Podcasts about Mayo Clinic

Host: Darryl S. Chutka, M.D. Guest: Konstantinos A. Papadakis, M.D. Due to the complexity and new pharmacologic options for the management of inflammatory bowel disease, patients often have their care provided by a gastroenterologist. They may not see their primary care provider as often as in the past and some of their preventive health maintenance may not get performed. Are patients receiving primarily specialty care still receiving good health maintenance?  Are we aware that patients with inflammatory bowel disease have some unique needs regarding their preventive health maintenance and some of the recommendations are different than the general population? These are questions I'll be asking my guest, gastroenterologist Konstantinos A. Papadakis, M.D., from the Mayo Clinic as we discuss “Health Maintenance in Inflammatory Bowel Disease” as part of our ongoing series on Inflammatory Bowel Disease. https://ce.mayo.edu/content/mayo-clinic-talks-inflammatory-bowel-disease Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts 

Linda Hasadsri, M.D., Ph.D., and Huong Cabral, M.S., CGC, explain how Mayo Clinic Laboratories' expanded test panel captures rarer as well as more common genetic causes of hereditary pancreatitis. That information is key to managing patients' enhanced risk for pancreatic cancer.Speaker 4: (00:32) Could you both please tell us a little bit about yourself and your background? Speaker 4: (02:23) Could you please give the audience a brief overview of this assay?  Speaker 4: (03:53) Which patients should have this test, and when should it be performed? Speaker 4: (04:49) What alternative testing options are available, and how do these compare to the new, expanded panel that we're going to be offering? Speaker 4: (08:20)How are the results used in patient care?

In this episode of It Takes Balls, Mayo Clinic's Dr. Chris Ray (cardio-oncology specialist) and Dr. Bryan Taylor (exercise physiologist) break down what every testicular cancer patient and survivor should know about protecting their heart, rebuilding their strength, and monitoring long-term health after treatment.The discussion dives into how certain chemotherapies - especially those used for testicular cancer - can quietly weaken blood vessels and heart tissue, even in young men. With cardiovascular disease being the leading long-term cause of death in cancer survivors, Dr. Ray explains why testicular cancer treatment should always include proactive cardiac screening and long-term fitness monitoring.Dr. Taylor adds depth by explaining the science of VO₂ testing and why cardiorespiratory fitness is one of the most powerful predictors of overall health. The doctors make a compelling case for “exercise as medicine,” outlining how even light movement during chemo, and structured training after, can dramatically reduce risk and speed up recovery.The episode also covers important topics like testosterone replacement therapy, understanding elevated heart rates during recovery, and why many survivors feel “ten years older on the inside” after chemo. Both experts emphasize that rebuilding your fitness is a long game, but one worth investing in early and consistently.Whether you're newly diagnosed or 10 years out, this conversation offers actionable guidance on improving quality of life, extending longevity, and asking your care team the right questions to protect your whole-body health starting with your heart.Have a question for a future expert guest? Submit here:https://www.testicularcancerawarenessfoundation.org/it-takes-balls-question-submissionWant to be a guest? Apply here:https://www.testicularcancerawarenessfoundation.org/it-takes-balls-submissionsFollow Testicular Cancer Awareness Foundation:⁠https://www.testescancer.orghttps://www.twitter.com/testescancer⁠⁠https://www.instagram.com/testescancerhttps://www.facebook.com/tca.orgDr. Ray:https://www.mayoclinic.org/biographies/ray-chris-m-d/bio-20470913Dr. Taylor:https://www.mayoclinic.org/biographies/taylor-bryan-j-ph-d/bio-20527883Follow Steven Crocker:https://www.twitter.com/stevencrockerhttps://www.instagram.com/stevencrockerhttps://www.facebook.com/steven.crocker2Theme song: No Time Like Now - Tom Willner www.tomwillner.com

How a Years Worth of Experience of PFA for AF has Revolutionized My Practice   Guest: Christopher DeSimone, M.D., Ph.D. Guest: Abhishek Deshmukh, M.B.B.S. Host: Anthony H. Kashou, M.D.   Patients most commonly have undergone traditional catheter ablation for AF via a thermal energy source. A newer energy modality is called Pulsed Field Ablation – using very high energy pulsation of strong voltages to destroy tissue responsible for AF. At Mayo Clinic, we have significant expertise in using this technology for our patients. This has changed our ablation practice, approach to ablation, and has made a tremendous impact on AF management.    Topics Discussed: How has the implementation of PFA for AFib changed your practice? What are some of the benefits of offering patients PFA? How has experience with this technology reflected your ablation approach? Where is the field of PFA heading to next for AFib? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Estás escuchando #JUNTOSRadio, ¿Qué es el trastorno de déficit de atención e hiperactividad?, ¿cuáles son los síntomas que se presentan en la infancia? y ¿cuál es la diferencia entre trastorno de déficit de atención e hiperactividad y un trastorno del aprendizaje? Nuestra invitada la Dra. María Jesús Avitia nos responde estas y otras preguntas. Sobre nuestra invitada: Dra. María Jesús Avitia es psicóloga certificada en el servicio bilingüe en la división de salud conductual y del desarrollo. Está especializada en la evaluación del autismo y ofrece clases de comportamiento en grupo para padres hispanohablantes. Su trabajo en estos grupos junto con su experiencia personal la ha motivado a crear oportunidades para mejorar el acceso a la atención y la información para nuestra población Latinx. Junto con sus colegas, la Dra. Avitia ha ayudado a crear una iniciativa llamada ACCESO, que significa Abriendo Caminos y Conexiones hacia un Espectro de Oportunidades, para conectar a las familias hispanohablantes que tienen niños con discapacidades del desarrollo con los recursos de la comunidad y recibir información en su lengua materna. Recursos informativos en español Medline Plus https://medlineplus.gov/spanish/atten... Mayo Clinic https://www.mayoclinic.org/es/disease... Facebook: @juntosKS    Instagram: juntos_ks    YouTube: Juntos KS    Twitter: @juntosKS    Página web: http://juntosks.org       Suscríbete en cualquiera de nuestras plataformas de Podcast: Podbean, Spotify, Amazon Music y Apple Podcast - Juntos Radio        Centro JUNTOS Para Mejorar La Salud Latina                                                                                                   4125 Rainbow Blvd. M.S. 1076,    Kansas City, KS 66160    No tenemos los derechos de autor de la música que aparece en este video. Todos los derechos de la música pertenecen a sus respectivos creadores.

Eric Topol (00:06):Hello, this is Eric Topol from Ground Truths, and I'm delighted to welcome Owen Tripp, who is a CEO of Included Health. And Owen, I'd like to start off if you would, with the story from 2016, because really what I'm interested in is patients and how to get the right doctor. So can you tell us about when you lost your hearing in your right ear back, what, nine years ago or so?Owen Tripp (00:38):Yeah, it's amazing to say nine years, Eric, but obviously as your listeners will soon understand a pretty vivid memory in my past. So I had been working as I do and noticed a loss of hearing in my right ear. I had never experienced any hearing loss before, and I went twice actually to a sort of national primary care chain that now owned by Amazon actually. And they described it as eustachian tube dysfunction, which is a pretty benign common thing that basically meant that my tubes were blocked and that I needed to have some drainage. They recommended Sudafed to no effect. And it was only a couple weeks later where I was walking some of the senior medical team at my company down to the San Francisco Giants game. And I was describing this experience of hearing loss and I said I was also losing a little bit of sensation in the right side of my face. And they said, that is not eustachian tube dysfunction. And well, I can let the story unfold from there. But basically my colleagues helped me quickly put together a plan to get this properly diagnosed and treated. The underlying condition is called vestibular schwannoma, even more commonly known as an acoustic neuroma. So a pretty rare benign brain tumor that exists on the vestibular nerve, and it would've cost my life had it not been treated.Eric Topol (02:28):So from what I gather, you saw an ENT physician, but that ENT physician was not really well versed in this condition, which is I guess a bit surprising. And then eventually you got to the right ENT physician in San Francisco. Is that right?Owen Tripp (02:49):Well, the first doctor was probably an internal medicine doctor, and I think it's fair to say that he had probably not seen many, if any cases. By the time I reached an ENT, they were interested in working me up for what's known as sudden sensorineural hearing loss (SSHL), which is basically a fancy term for you lose hearing for a variety of possible pathologies and reasons, but you go through a process of differential diagnosis to understand what's actually going on. By the time that I reached that ENT, the audio tests had showed that I had significant hearing loss in my right ear. And what an MRI would confirm was this mass that I just described to you, which was quite large. It was already about a centimeter large and growing into the inner ear canal.Eric Topol (03:49):Yeah, so I read that your Stanford brain scan suggested it was about size of a plum and that you then got the call that you had this mass in your brainstem tumor. So obviously that's a delicate operation to undergo. So the first thing was getting a diagnosis and then the next thing was getting the right surgeon to work on your brain to resect this. So how did you figure out who was the right person? Because there's only a few thousand of these operations done every year, as I understand.Owen Tripp (04:27):That's exactly right. Yeah, very few. And without putting your listeners to sleep too early in our discussion, what I'll say is that there are a lot of ways that you can actually do this. There are very few cases, any approach really requires either shrinking or removing that tumor entirely. My size of tumor meant it was really only going to be a surgical approach, and there I had to decide amongst multiple potential approaches. And this is what's interesting, Eric, you started saying you wanted to talk about the patient experience. You have to understand that I'm somebody, while not a doctor, I lead a very large healthcare company. We provide millions of visits and services per year on very complex medical diagnoses down to more standard day-to-day fare. And so, being in the world of medical complexity was not daunting on the basics, but then I'm the patient and now I have to make a surgical treatment decision amongst many possible choices, and I was able to get multiple opinions.Owen Tripp (05:42):I got an opinion from the House clinic, which is closer to you in LA. This is really the place where they invented the surgical approach to treating these things. I also got an approach shared with me from the Mayo Clinic and one from UCSF and one from Stanford, and ultimately, I picked the Stanford team. And these are fascinating and delicate structures as you know that you're dealing with in the brain, but the surgery is a long surgery performed by multiple surgeons. It's such an exhausting surgery that as you're sort of peeling away that tumor that you need relief. And so, after a 13 hour surgery, multiple nights in the hospital and some significant training to learn how to walk and move and not lose my balance, I am as you see me today, but it was possible under one of the surgical approaches that I would've lost the use of the right side of my face, which obviously was not an option given what I given what I do.Eric Topol (06:51):Yeah, well, I know there had to be a tough rehab and so glad that you recovered well, and I guess you still don't have hearing in that one ear, right?Owen Tripp:That's right.Eric Topol:But otherwise, you're walking well, and you've completely recovered from what could have been a very disastrous type of, not just the tumor itself, but also the way it would be operated on. 13 hours is a long time to be in the operating room as a patient.Owen Tripp (07:22):You've got a whole team in there. You've got people testing nerve function, you've got people obviously managing the anesthesiology, which is sufficiently complex given what's involved. You've got a specialized ENT called a neurotologist. You've got the neurosurgeon who creates access. So it's quite a team that does these things.Eric Topol (07:40):Yeah, wow. Now, the reason I wanted to delve into this from your past is because I get a call or email or whatever contact every week at least one, is can you help me find the right doctor for such and such? And this has been going on throughout my career. I mean, when I was back in 20 years ago at Cleveland Clinic, the people on the board, I said, well, I wrote about it in one of my books. Why did you become a trustee on the board? And he said, so I could get access to the right doctor. And so, this is amazing. We live in an information era supposedly where people can get information about this being the most precious part, which is they want to get the right diagnosis, they want to get the right treatment or prevention, whatever, and they can't get it. And I'm finding this just extraordinary given that we can do deep research through several different AI models and get reports generated on whatever you want, but you can't get the right doctor. So now let's go over to what you're working on. This company Included Health. When did you start that?Owen Tripp (08:59):Well, I started the company that was known as Grand Rounds in 2011. And Grand Rounds still to this day, we've rebranded as Included Health had a very simple but powerful idea, one you just obliquely referred to, which is if we get people to higher quality medicine by helping them find the right level and quality of care, that two good things would happen. One, the sort of obvious one, patients would get better, they'd move on with their lives, they'd return to health. But two and critically that we would actually help the system overall with the cost burden of unnecessary, inappropriate and low quality care because the coda to the example you gave of people calling you looking for a physician referral, and you and I both know this, my guess is you've probably had to clean plenty of it up in your career is if you go to the wrong doctor, you don't get out of the problem. The problem just persists. And that patient is likely to bounce around like a ping pong ball until they find what they actually need. And that costs the payers of healthcare in this country a lot of money. So I started the company in 2011 to try to solve that problem.Eric Topol (10:14):Yeah, one example, a patient of mine who I've looked after for some 35 years contacted me and said, a very close friend of mine lives in the Palm Springs region and he has this horrible skin condition and he's tortured and he's been to six centers, UCSF, Stanford, Oregon Health Science, Eisenhower, UCLA, and he had a full workup and he can't sleep because he's itching all the time. His whole skin is exfoliating and cellulitis and he had biopsies everywhere. He's put on all kinds of drugs, monoclonal antibodies. And I said to this patient of mine I said, I don't know, this is way out of my area. I checked at Scripps and turns out there was this kind of the Columbo of dermatology, he can solve any mystery. And the patient went to see him, and he was diagnosed within about a minute that he had scabies, and he was treated and completely recovered after having thousands and thousands of dollars of all these workups at these leading medical centers that you would expect could make a diagnosis of scabies.Owen Tripp (11:38):That's a pretty common diagnosis.Eric Topol (11:40):Yeah. I mean you might expect it more in somebody who was homeless perhaps, but that doesn't mean it can't happen in anyone. And within the first few minutes he did a scrape and showed the patient under the microscope and made a definitive diagnosis and the patient to this day is still trying to pay all his bills for all these biopsies and drugs and whatnot, and very upset that he went through all this for over a year and he thought he wanted to die, it was so bad. Now, I had never heard of Included Health and you have now links with a third of the Fortune 100 companies. So what do you do with these companies?Owen Tripp (12:22):Yeah, it's pretty cool. These companies, so very large organizations like Walmart and JPMorgan Chase and the rest of the big pioneers of American industry and business put us in as a benefit to help their employees have the same experience that I described to provide almost Eric Topol like guidance service to help people find access to high quality care, which might be referring them into the community or to an academic medical center, but often is also us providing care delivery ourselves through on-demand primary care, urgent care, behavioral health. And now just last year we introduced a couple of our first specialty lines. And the idea, Eric, is that these companies buy this because they know their employees will love it and they do. It is often one of, if not the most highly rated benefits available. But also because in getting their employees better care faster, the employees come back to work, they feel more connected to the company, they're able to do better and safer and higher quality work. And they get more mileage out of their health benefits. And you have to remember that the costs of health benefits in this country are inflating even in this time of hyperinflation. They're inflating faster than anything else, and this is one of most companies, number one pain points for how they are going to control their overall budget. So this is a solution that both give them visibility to controlling cost and can deliver them an excellent patient experience that is not an offer that they've been able to get from the traditional managed care operators.Eric Topol (14:11):So I guess there's a kind of multidimensional approach that you're describing. For one, you can help find a doctor that's the right doctor for the right patient. And you're also actually providing medical services too, right?Owen Tripp (14:27):That's right.Eric Topol (14:30):Are these physicians who are employed by Included Health?Owen Tripp (14:34):They are, and we feel very strongly about that. We think that in our model, we want to train people, hire people in a specific way, prepare them for the kind of work that we do. And there's a lot we could spend time talking about there, but one of the key features of that is teamwork. We want people to work in a collaborative model where they understand that while they may be expert in one specific thing that is connected to a service line, they're working in a much broader team in support of the member, in support of that patient. And we talk about the patients being very first here, and you and I had a laugh on this in the past, so many hospitals will say we're patient first. So many managed care companies will say they're patient first, but it is actually hard the way that the system is designed to truly be patient first. At Included Health, we measure whether patients will come back to us, whether they tell their friends about us, whether they have high quality member satisfaction and are they living more healthy days. So everybody gets surveyed for patient reported outcomes, which is highly unusual as you know, to have both the clinical outcomes and the patient reported outcomes as well.Eric Topol (15:41):Is that all through virtual visits or are there physical visits as well?Owen Tripp (15:47):Today that is all through virtual visits. So we provide 24/7/365 access to urgent care, primary care, behavioral health, the start of the specialty clinic, which we launched last year. And then we provide support for patients who have questions about how these things are going to be billed, what other benefits they have access to. And where appropriate, we send them out to care. So obviously we can't provide all the exams virtually. We can't provide everything that a comprehensive physical would today, but as you and I know that is also changing rapidly. And so, we can do things to put sensors and other observational devices in people's homes to collect that data positively.Eric Topol (16:32):Now, how is that different than Teladoc and all these other telehealth based companies? I mean because trying to understand on the one hand you have a service that you can provide that can be extremely helpful and seems to be relatively unique. Whereas the other seems to be shared with other companies that started in this telehealth space.Owen Tripp (16:57):I think the easiest way to think about the difference here is how a traditional telemedicine company is paid and how we're paid because I think it'll give you some clue as to why we've designed it the way we've designed it. So the traditional telehealth model is you put a quarter in the jukebox, you listen to a song when the song's over, you got to get out and move on with the rest of your life. And quite literally what I mean is that you're going to see one doctor, one time, you will never see that same doctor again. You are not going to have a connected experience across your visits. I mean, you might have an underlying chart, but there's not going to be a continuity of care and follow up there as you would in an integrated setting. Now by comparison, and that's all derived from the fact that those telehealth companies are paid by the drink, they're paid by the visit.Owen Tripp (17:49):In our model, we are committing to a set of experience goals and a set of outcomes to the companies that you refer to that pay our bill. And so, the visits that our members enjoy are all connected. So if you have a primary care visit, that is connected to your behavioral health visit, which is great and is as it should be. If you have a primary care appointment where you identify the need for follow-up cardiology for example. That patient can be followed through that cardiology visit that we circle back, that we make sure that the patient is educated, that he or she has all their questions answered. That's because we know that if the patient actually isn't confident in what they heard and they don't follow through on the plan, then it's all for naught. It's not going to work. And it's a simple sort of observation, but it's how we get paid and why we think it's a really important way to think about medicine.Eric Topol (18:44):So these companies, and they're pretty big companies like Google and AT&T and as you said, JPMorgan and the list goes on and on. Any one of the employees can get this. Is that how it works?Owen Tripp (18:56):That's right, that's right. And even better, most of what I've described to you today is at a low or zero cost to them. So this is a very affordable, easy way to access care. Thinking about one of our very large airline clients the other day, we're often dealing with their flight crews and ramp agents at very strange hours in very strange places away from home, so that they don't have to wait to get access to care. And you can understand that at a basic humanitarian level why that's great, but you can also understand it from a safety perspective that if there is something that is impeding that person's ability to be functioning at work, that becomes an issue for the corporation itself.Eric Topol (19:39):Yeah, so it's interesting you call it included because most of us in the country are excluded. That is, they don't have any way to turn through to get help for a really good referral. Everything's out of network if they are covered and they're not one of the fortunate to be in these companies that you're providing the service for. So do you have any peers or are there any others that are going to come into this space to help a lot of these people that are in a tough situation where they don't really have anyone to turn to?Owen Tripp (20:21):Well, I hope so. Because like you, I've dedicated my career to trying to use information and use science and use in my own right to bring along the model. At Included Health, we talk about raising the standard of care for everybody, and what we mean by that is, we actually hope that this becomes a model that others can follow. The same way the Cleveland Clinic did, the same way the Mayo Clinic did. They brought a model into the world that others soon try to replicate, and that was a good thing. So we'd like to see more attempt to do this. The reality is we have not seen that because unfortunately the old system has a lot of incentives in place to function exactly the way that it is designed. The health system is going to maximize the number of patients that correspond to the highest paying procedures and tests, et cetera. The managed care company is going to try to process the highest number of claims, work the most efficient utilization management and prior authorization, but left out in the middle of all of that is the patient. And so, we really wanted to build that model with the patient at the center, and when I started this company now over a decade ago, that was just a dream that we could do that. Now serving over 10 million members, this feels like it's possible and it feels like a model others could follow.Eric Topol (21:50):Yeah, well that was what struck me is here you're reaching 10 million people. I'd never heard of it. I was like, wow. I thought I try to keep up with things. But now the other thing I wanted to get into you with is AI. Obviously, that has a lot of promise in many different ways. As you know, there are some 12 million diagnostic serious errors a year in the US. I mean you were one, I've been part of them. Most people have been roughed up one way or another. Then there's 800,000 Americans who have disability or die from these errors a year, according to Johns Hopkins relatively recent study. So one of the ways that AI could help is accuracy. But of course, there's many other ways it can help make the lives of both patients helping to integrate their data and physicians to go through a patient's records and set points of their labs and all sorts of other things. Where do you see AI fitting into the model that you've built?Owen Tripp (22:58):Well, I'll give you two that I'm really excited about, that I don't think I hear other people talking about. And again, I'm going to start with that patient, with that member and what he or she wants and needs. One and Eric, bear with me, this is going to sound very banal, but one is just making sense of these very complicated plan documents and explanations of benefits. I'm aware of how well-trained you are and how much you've written. I believe you are the most published in your field. I believe that is a fact. And yet if I showed you a plan description document and an explanation of benefit and I asked you, Eric, could you tell me how much it's going to cost to have an MRI at this facility? I don't think you would've any way of figuring that out. And that is something that people confront every single day in this country. And a lot of people are not like you and me, in that we could probably tolerate a big cost range for that MRI. For some people that might actually be the difference between whether they eat or not, or get their kids prescription or not.Owen Tripp (24:05):And so, we want to make the questions about what your benefits cover and how you understand what's available to you in your plan. We want to make that really easy and we want to make it so that you don't have to have a PhD in insurance language to be able to ask the properly formatted question. As you know, the foundation models are terrific at that problem. So that's one.Eric Topol (24:27):And that's a good one, that's very practical and very much needed. Yeah.Owen Tripp (24:32):The second one I'm really excited about, and I think this will also be near and dear to your heart, is AI has this ability to be sort of nonjudgmental in the best possible way. And so, if we have a patient on a plan to manage hypertension or to manage weight or to manage other elements of a healthy lifestyle. And here we're not talking about deep science, we're just talking about what we've known to work for a long period of time. AI as a coach to help follow through on those goals and passively take data on how you're progressing, but have behind it the world's greatest medical team to be able to jump in when things become more acute or more complex. That's an awesome tool that I think every person needs to be carrying around, so that if my care plan or if my goal is about sleeping better, if my goal is about getting pregnant, if my goal is about reducing my blood pressure, that I can do that in a way that I can have a conversation where I don't feel as a patient that I'm screwing up or letting somebody down, and I can be honest with that AI.Owen Tripp (25:39):So I'm really excited about the potential for the AI as an adjunct coach and care team manager to continue to proceed along with that member with medical support behind that when necessary.Eric Topol (25:55):Yeah, I mean there's a couple of things I'd say about that. Firstly, the fact that you're thinking it from the patient perspective where most working in AI is thinking it from the clinician perspective, so that's really important. The next is that we get notifications, and you need to not sit every hour or something like that from a ring or from a smartwatch or whatever. That isn't particularly intelligent, although it may be needed. The point is we don't get notifications like, what was your blood pressure? Or can you send a PDF of your heart rhythm or this sort of thing. Now the problem too is that people are generating lots of data just by wearing a smartwatch or a fitness band. You've got your activity, your sleep, your heart rate, and all sorts of things that are derivatives of that. No less, you could have other sensors like a glucose monitoring and on and on. No less your electronic health record, and there's no integration of any of this.Eric Topol (27:00):So this idea that we could have a really intelligent AI virtual coach for the patient, which as you said could have connects with a physician as needed, bringing in the data or bringing in some type of issue that the doctor needs to attend to, but it doesn't seem like anything is getting done. We have the AI capabilities, but nothing's getting done. It's frustrating because I wrote about this in 2019 in the Deep Medicine book, and it's just like some of the most sophisticated companies you would think Apple, for the ring Oura and so many others. They have the data, but they don't integrate anything, and they don't really set up notifications for patients. How are we going to get out of this rut?Owen Tripp (27:51):We are producing oil tankers of data around personal experience and not actually turning that into positive energy for what patients can do. But I do want to be optimistic on this point because I actually think, and I shared this with you when we last saw each other. Your thinking was ahead of the time, but foundational for people like me to say, we need to go actually make that real. And let me explain to you what I mean by making it real. We need to bring together the insight that you have an elevated heart rate or that your step count is down, or that your sleep schedule is off. We need to bring that together with the possibility of connecting with a medical professional, which these devices do not have the ability to do that today, and nor do those companies really want to get in that business. And also make that context of what you can afford as a patient.Owen Tripp (28:51):So we have data that's suggestive of an underlying issue. We have a medical team that's prepared to actually help you on that issue. And then we have financial security to know that whatever is identified actually will be paid for. Now, that's not a hard triangle conceptually, but no one of those companies is actually interested in all the points of the triangle, and you have to be because otherwise it's not going to work for the patient. If your business is in selling devices. Really all I'm thinking about is how do I sell devices and subscriptions. If my business is exclusively in providing care, that's really all I'm thinking about. If my business is in managing risk and writing insurance policies, that's really all I'm thinking about. You have to do all those three things in concert.Eric Topol (29:34):Yeah, I mean in many ways it goes back to what we were talking about earlier, which is we're in this phenomenal era of information to the fifth power. But here we are, we have a lot of data from multiple sources, and it doesn't get integrated. So for example, a person has a problem and they don't know what is the root cause of it. Let's say it's poor sleep, or it could be that they're having stress, which would be manifest through their heart rate or heart rate variability or all sorts of other metrics. And there's no intelligence provided for them to interpret their data because it's all siloed and we're just not really doing that for patients. I hope that'll happen. Hopefully, Included Health could be a lead in that. Maybe you can show the way. Anyway, this has been a fun conversation, Owen. It's rare that I've talked in Ground Truths with any person running a company, but I thought yours.Eric Topol (30:36):Firstly, I didn't know anything about it and it's big. And secondly, that it's a kind of a unique model that really I'm hoping that others will get involved in and that someday we'll all be included. Maybe not with Included Health, but with better healthcare in this country, which is certainly not the norm, not the routine. And also, as you aptly pointed out at terrible costs with all sorts of waste, unnecessary tests and that sort of thing. So thanks for what you're doing and I'll be following your future efforts and hopefully we can keep making some strides.Owen Tripp (31:15):We will. And I wanted to say thanks for the conversation too and for your thinking on these topics. And look, I want to leave you just with a quick dose of optimism, and you and I both know this. The American system at its best is an extraordinary system, unrivaled in the world, in my opinion. But we do have to have more people included. All the services need to be included in one place. When we get there, we're going to really see what's possible here.Eric Topol (31:40):I do want to agree with you that if you can get to the right doctor and if you can afford it, that is ideally covered by your insurance. It is a phenomenal system, but getting there, that's the hard part. And every day people are confronted. I'm sure, thousands and thousands with serious condition either to get the diagnosis or the treatment, and they have a really rough time. So anyway, so thank you and I really appreciate your taking the time to meet with me today.****************************************************************Thanks for listening, watching, reading and subscribing to Ground Truths.An update on Super Agers:It is ranked #5 on the New York Times bestseller list (on the list for 4th time)https://www.nytimes.com/books/best-sellers/advice-how-to-and-miscellaneous/New podcastsPBS Walter Isaacson, Amanpour&Co Factually, With Adam ConoverPeter Lee, Microsoft Researchhttps://x.com/MSFTResearch/status/1943460270824714414If you found this interesting PLEASE share it!That makes the work involved in putting these together especially worthwhile.Thanks to Scripps Research, and my producer, Jessica Nguyen, and Sinjun Balabanoff for video/audio support.All content on Ground Truths—its newsletters, analyses, and podcasts, are free, open-access.Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don't hesitate to post comments and give me feedback. Let me know topics that you would like to see covered.Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. Get full access to Ground Truths at erictopol.substack.com/subscribe

Manager's note:  The Pain Beat, launched and supported by a generous grant from the MAYDAY Fund, with additional funding from the Rita Allen Foundation, brings together the world's leading pain investigators with the purpose of sparking dialogue and debate around important ideas in pain research. Guided by Rebecca Seal, scientific director of The Pain Beat and Editor-in-Chief of Pain Research Forum, the podcasts feature open and spirited discussions about the hottest topics in pain and how the field moves forward.  For this episode, Adam Dourson and Lite Yang served as both creators and producers.  Juliet Mwirigi moderates a lively in person discussion with a diverse panel of preclinical and clinical experts at the USASP meeting in Chicago.  Where are we in understanding and treating migraine?  What  successes have we had and what challenges do we still face?   Podcast participants include: Andrew Russo, PhD, University of Iowa, US Gregory Dussor, PhD, UT Dallas, US Hadas Nahman-Averbuch  PhD, University of Washington in Saint Louis, US Levi Sowers, PhD, University of Iowa, US Yohannes Woldeamanuel, MD, Mayo Clinic, US Juliet Mwirigi, PhD, Washington University in Saint Louis, US PRF thanks Kevin Seal for creating the music.

What if everything you thought you knew about weight, fat, and heart health was wrong?Join us as we sit down with world-renowned cardiologist Dr. Carl Chip Lavie, author of The Obesity Paradox, to explore why fitness may be a stronger predictor of health than weight itself.From the surprising data behind VO2 Max and body fat to the hidden dangers of sitting too long, this conversation will challenge conventional wisdom and give you science-backed strategies to live longer, healthier, and stronger.

Jessica Richter is a medtech executive and a board member with MedtechWOMEN. Jessica shares her inspiring journey from B2B sales to becoming a leader in the medtech industry, including overseeing a wide range of vital functions such as clinical trial strategy, regulatory affairs, and market access. Jessica provides insightful advice on overcoming common industry challenges, and underscores the value of quality systems, expert team-building, and fostering a supportive network for women through MedtechWOMEN.   Guest links: https://www.linkedin.com/in/jessica-richter-5aa43517/ | https://medtechwomen.org/ Charity supported: Save the Children Interested in being a guest on the show or have feedback to share? Email us at theleadingdifference@velentium.com.  PRODUCTION CREDITS Host: Lindsey Dinneen Editing: Marketing Wise Producer: Velentium   EPISODE TRANSCRIPT Episode 059 - Jessica Richter  [00:00:00] Lindsey Dinneen: Hi, I'm Lindsey and I'm talking with MedTech industry leaders on how they change lives for a better world. [00:00:09] Diane Bouis: The inventions and technologies are fascinating and so are the people who work with them. [00:00:15] Frank Jaskulke: There was a period of time where I realized, fundamentally, my job was to go hang out with really smart people that are saving lives and then do work that would help them save more lives. [00:00:28] Diane Bouis: I got into the business to save lives and it is incredibly motivating to work with people who are in that same business, saving or improving lives. [00:00:38] Duane Mancini: What better industry than where I get to wake up every day and just save people's lives. [00:00:42] Lindsey Dinneen: These are extraordinary people doing extraordinary work, and this is The Leading Difference. Hello and welcome back to another episode of The Leading Difference podcast. I'm your host, Lindsey, and today I'm excited to introduce you to my guest, Jessica Richter. Jessica is the Executive Vice President and General Manager at Veranex, a global provider of end-to-end solutions that accelerate MedTech innovation through deep expertise and integrated resources. As the leader of Veranex's contract research organization and consulting services business unit, she oversees clinical trial strategy and execution, clinical data services, regulatory affairs, quality and compliance, market access and reimbursement. She also manages operations, client engagement, business development and performance tracking. A seasoned leader in medical devices and diagnostics, Jessica has extensive experience in software as a medical device, surgical innovation, oncology, aesthetics, cardiology and gastroenterology. Her tenure at Medtronic and Becton Dickinson shaped her expertise in commercialization, sales strategy, physician education, patient advocacy, and change management. Beyond her current role, Jessica serves on the boards of medtech, women and UCLA's technology development group. She actively advises startups, accelerators, and universities, including medtech innovator UC Berkeley's Master of Translational Medicine Program, the Mayo Clinic's Executive Steering Committee for the Surgical Innovation Summit, and UCLA BioDesign.   Thank you so much for being here, Jessica. I'm so excited to speak with you. [00:02:15] Jessica Richter: Likewise, Lindsey, thank you so much for having me. [00:02:18] Lindsey Dinneen: Of course. Well, I'd love if you wouldn't mind sharing a little bit about yourself and your background and what led you to medtech. [00:02:26] Jessica Richter: Awesome. Yeah, happy to. So, I was born and raised in California. I am the youngest of three girls and my entire family is really in the healthcare delivery field. So both my grandfathers were surgeons. My mother is a nurse. Both my sisters are clinical psychologists. And so when I went to school, I had aspirations at one point to get into medicine, and then through a really challenging organic chemistry class, kind of started to realize that maybe the practice of medicine wasn't where I belonged. And so I initially graduated from Berkeley, had my sights set on potentially doing something in communications, and started off in business to business sales in the telecom industry. So as far from medtech as maybe one could think. Had some experience with software, this is when Blackberries were a thing, if you remember those. And then a friend of mine was a recruiter and reached out and said, "Hey, I, I know that you're into medical and into medicine, and that was something you were interested in. Have you ever considered a career in medical device sales?" And frankly I didn't even know that that existed. I mean, this was 20 years ago, so this was before, you know, internet and all of those things existed, obviously, but it wasn't as pervasive as it is now. And so I wasn't even aware that these jobs existed. The fact that you could be working on the delivery of care but not be a healthcare provider was an eyeopening moment. And so I got in and started actually working at a surgical company called Deval. It's part of CR Bard, which is now part of Becton Dickinson, and I cut my teeth in medical device sales. And then I went on to work in a commercial role within other companies Given Imaging, Covidian, Medtronic. I ascended to sales leadership, working with key opinion leaders, working on the patient advocacy side. And then about eight years ago, I had the opportunity through an organization that we'll talk a little bit more about, called MedtechWOMEN, that I was involved in to learn about a consultancy that was looking for a head of business development marketing. It was a small group called Experian Group. I joined them and then within nine months was promoted to Chief Operating Officer, which was a position that I absolutely loved because we were working on the pre-commercial side of things and regulatory quality systems, clinical trials. And I had always had experience in the post commercial side. So eyes open to what happens, everything leading up to commercial. And I got a masterclass from my colleagues there, learning so much about what happens again, pre-commercial. But then one of the other things that came out very quickly is I've always been someone who loves operational efficiency. And I know that's not sexy or cool, but I just like seeing something that isn't working optimally and get it working optimally is something that brings joy. So I had the opportunity to do that within Experian Group, and then really help the organization, which was already very successful, go from a very successful kind of local consultancy to a much larger, broader group with a broader footprint, more global client base. And then we were acquired by the firm that I currently work with called Veranex, and that really exploded capabilities of what was a 50% consultancy to now over a thousand people with a much broader global reach in the US, in Europe, and in India. [00:05:36] Lindsey Dinneen: Wow. That is incredible. Well, first of all, thank you for sharing your story and your background and all the amazing things that led you to where you are right now. That's incredible. So many questions, in a good way. But let's dive in a little bit about, yeah, so, so tell us a little bit more about your role right now, and what are you excited about as this consultancy continues to grow and new opportunities arise. What's on the future for you? [00:06:02] Jessica Richter: So now I lead one of three business units here at Veranex. So I lead our CRO and Consulting Services Business Unit, and that encompasses regulatory, quality, and clinical, as well as commercial strategy, market access reimbursement, things like coding, coverage, payment. So we help mid-size, early stage, and some of the largest strategic medtech companies, as well as some biopharma as well with companion diagnostics, navigate sometimes the tumultuous waters needed to bring a device from inception all the way through to commercialization. Veranex also has two other business units in preclinical as well as extensive design, development and engineering. So there's leaders in each of those capacities. And what we do on CRO and consulting services is really consultative. So we work with clients to develop strategies in all of these areas, and then we roll up our sleeves and work alongside them to make sure that those strategies are actually executable, so to help them along the way. And some of our clients have teams, so it's strategic and we're advisors. Other clients, if they're early, early, may not have extensive expertise or the ability to build out teams in that way. So we go in, or our team goes in, and really provides them that support along the entire continuum. It's interesting, just today, we have a client we've been working with for two years. They're in Switzerland, but they've been working with our US and global team. They just got news from FDA that they obtained FDA clearance. And I'll tell you, I think our team is as excited as theirs because, when you're in a company, it's all that you're living, breathing, doing. When you're consulting, you're a little bit at an arm's length. So when our clients achieve their results, and it's their work, but in concert with ours, the feeling of accomplishment really is just, it's one of those that's explosive. So we've celebrated that. We ring a bell. We'll share a lot, we'll do some marketing around it with this client. But it's really fun. That's the part that really drives not just me, but members of our team as to "How can we help more companies get more products to patients?" [00:07:58] Lindsey Dinneen: I love that. First of all, congratulations, that's exciting, and I'm thrilled for your clients and for you guys because it matters so much and what a great milestone. So that's wonderful. But yeah, so I'm curious, you've seen a lot of different sides to medtech and to the business side of things, and I'm curious what are some potential stumbling blocks that you have seen that companies, especially when they're perhaps a little bit younger or earlier on in the process, what are maybe one or two stumbling blocks that you see that you think, "You know what, hey, if we put a little bit of thought into this, we can overcome this very easily, but we need to be thinking about this from the start." [00:08:36] Jessica Richter: Okay. There's two things. One of them is gonna be a shameless plug, but I swear it's true, and that's quality. I think companies don't focus enough on quality systems 'cause it's just not the fun or sexy thing, but it's literally where we see companies struggle because they think about it too late. They do just in time. They think an EQMS is the answer, and it's not the only answer, it's a component. So quality would be the short answer. The longer answer is people. So what we see is oftentimes, people, especially in a cost constrained environment, which we are today, where fundraising is tough, people do need to be financially astute as far as what they're spending and how they're spending it. But sometimes you get more by spending a little bit more to get the right advice. So for example, if somebody is expert in engineering or expert in regulatory, excellent. Know where your expertise is not, and then supplement. So either hire a consultant or bring on an employee or have a member of your board that can advise them that way. More often than not, we see people trying to just kind of figure it out as they go, which isn't a bad strategy, but there are critical decisions and inflection points along the way. For example, if you're developing a clinical trial, thinking only about your regulatory strategy and not about your commercial goals or the claims you're going to make, you are gonna have to ultimately spend twice as much when you have to do secondary studies that you could have avoided by including that in endpoints. So there's little things like that along the way where if you don't know what you don't know, it's really difficult to see those hurdles. It's helpful to bring in people, even in an advisory capacity, to help you say, "Okay, these are the hurdles that you're gonna face." You're gonna have new hurdles that maybe that you won't know or people won't know, but it's really making sure that you surround yourself with experts in those key areas. [00:10:25] Lindsey Dinneen: Mm. That's great advice. Experts in those key areas. Well, speaking to the advisory point, I'd actually love to talk about your involvement with MedtechWOMEN, and tell us a little bit about that organization and how it serves women in this industry. [00:10:39] Jessica Richter: Absolutely. Thank you for asking. It's something that I could literally talk about for this entire podcast. So, I alluded to it earlier, but MedtechWOMEN, I got, and I say "roped in" lovingly, but I was introduced to this organization, gosh, maybe a decade ago now when I was at Covidian and then Medtronic, and a mentor of mine, Amy Belt Raimundo, was one of the founders of MedtechWOMEN. And she had mentioned to me, because there weren't a lot of female leaders within that section of my business at the time, so I was paired with her and it feels like kismet because she was this spark of like, this is what badass female leadership looks like. She knew her stuff, she was really focused on the issues. She made time and said yes anytime I had a question or wanted to meet. Our conversations were really meaningful and actionable. Sometimes we just talked as friends. It wasn't always so agenda based, but she introduced me to MedtechWOMEN and shared with me that there's this organization. It's all volunteers. It's kind of membership based and it's literally women getting together talking about the issues in our industry. And it wasn't as focused on things like work-life balance, which quite frankly is a challenge, no matter what your gender is. There are great forums for talking about work-life balance and how you prioritize your health and your mental wellbeing, and that is really, really important. But some of the events that I had gone to as far as women in leadership or women in medtech were really focused on those things and that wasn't what I wanted to talk about. I wanted to see incredible pioneers or trailblazers in our industry talking about the things that mattered in industry and sharing their perspectives. And that's exactly really the thesis of MedtechWOMEN. And so it was an organization founded over a decade ago. It started really as just an annual event, this MedtechVISION event, where we brought women together on a podium talking about the issues impacting healthcare today. It evolved. So after a couple of years and a couple of different topics, what we started to see is that there was a real thirst in the community that we had beyond just that individual or that one time a year we got together for the event. And so we developed a kind of MedtechWOMEN 2.0. We brought on an Executive Director. And we essentially launched a much, much grander vision of what MedtechWOMEN was. So it included membership. It included mentorship, so formal pairings. We created a board of directory, kind of a pathway to get to more women on boards. We also have local events, networking events, virtual events in partnership with our sister organizations like MedTech Color and Diversity by Doing. And then of course we still have our annual event. And then just this past month we actually brought on a new executive director. Her name is Yvonne Bokelman. She is a longtime industry veteran, tremendous leader in medtech, and someone who's really passionate about the organization, the mission, the vision. So we're excited to see what she will do in her role here. [00:13:38] Lindsey Dinneen: Yeah. That's incredible. Thank you so much for sharing a little bit about the organization and its history and who it is serving, and it really resonated because I agree with you that there's wonderful platforms for being able to talk about some of the. Some of the topics that tend to come up quite a bit for women, especially women leaders, and I love the fact that you are fully acknowledging that those things are great as well, but that your focus is a little bit different. And so I'm curious, what are some interesting stories or things that have happened maybe unexpectedly from this network of incredible women supporting each other, learning from each other. Can you share a little bit that? [00:14:17] Jessica Richter: Oh yeah, absolutely. And I'll tell you, many of us that have been members for a long period of time will attest to the fact that job opportunities come via this network, learning opportunities, sales and business opportunities. I mean, we network in the same way that we would in any other conference or any other meeting, but deals certainly have gotten done within and at MedtechWOMEN and MedtechVISION events. But most importantly, and one of the things that I always tout, is that MedtechWOMEN is a sisterhood that will take that call. And what I mean by that is if you have a question, if you need to phone a friend-- going back to what we were talking about earlier of that network of you don't know what you don't know, but somebody probably does-- within MedtechWOMEN, someone definitely does. And so what we encourage our members and our mentors and anyone that's a part of the organization to do is reach forward and reach back. And so when I say take that call, if someone calls-- and I just had literally three conversations in the last three weeks-- with more junior people looking for career advice or wanting to have a question about regulatory or their thinking about a decision point in their job, and what should they do? I always take that call and, you know, we're all busy. We all have things to do, but that 30 minute conversation can have a really big difference. And I know for me, likewise, when I have a question, when I'm coming up against something where it's helpful to have a thought partner, sometimes you want that outside of your own company, or outside of your boss, or outside of your team. And so the MedtechWOMEN Network is incredibly powerful and very supportive. And in my experience, and I've tried it both ways, we will always take that call. [00:15:53] Lindsey Dinneen: Oh wow. That's incredible. So, okay, so mentorship and leadership is obviously a key component of your life, something that you're passionate about. From your own experience as a woman in this industry, are there any things that come to mind that you would say, just pieces of advice-- let's say for other women who might be younger in their career and they're looking to grow, they're looking to become leaders, they're looking to become maybe thought leaders, or own their own company, things like that-- what are some things that you might suggest to them from your own experience would be helpful? [00:16:27] Jessica Richter: Oh yeah. It's, it's a great question, Lindsey, because there's a lot of things. I wish we could just mind share. First and foremost, I would tell women to go for it. I think sometimes we self-sabotage or hold ourselves back if we don't have all of the information or feel like we're a hundred percent qualified. And there's been tons of studies that demonstrate that. So first and foremost, go for it. I had this conversation with one of my mentees who was taking on a new role and I said, "It's okay that you're feeling this way or that way. Do it and do it scared." Like it's okay to not feel like you have all of the confidence, right? And it doesn't mean fake it till you make it, although there's a little bit of that too. But I would say don't let fear hold you back. So that would be the first piece of it. The other piece of it is make sure that you have, really, your own board, meaning advocates, mentors, coaches, thought partners, people that you can reach out to and rely upon. And that has to work both ways. I will tell you, I have learned as much from mentees as I have learned from mentors. And so recognizing that knowledge is shared both ways, no matter what your seniority is. For people that are junior, they have their on the pulse of things that I'm not as privy to, and sometimes I feel, feel that even more strongly. Likewise for people that have been in this industry 40, 50 years, they have institutional knowledge that I only wish that I had. And so, being at this midpoint in my career, I'm sandwiched between both and really appreciate, so I would implore people that are hoping and wanting to pursue leadership, go for it. [00:18:00] Lindsey Dinneen: Yeah. Thank you for that. I, I love that advice. I really appreciate it. So, you have had such an interesting career and going from communication and sales, and then to this new role and Chief Operating Officer, all these cool things. For your own leadership style, what would you say are maybe one or two key things that you have found to be really helpful for you as a leader in the industry in the way that you approach the people that you lead? [00:18:30] Jessica Richter: Another great question, Lindsey. So I would say, well --first maybe I'll share some lessons learned 'cause I've made a ton of mistakes. So I think one of the things that I didn't appreciate early on as a leader that I definitely appreciate now, is that we all have our own lens, our view with which we take on and see the world, and that's the view in which, you know. And so as a leader, initially, my thought was, "Well, everyone kind of sees and feels it this way with their own flavor." That is not true. Everyone has their own view and that's really shaped by their family, their background, their culture, lots of different aspects. And so I think for me, some advice as a leader would be, be humble, take the time to really seek to understand, and then, even if you are heightening your communication, multiply that times three or four and then you're probably scratching the surface, 'cause people need to hear things different ways, multiple times. And it doesn't mean you need to micromanage or drill things down, but when you're leading an organization and bringing people along on a change, especially, it is important that people understand the why, the who, the what, the how come, and that they hear that re repeatedly so that they can understand it, they can buy into it, and that you're creating an environment to make sure that their questions are addressed. So, lesson learned kind of recommendation on the leadership piece. I think the other just piece of advice is that sometimes people aspire to leadership because they think it's glamorous or there's gonna be a lot of money there, or it looks like the leader doesn't have to do that much work, they're just delegating. What I would say is leadership is not glamorous. It's often thankless. It's super hard. I work tons of hours and I love the team that I work with, and so for me the why is that. But if you are not loving that, don't do that. There's plenty of opportunities that you can contribute meaningfully as an individual contributor or a principal or a subject matter expert, and that's great too. So know that if you want to lead people and be involved on that side of leadership, I welcome it. I think it's fantastic. I think there's a lot of people that get into it with a misconception of what it will look like. And I'll tell you it's worthwhile, but it's hard. [00:20:43] Lindsey Dinneen: Yeah, absolutely. Yeah, when you were talking about that it, the glamor side of things, I just remember so vividly and I, I joke about it because I think it's funny-- but very quickly, I used to own my own dance studio and I built that from the ground up. And people would say things to me like, "Oh my goodness. What you're doing, you're living your dream. That's amazing! Oh my gosh, how cool is that?" And inside, I'm like, "Ha, yeah, I mean, I spent the first two hours as the janitor this morning, and then the next two hours as the CEO. And then, you know..." And it's funny, but it's true, you wear a lot of hats as a leader and sometimes your job is literally getting down into the nitty gritty and cleaning up, and that's fine too. So I love that. [00:21:24] Jessica Richter: My quip is always from the janitor to the GM, like, "What needs to get done? There's no task too big or too small." And ultimately, I think that what you described in yourself, and I love that, is servant leadership, right? Like for me, I've always responded well, when a leader isn't above any task and doesn't ask for something that they themselves would not be willing or aren't willing to do along with their team member. And so again, that's, that's not the definition of leadership, but in my eyes, that's a definition of leadership that really resonates with me. [00:21:55] Lindsey Dinneen: Mm-hmm. I agree. Yeah. Well, speaking of stories and those kinds of fun things too, are there any that stand out to you, perhaps along your career or with MedtechWOMEN, or anything really, that just affirm to you that, "Hey, I am in the right industry at the right time, doing what I should be doing?" [00:22:14] Jessica Richter: Oh yes. So there's a couple of different specific examples. So firstly, one of the things that has happened as of late, and I feel like-- not to get too woo or California on you-- but these synchronicities where you'll be thinking about something or remembering something, and suddenly a project and people come together around it-- and again, I think that's part of the power of the network. But there was a friend of mine that I had run into at a conference, we were talking about a specific aspect of their business that was really needing some, some development, and it turned out that after that conversation, literally not a week later, I got a call from a prospective client that was interested in working in this specific space. We were able to connect them with this person that was in need of that exact thing. And it was with software and with AI and so a partnership was forged and now they are literally about to embark in this really explosive and announcement will be forthcoming about it. But there's so many examples of little nuances and synchronicities like that, that again, happen because of staying open, staying curious, that powerful network right place, right time. But I also think it's the magic of our industry. It's really small. People sometimes fail to appreciate because you have these large organizations that are hundreds of thousands of people, but the leaders within the organization are fairly connected and tight. It's really an interconnected ecosystem. So that's just kind of one broad example. There's also other really small examples of the power, I think, of MedtechWOMEN in just how it ignites and how it brings people together, especially across senior and junior roles. So when we do our networking events, we try to do them regionally, just to try to bring different people together. And you can have like the CEO of sometimes a large organization, like Lisa Earnhardt from Abbott is a member and an active participant. She often will come to events talking to someone who's their very first year in medtech. And when you see these examples of sponsors of ours really showing up and demonstrating a commitment to giving back, and you see these people that are junior that may not even know the seniority of the leader that they're speaking to, recognizing that we're all people at the end of the day, trying to really ideally propel healthcare and help patients in their journeys to health and wellness. And so when you see examples of those sparks and those little ignites, it reinforces why we're here, what it is we're doing, and really the power of the organization. [00:24:41] Lindsey Dinneen: Yeah! Well, I think that the more times that you get to see those connection points, and those synergies or whatever we wanna call them, I think that that does impact us in a way that goes, "Yeah, the work that I do matters and it's impacting people's lives and maybe in very different ways." So some of it is, yeah, that end user and that patient, and oh my goodness, what this device can do for them and their quality of life. And sometimes it's the person behind the invention and what does that journey look like for them personally and the impact on their own family and their life. So I love hearing about those connection points. [00:25:16] Jessica Richter: Well, and that's the joy of working also with, I mean, large strategics for sure, but the startup companies, oftentimes it's a physician and engineer. The physician is seeing the unmet need because of the patients coming into their clinic. They're feeling hopeless 'cause they can't address it, but also empowered because they know what to do. So those are the really fun, kind of feel good projects, especially because there is no one better equipped than a clinician, right, to say, "Okay, here's the gap." Engineers can help to design and develop, but oftentimes that's where the teams are sort of left in the lurch to say, "Okay, what do we do from here?" And so it is incredibly powerful to enable these innovators, no matter what their backgrounds are along that journey. And it's not a quick one as you know, being on the manufacturing side. It's not something that's quick or easy. It's not something that is a high success rate. And when it works, there is no better feeling. When you commercialize a device or when you get it through the FDA, that's just the start. When it's actually used in patients and you start to hear those patient advocates and those stories, and you expand indications and are able to help more patients, that's the thing that makes it worthwhile. And when the going gets tough, 'cause it does that, those are the stories, right, that really inspire us to continue. [00:26:33] Lindsey Dinneen: Yes, absolutely. Amen to that. So, okay, so I have so many thoughts swirling around, but I do want to pivot the conversation a little bit just for fun. So imagine that you were to be offered a million dollars to teach a masterclass on anything you want. It can be within your industry, but it doesn't have to be. What would you choose to teach? [00:26:53] Jessica Richter: Oh, I love this question. I'll try to make it not about our industry 'cause it's something I've been working on a lot lately, and it's a testament to patience, which is something that I think we could all use more of, but I could definitely use more of. So we rescued a dog in Covid. She's a Doberman pit mix. Her name is Poppy and she's delightful. And she was severely neglected. So when we got her, we knew she was really shut down and that we would have to do work to bring her out of her shell. My husband and I don't have kids. We have a quiet home. I knew that we could take that on. And so while I won't say I am the expert, what I have done in the four years we've now had her, is extensively worked with her on the, what I would call the "Art of the Dog Walk." So we have learned how to really master exercise, training, and discipline as a way to show affection, 'cause for a dog that shut down like that, that's really what she needed to thrive. It was humbling and very educational for me. I've always been a huge animal lover. I used to volunteer when I had a lot more time with an animal rescue. And so I was able to parlay that and work with a trainer really on honing those skills so that Poppy could not just be social in the world, but be less shut down. So it would be so fun to share a masterclass on that 'cause I had so many reflections and learnings on patience. The art of going slow, the art of taking in the world, of just slowing that down, not being on my phone, right, being really present with her. And I sort of joke with my husband, I feel like now when I walk her-- I dunno if you've seen the movie "Avatar"-- but like we connect our avatars and we like go on into this world, and it's meditative. It's our morning practice and it's something that for me has been incredibly rewarding, and challenging, and a huge learning experience that, that I would love to share. [00:28:50] Lindsey Dinneen: Oh, that's wonderful. Oh my goodness. Yes. I am a huge dog lover, so anytime someone's telling me about their dog, it's just instant happiness. [00:28:59] Jessica Richter: Likewise. And for my, my favorite thing that it will always bring a smile to my face is the unlikely animal friends, like if you see like a squirrel a dog or a kookaburra or something, you're like, "Ahh!" [00:29:10] Lindsey Dinneen: It's so cute. It's precious. Yes. I love it. And to me it reinforces, "Hey, we can actually all get along if we try." I mean, I know it's a little different in the animal kingdom, but still, I still love that. Oh my goodness. Great. Well then, how do you wish to be remembered after you leave this world? [00:29:32] Jessica Richter: You know, legacy is something, that I think is important. It's funny, I've been working with my niece on her college essays and college admittance, and reflecting back to my views when I was 18 versus my views today in the world now. And even speaking to my mom about legacy, 'cause it's something, you know, she's approaching her eighties that she thinks more and more about. So it's conversations that we have a lot. I really would love to be remembered as an enabler, as someone who really enables those around me to be successful, to achieve more, to obtain what they want right to, to drive forward. I love being around creative people and innovators and people with really expansive imaginations, and I think my superpower is kind of capturing and enabling those things. So it would be great to be able to enable more people around me. And that's true with patients and healthcare and the clients that we support as well. You know, one of the things that has always been pointed out to me-- and again, my grandfather was a huge proponent of this-- is when things aren't going well in the world, you can focus on what's going wrong or you can look for the helpers. And so, as a surgeon, he was one of those helpers. And so I think he ingrained that in me very early on. And so I'd love to be remembered as someone who is a helpful enabler. [00:30:51] Lindsey Dinneen: Hmm. Yes. That's a beautiful legacy. I love that. [00:30:54] Jessica Richter: I am curious, Lindsey, I know this is like, you're the, you're the interviewer, but how would you like to be remembered? [00:31:02] Lindsey Dinneen: Oh, thank you for asking. First time! You know, there are so many things, so many things that I love doing for other people. But I really actually resonated with your idea of enabling. And I would say mine is very similar. And that is that I love helping people achieve their dreams. And that can look like lots of different things to lots of different people. So it's when I'm working with a company, it always started with one person's idea, right? All these big companies started off as this tiny little one person's idea that became something. And I think just helping that, those sparks, especially when maybe they're eager, but they're not quite ready. They're scared, they're nervous, they're whatever, and helping them see a clear path to achieving those dreams and goals is one of my favorite things. And whether that's just a personal, I wanna run a marathon, I don't even how to know how to get started, or whether it's, I have this great idea for a book, but I am concerned about, like, "Nobody will read it, no one will care." Well, that's not the point. Let's start somewhere. And so I think for me, it's about empowering people to live the life that they want to live and hope that they can live. That's what I would love to be remembered for. [00:32:16] Jessica Richter: Well, that's beautiful. I hope that via this and the other things that you're doing, it seems like you're already on that track. [00:32:22] Lindsey Dinneen: Well, thank you. I appreciate that. I really appreciate you asking me too. Thank you. Well, and then final question, and you've sort of perhaps alluded to this-- I'll see if it's different than your first time-- what is one thing that makes you smile every time you see or think about it? [00:32:37] Jessica Richter: Oh, well, definitely the unlikely animal pairings for sure. [00:32:41] Lindsey Dinneen: Yes. [00:32:42] Jessica Richter: Anytime with family. Family is super important to me. So anytime I can spend time with our family, that is for me, a smile doesn't go off of my face. And also kind of what you said, celebrating other people's wins. And I celebrate my own as well-- I think it's important that we do that-- but there is nothing like, it's a grin, like when someone on our team has an accomplishment, the grin is twice as big, right? Because you just, to see that reflected, that success, that attainment, that win reflected for the people that you work alongside, that brings a smile to my face every time. [00:33:20] Lindsey Dinneen: Yeah, nothing quite like it, and it's so powerful. Yeah, huh. Oh my goodness. Well, this has been an amazing conversation. I don't really want it to end, but I know we have other things we have to get to today, so I just wanna take some time to say thank you so very much for being here with me, Jessica. Thank you for sharing all about your incredible career so far and all the exciting things that are to come, and speaking to MedtechWOMEN and that incredible organization. So I'm really excited for our listeners who might not have been familiar with it to go check it out, lots of opportunity there. And gosh, I just wish you the most continued success as you work to change lives for a better world. [00:34:01] Jessica Richter: Thank you, Lindsey, for hosting and I would encourage anybody who's unfamiliar with MedtechWOMEN, if you're new to industry or if you've been here a while, there is a place for you within MedtechWOMEN. Membership is super low cost. It's $150 for standard membership a year, $75 for junior members. You can follow us on LinkedIn, but highly, highly encourage everyone to join the network. And thank you for the opportunity to share a little bit more about MedtechWOMEN today. [00:34:26] Lindsey Dinneen: Of course. We are so honored to be making a donation on your behalf as a thank you for your time today to Save the Children, which works to end the cycle of poverty by ensuring communities have the resources to provide children with a healthy, educational, and safe environment. So thank you so much for choosing that charity to support. Thank you also to our listeners for tuning in, and if you're feeling as inspired as I am right now, I'd love it if you share this episode with a colleague or two, and we'll catch you next time. [00:34:57] Jessica Richter: Thanks, Lindsey. [00:34:59] Ben Trombold: The Leading Difference is brought to you by Velentium. Velentium is a full-service CDMO with 100% in-house capability to design, develop, and manufacture medical devices from class two wearables to class three active implantable medical devices. Velentium specializes in active implantables, leads, programmers, and accessories across a wide range of indications, such as neuromodulation, deep brain stimulation, cardiac management, and diabetes management. Velentium's core competencies include electrical, firmware, and mechanical design, mobile apps, embedded cybersecurity, human factors and usability, automated test systems, systems engineering, and contract manufacturing. Velentium works with clients worldwide, from startups seeking funding to established Fortune 100 companies. Visit velentium.com to explore your next step in medical device development.

We know that kombucha is better for you than soda, right? But just how differently do these two beverages affect the gut? When you choose a ginger kombucha over, say, a cherry cola, the impact of that decision may be greater than you think. Dr. Will Bulsiewicz, gastroenterologist and best-selling author of Fiber Fueled, takes us inside the digestive tract to help us understand the big impact of these seemingly small choices.   Plus -- an update on Chuck Carroll's health journey. Doctors at the Mayo Clinic have a new theory about what may be causing Chuck's debilitating symptoms.   In this episode of The Exam Room you'll learn:   - How kombucha benefits the gut - The impact of soda vs kombucha on the body - How acid in soda and kombucha can put microplastics in your body - What to know about alcohol in kombucha - How added sugar impacts the microbiome and the immune system   — — SHOW LINKS — — Will Bulsiewicz Courses: https://theplantfedgut.com 38Tera: https://38tera.com Instagram: https://www.instagram.com/theguthealthmd — — — GreenFare 21-Day Kickstart with Chuck Starts July 12 in Herndon, VA. Register: https://greenfare.com/product/july-12th-saturday-21-day-kickstart-with-chuck — — — Chef AJ's Plant Powered Party in Las Vegas https://theplantpoweredparty.com — — EVENTS — — International Conference on Nutrition in Medicine Where: Washington, DC When: August 14-16, 2025 Tix & Speakers: https://www.pcrm.org/icnm — — BECOME AN EXAM ROOM VIP — — Sign up: https://www.pcrm.org/examroomvip — — THIS IS US — — The Exam Room Podcast Instagram: https://www.instagram.com/theexamroompodcast — — — Chuck Carroll Instagram: https://www.instagram.com/ChuckCarrollWLC Facebook: https://www.facebook.com/ChuckCarrollWLC X: https://www.twitter.com/ChuckCarrollWLC — — — Physicians Committee Instagram: https://www.instagram.com/physicianscommittee Facebook: https://www.facebook.com/PCRM.org X: https://www.twitter.com/pcrm YouTube: https://www.youtube.com/user/PCRM Jobs: https://www.pcrm.org/careers — — SUBSCRIBE & SHARE — — 5-Star Success: Share Your Story Apple: https://apple.co/2JXBkpy​​ Spotify: https://spoti.fi/2pMLoY3 — — — Please subscribe and give the show a 5-star rating on Apple Podcasts, Spotify, or many other podcast providers. Don't forget to share it with a friend for inspiration!

Our old friend surprised us with an in-studio visit! Mayo Clinic Big Knocker Bill Morice joins Dan for the first time in a long time to cover all types of medical topics.

Our old friend surprised us with an in-studio visit! Mayo Clinic Big Knocker Bill Morice joins Dan for the first time in a long time to cover all types of medical topics. See omnystudio.com/listener for privacy information.

Host: Darryl S. Chutka, M.D. Guests: Darrell S. Pardi, M.D., and Laura E. Raffals, M.D. Pouchitis is a relatively common complication in patients who have ulcerative colitis and have had a proctocolectomy with an ileal pouch-anal anastomosis. It represents inflammation of the ileal pouch and symptoms may include increased stool frequency, cramps, fecal urgency and occasionally bloody stools. The diagnosis is usually suspected from clinical symptoms and confirmed with endoscopy. Are there risk factors for the development of pouchitis? Is an endoscopy necessary for a diagnosis? How should patients be treated and how effective is treatment? These are some of the questions I'll be asking my guests, Darrell S. Pardi, M.D., and Laura E. Raffals, M.D., both gastroenterologists at the Mayo Clinic. We'll be discussing “Pouchitis” as part of our podcast series on “Inflammatory Bowel Disease”. https://ce.mayo.edu/content/mayo-clinic-talks-inflammatory-bowel-disease Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts 

Our old friend surprised us with an in-studio visit! Mayo Clinic Big Knocker Bill Morice joins Dan for the first time in a long time to cover all types of medical topics. See omnystudio.com/listener for privacy information.

Cancer therapies can save lives, but they often come with tough side effects that aren’t always fully addressed. What side effects should you expect from cancer treatments – and how can you manage them? We sat down with Elizabeth J. Cathcart-Rake, MD, an oncologist at Mayo Clinic, to explore how these effects impact patients’ physical, emotional, and financial well-being – and why quality of life deserves just as much attention. From nausea and fatigue to neuropathy and sexual side effects, we explore the most common fears and how to talk with your doctor. You’ll learn how different therapies (chemo, hormonal, immunotherapy, targeted therapy) impact your body, plus practical, evidence-based tools to help you feel like yourself during treatment.See omnystudio.com/listener for privacy information.

Looking for the latest on molluscum? We've got the expert. This week, we're joined by Elizabeth Swanson as she walks us through molluscum and also offers tips on physician burnout. Listen in as she discusses treatments and care for molluscum as well as useful tips for your personal journey as a physician. Each Thursday, join Dr. Raja and Dr. Hadar, board-certified dermatologists, as they share the latest evidence-based research in integrative dermatology. For access to CE/CME courses, become a member at LearnSkin.com.   Catch Dr. Swanson live at #IDS2025 for more on molluscum in dermatology!   Elizabeth Swanson, MD is a board-certified dermatologist and pediatric dermatologist. She obtained her medical degree from Tulane University School of Medicine in New Orleans. She performed her dermatology residency at Mayo Clinic in Rochester, Minnesota. After that, she completed a fellowship in Pediatric Dermatology at Phoenix Children's Hospital in Arizona. She was in private practice in Colorado from 2011 through 2020. She moved to Boise, Idaho, in the summer of 2020 to become the first and only pediatric dermatologist in the state of Idaho. She is active in local and national medical societies and organizations. She loves lecturing at conferences, discussing pediatric dermatology with audiences across the country. Since moving to Idaho, she works in private practice at Ada West Dermatology, and she is on staff at St. Luke's Children's Hospital, where she sees hospital consults and performs procedures.

Body Honey is a purpose-driven skincare brand born in the small town of Twisp, Washington, and rooted in one woman's personal battle with chronic dry skin. Founded by Sindi Scheinberg, with creative support from her close friend Val Husby, Body Honey was developed after Sindi moved from the wet Oregon coast to the dry North Cascades and faced severe skin issues that even led her to the Mayo Clinic. There, she learned the truth about harmful skincare ingredients and began creating her own all-natural remedies using organic, skin-healing ingredients—most notably honey, known for its anti-inflammatory and antimicrobial properties. ⁣ After a decade of quietly selling her handmade products to local outdoor shops, Sindi is now preparing to officially launch Body Honey as a certified organic brand in sustainable, recyclable aluminum packaging. ⁣ The product line includes concentrated formulas designed to be applied to damp skin, featuring edible-grade ingredients like organic shea butter, honey, bee pollen, and non-nano mineral SPF—ensuring safety, effectiveness, and environmental responsibility. The brand's name and hand-drawn logo, based on Sindi's father's handwriting, reflect deep family ties. Her father, a surgeon and inventor of the SAM Splint, inspired both her entrepreneurial spirit and commitment to healing. 

Our old friend surprised us with an in-studio visit! Mayo Clinic Big Knocker Bill Morice joins Dan for the first time in a long time to cover all types of medical topics.

On this episode of Integrative Cancer Solutions Dr. Karlfeldt is joined by Rick Hill and we hear Rick's remarkable cancer survival story that spans over four decades and represents a powerful testament to alternative cancer treatments. Diagnosed with cancer and initially treated at the prestigious Mayo Clinic, Rick underwent grueling surgeries that left him questioning the conventional medical approach. A pivotal moment came when he received a letter from John Valentine that convinced him to leave the Mayo Clinic and seek alternative treatments in Tijuana, Mexico. Despite initial skepticism about the dramatic lifestyle changes required, Rick committed to this new path that would ultimately save his life. Central to Rick's recovery was his connection to Dr. John Richardson and the Richardson Protocol, which successfully treated approximately 4,000 patients, many in stage four cancer. Rick criticizes the medical establishment for revoking Dr. Richardson's medical license and imprisoning him despite his remarkable success rate. The treatment protocol centered around vitamin B17 (Laetrile) and other natural extracts, combined with comprehensive lifestyle changes including colonics, fasting, juicing, and strict organic diets. Rick emphasizes how these treatments worked synergistically to support his immune system rather than simply targeting the cancer with toxic drugs. The journey required tremendous personal commitment and lifestyle transformation. Rick describes the challenges of adapting to a completely new diet and treatment regimen, acknowledging the initial difficulty and boredom that came with such drastic changes. He had to navigate skepticism from family members and the medical establishment while maintaining his commitment to alternative treatments. Rick also mentions his involvement in what he calls "low-key smuggling" to obtain necessary treatments across borders, highlighting the regulatory obstacles faced by those seeking alternative cancer therapies. Throughout his interview, Rick strongly criticizes the pharmaceutical industry's financial motivations for suppressing alternative treatments and the medical establishment's focus on drugs rather than immune system support. He expresses optimism about current political developments, particularly mentioning Bobby Kennedy's efforts toward "chemical freedom" and crossing party lines to address these issues. Rick emphasizes that his long-term survival demonstrates the effectiveness of alternative approaches when patients have the persistence and commitment to maintain healthy lifestyle changes. Rick's story extends beyond personal survival to advocacy and education. He authored a book titled "Too Young to Die" to raise awareness about alternative cancer treatments and continues to support other patients seeking similar paths. He expresses interest in collaborating with healthcare providers to help patients access alternative treatments and emphasizes the critical importance of community support, freedom of choice in cancer treatment, and the need for persistence in maintaining the lifestyle changes that support long-term cancer survival. His four-decade journey serves as both inspiration and practical guidance for others facing similar diagnoses.Rick Hill left the Mayo Clinic after receiving a letter from John Valentine and sought alternative cancer treatments in Tijuana, Mexico, leading to over 40 years of cancer-free survival.Dr. John Richardson successfully treated approximately 4,000 cancer patients (many stage four) with the Richardson Protocol using vitamin B17 (Laetrile) and natural extracts, but had his medical license revoked and was imprisoned by the medical establishment.Rick's recovery required dramatic lifestyle changes including strict organic diets, colonics, fasting, juicing, and complete commitment to natural treatments that support the immune system rather than toxic drugs.He criticizes the pharmaceutical industry's financial motivations for suppressing alternative treatments and expresses optimism about current political efforts, particularly Bobby Kennedy's work toward "chemical freedom."Rick authored the book "Too Young to Die" to raise awareness about alternative cancer treatments and continues advocating for patient freedom of choice and community support in cancer treatment decisions.----Grab my book A Better Way to Treat Cancer: A Comprehensive Guide to Understanding, Preventing and Most Effectively Treating Our Biggest Health Threat - https://www.amazon.com/dp/B0CM1KKD9X?ref_=pe_3052080_397514860 Unleashing 10X Power: A Revolutionary Approach to Conquering Cancerhttps://store.thekarlfeldtcenter.com/products/unleashing-10x-power-Price: $24.99-100% Off Discount Code: CANCERPODCAST1Healing Within: Unraveling the Emotional Roots of Cancerhttps://store.thekarlfeldtcenter.com/products/healing-within-Price: $24.99-100% Off Discount Code: CANCERPODCAST2----Integrative Cancer Solutions was created to instill hope and empowerment. Other people have been where you are right now and have already done the research for you. Listen to their stories and journeys and apply what they learned to achieve similar outcomes as they have, cancer remission and an even more fullness of life than before the diagnosis. Guests will discuss what therapies, supplements, and practitioners they relied on to beat cancer. Once diagnosed, time is of the essence. This podcast will dramatically reduce your learning curve as you search for your own solution to cancer. To learn more about the cutting-edge integrative cancer therapies Dr. Karlfeldt offer at his center, please visit www.TheKarlfeldtCenter.com

In today's episode we are discussing 2 journal club articles relating to risk factors of glaucoma with our Mayo Clinic colleague Dr Arthur Sit.   Long-Term Systemic Use of Calcium Channel Blockers and Incidence of Primary Open-Angle Glaucoma - Ophthalmology Glaucoma Relationship between Intraocular Pressure Fluctuation and Visual Field Progression Rates in the United Kingdom Glaucoma Treatment Study - PubMed Subscribe to the podcast:  https://MayoClinicOphthalmology.podbean.com Follow and reach out to us on X and IG: @mayocliniceye

Wearable tech is transforming how we track health, manage chronic conditions, and personalize care. In this episode, our host Cathy Wurzer and guests Dr. Arjun Arthreya, Electrical & Computer Engineer and Senior Associate Consultant at Mayo Clinic; and Dr. Jeannie Bailey, Associate Professor of Orthopedic Surgery at University of California, San Francisco, reveal how these tools are reshaping medical research and bringing precision medicine closer to home. From detecting burnout in healthcare workers to predicting surgical recovery, the possibilities are expanding rapidly. Learn how innovation in digital health is making care more proactive, accessible, and tailored to each patient.Get the latest health information from Mayo Clinic's experts, subscribe to Mayo Clinic's newsletter for free today:  https://mayocl.in/3EcNPNc

Host: Darryl S. Chutka, M.D. Guests: Darrell S. Pardi, M.D., and Laura E. Raffals, M.D. Microscopic colitis is one of the lesser-known members of the inflammatory bowel disease family. Symptoms include chronic, frequent diarrhea and fecal urgency. It's usually suspected from the patient's clinical symptoms and diagnosis is established by colonoscopy with biopsy. Biopsy is necessary as the colonic mucosa appears normal at endoscopy. A specific cause isn't known but it can be associated with several medications. Although it's not typically a life-threatening condition, it can lead to weight loss and potentially dehydration. How does microscopic colitis differ from ulcerative colitis or Crohn's Disease? Who's at risk of developing it? Since these patients usually present to primary care providers, when should we suspect it? How is it managed, and can it be cured?  These are some of the questions I'll be asking my guests, Darrell S. Pardi, M.D., and Laura E. Raffals, M.D., both gastroenterologists at the Mayo Clinic. We'll be discussing “Microscopic Colitis” as part of our ongoing series of podcasts on “Inflammatory Bowel Disease”. https://ce.mayo.edu/content/mayo-clinic-talks-inflammatory-bowel-disease Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts 

In this powerful and personal episode of the Healthspan Podcast, Dr. Robert Todd Hurst, MD, FACC, FASE sits down with a HealthspanMD patient to share her inspiring transformation story. After retiring from a prestigious career at the Mayo Clinic, she realized it was time to prioritize her own health. Motivated by a family history of stroke, dementia, and chronic disease, and disillusioned by a traditional, reactive healthcare model, she turned to HealthspanMD for a proactive, personalized approach to longevity and optimal wellness. What follows is a journey from fear and frustration to strength, confidence, and vitality. She shares how she has overcome a lifetime of dieting, reversed her health markers, got off blood pressure medication, and gained muscle while losing fat, all without extreme diets or hours in the gym.   Key Time Stamps:  00:42 – Why she sought care from HealthspanMD after retiring from Mayo Clinic  02:10 – Discovering proactive medicine and the influence of Peter Attia's “Outlive”  03:15 – First appointment at HealthspanMD  03:40 – Medicine 2.0 to Medicine 3.0  05:35 – Early challenges and aligning on a prevention-focused vision  07:10 – A lifelong struggle with dieting and power of knowledge  09:25 – A turning point with DEXA scans: gaining muscle & losing fat in her mid-60s  12:20 – The power of coaching, mindset, and long-term sustainability  14:05 – Getting off blood pressure medication after just 3 months  16:20 – Newfound optimism about aging and the future  18:30 – Final reflections on the care she received at HealthspanMD  This information is for educational purposes only and is not medical advice. Don't make any decisions about your medical treatment without first talking to your doctor.    Connect with HealthspanMD:  https://www.linkedin.com/company/healthspanmd/   https://www.facebook.com/healthspanmd   https://www.instagram.com/healthspanmd/  https://quiz.healthspanmd.com/    

Lipoprotein (a) Elevation: What Does it do to CV Risk and What do You Need to Know About Treatment   Guest: Vlad Vasile, M.D., Ph.D. Host: Stephen L. Kopecky, M.D.   Lipoprotein (a) is a blood biomarker that poses independent risk of heart attacks and stroke when elevated. All patients should be screened for this biomarker. Currently, there are no efficient treatments for lipoprotein (a) elevations, but likely the scenery will change as we will have treatments available in the near future. For now, we recommend a healthy lifestyle, medications that lower cholesterol, aspirin and screening of all first-degree relatives of patients with elevated lipoprotein (a), including children.   Topics Discussed: What is lipoprotein (a)? How does lipoprotein (a) increase cardiovascular risk? How do we treat lipoprotein (a) elevation? Do you screen children of patients with elevated lipoprotein (a)?    Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode.   Podcast episode transcript found here.

Dr. Harish Kinni, a triple-board-certified emergency medicine and critical care physician and assistant professor at the Mayo Clinic, provides an overview of the fundamentals of ventilator care for emergency department professionals. We will review key modes that we should know, the variables to set, how to adjust them for your patient's needs, and provide troubleshooting tips and tricks for when things suddenly go awry. This is sure to be one of the most helpful chapters of Always on EM, but don't let it take your breath away! CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Swart P, Nijbroek SGLH, Paulus F, Neto AS, Schultz MJ. Sex Differences in Use of Low Tidal Volume Ventilation in COVID-19-Insights From the PRoVENT-COVID Study. Front Med (Lausanne). 2022 Jan 3;8:780005. doi: 10.3389/fmed.2021.780005. PMID: 35300177; PMCID: PMC8923734. McNicholas BA, Madotto F, Pham T, Rezoagli E, Masterson CH, Horie S, Bellani G, Brochard L, Laffey JG; LUNG SAFE Investigators and the ESICM Trials Group. Demographics, management and outcome of females and males with acute respiratory distress syndrome in the LUNG SAFE prospective cohort study. Eur Respir J. 2019 Oct 17;54(4):1900609. doi: 10.1183/13993003.00609-2019. PMID: 31346004. Swart P, Deliberato RO, Johnson AEW, Pollard TJ, Bulgarelli L, Pelosi P, de Abreu MG, Schultz MJ, Neto AS. Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts. PLoS One. 2021 Jul 14;16(7):e0253933. doi: 10.1371/journal.pone.0253933. PMID: 34260619; PMCID: PMC8279424. Evans, Laura1; Rhodes, Andrew2; Alhazzani, Waleed3; Antonelli, Massimo4; Coopersmith, Craig M.5; French, Craig6; Machado, Flávia R.7; Mcintyre, Lauralyn8; Ostermann, Marlies9; Prescott, Hallie C.10; Schorr, Christa11; Simpson, Steven12; Wiersinga, W. Joost13; Alshamsi, Fayez14; Angus, Derek C.15; Arabi, Yaseen16; Azevedo, Luciano17; Beale, Richard18; Beilman, Gregory19; Belley-Cote, Emilie20; Burry, Lisa21; Cecconi, Maurizio22; Centofanti, John23; Coz Yataco, Angel24; De Waele, Jan25; Dellinger, R. Phillip26; Doi, Kent27; Du, Bin28; Estenssoro, Elisa29; Ferrer, Ricard30; Gomersall, Charles31; Hodgson, Carol32; Hylander Møller, Morten33; Iwashyna, Theodore34; Jacob, Shevin35; Kleinpell, Ruth36; Klompas, Michael37; Koh, Younsuck38; Kumar, Anand39; Kwizera, Arthur40; Lobo, Suzana41; Masur, Henry42; McGloughlin, Steven43; Mehta, Sangeeta44; Mehta, Yatin45; Mer, Mervyn46; Nunnally, Mark47; Oczkowski, Simon48; Osborn, Tiffany49; Papathanassoglou, Elizabeth50; Perner, Anders51; Puskarich, Michael52; Roberts, Jason53; Schweickert, William54; Seckel, Maureen55; Sevransky, Jonathan56; Sprung, Charles L.57; Welte, Tobias58; Zimmerman, Janice59; Levy, Mitchell60. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine 49(11):p e1063-e1143, November 2021. | DOI: 10.1097/CCM.0000000000005337  Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, Adhikari NKJ, Amato MBP, Branson R, Brower RG, Ferguson ND, Gajic O, Gattinoni L, Hess D, Mancebo J, Meade MO, McAuley DF, Pesenti A, Ranieri VM, Rubenfeld GD, Rubin E, Seckel M, Slutsky AS, Talmor D, Thompson BT, Wunsch H, Uleryk E, Brozek J, Brochard LJ; American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2017 May 1;195(9):1253-1263. doi: 10.1164/rccm.201703-0548ST. Erratum in: Am J Respir Crit Care Med. 2017 Jun 1;195(11):1540. doi: 10.1164/rccm.19511erratum. PMID: 28459336. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, Oczkowski S, Levy MM, Derde L, Dzierba A, Du B, Aboodi M, Wunsch H, Cecconi M, Koh Y, Chertow DS, Maitland K, Alshamsi F, Belley-Cote E, Greco M, Laundy M, Morgan JS, Kesecioglu J, McGeer A, Mermel L, Mammen MJ, Alexander PE, Arrington A, Centofanti JE, Citerio G, Baw B, Memish ZA, Hammond N, Hayden FG, Evans L, Rhodes A. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med. 2020 Jun;48(6):e440-e469. doi: 10.1097/CCM.0000000000004363. PMID: 32224769; PMCID: PMC7176264. Wang W, Scharfstein D, Wang C, Daniels C, Needham D, Brower R, NHLBI ARDS Clinical Network. Estimating the Causal Effect of Low Tidal Volume Ventilation on Survival in Patients with Acute Lung Injury. J R Stat Soc Ser C Appl Stat. 2011. PMC: PMC3197806 Brower RG, Thompson BT, NIH/NHLBI/ARDSNetwork. Tidal volumes in acute respiratory distress syndrome--one size does not fit all. Crit Care Med. 2006. Hager DN, Krishman JA, Hayden D, Brower RG, ARDSNet NIH / NHLBI. Tidal Volume Reduction in Patients with acute Lung Injury When Plateau Pressures Are Not High. Am J Resp Crit Care Med. 2005. Rubenfeld GD, Cooper C, Carter G, Thompson BT, Hudson LD. Barriers to providing lung protective ventilation to patients with acute lung injury. Crit Care Med. 2004. Chatburn RL, El-Khatib M, Mireles-Cabodevila E. A taxonomy for mechanical ventilation: 10 fundamental maxims. Respir Care. 2014 Nov;59(11):1747-63. doi: 10.4187/respcare.03057. Epub 2014 Aug 12. PMID: 25118309. Guo L, Wang W, Zhao N, Guo L, Chi C, Hou W, Wu A, Tong H, Wang Y, Wang C, Li E. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis. Crit Care. 2016 Jul 22;20(1):226. doi: 10.1186/s13054-016-1396-0. PMID: 27448995; PMCID: PMC4957383. Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB, NIH NHLBI ARDS Network. Comparison of the Sp02/FI02 Ratio and the PaO 2/FI02 in Patients with Acute Lung Injury or ARDS. Chest. 2007. Zhang G, Burla MJ, Caesar BB, Falank CR, Kyros P, Zucco VC, Strumilowska A, Cullinane DC, Sheppard FR. Emergency Department SpO2/FiO2 Ratios Correlate with Mechanical Ventilation and Intensive Care Unit Requirements in COVID-19 Patients. West J Emerg Med. 2024 May;25(3):325-331. doi: 10.5811/westjem.17975. PMID: 38801037; PMCID: PMC11112664.   WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs   Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

Host: Darryl S. Chutka, M.D. Guest: Edward V. Loftus JR, M.D. Inflammatory Bowel Disease is somewhat of an umbrella term for a group of chronic inflammatory conditions of the GI tract. The most common types include ulcerative colitis and Crohn's Disease. While there are similarities between the two, there are also differences. For many individuals with inflammatory bowel disease, it's only a mild illness. Unfortunately for some, it can lead to severe disability and potentially life-threatening complications. What are the similarities and differences between ulcerative colitis and Crohn's? When should we suspect a patient has an inflammatory bowel disease? What's the best way to establish a diagnosis and finally, what treatment options do we have? These are just some of the questions I'll be asking my guest, Edward V. Loftus JR, M.D., from the Division of Gastroenterology and Hepatology at the Mayo Clinic as we discuss “Inflammatory Bowel Disease and Its Treatment”. https://ce.mayo.edu/content/mayo-clinic-talks-inflammatory-bowel-disease Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts 

In this episode of “Answers From the Lab,” host Bobbi Pritt, M.D., chair of the Division of Clinical Microbiology at Mayo Clinic, and William Morice II, M.D., Ph.D., CEO and president of Mayo Clinic Laboratories, share insights from industry news and recent conferences, including PlatforMed. They explore:The significant interest in diagnostics for the advancement of cancer care.The Joint Commission's collaboration with the Coalition for Health AI to establish guidelines for the responsible use of artificial intelligence. The growing understanding that platforms offer an opportunity to expand access and make knowledge more accessible as platform-driven solutions become a reality.The role of laboratorians in guiding the ethical and effective use of data and emerging technologies — and what this means for educating future healthcare professionals.The critical importance of values and ethics in deploying new tools.

In this episode of the Brain & Life Podcast, co-host Dr. Daniel Correa is joined by Phil Rosenthal. Phil is the award-winning creator, executive producer, and host of “Somebody Feed Phil,” as well as a two-time New York Times Best Selling Author, soon-to-be restaurant owner, and cared for his mother during her journey with Amyotrophic lateral sclerosis (ALS). Phil shares about his mother's journey and how his family worked with doctors to prioritize her needs. Dr. Correa is also joined by Dr. Bjorn E. Oskarsson, a neurologist at Mayo Clinic in Jacksonville, Florida who specializes in ALS. Dr. Oskarsson explains ALS, how it can affect people in differing ways, and what treatment options typically look like.   Additional Resources Max and Helen's: A Neighborhood Diner Honoring Phil Rosenthal's Parents A Marathoner on a Quest to End ALS Tips on How to Choose and Pay for In-Home Health Care When is Palliative Care Appropriate?   Other Brain & Life Podcast Episodes on Similar Topics Making the Years Count with Brooke Eby, Influencer Living with ALS Finding Strength in ALS Advocacy with Podcaster Lorri Carey Aaron Lazar on His ALS Journey and the Impossible Dream   We want to hear from you! Have a question or want to hear a topic featured on the Brain & Life Podcast? Record a voicemail at 612-928-6206 Email us at BLpodcast@brainandlife.org   Social Media: Phil Rosenthal @phil.rosenthal; Dr. Bjorn E. Oskarsson @mayoclinic.flneuro Guests: Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD

Humor isn't just for laughs—it can be a powerful tool for navigating awkward or uncomfortable situations with grace and confidence. In this story, keynote speaker Jan McInnis shares a memorable moment when a potentially embarrassing wardrobe mishap could've overshadowed an entire presentation. Instead, with a quick wit and a well-timed joke, she not only saved the moment but also connected with the audience and diffused the tension in the room. It's a great reminder that finding the funny can turn even the most cringeworthy situations into opportunities for connection. https://www.TheWorkLady.com  Jan McInnis is a top change management keynote speaker and comedian. She uses short funny stories to emphasize her tips on how businesses can use humor to handle change. Jan is a top conference keynote speaker, comedian, Master of Ceremonies, and comedy writer. She has written for Jay Leno's The Tonight Show monologues as well as many other people, places, and groups—radio, TV, syndicated cartoon strips, guests on The Jerry Springer Show (her parents are proud). For over 25 years, she's traveled the country as a keynote speaker and comedian, sharing her unique and practical tips on how to use humor in business (yes, it's a business skill!). She's been featured in The Huffington Post, The Wall Street Journal, and The Washington Post for her clean humor, and she's the author of two books: Finding the Funny Fast – How to Create Quick Humor to Connect with Clients, Coworkers, and Crowds, and Convention Comedian: Stories and Wisdom From Two Decades of Chicken Dinners and Comedy Clubs. She also has a popular podcast titled Comedian Stories: Tales From the Road in Under 5 Minutes. In her former life, she was a marketing executive in Washington, D.C. for national non-profits, and she received the Greater Washington Society of Association Executives “Excellence in Education” Award. Jan's been featured at thousands of events from the Federal Reserve Banks to the Mayo Clinic.  https://www.TheWorkLady.com https://youtu.be/BtjxzDn-QLE https://www.linkedin.com/in/janmcinnis https://twitter.com/janmcinnis https://www.pinterest.com/janmcinnis/pins/ https://www.youtube.com/c/JanMcInnisComedian https://www.facebook.com/ComedianJanMcInnis https://www.instagram.com/jan.mcinnis/  Jan has shared her humor keynotes from Fortune 500 companies to international associations. Groups such as . .. Healthcare. . . Mayo Clinic, Health Information Management Associations, Healthcare Financial Management Associations, Hospitals, Abbott Pharmaceuticals, Sanofi Aventis Pharmaceuticals, Kaiser-Permanente, Davita Dialysis Centers, Blue Cross, Blue Shield, Home Healthcare Associations, Assisted Living Associations, Healthcare Associations, National Council for Prescription Drug Companies, Organization of Nurse Leaders, Medical Group Management Associations, Healthcare Risk Associations, Healthcare Quality Associations  Financial. . . Federal Reserve Banks, BDO Accounting, Transamerica Insurance & Investment Group, Merrill Lynch, treasury management associations, bankers associations, credit unions, Money Transmitter Regulators Association, Finance Officers Associations, automated clearing house associations, American Institute of CPAs, financial planning companies, Securities, Insurance, Licensing Association  Government . . . purchasing officers associations, city clerks, International Institute of Municipal Clerks, National League of Cities, International Worker's Compensation Fund, correctional associations, LA County Management Association, Social Security Administration, Southern California Public Power Authority, public utilities, U.S. Air Force, public personnel associations, public procurement associations, risk management associations, Rehabilitation associations, rural housing associations, community action associations  Women's Events. . . American Heart Associations, Go Red For Women luncheons, Speaking of Women's Health, International Association of Administrative Professionals, administrative professionals events, Toyota Women's Conference, Women in Insurance and Financial Services, Soroptimists, Women in Film & Video, ladies night out events, Henry Ford Health Centers Women's Event, spirit of women events, breast cancer awareness,  Education . . . School Business Officials associations, school superintendent associations, school boards associations, state education associations, community college associations, school administrators associations, school plant managers associations, Head Start associations, Texas adult protective services, school nutrition associations, Association of Elementary and Middle School Principals, principal associations, library associations  Emergency, safety, and Disaster . . . International Association of Emergency Managers, Disney Emergency Managers, state emergency management associations, insurance groups, COPIC, Salt Lake County Public Works and Municipal Services Disaster Recovery Conference, Pennsylvania Governor's Occupational Safety and Health conference, Mid Atlantic Safety conference and Chesapeake Regional Safety Council, Risk associations.  

Normal pressure hydrocephalus (NPH) is a clinical syndrome characterized by the triad of gait apraxia, cognitive impairment, and bladder dysfunction in the radiographic context of ventriculomegaly and normal intracranial pressure. Accurate diagnosis requires consideration of clinical and imaging signs, complemented by tests to exclude common mimics. In this episode, Lyell Jones, MD, FAAN speaks with Abhay R. Moghekar, MBBS, author of the article “Clinical Features and Diagnosis of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Moghekar is an associate professor of neurology at Johns Hopkins University School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Clinical Features and Diagnosis of Normal Pressure Hydrocephalus Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Abhay Moghekar, who recently authored an article on the clinical features and diagnosis of normal pressure hydrocephalus for our first-ever issue of Continuum dedicated to disorders of CSF dynamics. Dr Moghekar is an associate professor of neurology and the research director of the Cerebrospinal Fluid Center at Johns Hopkins University in Baltimore, Maryland. Dr Moghekar, welcome, and thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Moghekar: Thank you, Dr Jones. I'm Abhay Moghekar. I'm a neurologist at Hopkins, and I specialize in seeing patients with CSF disorders, of which normal pressure hydrocephalus happens to be the most common. Dr Jones: And let's get right to it. I think most of our listeners who are neurologists in practice have encountered normal pressure hydrocephalus, or NPH; and it's a challenging disorder for all the reasons that you outline in your really outstanding article. If you were going to think of one single most important message to our listeners about recognizing patients with NPH, what would that be? Dr Moghekar: I think I would say there are two important messages. One is that the triad is not sufficient to make the diagnosis, and the triad is not necessary to make the diagnosis. You know these three elements of the triad: cognitive problems, gait problems, bladder control problems are so common in the elderly that if you pick 10 people out in the community that have this triad, it's unlikely that even one of them has true NPH. On the other hand, you don't need all three elements of the triad to make the diagnosis because the order of symptoms matters. Often patients develop gait dysfunction first, then cognitive dysfunction, and then urinary incontinence. If you wait for all three elements of the triad to be present, it may be too late to offer them any clear benefit. And hence, you know, it's neither sufficient nor necessary to make the diagnosis. Dr Jones: That's a really great point. I think most of our listeners are familiar with the fact that, you know, we're taught these classic triads or pentads or whatever, and they're rarely all present. In a way, it's maybe a useful prompt, but it could be distracting or misleading, even in a way, in terms of recognizing the patient. So what clues do you use, Dr Moghekar, to really think that a patient may have NPH? Dr Moghekar: So, there are two important aspects about gait dysfunction. Say somebody comes in with all three elements of the triad. You want to know two things. Which came first? If gate impairment precedes cognitive impairment, it's still very likely that NPH is in the differential. And of the two, which are more- relatively more affected? So, if somebody has very severe dementia and they have a little bit of gait problems, NPH is not as likely. So, is gait affected earlier than cognitive dysfunction, and is it affected to a more severe degree than cognitive dysfunction? And those two things clue me in to the possibility of NPH. You still obviously need to get imaging to make sure that they have large ventricles. One of the problems with imaging is large ventricles are present in so many different patients. Normal aging causes large ventricles. Obviously, many neurodegenerative disorders because of cerebral atrophy will cause large ventricles. And there's an often-used metric called as the events index, which is the ratio of the bitemporal horns- of the frontal horns of the lateral ventricles compared to the maximum diameter of the skull at that level. And if that ratio is more than 0.3, it's often used as a de facto measure of ventriculomegaly. What we've increasingly realized is that this ratio changes with age. And there's an excellent study that used the ADNI database that looked at how this ratio changes by age and sex. So, in fact, we now know that an 85-year-old woman who has an events index of 0.37 which would be considered ventriculomegaly is actually normal for age and sex. So, we need to start adopting these more modern age- and sex-appropriate age cutoffs of ventriculomegaly so as not to overcall everybody with big ventricles as having possible NPH. Dr Jones: That's very helpful. And I do want to come back to this challenge that we've seen in our field of overdiagnosis and underdiagnosis. But I think most of us are familiar with the concept of how hydrocephalus could cause neurologic deficits. But what's the latest on the mechanism of NPH? Why do some patients get this and others don't? Dr Moghekar: Very good question. I don't think we know for sure. And it for a long time we thought it was a plumbing issue. Right? And that's why shunts work. People thought it was impaired CSF absorption, but multiple studies have shown that not to be true. It's likely a combination of impaired cerebral blood flow, biomechanical factors like compliance, and even congenital factors that play a role in the pathogenesis of NPH. And yes, while putting in shunts likely drains CSF, putting in a shunt also definitely changes the compliance of the brain and affects blood flow to the subcortical regions of the brain. So, there are likely multiple mechanisms by which shunts benefit, and hence it's very likely that there's no single explanation for the pathogenesis of NPH. Dr Jones: We explored this in a recent Continuum issue on dementia. Many patients who have cognitive impairment have co-pathologies, multiple different causes. I was interested to read in your article about the genetic risk profile for NPH. It's not something I'd ever really considered in a disorder that is predominantly seen in older patients. Tell us a little more about those genetic risks. Dr Moghekar: Yeah, everyone is aware of the role genetics plays in congenital hydrocephalus, but until recently we were not aware that certain genetic factors may also be relevant to adult-onset normal pressure hydrocephalus. We've suspected this for a long time because nearly half of our patients who come to us to see us in clinic with NPH have head circumferences that are more than 90th percentile for height. And you know, that clearly indicates that this started shortly at the time after birth or soon afterwards. So, we've suspected for a long time that genetic factors play a role, but for a long time there were not enough large studies or well-conducted studies. But recently studies out of Japan and the US have shown mutations in genes like CF43 and CWH43 are disproportionately increased in patients with NPH. So, we are discovering increasingly that there are genetic factors that underlie even adult onset in patients. There are many more waiting to be discovered. Dr Jones: Really fascinating. And obviously getting more insight into the risk and mechanisms would be helpful in identifying these patients potentially earlier. And another thing that I learned in your article that I thought was really interesting, and maybe you can tell us more about it, is the association between normal pressure hydrocephalus and the observation of cervical spinal stenosis, many of whom require decompression. What's behind that association, do you think? Dr Moghekar: That's a very interesting study that was actually done at your institution, at Mayo Clinic, that showed this association. You know, as we all get older, you know, the incidence of cervical stenosis due to osteoarthritis goes up, but the incidence of significant, clinically significant cervical stenosis in the NPH population was much higher than what we would have expected. Whether this is merely an association in a vulnerable population or is it actually causal is not known and will need further study. Dr Jones: It's interesting to speculate, does that stenosis affect the flow of CSF and somehow predispose to a- again, maybe a partial degree for some patients? Dr Moghekar: Yeah, which goes back to the possible hydrodynamic theory of normal pressure hydrocephalus; you know, if it's obstructing normal CSF flow, you know, are the hydrodynamics affected in the brain that in turn could lead to the development of hydrocephalus. Dr Jones: One of the things I really enjoyed about your article, Abhay, was the very strong clinical focus, right? We can't just take an isolated biomarker or radiographic feature and rely on that, right? We really do need to have clinical suspicion, clinical judgment. And I think most of our listeners who've been in practice are familiar with the use and the importance of the large-volume lumbar puncture to determine who may have, and by exclusion not have, NPH, and then who might respond to CSF diversion. And I think those of us who have been in this situation are also familiar with the scenario where you think someone may have NPH and you do a large-volume lumbar puncture and they feel better, but you can't objectively see a difference. How do you make that test useful and objective in your practice? What do you do? Dr Moghekar: Yeah, it's a huge challenge in getting this objective assessment done carefully because you have to remember, you know, subconsciously you're telling the patients, I think you have NPH. I'm going to do this spinal tap, and if you walk better afterwards, you're going to get a shunt and you're going to be cured. And you can imagine the huge placebo response that can elicit in our subjects. So, we always like to see, definitely, did the patient subjectively feel better? Because yes, that's an important metric to consider because we want them to feel better. But we also wanted to be grounded in objective truths. And for that, we need to do different tests of speed, balance and endurance. Not everyone has the resources to do this, but I think it's important to test different domains. Just like for cognition, you know, we just don't test memory, right? We test executive function, language, visuospatial function. Similarly, walking is not just walking, right? It's gait speed, it's balance, and it's endurance. So, you need to ideally test at least most of these different domains for gait and you need to have some kind of clear criteria as to how are you going to define improvement. You know, is a 5% improvement, is a 10% improvement in gait, enough? Is 20%? Where is that cutoff? And as a field, we've not done a great job of coming up with standardized criteria for this. And it varies currently, the practice varies quite significantly from center to center at the current time. Dr Jones: So, one of the nice things you had in your article was helpful tips to be objective if you're in a lower-resource setting. For you, this isn't a common scenario that someone encounters in their practice as opposed to a center that maybe does a large volume of these. What are some relatively straightforward objective measures that a neurologist or someone else might use to determine if someone is improving after a large-volume LP? Dr Moghekar: Yeah, excellent question, Dr Jones, and very practically relevant too. So, you need to at least assess two of the domains that are most affected. One is speed and one is balance. You know, these patients fall ultimately, right, if you don't treat them correctly. In terms of speed, there are two very simple tests that anybody can do within a couple of minutes. One is the timed “up-and-go” test. It's a test that's even recommended by the CDC. It correlates very well with faults and disability and it can be done in any clinic. You just need about ten feet of space and a chair and a stopwatch, and it takes about a minute or slightly more to do that test. And there are objective age-associated norms for the timed up-and-go test, so it's easy to know if your patient is normal or not. The same thing goes for the 10-meter walk test. You do need a slightly longer walkway, but it's a fairly easy and well-standardized test. So, you can do one of those two; you don't need to do both of them. And for balance, you can do the 30-second “sit-to-stand”; and it's literally, again, 30 seconds. You need a chair, and you need somebody to watch the patient and see how many times they can sit up and stand up from a seated position. Then again, good normative data for that. If you want to be a little more sophisticated, you can do the 4-stage balance test. So, I think these are tests that don't add too much time to your daily assessment and can be done with even trained medical assistants in any clinic. And you don't need a trained physical therapist to do these assessments. Dr Jones: Very practical. And again, something that is pretty easily deployed, something we do before and then after the LP. I did see you mentioned in your article the dual timed up-and-go test where it's a simultaneous gait and executive function test. And I've got to be honest with you, Dr Moghekar, I was a little worried if I would pass that test, but that may be beyond the scope of our time today. Actually, how do you do that? How do you do the simultaneous cognitive assessment? Dr Moghekar: So, we asked them to count back from 100, subtracting 3. And we do it particularly in patients who are mildly impaired right? So, if they're already walking really good, but then you give them a cognitive stressor, you know, that will slow them down. So, we reserve it for patients who are high-performing. Dr Jones: That's fantastic. I'm probably aging myself a little here. I have noticed in my career, a little bit of a pendulum swing in terms of the recognition or acceptance of the prevalence of normal pressure hydrocephalus. I recall when I was a resident, many, many people that we saw in clinic had normal pressure hydrocephalus. Then it seemed for a while that it really faded into the background and was much less discussed and much less recognized and diagnosed, and less treated. And now that pendulum seems to have swung back the other way. What's behind that from your perspective? Dr Moghekar: It's an interesting backstory to all of this. When the first article about NPH was published in the Newman Journal of Medicine, it was actually a combined article with both neurologists and neurosurgeons on it. They did describe it as a treatable dementia. And what that did is it opened up the floodgates so that everybody with any kind of dementia started getting shunts left, right, and center. And back then, shunts were not programmable. There were no antibiotic impregnated catheters. So, the incidence of subdural hematomas and shunt-related infections was very high. In fact, one of our esteemed neurologists back then, Houston Merritt, wrote a scathing editorial that Victor and Adam should lose their professorships for writing such an article because the outcomes of these patients were so bad. So, for a very long period of time, neurologists stopped seeing these patients and stopped believing in NPH as a separate entity. And it became the domain of neurosurgeons for over two or three decades, until more recently when randomized trials started being done early on out of Europe. And now there's a big NIH study going on in the US, and these studies showed, in fact, that NPH exists as a true, distinct entity. And finally, neurologists have started getting more interested in the science and understanding the pathophysiology and taking care of these patients compared to the past. Dr Jones: That's really helpful context. And I guess that maybe isn't rare when you have a disorder that doesn't have a simple, straightforward biomarker and is complex in terms of the tests you need to do to support the diagnosis, and the treatment itself is somewhat invasive. So, when you talk to your patients, Dr Moghekar, and you've established the diagnosis and have recommended them for CSF diversion, what do you tell them? And the reason I ask is that you mentioned before we started recording, you had a patient who had a shunt placed and responded well, but continued to respond over time. Tell us a little bit more about what our patients can expect if they do have CSF diversion? Dr Moghekar: When we do the spinal tap and they meet our criteria for improvement and they go on to have a shunt, we tell them that we expect gait improvement definitely, but cognitive improvement may not happen in everyone depending on what time, you know, they showed up for their assessment and intervention. But we definitely expect gait improvement. And we tell them that the minimum gait improvement we can expect is the same degree of improvement they had after their large-volume lumbar puncture, but it can be even more. And as the brain remodels, as the hydrodynamics adapt to these shunts… so, we have patients who continue to improve one year, two years, and even three years into the course of the intervention. So, we're, you know, hopeful. At the same time, we want to be realistic. This is the same population that's at risk for developing neurodegenerative disorders related to aging. So not a small fraction of our patients will also have Alzheimer's disease, for example, or go on to develop Lewy body dementia. And it's the role of the neurologist to pick up on these comorbid conditions. And that's why it's important for us to keep following these patients and not leave them just to the neurosurgeon to follow up. Dr Jones: And what a great note to end on, Dr Moghekar. And again, I want to thank you for joining us, and thank you for such a wonderful discussion and such a fantastic article on the clinical diagnosis of normal pressure hydrocephalus. I learned a lot reading the article, and I learned a lot more today just in the conversation with you. So, thank you for being with us. Dr Moghekar: Happy to do that, Dr Jones. It was a pleasure. Dr Jones: Again, we've been speaking with Dr Abhay Moghekar, author of a wonderful article on the clinical features and diagnosis of NPH in Continuum's first-ever issue dedicated to disorders of CSF dynamics. Please check it out. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Lyme disease was first identified 50 years ago. It has become one of the most recognized and widespread vector-borne illnesses in the world. Transmitted by ticks, this elusive infection presents ongoing challenges in detection and treatment. In this episode, our host Cathy Wurzer and guests Dr. Bobbi Pritt, Microbiology Division Chair at Mayo Clinic; and Dr. Allen Steere, Distinguished Physician at Massachusetts General Hospital delve into how researchers are advancing diagnostic tools to outsmart Lyme disease, and what these innovations mean for the future of global health.Get the latest health information from Mayo Clinic's experts, subscribe to Mayo Clinic's newsletter for free today:  https://mayocl.in/3EcNPNc

Ερευνητές στην Mayo Clinic των ΗΠΑ ανέπτυξαν ένα νέο εργαλείο τεχνητής νοημοσύνης (ΑΙ) που βοηθά τους γιατρούς να εντοπίζουν εγκεφαλική δραστηριότητα που σχετίζεται με εννέα τύπους άνοιας, συμπεριλαμβανομένης της νόσου Αλτσχάιμερ στο 88% των περιπτώσεων.

Plus AI Notetakers Take Over MeetingsLike this? Get AIDAILY, delivered to your inbox, 3x a week. Subscribe to our newsletter at https://aidaily.usCan AI Be as Irrational as We Are? (Actually, Probably More)Psych researchers dropped GPT‑4o into a "cognitive dissonance" test—prompting it to write pro- or anti-Putin essays. The AI shifted its stance to match its own writing, and even more so when it felt "free" to choose. Conclusion: AI can twist beliefs just like us… maybe even harder.AI Note‑Takers Are Ghosting Meetings—and It's Getting WeirdAI bots from Zoom, Teams, Otter.ai, and more are swooping into meetings, taking notes even when the human isn't there. Sure, it's efficient—but it's also messing with privacy, etiquette, and real convo vibes. People worry bots will kill off spontaneity and dump too much data into the ether. Canva Cofounder: Creatives Are So Missing the AI Train

Host: Darryl S. Chutka, M.D. Guests: David H. Bruining, M.D., and Nayantara Coelho-Prabhu, M.B.B.S. An early diagnosis of inflammatory bowel disease is important in preventing long-term complications. Prompt treatment can improve quality of life, reduce the likelihood of hospitalizations, and help maintain remissions. However, establishing a diagnosis is often challenging due to the nonspecific and fluctuating nature of symptoms. Inflammatory bowel disease can also mimic other GI conditions. In addition, diagnostic confirmation usually requires a combination of blood tests, imaging, endoscopy, and histological analysis, making the process both time consuming and complex.  The topic for today's podcast is “Diagnosing Inflammatory Bowel Disease and Monitoring Modalities” and my guests are David H. Bruining, M.D., and Nayantara Coelho-Prabhu, M.B.B.S., from the Division of Gastroenterology and Hepatology at the Rochester campus of the Mayo Clinic. https://ce.mayo.edu/content/mayo-clinic-talks-inflammatory-bowel-disease   Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts   

Joshua Bornhorst, Ph.D., explains how Mayo Clinic Laboratories' labile copper assay (Mayo ID: LBCS) improves upon standard blood tests for Wilson's disease. The new test measures not just overall copper but also the fraction of copper that is bioavailable, or labile bound.(00:32) Can you tell us a little bit about yourself and your background? (01:33) Could you give us a brief overview of this assay? (02:47) Which patients should have this testing, and when should it be performed? (03:48) How would the results be used in patient care?

Dr. Iris Wang of the Mayo Clinic shares cutting-edge insights on gut health across the lifespan, including advancements in pharmacogenomics for personalized medication selection and innovative breathing techniques to relieve abdominal distension. She busts common myths about bloating, revealing how diaphragmatic dysfunction rather than excess gas may be the culprit. Dr. Wang also emphasizes the importance of starting gut health education early, helping kids and parents alike understand that pooping shouldn't be painful or forced. • How pharmacogenomics helps identify why some patients metabolize medications differently, leading to better medication choices with exploration on the hope and/or hype of precision medicine in the GI world (Wang et al 2019)• Explanation of abdomino-phrenic dyssynergia (APD) – when the diaphragm moves downward instead of upward, causing visible abdominal distention• Specialized breathing technique developed in Barcelona that retrain the diaphragm for bloating relief (Barba E et al 2024) - see video link below• The importance of normalizing healthy pooping habits from childhood through education & tools like toileting stools (e.g. Squatty Potty)• Warning signs for parents about childhood constipation – including stool leakage, straining, & urinary problems (Tran DL et al 2023)• How yoga can support gut health through mindful movement, core engagement, & stress reductionYoga videos:Yoga For Digestion Flow| Yoga With Adriene (26 mins)Yoga for Bloating, Digestion, Ulcerative Colitis, IBD & IBS (12 mins)Check out Dr. Wang's children's book Boo Can't Poo, which helps normalize healthy pooping habits for kids while educating parents too.References:Wang XJ, Camilleri M. Personalized medicine in functional gastrointestinal disorders: Understanding pathogenesis to increase diagnostic and treatment efficacy. World J Gastroenterol. 2019 Mar 14;25(10):1185-1196.Barba E, Livovsky DM, Accarino A, Azpiroz F. Thoracoabdominal Wall Motion-Guided Biofeedback Treatment of Abdominal Distention: A Randomized Placebo-Controlled Trial. Gastroenterology. 2024;167(3):538-546.e1.Specialized breathing technique for abdominal distention: Video DemonstrationTran DL, Sintusek P. Functional constipation in children: What physicians should know. World J Gastroenterol. 2023 Feb 28;29(8):1261-1288.Learn more about Kate and Dr. Riehl:Website: www.katescarlata.com and www.drriehl.comInstagram: @katescarlata @drriehl and @theguthealthpodcastOrder Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS. The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

How to Tell Patients about Adding in Intervals to Their Physical Activity Program   Guest: Kate Russell, C.E.P. Host: Stephen L. Kopecky, M.D.   Intervals are a hugely beneficial addition to any exercise program. As with any exercise topic, finding good information can be difficult and overwhelming. We will discuss how to modify intervals to fit patients of all ages, fitness levels, and limitations   Topics Discussed: How do I do intervals if I am unable to run? Should I base my intensity on heart rates? What's more important, the length of the interval or the intensity?   Click here for the citation for the research article that Dr. Kopecky references, or see below: Stamatakis E, Ahmadi M, Biswas RK, et al. Br J Sports Med Epub ahead of print: [01.13.2025]. doi:10.1136/ bjsports-2024-108484   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

In 2025, Creating Dementia Solutions is looking deeper into what The Lancet Commission on dementia prevention, intervention and care has indicated are ways people can reduce their risk of dementia.Some call it Type 3 diabetes. It's a term that's used somewhat informally to refer to, as the Mayo Clinic reports, insulin non-responsiveness in the brain. Researchers are said to now be zeroing in on the risk of Alzheimer's Disease in connection with "Type 3" diabetes.In this episode of Creating Dementia Solutions, our diabetes-related discussion with TR Shaw zeroes in on some of what is being said about the dementia-diabetes connection.Episode ResourcesThe Lancet Commission Risk Factors for DementiaMiles for Memories websiteMiles for Memories technologySherii Sherban talks to Community Matters about MFM technologyMore Creating Dementia Solutions episodes ABOUT MILES FOR MEMORIESMiles For Memories is a Calhoun County, Michigan organization created in 2013 to raise awareness and funds for Alzheimer's Disease. Later in 2014, the vision was expanded to include all types of dementia. MFM raises money each year through sponsorships, community events, and grants to gather funds to create local programming for both the person living with dementia and the caregiver. Along with local efforts, 20% of the funds to prevention-related dementia research. Miles for Memories is a committee of 70-plus volunteers and are always looking for more to get involved.

It's time to focus on the often-misunderstood art of assertiveness—what it is, what it isn't, and how learning to speak up for yourself with clarity and respect can change your life. Whether it is Crina telling it like it is or just learning to speak up with friends, this episode illustrates just how transformative assertiveness can be, especially for those of us who've spent years saying “yes” when we really meant “no.” Drawing on guidance from the Mayo Clinic, the episode breaks down assertiveness as a healthy, balanced communication style—firm but respectful, confident without being combative. It's a powerful antidote to stress, resentment, and burnout, especially if you tend to overextend yourself in an effort to keep the peace. Unlike aggression, which bulldozes others, or passivity, which erases your own needs, assertiveness helps you communicate clearly while still honoring relationships and boundaries. Listeners are reminded that assertiveness isn't about being the loudest voice in the room—it's about knowing what you need, expressing it directly, and listening to others with the same respect you expect in return. It's a skill, not a personality trait, and it can be learned and practiced. The episode offers practical tools: use “I” statements to own your feelings, practice saying no without apology, and pay attention to your body language—standing tall, making eye contact, giving yourself some time to respond and staying calm in moments of tension.  And any of us who struggle with this may want to start small. You'll also learn how to identify the traps of passive or passive-aggressive behavior—like saying yes when you mean no, or expressing frustration through sarcasm—and how these patterns can damage relationships and leave you feeling powerless. With time and effort, assertiveness can lead to greater self-confidence, healthier connections, and more honest communication both at work and in your personal life. The takeaway? Assertiveness isn't just about getting what you want—it's about being clear about who you are. Whether you're dealing with a pushy colleague, a longtime friend, or a well-meaning but overbearing father-in-law, learning to assert yourself with clarity, confidence and calm is one of the most powerful tools we can develop. Good Read:   Being assertive: Reduce stress, communicate better - Mayo Clinic

Send us a textThis is our 5th annual special Pride episode.  San Diego celebrates Pride mid-July.  We are very lucky to welcome back our favorite guest for his third annual Pride episode . . . the multi-hyphenate, guru of gay health and well-being, the influencer that had us at "butt stuff" . . . Dr. Carlton Thomas.  Aside from being a board certified, Mayo Clinic trained gastroenterologist that focuses on gay health, Dr. C continues to change the way conventional medicine views health issues of the LGBTQIA+ community.  He co-hosts his own podcast, Butt Honestly, and travels the world presenting his sex-positive view on health.  Come celebrate Pride the way it was meant to be celebrated -- with good friends, a few laughs, some wine and talk of leather. Instagram, Bluesky and TikTok: @doctorcarltonTwitter:  @doctor_carltonPodcast:  Butt Honestly - available on all streaming services@tugayspodtugayspod@yahoo.com#lgbt #lgbtq #lgbtqia+ #sandiego #gaysandiego #gaycommedy #pride #sdpride25 Gay San Diego comedy LGBT LGBTQ LGBTQIA+@tugayspod tugayspod@yahoo.com#lgbt #lgbtq #lgbtqia+ #sandiego #gaysandiego #gaycommedyGay San Diego comedy LGBT LGBTQ LGBTQIA+Producers: Nick Stone & Andy Smith

I interviewed Dr. Roxana Dronca and Dr. Jeremy Jones who are both oncologists and are leads of Mayo Clinic's Cancer Care Beyond Walls program. Dr. Dronca had the idea of trying to find a way to deliver care of cancer patients in their home and Dr. Jones is responsible for bringing this model to other sites and even partner hospitals.   Episode Resources Connect with Arundhati Parmar aparmar@medcitynews.com  https://twitter.com/aparmarbb?lang=en https://medcitynews.com/   Review, Subscribe and Share If you like what you hear please leave a review by clicking here   Make sure you're subscribed to the podcast so you get the latest episodes. Click here to subscribe with Apple Podcasts  Click here to subscribe with Spotify Click here to subscribe with Podbean Click here to subscribe with RSS  

Join us as we get to know Dr. Dontre' Douse, ENT head and neck surgeon, as he prepares to bring much-needed ENT care to Tifton and the surrounding region in August of 2025. Dr. Douse shares his journey from Savannah to the Mayo Clinic and back to Georgia, his passion for serving rural communities, and what inspired his special interest in head and neck cancer care. Tune in to hear how comprehensive ENT services—including sinus surgery, ear tubes, and cochlear implants—will soon be available close to home through Southwell Ear Nose and Throat. 

Idiopathic intracranial hypertension (IIH), a condition of increased intracranial pressure (ICP), causes debilitating headaches and, in some, visual loss. The visual defects are often in the periphery and not appreciated by the patient until advanced; therefore, monitoring visual function with serial examinations and visual fields is essential. In this episode, Kait Nevel, MD speaks with John J. Chen, MD, PhD, and Susan P. Mollan, MBChB, PhD, FRCOphth, authors of the article “Treatment and Monitoring of Idiopathic Intracranial Hypertension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Chen is a professor of ophthalmology and neurology at the Mayo Clinic in Rochester, Minnesota. Dr. Mollan is an honorary professor of metabolism and systems science in the department of neuro-ophthalmology at University Hospitals Birmingham in Birmingham, United Kingdom. Additional Resources Read the article: Treatment and Monitoring of Idiopathic Intracranial Hypertension Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Guests: @chenmayo, @DrMollan Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kate Nevel. Today, I'm interviewing Drs John Chen and Susan Mollan about their article on treatment and monitoring of idiopathic intracranial hypertension, which appears in the June 2025 Continuum issue on disorders of CSF dynamics. Drs Chen and Mollan, welcome to the podcast. And please, could you introduce yourselves to the audience? Dr Chen: Hello, everyone. I'm John Chen, one of the neuro-ophthalmologists at the Mayo Clinic. Thanks for having us here. Dr Mollan: Yeah, it's great to be with you here. I'm Susan Mollan. I'm a consultant neuro-ophthalmologist in Birmingham, England. Dr Nevel: Wonderful. So great to have you both here today, and our listeners. To start us off, talking about your article, can you share with us what you think is the most important takeaway from your article for the practicing neurologist out there? Dr Chen: Yeah, so our article talked about the treatment and monitoring of IIH. And I think one takeaway point is, IIH is becoming much more prevalent now that there's this worldwide obesity epidemic with obesity having- essentially being the largest risk factor for IIH other than female. It's really important to monitor vision because vision loss is often peripheral vision loss at first, which the patient may be completely unaware of. And so, it's important to pair up with an ophthalmologist so you can monitor the papilledema of the visual fields and make sure they don't get permanent vision loss. And in the article, we also talk about- there's been changes in the treatment of severe IIH, where traditionally, we used VP shunts; but there's been a trend toward using more venous sinus stenting in addition to the traditional surgeries. Dr Nevel: Great, thank you. I think probably most of our listeners or a lot of neurologists out there have a pretty good understanding of kind of the basics of the IIH. But can you kind of just go over a few key characteristics of IIH, and maybe some things that are less commonly known or things that are maybe just been kind of better understood over the past decade, perhaps? Dr Mollan: Yes, certainly. I think, as Dr Chen said, it's because this condition is becoming more prevalent, people recognize it. I think it's- we like to go back to the diagnostic criteria so that we're making a very accurate diagnosis. So, the patients may come in to the emergency room with, say, papilledema that's been identified elsewhere or crashing headaches. And it's important to go through that sort of diagnostic pathway, taking a blood pressure, taking a full blood count to make sure the patient is anemic, and then moving forward with that confirmation of papilledema into urgent neuroimaging, whether it's CT or MRI, but including venography to exclude a venous sinus thrombosis. And then if you have no structural lesion that's causing the raised ICP, it's moving forward with your lumbar puncture and carefully checking those pressures. But the patients may not only have crashing headache, they often have pulsatile tinnitus and neck pain. I think some of the features that we're now recognizing is the systemic metabolic effects that are unique to IIH. And so, there's an increased risk of cardiometabolic disease that's over and above what is conferred by obesity. Also, our patients have a sort of maternal health burden where they get impaired fertility, gestational diabetes and preeclampsia. And there's also an associated mental health burden, amongst other things. So we're really starting to understand the spectrum of the disease a bit more. Dr Nevel: Yeah, thank you for that. And that really struck me in your article, how important it is to be aware of those things so that we're making sure that we're managing our whole patient and connecting them with the appropriate providers for some of those other issues that may be associated. For the practicing neurologist out there without all the neuro-ophthalmology equipment, if you will, what should our bedside exam focus on to help us get maybe an early but accurate picture of the patient's visual function when we suspect IIH to be at play, perhaps before they can get in with the neuro-ophthalmologist? Dr Chen: Yeah, I think at the bedside you can still check visual acuity and confrontational visual fields, you know, with finger counting. Of course, you have to know that those are, kind of, crude kind of ways of screening. With papilledema, oftentimes the visual acuity is intact. And the confrontational visual fields aren't as sensitive as automated perimetry. Another important thing will be to do your direct ophthalmoscope and look at the amount of papilledema. If it's grade one or two papilledema on the more mild side, it's actually not vision threatening. It's the higher degrees of papilledema that can cause rapid vision loss. And so, if you look in and you see grade one papilledema, obviously you need to do the full workup, the MRI, MRV, lumbar puncture. But in terms of rapidly getting to an ophthalmologist to screen for vision loss, it's not going to be as important because you're not going to have vision loss at that low grade. If you look in and you see this rip-roaring papilledema, grade five papilledema, that patient is going to be at very severe risk of vision loss. So, I think that exam, looking at the optic nerve can be very helpful. And of course, talking to the patient about symptoms; is there decreased vision Is there double vision from a sixth nerve palsy? Are there transient visual obscurations which would indicate at least a higher degree of papilledema? That'd be helpful as well. Dr Nevel: Great, thank you. And when the patient does get in with a neuro-ophthalmologist, you talk in your article and, of course, in clinical practice, how OCT testing is important to monitor in this condition. Can you provide for the listeners the definition of OCT and how it plays a role in monitoring patients with IIH? Dr Mollan: Sure. So, OCT is short for optical coherence tomography imaging, and really the eye has been at the forefront of OCT alone. Our sort of cardiology colleagues are catching up on the imaging of blood vessels. But what it allows us to do is give us really good cross-sectional, anatomical-level changes that we can see both in the retina and also at the optic nerve head. And it gives us some really good measurements. It's not so good at sort of saying, is this definitely papilledema or not? That sort of lower end of disc elevation. But it is very good at ruling out what we call the pseudopapilledema. So, things like drusens or these other little masses we find underneath the optic nerve head. But in terms of monitoring, because we can longitudinally take these images and the reproducibility is pretty good at the optic nerve head, it allows us to see whether there's direct changes: either the papilledema getting worse or the papilledema getting better at the optic nerve head. It also gives us some indication of what's going on in the ganglion cell layer complex. And that can be helpful when we're thinking about sort of looking at structure versus function. So, ophthalmologists in general, we love OCT; and we spend much more time nowadays looking at the OCT than we really do the back of the eye. And it's just become critical for patients with papilledema to be able to be very accurate from visit to visit to see what's changing. Dr Nevel: How do you determine how frequently somebody needs to see the neuro-ophthalmologist with IIH and how often they need that OCT evaluation? Dr Chen: Once the diagnosis of IIH is made, how often they need to be seen and how frequent they need to be seen depends on the degree of papilledema. And again, OCT is really nice. You can quantify it and then different providers can actually use the same OCT numbers, which is super helpful. But again, if it's grade three papilledema or higher, or article thickness of 200 or higher, I tend to follow them a little bit more closely, trying to treat them more aggressively. Try to get the papilledema down into a safer zone. If it's grade one or two papilledema, we see them less frequently. So, my first visit might be three months out. They come with grade five papilledema, I'm seeing them within a few days to make sure that's papilledema's come down quickly because we're trying to decide, are they going to need surgery or not? Dr Nevel: Yeah, great. And that's a nice segue into talking a little bit about how we treat patients with IIH after the diagnosis is confirmed. And I'd like to just point out you have a very lovely figure in your article---Figure 5-6,---that I'd like to direct our listeners to read your article and check out that figure, which is kind of an algorithm on how we think about the various treatment options for patients who have IIH, which seems to rely a lot on the degree of presence of papilledema and the presence of vision disturbance. Could you maybe walk us through a little bit about how you think about the different treatment options for patients with IIH and when more urgent surgical intervention might be indicated? Dr Mollan: Yeah, sure. We always find it quite hard in any medical specialty to write these kind of flow diagrams because it's really an individual we're looking at. But these are kind of what we'd say is “broad brushstrokes” into those patients that we worry about, sort of, red disease in those patients, more amber disease. Now obviously, even those patients that may not have severe papilledema, they may have crashing headaches. So, they may be an urgent referral themselves because of that. And so, it's nice to try and work out which end of the spectrum you're working with. If we think of the papilledema, Dr Chen's already laid out the sort of lower end of the prison's scale---our grades one, our grades two---that we're less anxious about. And those patients, we would definitely be having discussions about medical management, which includes acetazolamide therapy; but also thinking about weight management. And it may well be that we talk a little bit further about weight management, but I think it's helpful to sort of coach those conversations after you've made a definite diagnosis. And then laying out the risk that's caused, potentially, the IIH in an individual. And then having a sort of open conversation with them about what changes they can have in their lifestyle alongside thinking about medical therapy. There's some patients with very low levels of papilledema that we decide not to put on medicines initially. As patients progress up that papilledema grade, we're definitely thinking about medical therapy. And our first line from the IIH treatment trial would be using acetazolamide, but we need to be thinking about using appropriate dosing. So, a lot of the patients that I see can be sent to me with very low doses that may be inappropriate for that person. In the IIHTT they used up to four grams daily in a divided dose. And you do need to counsel your patients when you're putting them on acetazolamide because of the side effects. You've got quite a nice table in this article about the side effects. I think if you get the patient on board, that they understand that they will experience side effects, that is helpful because they will expect it, and then possibly tolerate it a bit better. Moving through to that area where we're more anxious, that visual-threatening papilledema. As Dr Chen said, it's sort of like you look in and it's sort of “blood and thunder” in there. And you need to be getting on and encouraging the ophthalmologist to get a formal assessment of the visual field. It's very difficult to determine exactly the level at which- and we talk about the mean deviation in a lot of our research studies. But in general, it's a combination of things: the patient's journey to get to you, their symptoms, what's going on with the visual field, but what's also happening at the OCT. So, we look in and we see that fluid is seeping towards the fovea. We get very anxious, and those patients may not even have enough time for a rapid escalation of acetazolamide. It may well be at the first presentation, which we would term, like, fulminant; that we'd be thinking about surgical intervention. And I think before I stop, the other thing to say is, the surgical landscape is really changing. So, we're having some good studies coming out in terms of stenting. And so, there is a sort of bracket where it may well be that we are thinking about neuroradiological intervention in an earlier case. They may not quite be at that visual-threatening stage, but they may be resistant to medical treatments. Dr Nevel: Thank you for that. What do you think is a potential pitfall or a mistake to avoid, if you will, in the management of patients with IIH? Dr Chen: I think it's- in terms of pitfalls, I think the potential pitfalls I've seen are essentially patients where we don't necessarily create a good patient physician relationship. Where they don't have buy-ins on the treatment, they don't have buy-ins to come back, and they're lost to follow-up. And these patients can be dangerous, because they could have vision threatening papilledema and if not getting the appropriate treatment---and if they're not monitoring the vision---this can lead to poor outcomes. So, I've definitely seen that happen. As Dr Mollan said, you really have to tell them about the side effects from the medications. If you just take acetazolamide, letting them know the paresthesias and the changes in taste and some of these other side effects, they're going to immediately stop the medication. Again, and these medications do work, proven in the IIH treatment trial. So again, I think that patient-physician relationship is very important to make sure they have appropriate follow up. Dr Nevel: The topic of weight loss in this patient population can be tricky, and I know I talked with Susie in a prior interview about how to approach this topic with our patients in a sensitive and compassionate manner. Once this topic is broached, I find many patients are looking for advice on strategies for weight loss, or potentially medications or other interventions. How do you prioritize or think about the different weight loss strategies or treatments with your patients, and how do you think about the way that you recommend these different treatments or not? Dr Mollan: Yeah. I think that's a really great question because we sort of stray here into a specialty that we have not been trained in. One thing I definitely ask my patients: if they've been on a weight loss journey before, and what's worked for them and what's not worked for them. And within our different healthcare systems, we have access to different tiers of weight management approaches. But for the person sitting in front of me, that possibly there may be a long journey to access more professional care, it's about understanding. iIs there things that are free, such as, we have some apps in the National Health Service which are weight management applications where they can actually just start putting in their calories, their daily calorie intake. And those apps can be quite helpful and guiding in terms of targeting areas, but also informing the patient of what types of foods to avoid in their diet and what types of foods to include in their diet. And with some of the programs that are completely complementary, they also sometimes add on things about exercise. But I think it is a really difficult thing to manage as, say, an ophthalmologist or a neurologist, mainly because it's not our area of expertise. And I think we've all got to find, in our local hospitals and healthcare systems, those pathways where the patients may be able to access nutritional support, and sort of behavioral lifestyle therapy support, all the way through to the new medications for weight loss; and also for some people, bariatric surgery pathways. It's a tricky topic. Dr Nevel: So how should we counsel our patients about what to expect in the future in terms of visual outcomes? Dr Chen: I think a lot of that depends on the degree of papilledema when they present. If a patient comes in with grade five papilledema, that fulminant IIH that Dr Mollan had mentioned, these patients can have very severe vision loss. And even if we treat them very aggressively with high-dose medications and urgent surgical interventions, sometimes they can have permanent vision loss. And so, we counsel them that, you know, there's a strong chance that they're going to have a good amount of vision loss. But some patients, we're very surprised and we get a lot of vision back. So, we kind of set expectations, but we're cautiously optimistic that we can get vision back. If a patient presents with more mild papilledema like grade one or two papilledema, they're most likely not going to have any permanent vision loss as long as we're treating them, we're monitoring their vision, they're coming to their follow-ups. They tend to do very well from a vision perspective. Dr Nevel: That's great, thank you. And you know, ties into what you said earlier about really making sure that, you know, we create good- as with any patient, but good physician-patient relationships so that they, you know, trust us and they come to follow up so we can really monitor their vision appropriately. What do you think is going on in research in this area that's exciting? What do you think one of the next breakthroughs or thing that we need to understand the most about treatment and monitoring of IIH? Dr Chen: I think surgically, venous sinus stenting is going to probably take over the bulk of surgeries. We still need that randomized clinical trial, but we have some amazing outcomes with venous sinus stenting. And there's many efforts on randomized clinical trials for venous sinus stenting. So we'll have those results soon. From a medical standpoint, Dr Mollan can actually say, actually, more about this. Dr Mollan: I completely agree. The GLP-1 receptor agonists, the twofold prong approach: one is the weight loss where these patients, you know, have significant weight loss to put their disease into remission; and the other side of it is whether certain GLP-1s have the ability to reduce intracranial pressure. So, a phase 2 study that we undertook here in Birmingham did show that we were able to reduce intracranial pressure, but we don't think it's a class effect. So, I think the sort of big breakthrough will be looking at novel therapies like xenotide and other drugs that, say, work on the proximal kidney tubule. Are they able to reduce intracranial pressure directly? And I think we are on the cusp of a real breakthrough for this disease. Dr Nevel: Great. Thank you so much for chatting with me today. And I really learned a lot, appreciated the opportunity. I hope our listeners learned something today, too. So again, today I've been interviewing Drs John Chen and Susan Mollan about their article on treatment and monitoring of idiopathic intracranial hypertension, which appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Dr. Vamsi Velcheti and Dr. Nate Pennell discuss novel treatment approaches in small cell and non-small cell lung cancer that were featured at the 2025 ASCO Annual Meeting. TRANSCRIPT Dr. Vamsi Velcheti: Hello, I'm Dr. Vamsi Velcheti, your guest host of the ASCO Daily News Podcast. I'm a professor of medicine and chief of hematology and oncology at the Mayo Clinic in Jacksonville, Florida. The 2025 ASCO Annual Meeting featured some exciting advancements in small cell lung cancer, targeted therapies for non-small cell lung cancer, and other novel [treatment] approaches. Today, I'm delighted to be joined by Dr. Nate Pennell to discuss some of the key abstracts that are advancing the lung cancer field. Dr. Pennell is the co-director of the Cleveland Clinic Lung Cancer Program and also the vice chair of clinical research at the Taussig Cancer Institute. Our full disclosures are available in the transcript of this episode. Nate, it's great to have you back on the podcast. Thanks so much for being here. Dr. Nate Pennell: Thanks, Vamsi. Always a pleasure. Dr. Vamsi Velcheti: Let's get started, and I think the first abstract that really caught my attention was Abstract 8516, “The Randomized Trial of Relevance of Time of Day of Immunotherapy for Progression-Free and Overall Survival in Patients With Non-Small Cell Lung Cancer.” What are your thoughts about this, Nate? Dr. Nate Pennell: I agree. I thought this was one of the most discussed abstracts, certainly in the lung cancer session, but I think even outside of lung cancer, it got some discussion. So, just to put this in perspective, there have been a number of publications that have all been remarkably consistent, and not just in lung cancer but across multiple cancer types, that immunotherapy, immune checkpoint inhibitors, are commonly used. And all of them have suggested, when looking at retrospective cohorts, that patients who receive immune checkpoint inhibitors earlier in the day – so in the morning or before the early afternoon – for whatever reason, appear to have better outcomes than those who get it later in the day, and this has been repeated. And I think many people just sort of assumed that this was some sort of strange association and that there was something fundamentally different from a prognostic standpoint in people who came in in the morning to get their treatment versus those who came later in the afternoon, and that was probably the explanation. The authors of this randomized trial actually decided to test this concept. And so, about 210 patients with previously untreated advanced non-small cell lung cancer were randomly assigned to get chemo and immune checkpoint inhibitor – either pembrolizumab or sintilimab – and half of them were randomly assigned to get the treatment before 3 PM in the afternoon, and half of them were assigned to get it after 3 PM in the afternoon. And it almost completely recapitulated what was seen in the retrospective cohorts. So, the median progression-free survival in those who got earlier treatment was 13.2 months versus only 6.5 months in those who got it later in the day. So, really enormous difference with a hazard ratio of 0.43, which was statistically significant. And perhaps even more striking, the median overall survival was not reached in the early group versus 17.8 months in the late group with a hazard ratio of 0.43, also highly statistically significant. Even the response rate was 20% higher in the early patients; 75% response rate compared to 56% in the late-time-of-day patients. So very consistent across all measures of efficacy with pretty good matched characteristics across the different groups. And so, I have to tell you, I don't know what to make of this. I certainly was a skeptic about the retrospective series, but now we have a prospective randomized trial that shows essentially the same thing. So, maybe there is a difference between getting treated in the morning, although I have yet to hear someone give a very good mechanistic explanation as to why this would be. What were your thoughts on this? Dr. Vamsi Velcheti: It's indeed fascinating, Nate, and I actually think this was a very interesting abstract. Really, I was caught off guard looking at the data. I mean, if it were a drug, we would be so excited, right? I mean, with those kind of survival benefits. I don't know. I think circadian rhythm probably has something to do with it, like different cytokine profiles at the time of administration. I mean, who knows? But I think it's a randomized trial, and I think I would expect to see a mad rush for treatment appointments early in the morning given this, and at least I want my patients to come in first thing in the morning. It'll be interesting to see. Dr. Nate Pennell: It's important to point out that in this study, everyone got chemo and immunotherapy. And, at least in our cancer center, most patients who are getting platinum-doublet chemotherapy and immunotherapy actually do get treated earlier in the day already, just because of the length of the infusion appointment that's needed. So it really is oftentimes people getting single-agent immunotherapy who are often getting the later, shorter visits. But if you have a choice, I think it would be very reasonable to have people treated earlier in the day. And I do think most of the impressions that I got from people about this is that they would like to see it reproduced but certainly well worth further investigation. And I personally would like to see more investigation into what the rationale would be for this because I still can't quite figure out, yes, if you got it at, say, you know, 5 PM, that's later in the day and I can understand that maybe your immune system is somewhat less receptive at that point than it would be in the morning. But because these checkpoint inhibitors have such long half-lives, it's still in your system the next morning when your immune system is supposedly more receptive. So I don't quite understand why that would be the case. Well, let's move on to the next study. I would like to hear your thoughts on Abstract 8515, “Plasma-Guided, Adaptive First-Line Chemoimmunotherapy for Non-Small Cell Lung Cancer.” Dr. Vamsi Velcheti: Yeah, this was another abstract that seems to be really interesting in my opinion. I think there's kind of a lot of emphasis lately on ctDNA and MRD-based assays to monitor disease. In the lung cancer space, we haven't had a lot of clinical trials looking at this prospectively, and this was one of those pilot studies where they looked at circulating free DNA (cfDNA)-based response-adaptive strategy for frontline patients who are PD-L1 positive. So, patients started with pembrolizumab monotherapy, and based on plasma molecular response after 2 cycles, those patients without response received early treatment intensification with a platinum doublet. So the approach essentially was to reduce the chemotherapy exposure in patients who respond to immunotherapy. And only about 17.5% of the patients on the trial received chemotherapy based on lack of molecular response. So, in this trial, what they found was patients with the cfDNA response had a markedly improved PFS of 16.4 months versus 4.8 months. So essentially, like, this is a really nice study to set a foundation on which we have to do larger studies to incorporate molecular markers trying to look at cfDNA response to inform treatment strategy, either escalation or de-escalation strategies. So, I thought it was a very interesting study. Dr. Nate Pennell: Yeah. I mean, we always have this question for patients, “Should they get immunotherapy alone or combined with chemo?” and I think this certainly is intriguing, suggesting that there may be ways you can monitor people and perhaps rescue those that aren't going to respond to single agent. I'd like to see a randomized trial against, you know, this strategy, perhaps against everyone getting, say, chemoimmunotherapy or make sure that you're not potentially harming people by doing this strategy. But I agree, it's time to move beyond just observing that cell-free DNA is prognostic and important and start using it to actually guide treatment. Dr. Vamsi Velcheti: Yeah, and I would just caution though, like, you know, I think we need more data, but, however, it's certainly a very interesting piece of data to kind of help inform future trials. So, there was another abstract that caught my attention, and I think this would be a very interesting abstract in the EGFR space. Abstract 8506, "Patritumab Deruxtecan (HER3-DXd) in Resistant EGFR-Mutant Advanced Non-Small Cell Lung Cancer Patients After Third-Generation EGFR TKI," it's the HERTHENA-Lung02 study. What do you think about the results of this study? Dr. Nate Pennell: Yeah, this was, I would say, very widely anticipated and ultimately a little disappointing, despite being a positive trial. So, these are patients with EGFR-mutant non-small cell lung cancer who have progressed after a third-generation EGFR TKI like osimertinib. This is really an area of major unmet need. We do have drugs like amivantamab in this space, but still definitely an area where essentially patients move from having a highly effective oral therapy to being in the realm of chemotherapy as their best option. So, this HER3 antibody-drug conjugate, patritumab deruxtecan, had some good single-arm data for this. And we're sort of hoping this would become an available option for patients. This trial was designed against platinum-doublet chemotherapy in this setting and with a primary endpoint of progression-free survival. And it actually was positive for improved progression-free survival compared to chemo with a hazard ratio of 0.77. But when you look at the medians, you can see that the median PFS was only 5.8 versus 5.4 months. It was really a modest difference between the two arms. And on the interim analysis, it appeared that there will not be a difference in overall survival between the two arms. In fact, the hazard ratio at the interim analysis was 0.98 for the two arms. So based on this, unfortunately, the company that developed the HER3-DXd has withdrawn their application to the FDA for approval of the drug, anticipating that they probably wouldn't get past approval without that overall survival endpoint. So, unfortunately, probably not, at least for the near future, going to be a new option for these patients. Dr. Vamsi Velcheti: Yeah, I think this is a space that's clearly an unmet need, and this was a big disappointment, I should say. I think all of us were going into the meeting anticipating some change in the standard of care here. Dr. Nate Pennell: Yeah, I agree. It was something that I was telling patients, honestly, that I was expecting this to be coming, and so now, definitely a bit of a disappointment. But it happens and, hopefully, it will still find perhaps a role or other drugs with a similar target. Certainly an active area. Well, let's leave the EGFR-mutant space and move into small cell. There were a couple of very impactful studies. And one of them was Abstract 8006, “Lurbinectedin Plus Atezolizumab as First-Line Maintenance Treatment in Patients With Extensive-Stage Small Cell Lung Cancer, Primary Results from the Phase III IMforte Trial.” So, what was your impression of this? Dr. Vamsi Velcheti: Yeah, I think this is definitely an interesting study, and small cell, I remember those days when we had barely any studies of small cell at ASCO, and now we have a lot of exciting developments in the small cell space. It's really good to see. The IMforte trial is essentially like a maintenance lurbinectedin trial with atezolizumab maintenance. And the study was a positive trial. The primary endpoint was a PFS, and the study showed improvement in both PFS and OS with the addition of lurbinectedin to atezolizumab maintenance. And definitely, it's a positive trial, met its primary endpoint, but I always am a little skeptical of adding maintenance cytotoxic therapies here in this setting. In my practice, and I'd like to hear your opinion, Nate, most patients with small cell after 4 cycles of a platinum doublet, they're kind of really beaten up. Adding more cytotoxic therapy in the maintenance space is going to be tough, I think, for a lot of patients. But also, most importantly, I think this rapidly evolving landscape for patients with small cell lung cancer with multiple new, exciting agents, actually like some FDA-approved like tarlatamab, also like a lot of these emerging therapeutics like I-DXd and other ADCs in this space. You kind of wonder, is it really optimal strategy to bring on like another cytotoxic agent right after induction chemotherapy, or do you kind of delay that? Or maybe have like a different strategy in terms of maintenance. I know that the tarlatamab maintenance trial is probably going to read out at some point too. I think it's a little challenging. The hazard ratio is also 0.73. As I said, it's a positive trial, but it's just incremental benefit of adding lurbi. And also on the trial, we need to also pay attention to the post-progression second-line treatments, number of patients who received tarlatamab or any other investigational agents.  So I think it's a lot of questions still. I'm not quite sure I'd be able to embrace this completely. I think a vast majority of my patients might not be eligible anyway for cytotoxic chemotherapy maintenance right away, but yeah, it's tough. Dr. Nate Pennell: Yeah. I would call this a single and not a home run. It definitely is real. It was a real overall survival benefit. Certainly not surprising that a maintenance therapy would improve progression-free survival. We've known that for a long time in small cell, but first to really show an overall survival benefit. But I completely agree with you. I mean, many people are not going to want to continue further cytotoxics after 4 cycles of platinum-doublet chemo. So I would say, for those that are young and healthy and fly through chemo without a lot of toxicity, I think certainly something worth mentioning. The problem with small cell, of course, is that so many people get sick so quickly while on that observation period after first-line chemo that they don't make it to second-line treatment. And so, giving everyone maintenance therapy essentially ensures everyone gets that second-line treatment. But they also lose that potentially precious few months where they feel good and normal and are able to be off of treatment. So, I would say this is something where we're really going to have to kind of sit and have that shared decision-making visit with patients and decide what's meaningful to them. Dr. Vamsi Velcheti: Yeah, I agree. The next abstract that was a Late-Breaking Abstract, 8000, “Overall Survival of Neoadjuvant Nivolumab Plus Chemotherapy in Patients With Resectable Non-Small Cell Lung Cancer in CheckMate-816.” This was a highly anticipated read-out of the OS data from 816. What did you make of this abstract? Dr. Nate Pennell: Yeah, I thought this was great. Of course, CheckMate-816 changed practice a number of years ago when it first reported out. So, this was the first of the neoadjuvant or perioperative chemoimmunotherapy studies in resectable non-small cell lung cancer. So, just to review, this was a phase 3 study for patients with what we would now consider stage II or stage IIIA resectable non-small cell lung cancer. And they received three cycles of either chemotherapy or chemotherapy plus nivolumab, and that was it. That was the whole treatment. No adjuvant treatment was given afterwards. They went to resection. And patients who received the chemoimmunotherapy had a much higher pathologic complete response rate and a much better event-free survival. And based on this, this regimen was approved and, I think, at least in the United States, widely adopted.  Now, since the first presentation of CheckMate 816, there have been a number of perioperative studies that have included an adjuvant component of immunotherapy – KEYNOTE-671, the AEGEAN study – and these also have shown improved outcomes. The KEYNOTE study with pembrolizumab also with an overall survival benefit. And I think people forgot a little bit about CheckMate-816. So, this was the 5-year overall survival final analysis. And it did show a statistically and, I think, clinically meaningful difference in overall survival with the 3 cycles of neoadjuvant chemo-nivo compared to chemo with a hazard ratio of 0.72. The 5-year overall survival of 65% in the chemo-IO group versus 55% with the chemo alone. So a meaningful improvement. And interestingly, that hazard ratio of 0.72 is very similar to what was seen in the peri-operative pembro study that included the adjuvant component. So, very much still relevant for people who think that perhaps the value of those neoadjuvant treatments might be really where most of the impact comes from this type of approach. They also gave us an update on those with pathologic complete response, showing really astronomically good outcomes. If you have a pathologic complete response, which was more than a quarter of patients, the long-term survival was just phenomenal. I mean, 95% alive at 5 years if they were in that group and suggesting that in those patients at least, the adjuvant treatment may not be all that important.  So, I think this was an exciting update and still leaves very much the open question about the importance of continuing immunotherapy after surgery after the neoadjuvant component. Dr. Vamsi Velcheti: Yeah, I completely agree, Nate. I think the million-dollar question is: “Is there like a population of patients who don't have complete response but like maybe close to complete response?” So, would you like still consider stopping adjuvant IO? I probably would not be comfortable, but I think sometimes, you know, we all have patients who are like very apprehensive of continuing treatments. So, I think that we really need more studies, especially for those patients who don't achieve a complete CR. I think trying to find strategies for like de-escalation based on MRD or other risk factors. But we need more trials in that space to inform not just de-escalation, but there are some patients who don't respond at all to a neoadjuvant IO. So, there may be an opportunity for escalating adjuvant therapies. So, it is an interesting space to watch out for. Dr. Nate Pennell: No, absolutely. Moving to KRAS-mutant space, so our very common situation in patients with non-small cell lung cancer, we had the results of Abstract 8500, “First-Line Adagrasib With Pembrolizumab in Patients With Advanced or Metastatic KRASG12C-Mutated Non-Small Cell Lung Cancer” from the phase 2 portion of the KRYSTAL-7 study. Why was this an interesting and important study? Dr. Vamsi Velcheti: First of all, there were attempts to kind of combine KRASG12C inhibitors in the past with immune checkpoint inhibitors, notably sotorasib with pembrolizumab. Unfortunately, those trials have led to like a lot of toxicity, with increased especially liver toxicity, which was a major issue. This is a phase 2 study of adagrasib in combination with pembrolizumab, and this is a study in the frontline setting in patients with the G12C-mutant metastatic non-small cell lung cancer. And across all the PD-L1 groups, the ORR was 44%, and the median PFS was 11 months, comparable to the previous data that we have seen with adagrasib in this setting. So it's not like a major improvement in clinical efficacy. However, I think the toxicity profile that we were seeing was slightly better than the previous trials in combination with sotorasib, but you still have a fair amount of transaminitis even in the study. At this point, this is not ready for clinical primetime. I don't think we should be using sotorasib or adagrasib in the frontline or even in the second line in combination with checkpoint inhibitors. Combining these drugs with checkpoint inhibitors in the clinical practice might lead to adverse outcomes. So, we need to wait for more data like newer-generation G12C inhibitors which are also being studied in combination, so we'll have to kind of wait for more data to emerge in this space. Dr. Nate Pennell: I agree, this is not immediately practice changing. This is really an attempt to try to combine targeted treatment with immune checkpoint inhibitor. And I agree with you that, you know, it does appear to be perhaps a little bit better tolerated than some of the prior combinations that have tried in this space. The outcomes overall were not that impressive, although in the PD-L1 greater than 50%, it did have a better response rate perhaps than you would expect with either drug alone. And I do think that the company is focusing on that population for a future randomized trial, which certainly would inform this question better. But in the meantime, I agree with you, there's a lot of newer drugs that are coming along that potentially may be more active and better tolerated. And so, I'd say for now, interesting but we'll wait and see. Dr. Vamsi Velcheti: Yeah, so now moving back again to small cell. So, there was a Late-Breaking Abstract, 8008. This is a study of tarlatamab versus chemotherapy as second-line treatment for small cell lung cancer. They presented the primary analysis of the phase III DeLLphi-304 study. What do you think about this? Dr. Nate Pennell: Yeah, I thought this was really exciting. This was, I would say, perhaps the most important lung study that was presented. Tarlatamab is, of course, the anti-DLL3 bispecific T-cell engager compound, which is already FDA approved based on a prior single-arm phase II study, which showed a very nice response rate as a single agent in previously treated small cell lung cancer and relatively manageable side effects, although somewhat unique to solid tumor docs in the use of these bispecific drugs in things like cytokine release syndrome and ICANS, the neurologic toxicities. So, this trial was important because tarlatamab was approved, but there were also other chemotherapy drugs approved in the previously treated space. And so, this was a head-to-head second-line competition comparison between tarlatamab and either topotecan, lurbinectedin, or amrubicin in previously treated small cell patients with a primary endpoint of overall survival. So, a very well-designed trial. And it did show, I think, a very impressive improvement in overall survival with a median overall survival in the tarlatamab group of 13.6 months compared to 8.3 months with chemotherapy, hazard ratio of 0.6. And progression-free survival was also longer at 4.2 months versus 3.2 months, hazard ratio of 0.72. In addition to showing improvements in cancer-related symptoms that were improved in tarlatamab compared to chemotherapy, there was actually also significantly lower rates of serious treatment-related adverse events with tarlatamab compared to chemotherapy. So, you do still see the cytokine release syndrome, which is seen in most people but is manageable because these patients are admitted to the hospital for the first two cycles, as well as a significant number of patients with neurologic side effects, the so-called ICANS, which also can be treated with steroids. And so, I think based upon the very significant improvement in outcomes, I would expect that this should become our kind of standard second-line treatment since it seems to be much better than chemo. However, tarlatamab is definitely a new drug that a lot of places are not used to using, and I think a lot of cancer centers, especially ones that aren't tied to a hospital, may have questions about how to deal with the CRS. So, I'm curious your thoughts on that. Dr. Vamsi Velcheti: Yeah, thank you, Nate. And I completely agree. I think the data looked really promising, and I've already been using tarlatamab in the second-line space. The durability of response and overall, having used tarlatamab quite a bit - like, I participated in some of the early trials and also used it as standard of care - tarlatamab has unique challenges in terms of like need for hospitalization for monitoring for the first few treatments and make sure, you know, we monitor those patients for CRS and ICANS. But once you get past that initial administration and monitoring of CRS, these patients have a much better quality of life, they're off chemotherapy, and I think it's really about the logistics of actually administering tarlatamab and coordination with the hospital and administration in the outpatient setting. It's definitely challenging, but I think it definitely can be done and should be done given what we are seeing in terms of clinical efficacy here. Dr. Nate Pennell: I agree. I think hospital systems now are just going to have to find a way to be able to get this on formulary and use it because it clearly seems to be more effective and generally better tolerated by patients. So, should move forward, I think. Finally, there's an abstract I wanted to ask you about, Abstract 8001, which is the “Neoadjuvant osimertinib with or without chemotherapy versus chemotherapy alone in resectable epidermal growth factor receptor-mutated non-small cell lung cancer: The NeoADAURA Study”. And this is one that I think was also fairly highly anticipated. So, what are your thoughts? Dr. Vamsi Velcheti: You know, I wasn't probably surprised with the results, and I believe we were all expecting a positive trial, and we certainly were handed a positive trial here. It's a phase III trial of osimertinib and chemotherapy or osimertinib in the neoadjuvant space followed by surgery, followed by osimertinib. It's a global phase 3 trial and very well conducted, and patients with stage II to stage IIIB were enrolled in the study. And in the trial, patients who had a neoadjuvant osimertinib with or without chemotherapy showed a significant improvement in major pathologic response rates over chemotherapy alone. And the EFS was also positive for osimertinib and chemotherapy, osimertinib monotherapy as well compared to chemotherapy alone. So overall, the study met its primary endpoint, and I think it sheds light on how we manage our patients with early-stage lung cancer. I think osimertinib, we know that osimertinib is already FDA approved in the adjuvant space, but what we didn't really know is how was osimertinib going to work in the neoadjuvant space. And there are always situations, especially for stage III patients, where we are on the fence about, are these patients already close to being metastatic? They have, like, almost all these patients have micrometastatic disease, even if they have stage III. As we saw in the LAURA data, when you look at the control arm, it was like a very short PFS. Chemoradiation does nothing for those patients, and I think these patients have systemic mets, either gross or micrometastatic disease at onset. So, it's really important to incorporate osimertinib early in the treatment course. And I think, especially for the locally advanced patients, I think it's even more important to kind of incorporate osimertinib in the neoadjuvant space and get effective local control with surgery and treat them with adjuvant. I'm curious to hear your thoughts, Nate. Dr. Nate Pennell: I am a believer and have long been a believer in targeted adjuvant treatments, and, you know, it has always bothered me somewhat that we're using our far and away most effective systemic therapy; we wait until after they go through all their pre-op treatments, they go through surgery, then they go through chemotherapy, and then finally months later, they get their osimertinib, and it still clearly improves survival in the adjuvant setting. Why not just start the osimertinib as soon as you know that the patient has EGFR-mutant non-small cell lung cancer, and then you can move on to surgery and adjuvant treatment afterwards? And I think what was remarkable about this study is that all of these patients almost - 90% in each arm - went to surgery. So, you weren't harming them with the neoadjuvant treatment. And clearly better major pathologic response, nodal downstaging, event-free survival was better. But I don't know that this trial is ever going to show an overall survival difference between neoadjuvant versus just surgery and adjuvant treatment, given how effective the drug is in the adjuvant setting. Nonetheless, I think the data is compelling enough to consider this, certainly for our N2-positive, stage IIIA patients or a IIIB who might be otherwise surgical candidates. I think based on this, I would certainly consider that. Dr. Vamsi Velcheti: Yeah, and especially for EGFR, like even for stage IIIB patients, in the light of the LAURA study, those patients who do not do too well with chemoradiation. So you're kind of delaying effective systemic therapy, as you said, waiting for the chemoradiation to finish. So I think probably time to revisit how we kind of manage these locally advanced EGFR patients. Dr. Nate Pennell: Yep, I agree. Dr. Vamsi Velcheti: Nate, thank you so much for sharing your fantastic insights today on the ASCO Daily News Podcast. It's been an exciting ASCO again. You know, we've seen a lot of positive trials impacting our care of non-small cell lung cancer and small cell lung cancer patients. Dr. Nate Pennell: Thanks for inviting me, Vamsi. Always a pleasure to discuss these with you. Dr. Vamsi Velcheti: And thanks to our listeners for your time today. You will find links to all of the abstracts discussed today in the transcript of the episode. Finally, if you value the insights that you hear from the ASCO Daily News Podcast, please take a moment to rate, review, subscribe wherever you get your podcast. 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. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. More on today's speakers:    Dr. Vamsi Velcheti   @VamsiVelcheti    Dr. Nathan Pennell   @n8pennell   Follow ASCO on social media:     @ASCO on Twitter     ASCO on Facebook     ASCO on LinkedIn   ASCO on BlueSky   Disclosures:   Dr. Vamsi Velcheti:   Honoraria: ITeos Therapeutics   Consulting or Advisory Role: Bristol-Myers Squibb, Merck, Foundation Medicine, AstraZeneca/MedImmune, Novartis, Lilly, EMD Serono, GSK, Amgen, Elevation Oncology, Taiho Oncology, Merus   Research Funding (Inst.): Genentech, Trovagene, Eisai, OncoPlex Diagnostics, Alkermes, NantOmics, Genoptix, Altor BioScience, Merck, Bristol-Myers Squibb, Atreca, Heat Biologics, Leap Therapeutics, RSIP Vision, GlaxoSmithKline   Dr. Nathan Pennell:     Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron    Research Funding (Inst): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi 

Host: Darryl S. Chutka, M.D. Guests: Jesse D. Bracamonte, D.O., Casey Martinez, Kiyan Heybati If you're a physician, there are several events during your medical journey that you'll always remember, receiving your letter of acceptance for medical school, medical school graduation and Match Day. For those of you who aren't physicians, Match Day is a very exciting day for medical students. It represents the day students learn where they'll be doing their residency training. It's a complicated process that uses an algorithm to match students and residency positions. But what happens if a student doesn't match with a residency program, what are their options? What do residency programs consider when ranking the numerous student candidates?  What are some common mistakes students make during the match process and how can students maximize their chances of matching with one of their top residency choices? These are questions I'll be asking my guests, Jesse D. Bracamonte, D.O., a family physician and Associate Dean of Student Affairs at the Arizona campus of the Mayo Clinic, as well as Casey Martinez and Kiyan Heybati, both senior medical students from the Mayo Clinic Alix School of Medicine. Our topic of discussion for this podcast will be “Navigating the Match: What Every Medical Student Should Know”. Connect with us and learn more here: https://ce.mayo.edu/online-education/content/mayo-clinic-podcasts

John Lieske, M.D., and Sandra Taler, M.D., explain how Mayo Clinic Laboratories' mass spectrometry assay helps evaluate patients for resistant hypertension. The test detects antihypertensive medications in urine, providing evidence of whether patients are absorbing their medications or whether a new treatment approach might be needed. Speaker 3: (00:33) Could you tell us a little about yourselves and your backgrounds? Speaker 3: (01:41) Dr. Taler, could you provide us with a brief background on resistant hypertension? Speaker 3: (03:43) Can you provide a little bit more background on patients who aren't taking their medications? Speaker 3: (05:11) How do physicians currently assess whether patients are taking their medications? Speaker 3: (07:03) Dr. Lieske, could you tell us how this new assay can be used to help physicians manage their patients with hypertension? Speaker 3: (09:43) Dr. Taler, can you tell us how doctors can use this new testing to manage their patients?

Nancie discusses her "brand fix" classifications of refine, purposefully manage, and transform, how to get started with data even when money and time are tight, some "Taylor Swift" approaches to brand work, and the difference between mission and brand. Key topics include: how to get the organization in harmony; why "The Big Reveal" is usually the wrong way to go; and her belief that both Sephora and Apple are losing brand steam. Tune in to hear case studies on Georgetown, The Mayo Clinic, and Samsung and a humorous story about a heart attack.You were brought in to fix the brand… but what exactly does that mean? In this week's episode of CMO Confidential, host and 5x CMO Mike Linton sits down with brand strategist Nancie McDonnell Ruder, founder of Noetic Consulting, to unpack the real-world challenges behind “fixing” a brand.From navigating crises at major healthcare institutions to helping Georgetown University build brand alignment across decentralized marketing teams, Nancie shares her proven frameworks and hard-won insights on strengthening brands from the inside out.They discuss: • The difference between a brand crisis, a refinement, and a transformation • What to do when your brand is suffering—but the real problem lies elsewhere • Why internal alignment and education are non-negotiable for brand success • The 5 best practices for brand revitalization (with names like Taylor Swift songs!) • Brand fails to avoid—including the “Big Reveal” trap and skipping customer data • And yes… the show ends with a heart attack, mouth-to-mouth CPR, and a forehead kiss (you'll just have to listen)00:00 – Intro: Welcome & episode setup01:02 – What does it really mean to “fix the brand”?03:45 – The Georgetown University brand refinement case06:25 – Standing up a brand for the first time (Mayo Clinic example)08:55 – Brand crisis vs. product/perception issue: How to tell the difference11:40 – Diagnosing the real problem: What does the data say?14:05 – Samsung's brand affinity challenge and how they solved it16:20 – The 5 best practices for brand revitalization (Taylor Swift edition)19:45 – Worst practices: The “big reveal,” internal misalignment, and ignoring skeptics23:05 – The importance of activating the brand internally25:30 – Brands to watch: Sephora, Apple, and Domino's28:20 – Funniest brand moment: A heart attack, CPR, and unexpected teamwork31:15 – Final takeaway + Mike's sauceless pizza story33:30 – Outro: Upcoming episodes and where to subscribeIf you're a CMO, CEO, board member, or founder facing brand issues—or aiming to avoid them—this episode is your toolkit.

Broadcast from KSQD, Santa Cruz on 6-19, 2025: Dr. Dawn presents the VITAL study evidence showing 2,000 IU daily vitamin D prevents telomere shortening in immune cells, effectively slowing biological aging by three years. Groundbreaking mouse research reveals maternal iron deficiency can alter fetal sex development. When iron levels dropped 60%, the SYR gene controlling male development switched off, causing 6 of 39 XY offspring to develop ovaries instead of testes. Thus, mammalian sex can be influenced by environmental factors just like in amphibians and fish. Dr. Dawn connects this to gender identity questions, advocating supporting puberty blockers based on their 30-year safety record. Dr. Dawn advocates widespread CPR and AED training after describing a successful Buffalo airport rescue. With 350,000 annual out-of-hospital cardiac arrests and 90% fatality rates, immediate AED intervention can triple survival odds. She promotes the Pulsepoint app registering 185,000 AEDs and praises countries like Norway achieving 90% population CPR training through driver's license requirements. Post-Roe v. Wade data shows vasectomies doubled in men aged 19-26 while tubal ligations rose 70%, mostly in abortion-ban states. Dr. Dawn notes the irony that policies intended to increase births prompted widespread voluntary sterilization. Environmental concerns from January 2025 Moss Landing battery fire and LA wildfires highlight toxic contamination from burning lithium, plastics, and building materials. She advocates fire-resistant landscaping and home hardening, noting some fire-resistant homes survived while surroundings burned. British research shows pet ownership provides life satisfaction equivalent to $90,000 annual income boost. Dr. Dawn experiences this firsthand, noting pets provide family-like benefits without complex interpersonal dynamics. Sleep study reveals 15 minutes additional nightly sleep improves cognitive performance in tweens. Children sleeping 7.25 versus 7.10 hours showed better academics and larger brain volumes, though Dr. Dawn questions causation versus correlation. Mayo Clinic identified Interleukin-23 as a reliable cellular senescence biomarker across multiple tissues. Natural compounds like quercetin, fisetin, and luteolin can reduce these aging markers, supporting her dietary supplementation philosophy.

Broadcast from KSQD, Santa Cruz on 6-19, 2025: Dr. Dawn presents the VITAL study evidence showing 2,000 IU daily vitamin D prevents telomere shortening in immune cells, effectively slowing biological aging by three years. Groundbreaking mouse research reveals maternal iron deficiency can alter fetal sex development. When iron levels dropped 60%, the SYR gene controlling male development switched off, causing 6 of 39 XY offspring to develop ovaries instead of testes. Thus, mammalian sex can be influenced by environmental factors just like in amphibians and fish. Dr. Dawn connects this to gender identity questions, advocating supporting puberty blockers based on their 30-year safety record. Dr. Dawn advocates widespread CPR and AED training after describing a successful Buffalo airport rescue. With 350,000 annual out-of-hospital cardiac arrests and 90% fatality rates, immediate AED intervention can triple survival odds. She promotes the Pulsepoint app registering 185,000 AEDs and praises countries like Norway achieving 90% population CPR training through driver's license requirements. Post-Roe v. Wade data shows vasectomies doubled in men aged 19-26 while tubal ligations rose 70%, mostly in abortion-ban states. Dr. Dawn notes the irony that policies intended to increase births prompted widespread voluntary sterilization. Environmental concerns from January 2025 Moss Landing battery fire and LA wildfires highlight toxic contamination from burning lithium, plastics, and building materials. She advocates fire-resistant landscaping and home hardening, noting some fire-resistant homes survived while surroundings burned. British research shows pet ownership provides life satisfaction equivalent to $90,000 annual income boost. Dr. Dawn experiences this firsthand, noting pets provide family-like benefits without complex interpersonal dynamics. Sleep study reveals 15 minutes additional nightly sleep improves cognitive performance in tweens. Children sleeping 7.25 versus 7.10 hours showed better academics and larger brain volumes, though Dr. Dawn questions causation versus correlation. Mayo Clinic identified Interleukin-23 as a reliable cellular senescence biomarker across multiple tissues. Natural compounds like quercetin, fisetin, and luteolin can reduce these aging markers, supporting her dietary supplementation philosophy.

When bringing people to the edge of death is your day job. Guest: Adam Richman, perfusionist at the Mayo Clinic⁠ and Unexplainable listener. For show transcripts, go to ⁠⁠⁠⁠⁠⁠⁠⁠vox.com/unxtranscripts⁠⁠⁠⁠⁠⁠⁠⁠ For more, go to ⁠⁠⁠⁠⁠⁠⁠⁠vox.com/unexplainable⁠⁠⁠⁠⁠⁠⁠⁠ And please email us! ⁠⁠unexplainable@vox.com⁠⁠ We read every email. Support Unexplainable (and get ad-free episodes) by becoming a Vox Member today: ⁠⁠⁠⁠⁠⁠⁠⁠vox.com/members⁠⁠⁠ Help us plan for the future of Unexplainable by filling out a brief survey: ⁠⁠⁠⁠⁠voxmedia.com/survey⁠⁠⁠⁠⁠. Thank you! Learn more about your ad choices. Visit podcastchoices.com/adchoices