Podcasts about Mayo Clinic

Host: Darryl S. Chutka, M.D. Guest: Sunanda V. Kane, M.D. Most people who develop inflammatory bowel disease are diagnosed before the age of 30. In women, this often occurs during the middle of their reproductive years. Some with inflammatory bowel disease choose to avoid pregnancy, usually due to misconceptions about pregnancy risks. Yet if properly managed, women can experience a normal, uneventful pregnancy and deliver a healthy child.  What effect does inflammatory bowel disease have on fertility? Do patients have a greater chance of a normal pregnancy if the bowel disease is in remission? How can patients minimize the risk of inflammatory bowel disease flares during pregnancy and are the pharmacologic therapies commonly used to treat inflammatory bowel disease safe to use during pregnancy? These are some of the questions I'll ask my guest, Sunanda V. Kane, M.D., from the Division of Gastroenterology and Hepatology at the Mayo Clinic as we discuss “Inflammatory Bowel Disease and Pregnancy”. 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 

A recent Review discusses the epidemiology, risk factors, diagnosis, and treatment of ovarian cancer. William Cliby, MD, and John Weroha, MD, PhD, both from the Mayo Clinic in Rochester, Minnesota, discuss this and more with JAMA Associate Editor Margaret Wheeler, MD. Related Content: Ovarian Cancer Endometriosis Typology and Ovarian Cancer Risk Screening for Ovarian Cancer ----------------------------------- JAMA Editors' Summary

Carlie Irsay-Gordon wants greatness over wins - and says Richardson still has time, but urgency is needed! Sounds like a very competent NFL owner! Caitlin Clark making a tremendous living, so still fighting for WNBA players to earn more! Will Levis to Mayo Clinic for AC joint repair! Cubs lineup could rival best in baseball history if Eugenio Suarez is acquired! Here is the link for the only autobiography ever published without praise for its author: https://www.amazon.com/Oops-Art-Learning-Mistakes-Adventures/dp/173420740X https://kentsterling.com/2025/07/03/rule-for-kent-sterling-conest/

Join me, Seth Farbman, as we dive into the fascinating story behind YourBio Health, a medical device company that has created a revolutionary solution for blood draws. Hear from the impressive team of experts, including CEO, Paul Owen, with his 35 years of experience in the healthcare industry including the Mayo Clinic, Chief Medical Officer Dr. Robson with his background in leading clinical initiatives at Walgreens, and Chief Scientific Officer Dr. Mina, previously a professor at Harvard Medical School.

This episode marks the end of “Lab Medicine Rounds.” Host Justin Kreuter, M.D., reflects on the impact of the series and introduces an upcoming video-based project that will bring lab stories to life in powerful new ways.

Host: Darryl S. Chutka, M.D. Guests: Amanda M. Johnson, M.D., and Victor G. Chedid, M.D., M.S. This podcast continues our series on inflammatory bowel disease. The topic is important and timely: “Inflammatory Bowel Disease in Special Populations: The Elderly, the Obese and the LGBTQ Patient.” It's critical that we broaden our perspective in addressing the unique challenges faced by these often-unrecognized population groups. How common is the presentation of inflammatory bowel disease in those over 65? How does age affect the treatments commonly used? Does obesity alter the disease presentation or activity and what are some of the unique challenges our LGBTQ patients face with inflammatory bowel disease? These are just some of the questions I'll be asking my guests, Amanda M. Johnson, M.D., and Victor G. Chedid, M.D., M.S., both gastroenterologists at 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

In this episode of ASTCT Talks, Dr. Rahul Banerjee sits down with Dr. Kenneth Lim and Dr. Yi Lin of Mayo Clinic to discuss a critical and emerging topic in CAR T-cell therapy: delayed neurotoxicities following cilta-cel treatment in multiple myeloma. They break down the clinical features of nerve palsies and Parkinsonism-like symptoms, share diagnostic and treatment strategies and explore emerging predictive markers like absolute lymphocyte count. Given that cilta-cel is increasingly being used in second-line myeloma treatment and is even being studied in first-line treatment to replace stem cell transplantation, this conversation is a timely and insightful look at improving patient outcomes in CAR T-cell therapy.

Normal pressure hydrocephalus (NPH) is a pathologic condition whereby excess CSF is retained in and around the brain despite normal intracranial pressure. MRI-safe programmable shunt valves allow for fluid drainage adjustment based on patients' symptoms and radiographic images. Approximately 75% of patients with NPH improve after shunt surgery regardless of shunt type or location. In this episode, Aaron Berkowitz, MD, PhD, FAAN, speaks with Kaisorn L. Chaichana, MD, author of the article “Management of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology at the University of California San Francisco in the Department of Neurology in San Francisco, California. Dr. Chaichana is a professor of neurology in the department of neurological surgery at the Mayo Clinic in Jacksonville, Florida. Additional Resources Read the article: Management 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 Guest: @kchaichanamd 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 Berkowitz: This is Dr Aaron Berkowitz, and today I'm interviewing Dr Kaisorn Chaichana about his article on management of normal pressure hydrocephalus, which he wrote with Dr Jeremy Cutsforth-Gregory. The article appears in the June 2025 Continuum issue on disorders of CSF dynamics. Welcome to the podcast, and please introduce yourself to our audience. Dr Chaichana: Yeah, thank you for having me. I'm Kaisorn Chaichana. I'm a neurosurgeon at Mayo Clinic in Jacksonville, Florida. Part of my practice is doing hydrocephalus care, which includes shunts for patients with normal pressure hydrocephalus. Dr Berkowitz: Fantastic. Well, before we get into shunt considerations and NPH specifically, which I know is the focus of your article, I thought it would be a great opportunity for a neurologist to pick a neurosurgeon's brain a bit about shunts. So, to start, can you lay out for us the different types of shunts and shunt procedures, the advantages, disadvantages of each type of shunt, how you think about which shunt procedure should be used for which patient, that type of thing? Dr Chaichana: Yeah. So, there are different types of shunts, and the most common one that is used is called a ventricular peritoneal shunt. So, it has a ventricular catheter, it has a catheter that tunnels underneath the skin and it goes into the peritoneum where the fluid goes from the ventricular system into the peritoneum. Typically, the shunts are in the ventricle because that is the largest fluid-filled space in the brain. Other terminal areas include the atrium, which is really the jugular vein, and those are called ventricular atrial shunts. You can also have ventricular pleural shunts, which end in the pleural space and drain flui into the pleural space. Those are pretty much the most common ventricular shunts. There's also a lumboperitoneal shunt that drains from the lumbar spine, similar to a lumbar drain into the peritoneum. For the lumbar shunts, we don't typically have a lumbar pleural or lumbar atrial shunt just because of the pressure dynamics, because the lumbar spine is below the lung and as well as the atrium. And so, the drainage pattern is very different than ventricular peritoneal which is top to bottom. The most common shunt, why we use the ventricular peritoneal shunt the most, is because it has the most control. So, the peritoneum is set at a standard pressure in the intraabdominal pressure, whereas the ventricular atrial shunt depends on your venous return or venous pressure and your ventricular pleural shunt varies with inspiration and expiration. So, the easiest way for us to control the fluid, the ventricular system is through the ventricular peritoneal shunt. And that's why that's our most common shunt that we use. Dr Berkowitz: Fantastic. So, as you mention in the article, neurologists may be reluctant to offer a shunt to patients with NPH because many patients may not improve, or they improve only transiently; and out of fear of shunt complications. So, of course, as neurologists, we often only hear about a patient's shunt when there is a problem. So, we have this sort of biased view of seeing a lot of shunt malfunction and shunt infection. Of course, we might not see the patient if their shunt is working just fine. How common are these complications in practice, and how do you as a neurosurgeon weigh the risks against the often uncertain or transient benefits of a shunt in a patient with NPH who may be older and multiple medical comorbidities? How do you think about that and talk about it with patients? Dr Chaichana: When you hear about shunt complications, most of the shunt complications you hear about are typically in patients with congenital hydrocephalus. Those patients often require several shunt revisions just from either growing or the shunt stays in for a long time or the ventricular caliber is a lot less than some with normal pressure hydrocephalus. So, we don't really see a lot of complications with normal pressure hydrocephalus. So that shunt placement in these patients is typically pretty safe. The procedure's a relatively short procedure, around 30 minutes to 45 minutes to place a shunt, and we can control the pressure within the shunt setting so that we don't overdrain---which means too much fluid drains from the ventricular system---which can cause things like a subdural, which is probably the most common complication associated with normal pressure hydrocephalus. So, to obviate those risks, what we do is typically insert the shunt and then keep the shunt setting at a high setting. The higher the setting, the less it drains, and then we bring it slowly down based on the patient's symptoms to try to minimize the risk of this over drainage in the subdural hematoma while at the same time benefiting the patient. So, there's a concern for shunt in patients with normal pressure hydrocephalus. The concern or the complication risks are very low. The problem with normal pressure hydrocephalus, though, is that over time these patients benefit less and less from drainage or their disease process takes over. So, I do recommend placing this shunt as soon as possible just so that we can maximize their quality of life for that period of time. Dr Berkowitz: So, if I'm understanding you, then the risk of complication is more sort of due to the mechanical factors in patients with congenital hydrocephalus or sort of outgrowing the shunt, their pressure dynamics may be changing over time. And in your experience, an older patient with NPH, although they may have more medical comorbidities, the procedure itself is relatively quick and low-risk. And the actual complications due to mechanical factors, my understanding, are just much less common because the patient is obviously fully grown and they're getting one sort of procedure at one point in time and tend to need less revision, have less complication. Is that right? Dr Chaichana: Yeah, that's correct. The complication risk for normal hydrocephalus is a lot less than other types of hydrocephalus. Dr Berkowitz: That's helpful to know. While we're talking about some of these complications, let's say we're following a patient in neurology with NPH who has a shunt. What are some of the symptoms and signs of shunt malfunction or shunt infection? And what are the best studies to order to evaluate for these if we're concerned about them? Dr Chaichana: Yeah. So basically, for shunt malfunction, it's basically broken down into two categories. It's either overdrainage or underdrainage. So, underdrainage is where the shunt doesn't function enough. And so basically, they return to their state before the shunt was placed. So that could be worsening gait function, memory function, urinary incontinence are the typical symptoms we look for in patients with normal pressure hydrocephalus and underdrainage, or the shunt is not working. For patients that are having overdrainage, which is draining too much, the classic sign is typically headaches when they stand up. And the reason behind that is when there's overdrainage, there's less cerebrospinal fluid in their ventricular system, which means less intracranial pressure. So that when they stand up, the pressure differential between their head and the ground is more than when they're lying down. And because of that pressure differential, they usually have worsening headaches when standing up or sitting up. The other thing are severe headaches, which would be a sign of a subdural hematoma or focality in their neurological symptoms that could point to a subdural hematoma, such as weakness, numbness, speaking problems, depending on the hemisphere. How we work this up is, regardless if you're concerned about overdrainage or underdrainage, we usually start with a CAT scan or an MRI scan. Typically, we prefer a CAT scan because it's quicker, but the CAT scan will show us if the ventricular caliber is the same and/or the placement of the proximal catheter. So, what we look for when we see that CAT scan or that MRI to see the location of the proximal catheter to make sure it hasn't changed from any previous settings. And then we see the caliber of the ventricles. If the caliber of the ventricles is smaller, that could be a sign of overdrainage. If the caliber of the ventricles are larger, it could be a sign of underdrainage. The other thing we look for are subdural fluid collections or hydromas or subdural hematomas, which would be another sign of lower endocranial pressure, which would be a sign of overdrainage. So those are the biggest signs we look for, for underdrainage and overdrainage. Other things we can look for if we're concerned of the shunt is fractured, we do a shunt X-ray and what a shunt x-ray is is x-rays of the skull, the neck and the abdomen to see the catheter to make sure it's not kinked or fractured. If you're really concerned, you can't tell from the x-ray, another scan to order is a CT of the chest and abdomen and pelvis to look at the location of the catheter to make sure there's no brakes in the catheter, there's no fluid collections on the distal portion of the catheter, which would be a sign of shunt malfunction as well. Other tests that you can do to really exclude shunt malfunction is a shunt patency test, and what that is a nuclear medicine test where radionucleotide is injected into the valve and then the radionucleotide is traced over time or imaged through time to make sure that it's draining appropriately from the valve into the distal catheter into the peritoneum or the distal site. If there's a shunt malfunction that's not drainage, that radioisotope would remain stagnant either in the valve or in the catheter. There's overdrainage, we can't really tell, but there will be a quick drainage of the radioisotope. For shunt infection, we start with an imaging just to make sure there's not a shunt malfunction, and that usually requires cerebrospinal fluid to test. The cerebrospinal fluid can come from the valve itself, or it can come from other areas like the lumbar spine. If the lumbar spine is showing signs of shunt infection, then that usually means the shunt is infected. If the valve is aspirated with- at the bedside with a butterfly needle into the valve and that shows signs of shunt infection, that also could be a sign of infection. Dr Berkowitz: That's very helpful. You mentioned CT and shunt series. One question that often comes up when obtaining neuroimaging in patients with a shunt, who have NPH or otherwise, is whether we need to call you when we're doing an MRI to reprogram the shunt before or after. Is there a way we can know as a neurologists at the bedside or as patients carry a card, like with some devices where we know whether we have to call and bother our neurosurgery colleagues to get this MRI? Or if the radiology techs ask us, is this safe? And is the patient's shunt going to get turned off? How do we go about determining this? Dr Chaichana: Yeah, so unfortunately, a lot of patients don't carry a card. We typically offer a card when we do the shunt, but that card, there's two problems with it. One is it tells the model, but the second thing is it has to be updated any time the shunt is changed to a different setting. Oftentimes patients don't know that shunt setting, and often times they don't know that company brand that they use. There are different types of shunts with different types of settings. If there's ever concern as to what type of shunt they have, an x-ray is usually the best bet to see with a shunt series, or a skull x-ray. A lateral skull x-ray usually looks at the valve, and the valve has certain radio-dense markers that indicate what type of shunt it is. And that way you can call neurosurgery and we can always tell you what the shunt setting is before the MRI is done. Problem with an MRI scan if you do it without a shunt x-ray before is that you don't know the setting before unless the patient really knows or it's in the patient chart, and the MRI can need to change the setting. It doesn't usually turn it off, but it would change the setting, which would change the fluid dynamics within their ventricular system, which could lead to overdrainage or underdrainage. So, any time a patient needs MRI imaging, whether it's even the brain MRI, a spine MRI, or even abdominal MRI, really a shunt x-ray should be done just to see the shunt setting so that it could be returned to that setting after the MRI is done. Dr Berkowitz: So, the only way to know sort of what type of shunt it would be short of the patient knowing or the patient getting care at the same hospital where the shunt was placed and looking it up in the operative reports would be a skull film. That would then tell us what type of shunt is there and then the marking of the setting. And then we would be able to call our colleagues in neurosurgery and say, this patient is getting an MRI this is the setting, this is the type of shunt. And do we need to call you afterwards to come by and reprogram it? Is that right? Dr Chaichana: That's correct, yeah. Dr Berkowitz: Is there anything we would be able to see on there, or it's best we just- best we just call you and clarify? Dr Chaichana: The easiest thing to do is, when you get the skull x-ray, you can Google different types of shunts or search for different shunts, and they'll have markers that show the type of shunt it is as well as the setting that it's at. And just match it up with the picture. Dr Berkowitz: And as long as it's not a programmable shunt, there's no concern about doing the MRI. Is that right? Dr Chaichana: Correct. So, if it's a programmable shunt, even if it's MRI-compatible, we still like to get the setting before and make sure the setting after the MRI is the same. Nonprogrammable shunts can't be changed with MRI scans, and those don't need neurosurgery after the MRI scan, but it should be confirmed before the scan is done. Dr Berkowitz: Very helpful. Okay, so let's turn to NPH specifically. As you know, there's a lot of debate in the literature, some arguing, even, NPH might not even exist, some saying it's underdiagnosed. I think. I don't know if it was last year at our American Academy of Neurology conference or certainly in recent years, there was a pro and con debate of “we are underdiagnosing NPH” versus “we are overdiagnosing NPH.” What's your perspective as a neurosurgeon? What's the perspective in neurosurgery? Is this something we're underdiagnosing, and the times you shunt these patients you see miraculous results? Is this something that we're overdiagnosing, you get a lot of patients sent to that you think maybe won't benefit from a shunt? Or is it just really hard to say and some patients have shunt-responsive noncommunicating hydrocephalus of unclear etiology and either concurrent Parkinson's disease, Alzheimer's, cervical lumbar stenosis, neuropathy, vestibular problems, and all these other issues that play into multifactorial gait to sort of display a certain amount of the percentage of problem in a given patient or take overtime? What's your perspective if you're open to sharing it, or what's the perspective of neurosurgery? Is this debated as it is in neurology or this is just a standard thing you see and patients respond to shunt to some degree in some proportion of the time? And what are the sort of predictors you see in your experience? Dr Chaichana: Yeah, so, for me, I'd say it's too complicated for a neurosurgeon to evaluate. We rely on neurology to tell us whether or not they need a shunt. But I think the problem is, obviously, a part of the workout for at least the ones that I like to do, is that I want them to have a high-volume lumbar puncture with pre- and postgait analysis to see if there's really an objective measure of them improving. If they have an objective measure of improvement---and what's even better is that they have a subjective measure of improvement on top of the objective measure of improvement---then they benefit from a shunt. The problem is, some patients do benefit even though they don't have objective performance increases after a high-volume shunt. And those are the ones that make me the most worrisome to do the shunt, just because I don't like to do a procedure where there's no benefit for the patient. I do see, according to the literature as well, that there's around a 30 to 40%, even 50%, increase in gait function, even in patients that don't have large improvements following the high-volume lumbar puncture. And those are the most challenging patients for us as neurosurgeons because we'll put the shunt in, they say we're no better in terms of their gait, no better in terms of their urinary incontinence. We try to lower their shunt down to a certain setting and we're kind of stuck after that point. The good thing about NPH, though, is that, from the neurosurgery side, the shunt, like I said, is a pretty benign, low-risk procedure. So, we're not putting the patient through a very severe procedure to see if there's any benefit. So, in cases where we try to improve their quality of life in patients that don't have a benefit from high-volume lumbar puncture, we give them the odds of whether or not it's improving and say it might not improve. But because the procedure's minimally invasive, I think it's a good way to see if we can benefit their quality of life. Dr Berkowitz: Yeah, it's a very helpful perspective. Yeah, those are the most challenging cases on our side as well, right. If the patient- we think they may have NPH, or their gait and/or urinary and/or cognitive problems are- at least have a component of NPH that could be reversible, we certainly want to do the large volume lumbar puncture and/or consider a lumbar drain trial, all discussed in other articles and interviews for this issue of Continuum, But the really tough ones, as you said, there is this literature on patients who don't respond to the large-volume lumbar puncture for some reason but still may be shunt responsive. And despite all the imaging predictors and all the other ways we try to think about this, it's hard to know who's going to benefit. I think that's really a helpful perspective from your end that, as you say in the very beginning of your article, right, maybe there's a little bit too much fear of shunting on the neurology side because when we hear about shunts, it's often in the setting of complication. And so, we're not sort of getting the full spectrum of all the patients you shunt and you see who are doing just fine. They might not improve---the question is related to NPH---but at least they're not harmed by the shunt, and we're maybe overbiased and/or seeing a overly representative sample of negative shunt outcomes when they're actually not that common in practice. Is that a fair summary of your perspective? Dr Chaichana: Yeah, that's correct. So, I mean, complications can occur---and anytime you do a surgery, there are risks of complications---but I think they're relatively low for the benefit that we can help their quality of life. And the procedure's pretty short. So, the risk, it mostly outweighs the benefits in cases with normal pressure hydrocephalus. Dr Berkowitz: Very helpful perspective. So, well, thanks so much again. Today I've been interviewing Dr Kaisorn Chaichana about his article on management of normal pressure hydrocephalus, which he wrote with Dr Jeremy Cutsforth-Gregory. This article 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.

Send us a textPolycystic kidney disease (PKD) is the most common inherited kidney disease. Those with PKD have a 50% chance to pass it on to their children and have progressively worse kidney function as they age. World-known PKD researcher Dr. Fouad Chebib joins Dr. Michael Koren to discuss the symptoms, risks, genetic cause, and treatment options for PKD. They also get into some new treatement methods being explored in clinical trials and what the future of PKD treatment may look like.Dr. Chebib leads the Polycystic Kidney Disease Foundation Center of Excellence and the Discovery and Translational PKD Research Laboratory at the Mayo Clinic, Florida.The Mayo Clinical Polycystic Kidney Disease (PKD) Resource Center includes many article by Dr. Chebib himself.Be a part of advancing science by participating in clinical research.Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.comListen on SpotifyListen on Apple PodcastsWatch on YouTubeShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramX (Formerly Twitter)LinkedInWant to learn more? Checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.comMusic: Storyblocks - Corporate InspiredThank you for listening!

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.

​In this episode, Laney discusses her experience learning about eye movements from taking a training in Eye Movement Desensitization Reprocessing (EMDR). After trying it one time she then found a way to be as direct and quick as possible, which she called Accelerated Resolution Therapy (ART). She discusses her approach to utilizing ART to help clients rescript past negative images and narratives. With a background in Gestalt therapy, Laney incorporates rapid eye movements and guided associations to support clients in transforming adverse cognitions into more positive, empowering perspectives. She discovered a way to have the clients brain erase negative images, which cause triggers. Laney has developed this accelerated, directive therapeutic method to address conditions such as ADHD, OCD, eating disorders, generalized anxiety, and depression. She emphasizes the efficiency of ART, noting that clients often experience significant breakthroughs in just a few sessions—sometimes even in a single session. Laney likens the process to a dental procedure: identifying and removing emotional “decay” and replacing it with a metaphorical filling. When clients become emotionally stuck, therapists may employ a technique called Scene Matching, which connects current emotions to past experiences with similar emotional tones, facilitating healing and insight. Much like Fritz Perls' empty chair technique in Gestalt therapy, ART utilizes metaphorical visualization to allow clients to process unresolved experiences internally. Laney distinguishes ART from EMDR by highlighting its structured, therapist-directed approach, as opposed to EMDR's emphasis on building a longer-term client-therapist relationship and a free association approach. ART's clinical precision and efficiency are key to its growing popularity. She explained how today, over 16,000 clinicians have been trained in ART. She discussed research in ART and how in July 2025, Laney and a team of professionals from Yale will begin training clinicians in Kenya. Laney Rosenzweig, MS, LMFT is a Licensed Marriage and Family Therapist who has been in the mental health field since 1989. Laney is the Founder/Developer of Accelerated Resolution Therapy (ART) developed in 2008. She is the CEO of Rosenzweig Center for Rapid Recovery, which trains clinicians in ART. ART has a treatment protocol that is directive, standardized and easy to apply using. It is an eye movement therapy. Her introduction of the Voluntary Image Replacement (VIR), which guides clients to erase negative images from view in their mind, is a unique and powerful way to quickly eliminate triggers and eradicate symptoms. Laney has traveled the globe training licensed mental health professionals in ART and has over 65 ART trainers. Yale University has trained clinicians and in the process of doing a study as well as Mayo Clinic and the Canadian Military. She is available for presentations to civilian and military groups who are seeking an alternative to longer, less effective treatments for trauma and other mental health problems. The website is www.ARTworksNOW.com. There is an intro to ART every 4th Wednesday of the month at 6 pm Eastern and the link can be found on the top of the website.

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. See omnystudio.com/listener for privacy information.

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.

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. 

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

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.

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

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?

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