few years old. But, boy, it's been fabulous. We now have a designated chair, the state affiliate council is invited to the board of directors and sits in and presents. And the state affiliate councils meets at ASCO headquarters at least once a year. And we've had a couple presidents who are, besides Joe, Doug Blayney and Skip Burris now coming in in June. So I think we've been reaching out. It always struck me when I sat in the headquarters, the seven founding members were, for the most part, community people. They met just to talk about how do you give chemotherapy. It wasn't, you know, about Tom Frei or Freireich or Jim Holland. It was folks in the community. And then it grew into an academic society. And I think you and then Joe Bailes and others kind of brought us back and grounded us. And to me, that's a really critical evolution in our society. I think it's made us much stronger. So those are most of my questions. You've answered almost everything I had written down that I always wanted to ask you if I got a moment in a cab with you. I want to thank you for taking time to do this. But more importantly, I want to thank you for all the contributions you have made to the field. I mean, I don't think I would be here and I don't think most of us who do oncology would be here if it weren't for you and the Gang of Five and the things you've done, both by the courage to moving forward to giving the kinds of chemotherapy and stuff, establishing science in the field, but also the policy stuff. Your articles in The New England Journal over the years, I think have been classics. You should put this all in a book and send them out to everybody because they have to do with not just giving chemotherapy, but the whys and hows of what we do. So I know I'm being long-winded, but that's because I'm a big fan. Well, thank you very much. Dr. Young: You know one of the things, I got to say is that I've just been a very lucky person. I happened to have had great opportunities. And I think I was able to take advantage of those opportunities. But somebody gave me those opportunities and put me at the right place at the right time. And so I am a very lucky guy. Dr. Hayes: Well, and I want to finish up and say how nice it is to see at least one graduate of Ohio State University do well. You know, it doesn't come very often. So congrat-- Dr. Young: Yeah, yeah, yeah, yeah, yeah The team up north, the team that will not be named, yes. Dr. Hayes: Thank you so much. And appreciate all you've done. Again, appreciate your taking time with us. Dr. Young: Thank you very much, Dan. Dr. Hayes: 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 listened. 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 ASCO's many podcasts. You can find all the shows at podcast.asco.org.

Welcome to The Shift expert series with naturopath, nutritionist and author Katherine Maslen as she explores the state of human health, the dysfunction of the health industry and provides people with the tools, knowledge and understanding to make the shift in their lives.  In the expert series of The Shift, Katherine explores deeper conversations with the world leaders featured in season one, the investigative docu-series on the gut. If you want to make the shift towards more informed decisions regarding better health, then this podcast is for you. Dr Leo Galland is an Internist and an MD from New York that specialises in the treatment of complex chronic disorders and is considered globally as one of the leading pioneers in studying the gut microbiome and intestinal permeability.  He is listed as one of the Leading Physicians of the World and America's Top Doctors.   Dr Galland is a graduate of Harvard University and New York University School of Medicine, and is board-certified in internal medicine.  In 2017, Dr. Galland was awarded the Albert Nelson Marquis Lifetime Achievement Award by Marquis Who's Who, which recognised his contribution to the medical world.   Dr Leo Galland has published 7 books including The Allergy Solution, The Fat Resistance Diet and Already Here.  He has received international recognition for developing innovative nutritional therapies to treat autoimmune, inflammatory, allergic, infectious and gastrointestinal disorders and has described his work in numerous scientific articles and textbook chapters.   In this episode Katherine and Dr Galland explore: What an Internists role is in medicine and what drew Dr Galland to become a professional in this field   Studying at Harvard University and New York University School of Medicine Why Dr Leo believes in the integrative medicine approach and how through practicing he has become better placed to effectively help his patients Profound examples of patient success stories through alternative medicine and changes to diet Dr Galland's research into gut microbes and how his findings have helped to shape today's understanding of the microbiome Fascinating studies into the effects of yo-yo dieting and mice The gut microbiomes role in neuro-inflammation, hormone production and studies linking the microbiome to stress and mental health The global increase in auto-immune diseases and allergies, and how our environments, nutrition and lifestyle choices impact the development of these conditions Hidden allergies and potential causes including food intolerances and exposure to harmful chemicals such as formaldehyde The loss of Dr Gallands son Christopher who passed away at the age of 22, but left Leo with a remarkable gift inspiring him to consider the afterlife and to share Christopher's story by writing the book Already Here  Links: Dr Leo Galland - Website Dr Leo Galland - Facebook Dr Leo Galland - Instagram Dr Leo Galland - Twitter Dr Leo Galland - LinkedIn The Shift Season 1

An informative interview with Dr. Natalie Beyeler, a practicing internal medicine doctor with 35 years of clinical experience on how to make those 15 minutes in the exam room count. Dr. Beyeler recounts her clinical observations practicing internal medicine in rural community hospitals, the lessons she's learned on patient recovery, longevity, and how patients can partner with their providers to take their health into their own hands. Internal medicine is a specialty where scientific knowledge and clinical expertise is used to prevent, diagnose and treat diseases that affect adults. Internists may continue their education to focus on diseases of the heart (cardiology) or other subspecialties, but every internal medicine physician has spent three of their seven years in medical school or post-graduate school on subjects that affect a broad range of medical problems rather than on one organ system. Dr. Natalie Beyeler is a highly sought after medical internist specialist whose 35+ years of clinical experience and integrative approach to healing make her a one of a kind provider. Bridging her intuition with scientific knowledge Dr. Beyeler uses her clinical expertise to prevent, diagnose, and treat diseases that affect adults in her thriving medical practice. Practicing internal medicine in rural community hospitals, Dr. Beyeler gives each patient her undivided attention while treating their ailments, mending their wounds, and infusing heart-based healing into everything she does. Dr. Beyeler is a board certified physician with the American Board of Internal Medicine who obtained her medical degree from the Philadelphia College of Osteopathic Medicine in Philadelphia, PA. She is a U.S. Army veteran who completed her medical internships and residency at Tripler Army Medical Center, Honolulu, HI and practiced at Fort Richardson Army Hospital before opening a private practice. Dr. Beyeler is an educator by nature, sharing all that she knows about patient care and recovery, longevity, and how patients can partner with their providers to take their health into their own hands. She is outdoor enthusiast who lives in Palmer, Alaska with her many horses and dogs. She loves spending as much time out doors gardening as possible as well as being with her three adult children, their spouses and seven grandchildren! For more tools to up-level your metaphysical game, get your questions answered and connect with me LIVE at the next new or full moon join the Lunar Manifestations Moon Circle now! Can't wait to meet you! In gratitude, -Autumn About Autumn: Autumn is a certified health coach and medium who holds a Masters in Secondary Education and a Bachelor of Arts in International Studies with a focus on Conflict Resolution, Human Rights, and Peace Studies. She is a proud Army wife, mother of two, and lifelong educator with over a decade of professional teaching experience. LINKS: Lunar Manifestations Moon Circle: https://www.goldenotterdivinations.com/joinnow Ritual Download: https://www.goldenotterdivinations.com/shop YouTube Channel: https://www.youtube.com/channel/UC72C3cggcnGvNVsO5TRZdVg Instagram: https://www.instagram.com/goldenotterdivinations/ 1:1 Sessions: https://www.goldenotterdivinations.com/book-online --- Send in a voice message: https://anchor.fm/autumn-seibel/message

Burnout is an important subject between doctors and internists, it is a big problem and we need to shed the light on it. We sat with Dr. Sean Greenhalgh, an assistant professor, and an internist at Loyola Hospital and an advocate for physician wellness and an expert on this subject. We talked about burnout symptoms, how to assess it, and how to manage it. We also interviewed residents and listened to their experience with burnout and how Internal medicine residency programs are approaching and managing this issue. Arya Nikamal, DO IM Resident at Advocate Christ Medical Center Qusai Alitter, MD IM Resident at West Suburban Medical Center Music: Philip Mathew

Session 92 Dr. Neeta Ogden is an allergist and immunologist. She has been out of training for about 13 years and she talks about her career as an allergist in a community setting. She shares some tips and tricks for you as you're going through the process to hopefully become an allergist if this is something you're interested in. [01:16] An Interest in Allergy There are two paths to Allergy fellowship – internal medicine residency and peds residency. Neeta took the internal medicine route. She remembers being in one rotation and the patient was very sick. He needed penicillin desensitization. And she found this very interesting that it was so specific. She describes the field as being precise, systematic, and specialized, which simply drew her to it. Then she did some HIV research at the hospital she was training at. Although she comes from a family of doctors, she never really came across Allergy until her residency. She also liked Dermatology at that time because there was an overlap between the two, but she hasn't really thought about doing anything other than Allergy. Otherwise, she would have just really chosen internal medicine. She thought Allergy was also a great lifestyle specialty. She didn't want to be taking crazy calls at the hospital so this was part of her thought process in choosing the specialty too. [06:24] Types of Patients With the huge rise of food and environmental allergies today, her day-to-day practice is mostly private practice. She sees a variety of both children and adult patients. She manages a lot of skin allergy. She also sees children with food allergies, allergic rhinitis, and asthma. She doesn't see a lot of complicated immunology although it could come up once in a while. "There's a ton of rashes and hives and allergic skin reactions more than I probably would have thought I would see." Allergy is driven by immunology and the immune system, the TH2 arm of our immune system specifically. But there's also a specific discipline of immunology like DBID. But she really doesn't see as much. That being said, immunology and allergy are both driven by the same pathophysiology. Immunology is rare and is a discipline that highly evolves in academic centers. In fact, Neeta would 100% defer to academic medical centers for immunology or complicated immunology. [10:16] Community vs. Academic Although Neeta still sees patients at the hospital, it's not the same thing as being in an academic setting which she also misses. Nevertheless, this decision was driven by a lifestyle choice. She joined her family of doctors, a multispecialty private practice, which gave her incredible flexibility of time and overhead. Being a mother, she also thought she'd be more successful in treating patients if she had this level of flexibility. [11:11] Diagnostics Neeta does diagnostics for almost every single patient. Patients are referred to her to find out what they're allergic to. 95% of patients end up getting bloodwork or allergy test in her office. [11:45] A Typical Day A typical day for Neeta would be walking into the office, rotating between three exam rooms. She does a variety of procedures – skin testing, patch testing, pulmonary function testing. Patients end up staying in the exam room for a considerable length of time. So what she does is bringing them on different days for specific testing. [13:05] Procedure Work Procedures done may vary from doctor to doctor. Neeta says procedures can be delegated to staff provided they're trained well. She does scratch testing, pulmonary function testing, and patch testing, application, and removal. They could also do variations of nasal endoscopy. [13:50] Taking Calls and LIfe Outside of Work Neeta takes calls at the hospital but it's not that often. She can get called for desensitization for patients who need it. Other issues she would usually encounter include endroedema and complicated asthma. But then again, it's not that often. "Internists, general doctors, and ER docs know how to get patients to a safe place and then discharge them with an instruction to see an allergist. Neeta describes this specialty as being one of the nicest specialties. You can have a rigorous work life but you can still spend time with your family. [15:50] The Training Path You obviously go through medical school for four years and then followed by a residency either in pediatrics or internal medicine. Around 3rd to 4th year, you will be applying for an Allergy Fellowship. At her time, the specialty was pretty competitive. The fellowship is really for everybody including peds and adults. Then when you ultimately go out, you treat both. To be competitive to match, try to find the chief of Allergy/Immunology at the hospital and get involved with research to show your interest. "Show some sincere interest and truly research. Dedicated work never hurts." [18:30] Subspecialty Opportunities and Bias Towards DOs There are medial centers that have a Food Allergy fellowship as well as other subsets where you may be able to go deeper. As for any negative biases towards DOs, Neeta hasn't really seen anything at all. There are just so many DOs everywhere and they're great doctors. [19:50] Working with Primary Care and Other Specialties Neeta wishes that primary care physicians wouldn't just test a battery food allergy test because people may leave the office thinking they're allergic to all these things and they need to stop. When in reality, we all have antibodies circulating in our bodies. So there isn't really any clinical relevance without a history of a reaction. So it's important for them to know how to interpret those tests or just leave it to the allergist. She also hopes they don't lead people to believe it's an immunology when it's actually an intolerance. She has seen a lot of primary care physicians though that know the updated food guidelines in terms of allergy that all infants should be started on. Hopefully, this is going to turn around peanut allergy cases that have been rising in the last two decades. Asthma is another one that she commonly hears where a primary care physician says they don't have asthma because they're not wheezing. But nocturnal hop especially in children is equivalent to wheezing. So she wishes she wouldn't hear as much of this as this makes the parents of patients doubt you. Other specialties she works the closest with include Dermatology, GI, ENT, Pulmonology, etc. She says asthma is either taken care of by pulmonologist or an allergist. But an allergist can probably help more since much of asthma is driven by allergy. "So much of asthma is driven by allergy and an allergist can do a bit more to help." Neeta further shares an advice to aspiring primary care doctors who would be consideirng whether to send their patients to an allergist or a pulmonologist. If the asthma is triggered, pulmonary may be the better route. But the medications they're going to use are just the same anyway. That being said, you can't go wrong. [24:50] Special Opportunities Outside of Clinical Medicine A big part of her life is doing work in the media. Neeta has done a lot of TV and educational media around the issue of allergy, which has become a hot topic. You could also write or have a podcast. [25:50] Most and Least Liked Things About Allergy What she wished she knew that she knows now going into the field is that the field requires a bit of being business savvy. What she likes most about the field is the ability to make people feel better. "Even though so many allergy medications are over the counter, I don't think people know how to use them efficiently." What she likes the least, on the other hand, are chronic issues that can make people feel miserable. In many cases, they don't respond to therapies. Treating the chronic asthmatic isn't also fun. [27:44] Major Changes in the Future Neeta has read about allergists fighting against an FDA regulation that allergists can no longer make shots for their patients. This would be problematic since this is a huge source of income if you're administering shots. Moreover, there's the automization of skin tests and the interpretation can take the allergists out of the picture. But that being said, you may think people may no longer need allergists. But people need that expertise. [28:31] Final Words of Wisdom If she had to do it all over again, Neeta would have chosen the same specialty. She simply loves it! She loves the "detective" aspect of it. One of the biggest medical mystery allergy-related cases she had seen was the drug reaction with eosinophilic systemic syndrome. Finally, Neeta wishes to imparts to medical students and premeds that allergists are needed. You have to be willing to make time for people. Empathy is also needed. Keep in mind how valuable you are. Realize how much difference your words and your education can make in the lives of patients. "It's a specialty that continues to be incredibly relevant because allergies are only going to get worse." Links: NeetaOgden.com MedEd Media Network

In today's VETgirl online veterinary CE podcast, we review the effect of client complains on veterinary internists. And let's be real here. This podcast doesn't just apply to veterinary internists. It applies to everyone single one of us in the field of veterinary medicine. This is a subject near and dear to VETgirl's heart, as wellness, self care and our emotional wellbeing as veterinary professionals is really important to us. That's why we hired Jeannine Moga, MA, MSW, LCSW, as our Chief Happiness Officer in 2019.

In today's VETgirl online veterinary CE podcast, we review the effect of client complains on veterinary internists. And let's be real here. This podcast doesn't just apply to veterinary internists. It applies to everyone single one of us in the field of veterinary medicine. This is a subject near and dear to VETgirl's heart, as wellness, self care and our emotional wellbeing as veterinary professionals is really important to us. That's why we hired Jeannine Moga, MA, MSW, LCSW, as our Chief Happiness Officer in 2019.

An informative interview with Dr. Natalie Beyeler, a practicing internal medicine doctor with 35 years of clinical experience on how to make those 15 minutes in the exam room count. Dr. Beyeler recounts her clinical observations practicing internal medicine in rural community hospitals, the lessons shes learned on patient recovery, longevity, and how patients can partner with their providers to take their health into their own hands. Internal medicine is a specialty where scientific knowledge and clinical expertise is used to prevent, diagnose and treat diseases that affect adults. Internists may continue their education to focus on diseases of the heart (cardiology) or other subspecialties, but every internal medicine physician has spent three of their seven years in medical school or post-graduate school on subjects that affect a broad range of medical problems rather than on one organ system.

According to the Society of Hospital Medicine, hospital medicine is a medical specialty dedicated to the delivery of comprehensive medical care to hospitalized patients.Internists practicing hospital medicine are frequently called "hospitalists.In this segment, Dr. Fari Kamalpour, DO, Director of the Hospitalist program at Corona Regional Medical Center, discusses the role of a hospitalist and why they are an important part of your care team if you have to be hospitalized.

Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview national and international experts to bring you clinical pearls and practice changing knowledge. Doctors Matthew Watto, Stuart Brigham, and Paul Williams deliver some knowledge food for your brain hole. Comments or questions? Email thecurbsiders@gmail.com

What was discussed? Quote of the day: “Feeling blue? Change your color.” 1. Control Costs Controlling your costs might seem obvious but they can easily get out of line if you aren't careful. Upgrading your software, giving yearly raises, or hiring new staff are just a few ways that costs can sometimes sneak up on you. You have to take your costs seriously, even if some might criticize you or call you obsessive -- at the end of the day it's your business and the costs do matter. Controlling costs should be a focus throughout the growth of your business. Medical office employees often fail to accurately verify recorded write offs and they fail to properly handle charge reconciliations. Ensure that your office staff doesn't become complacent in these areas. Try to go through the books at least every other month, line by line, and check how much you're spending. 2. Listen to your Patients Listen to your patients and what they're actually looking for from your practice. Take a look at your online reviews and see what your patients are saying about your practice. Often times a practice will receive a negative review not because of the practitioner, but because of the office staff. Complaints against your staff can impact patient volume and how often they're coming back. 3. Offer Ancillary Services Having a specialty is great but it's extremely important to offer additional services that can grow your practice and help your patients. At least 31% of Anesthesiologists, 20% of Family Practitioners, 20% of Internists, 19% of OBGYNs, 33% of Orthopedic Surgeons and 18% of Pediatricians offer additional or complimentary services. Additional services include pharmacy services, physical therapy, toxicology tests, alternative treatments, allergy treatments, urgent care services, cosmetic services, and more. 4. Look at Benchmarks Pay attention to your key metrics and compare them to regional and specialty providers in your area. Looking at medical practice benchmarks will help you determine how much other providers are charging, what they're charging for, and how your own prices add up. If you'd like to find out more information on this topic, check out our blog post. 5. Use Smart Scheduling Unfilled appointments and no-shows are inevitable, but need to be minimized as much as possible to maintain and increase revenue. Consider moving away from Wave Scheduling to Modified Wave Scheduling. Wave Scheduling is when appointments are scheduled at the top of the hour. Modified Wave Scheduling sets two appointments at the hour – one at quarter past and the other at half past. This allows doctors to use the last part of each hour for documentation and follow up calls. By optimizing the doctor's time, patients experience better care and will be happier which will lead to better reviews and an increase in revenue. Try to take at least one or two items from this list to help you grow your revenue and your practice. Put them in place and see what kind of improvements they make! If you need assistance with increasing your revenue, contact us today so we can see if we're a good fit for each other. Be sure to follow us on Twitter @TitanWebAgency if you enjoyed this podcast! Have you considered hiring a company to help you market your practice? If so, be sure to check out this free report I put together called: The Consumer Awareness Guide to Choosing an Online Marketing Agency. Learn the exact questions you need to ask to ensure you don't get ripped off.  You can pick it up at: http://titanwebagency.com/report Check out the show notes at: titanwebagency.com/podcast/088 Connect With Us: ·Follow us on Twitter: @titanwebagency ·And on Facebook: Titan Web Agency Facebook Page ·Join our Facebook Group ·Subscribe in iTunes

Host: Brian P. McDonough, MD, FAAFP Host Dr. Brian McDonough is joined by Dr. Karl Doghramji, Professor of Psychiatry and Medical Director of the Jefferson Sleep Disorders Center at Jefferson Medical College in Philadelphia, PA. Dr. Doghramji speaks on the latest trends and updates from his field of expertise, sleep medicine.

Interview with Jaclyn Yoong, MBBS, FRACP and Jennifer S. Temel, MD, authors of Early Palliative Care in Advanced Lung Cancer: A Qualitative Study, and Alexander K. Smith, MD, MS, MPH, author of Palliative Care: An Approach for All Internists Comment on “Early Palliative Care in Advanced Lung Cancer: A Qualitative Study”