Podcasts about Mount Sinai Beth Israel

In today's episode, Dr. Edward Shalts, a Holistic Psychiatrist and Homeopath, joins us to discuss his latest book, Super Remedies: That Can Change Your Life. A compassionate physician for over forty years, Dr. Shalts specializes in conventional, integrative, and functional psychiatry – effectively treating adults and children for stress, sleep issues, anxiety, PTSD, ADHD, depression, bipolar disorder, and more… Dr. Shalts received his training at Beth Israel Medical Center (now Mount Sinai Beth Israel), where he served as Chief Resident. He has also previously worked as a neuroendocrinology research fellow at Columbia University, written four books, and is a Founding Diplomate of the American Holistic Medical Association. In this conversation, we dive into: How homeopathic remedies provide swift, natural relief from common ailments. The ways in which conventional medical care falls short. The benefits of making individualized remedy choices based on science.   Ready to learn more about the concept of healing from the inside out? Tune in and transform your approach to health and wellness! Be sure to follow along with Dr. Shalts and his work by visiting his website. Episode also available on Apple Podcasts: http://apple.co/30PvU9

How can natural remedies unlock powerful healing without the side effects of conventional treatments? What role does conscious, science-based medicine play in overcoming mental health challenges today? In this episode, we sit down with Dr. Edward Shalts — holistic psychiatrist, homeopath, author of Super Remedies: That Can Change Your Life, and Founding Diplomate of the American Holistic Medical Association — to explore a revolutionary approach to mind-body medicine. With over forty years of compassionate practice, Dr. Shalts has helped thousands find relief from stress, anxiety, PTSD, ADHD, depression, and more by blending the best of conventional, integrative, and homeopathic wisdom. Trained at Beth Israel Medical Center (now Mount Sinai Beth Israel) and a former research fellow at Columbia University, he brings a deep, science-driven perspective to natural healing. Join us to discover: Why individualized homeopathic remedies can offer swift, lasting relief. How traditional healthcare models often miss the full picture of healing. What it really means to embrace conscious medicine for a healthier future. Ready to rethink your wellness journey? Tune in now — and follow Dr. Shalts' work through his website for more on holistic healing breakthroughs. Episode also available on Apple Podcasts: https://apple.co/38oMlMr

Dr. Yasmine Elamir joins us to address the stigmas of obesity by sharing her personal journey of overcoming Type 2 Diabesity. A triple board-certified Endocrinologist, Obesity Specialist, and Best-Selling Author with nine years of experience, Dr. Elamir compassionately guides her patients toward curing Type 2 Diabetes and achieving sustainable weight loss through her innovative app and methods. She earned her bachelor's degree from Johns Hopkins University and her medical degree from Ross University, completing her Internal Medicine residency at Robert Wood Johnson Barnabas Health and a fellowship in Endocrinology, Diabetes, and Metabolism at Mount Sinai Beth Israel, where she was Chief Fellow. As a certified Health and Wellness Coach, Dr.Elamir's mission and trajectory is to empower individuals with the knowledge and tools to heal and live free from diabesity. Dr. Yas is one of the most endearing and compassionate individuals I have ever met.Podcast Description TemplateYou can connect with Dr. Yasmine Elamir on Instagram @diabetes_md or check out her website https://linktr.ee/Dr.Yasmine

In this episode, Scott Becker covers five key healthcare stories, including Mayo Clinic's $1.9 billion expansion in Arizona, Ohio Health's $1 billion project, a $52 million window replacement at a children's hospital, Sutter Health's antitrust settlement, and Mount Sinai Beth Israel's ongoing closure challenges.

Cannabis or marijuana is becoming increasingly more popular in the United States for recreational and medical use. What is cannabis? Are there benefits to using it? Is it ok for someone with kidney disease or dialysis to use it? Learn all this and more in today's episode. Joshua Rein, DO, FASN, is a board-certified nephrologist, kidney physiologist, and certified hypertension specialist. He is an Assistant Professor in the Barbara T. Murphy Division of Nephrology in the Department of Medicine at the Icahn School of Medicine at Mount Sinai in NYC and a Staff Physician at the James J. Peters, Veterans Affairs Medical Center. He received his medical degree from the New York College of Osteopathic Medicine, completed internal medicine at Mount Sinai Beth Israel, and completed clinical and research nephrology fellowships at Mount Sinai Hospital. Dr. Rein is interested in the effects of cannabis and cannabinoids on kidney health and disease given their widespread growing popularity despite an uncertain impact on health. Dr. Rein's research, funded by a Veterans Affairs Career Development Award, utilizes preclinical animal models to characterize the kidney endocannabinoid system and examine the physiological impact of cannabinoids on the regulation of fluid and electrolyte balance by the kidney. His clinical research focuses on the risks, benefits, and clinical significance of cannabis consumption among people with kidney disease and those at risk for developing kidney disease.   Additional Resources: Nephrologist's Guide to Cannabis Cannabis Usage Study AJKD Blog   Do you have comments, questions, or suggestions? Email us at NKFpodcast@kidney.org. Also, make sure to rate and review us wherever you listen to podcasts.

Today, I have the pleasure of speaking with John Samuels, Founder and CEO of Better Health Advisors. For over 20 years, John served as a senior healthcare leader in New York City's top hospitals including Northwell Health and Mount Sinai Beth Israel. As Assistant Vice President of Emergency Medicine, he was responsible for the operation of 16 emergency departments and a rapidly expanding network of urgent care centers. John is a licensed nursing home administrator in New York and New Jersey, and has served on the boards of directors for Mary McDowell Friends Academy, the Phillips School of Nursing at Mount Sinai Medical Center, the 360 Academic Sports Academy, the National Association of Healthcare Advocacy Consultants, and the Sepsis Alliance. John's philosophy, which also underlies his company's mission, is that superior healthcare planning and services are about mitigating risk intergenerationally. In our conversation, he elaborates on this way of thinking about healthcare and its implications for enterprise families of significant means. John also advocates for a wholistic approach to the health and wellness needs and solutions for enterprise families and their individual members. He tells us what he means by that and what is the scope of his definition of holistic healthcare. John then offers some practical tips and suggestions for families who want to be proactive about managing their health risks and wish to take a holistic approach to their healthcare needs and services. He also provides his practical advice for family members or family leaders who find themselves in a reactive or urgent situation involving the health of a family member, sharing some of the resources or actions they should consider in these critical situations. This is a must-hear conversation with a leading domain expert in the field of generational family wellness and holistic healthcare for enterprise families.

In this episode of New Frontiers, Dr. Kara Fitzgerald sits down with Dr. Valerie Gershenhorn, a leading expert in functional dermatology and a Clinical Team Member for Diagnostic Solutions Laboratory, to explore the profound impact of the gut-skin axis and autonomic nervous system on chronic skin conditions like acne, eczema, and more. Dr. Gershenhorn shares her comprehensive approach, including the use of functional testing, targeted nutrition, and specific supplements to address the root causes of skin issues. Clinicians will gain valuable insights into how gut health influences skin conditions and practical strategies for discovering imbalances with GI-MAP testing, and how to correct these findings in clinical practice. This episode is a must-listen for those looking to deepen their understanding of the connection between gut and skin health. ~DrKF Check out the show notes at https://www.drkarafitzgerald.com/fxmed-podcast/ for the full list of links and resources. GUEST DETAILS Valerie Gershenhorn, DO, is a Clinical Team Member for Diagnostic Solutions Laboratory. She attended the New York College of Osteopathic Medicine, where she graduated in the top 5% of her class. Dr. Gershenhorn then went on to complete an internal medicine residency at Mount Sinai Beth Israel in New York where she became chief resident. After staying on for a chief residency year, Dr. Gershenhorn earned board certification in internal medicine. Dr. Gershenhorn completed her dermatology residency at Lehigh Valley Hospital and earned board certification in dermatology. She has been practicing dermatology since 2006. Dr. Gershenhorn feels aligned with integrative dermatology because she believes that the skin is a “check engine light” for what is happening within the body. WellEnci https://wellenci.org/about-us Email valerie.gershenhorn@diagnosticsolutionslab.com/ THANKS TO OUR SPONSOR Diagnostic Solutions Laboratory: Website New Frontiers Listeners, elevate your patient care - download the GI-MAP Gut Skin Handout. https://tinyurl.com/5dedxavw SHOW NOTES GI-MAP by DSL https://bit.ly/2IEhVrS GI-MAP Sample Report https://tinyurl.com/3jxa9d8z OAp - Organic Acids Profile https://tinyurl.com/463ny5r2 OAp - Sample Report https://tinyurl.com/3puz5u9e Study: High levels of Helicobacter pylori antigens and antibodies in patients with severe acne vulgaris https://tinyurl.com/wmhnwvpu Dr. Julie Greenberg https://tinyurl.com/4tjcsb8n Study: Filaggrin and beyond… (Includes filaggrin schematic) https://tinyurl.com/mudfumuv CONNECT WITH DrKF on: YouTube: https://tinyurl.com/hjpc8daz Instagram: https://www.instagram.com/drkarafitzgerald/

In today's episode, Nanette Silverberg reviews the key highlights from her vitiligo sessions at the 2024 Revolutionizing Alopecia Areata, Vitiligo, and Eczema Conference, also known this year as RAVE. Dr. Silverberg is the chief of pediatric dermatology for the Mount Sinai Health System and site director of pediatric and adolescent dermatology at Mount Sinai West and Mount Sinai Beth Israel in New York, as well as the conference chair of the vitiligo portion of RAVE. At the conference, Dr. Silverberg presented “Topical Therapeutics for Vitiligo” and “Excellence in Vitiligo Clinical Practice.” Today, Dr. Silverberg shares the top takeaways from her sessions that clinicians can utilize in their practice. 

Wondering the amount of toxins patients are up against? You might be surprised. This week, we're joined by Dr. Valerie Gershenhorn as she dives into some root causes for skin conditions. Listen in as she discusses what it means to treat the inside of a patient, and how we can limit toxins in the body. 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. Valerie Gershenhorn, DO has always believed in the integrative approach to healing. This is why she attended the New York College of Osteopathic Medicine, where she graduated in the top 5% of her class. Dr. Gershenhorn then went on to complete an internal medicine residency at Mount Sinai Beth Israel in New York where she became chief resident. After staying on for a chief residency year, Dr. Gershenhorn earned board certification in internal medicine. Dr. Gershenhorn completed her dermatology residency at Lehigh Valley Hospital and earned board certification in dermatology. She has been practicing dermatology since 2006. Dr. Gershenhorn feels aligned with integrative dermatology because she believes that the skin is a “check engine light” for what is happening within the body. Her approach to patients always involves their internal health and well-being. Following her passion, Dr. Gershenhorn completed Dr. Andrew Weil's Integrative Medicine program in 2020. In 2023 Dr Gershenhorn completed a Root Cause Dermatology course under the mentorship of Julie Greenberg ND in which she learned how to interpret advanced functional labs such as GI MAP stool test, OAT (Organic Acid Test), Mycotoxin test, DUTCH Hormone test, and many more tests to uncover root cause issues linked to skin dis-ease.   It is Dr. Gershenhorn's honor to listen to and work with each patient to find the most optimal treatments. Her mission is to teach others how to become participants in their health journey and give them a blueprint for healing of the mind, body, and spirit.  

Saumya Dave, M.D. is a psychiatrist, author, and mom to a toddler. She completed her psychiatry training at Mount Sinai Beth Israel, where she was a chief resident and currently teaches a Narrative Medicine course. In her private practice, she is especially passionate about working with women in areas such as self-care, motherhood, and burnout. Her third novel, THE GUILT PILL, will be released in early 2025 and explores motherhood, guilt, and ambition.  In this conversation we discuss the impact of mom guilt and the importance of self-compassion in navigating these feelings. Learn more about Saumya  www.saumyadave.com Follow Saumya on Instagram: www.instagram.com/SaumyaJDave Follow Saumya on Twitter/X: www.twitter.com/saumyajdave Follow Erin on Instagram:⁠⁠⁠⁠ ⁠⁠⁠⁠⁠instagram.com/feminist.mom.therapist⁠⁠⁠⁠⁠⁠⁠⁠⁠ Learn more about Erin Spahr:⁠⁠⁠⁠ ⁠⁠⁠⁠⁠erinspahrtherapy.com⁠⁠⁠⁠⁠⁠⁠⁠⁠  Introducing the Inclusive Provider Directory! It is free for families to search. Providers can become a member and create a profile, as well as accessing a number of additional benefits. Friends of the podcast get $30 off the first year of their annual membership with code FEMINIST30. Support the podcast with a monthly donation:⁠⁠⁠ ⁠https://podcasters.spotify.com/pod/show/feministmompodcast/support⁠⁠⁠⁠ Please note: The information provided on this podcast is for educational and entertainment purposes only. The content shared here is not intended to be professional medical advice, diagnosis, or treatment. This page may contain affiliate links. --- Support this podcast: https://podcasters.spotify.com/pod/show/feministmompodcast/support

Christine Mahoney, Chief Nursing Officer and Senior Vice President and MSHS VP Critical of Care Nursing at Mount Sinai Beth Israel and Downtown joins the podcast to discuss her background, most successful project or initiative from the last year, how she sees the clinical workforce evolving, best advice for aspiring physician and nurse leaders, and more!

Christine Mahoney, Chief Nursing Officer and Senior Vice President and MSHS VP Critical of Care Nursing at Mount Sinai Beth Israel and Downtown joins the podcast to discuss her background, most successful project or initiative from the last year, how she sees the clinical workforce evolving, best advice for aspiring physician and nurse leaders, and more!

Christine Mahoney, Chief Nursing Officer and Senior Vice President and MSHS VP Critical of Care Nursing at Mount Sinai Beth Israel and Downtown joins the podcast to discuss her background, most successful project or initiative from the last year, how she sees the clinical workforce evolving, best advice for aspiring physician and nurse leaders, and more!

Healthcare-associated infections (HAIs) are a big problem in health systems across the country. HAIs can be defeated, and Mount Sinai Beth Israel in New York City recently experienced great success in getting to the magic number of zero with three different HAIs. Today's guest, Dr. Waleed Javaid, MSBI epidemiologist and director of Infection Prevention and Control, shares tried and true strategies he and his team have implemented that can be adapted by other health care organizations.

Dr. Richard Amerling, past president of the Association of American Physicians and Surgeons and Chief Academic Officer for the Wellness Company, joins the program to discuss the transition of the American medical system from a patient first paradigm to Big Pharma lap dog/patient last paradigm. We discuss the horrific consequences to patients this change has brought. We also discuss the transgender psyop that has been unleashed on the American people to destabilize communities; harming children and young adults while bringing massive money to the medical establishment and big Pharma. He believes that basic medical ethics are no longer being followed. You can learn more about Dr. Richard Amerling and his company at www.twc.health Follow on my Substack at SarahWestall.Substack.com See Important Proven Solutions to Keep Your from getting sick even if you had the mRNA Shot - Dr. Nieusma Protect your IRA and other assets, contact info@MilesFranklin.com - Tell them "Sarah Sent Me" and get the best service and prices in the country. MUSIC CREDITS: "Do You Trust Me" by Michael Vignola, licensed for broad internet media use, including video and audio     See on Bastyon | Bitchute | Odysee | Rumble | Freedom.Social | SarahWestall.TV     Biography of Dr. Richard Amerling Dr. Amerling is a native New Yorker. He graduated Stuyvesant High School, City College of New York, then earned his medical degree at the Catholic University of Louvain in Brussels, Belgium in 1981. He completed his Internship and Residency in Internal Medicine at New York Hospital, Queens in 1986. He is Past-President of the Association of American Physicians and Surgeons and serves currently on their Board of Directors. Dr. Amerling's work has been published as chapters in textbooks and in peer-reviewed medical journals. He has published numerous op-Eds and letters on health care economics and politics. From 1990-2016 Dr. Amerling was on staff at the Beth Israel Medical Center (now Mount Sinai Beth Israel). In October 2016, Dr. Amerling accepted a position as Professor at St. George's University School of Medicine in Grenada. From April-August 2020, after SGU went to online teaching, he volunteered as a nephrologist at NYU/Bellevue to help with their acute dialysis program. In July 2021, Dr. Amerling was placed on administrative leave by SGU for non-compliance with their vaccine mandate, and ultimately terminated in January 2022. Dr. Richard Amerling is a founding member and Principal Academic Officer of The Wellness Company.    

We are all familiar with the labyrinth of the healthcare system:  The paperwork, the confusion and the cost can be overwhelming. One of the blind spots in wealth management at all levels is the advice for the most significant liability most families will face: healthcare.  I spoke to JOHN SAMUELS, founder of Better Health Advisors, to get smarter on the topic of how to better advise people around this thorny issue. For more than 20 years, JOHN served as a senior healthcare leader in top New York City hospitals, including Northwell Health and Mount Sinai Beth Israel. In 2016, John founded Better Health Advisors, an independent healthcare advisory firm, to share the expertise he developed as a healthcare insider with members of the public. He brings a unique viewpoint on the intersection between healthcare and wealth planning. After listening, I hope you better understand the landscape around helping families deal with this imprecise, paperwork heavy, massively expensive and emotionally taxing issue.  OUTLINE Talk about your background in emergency medicine and how that led to the founding of your company Why do you consider a person's health their greatest asset? Why is health management as important as wealth management  Do wealthy people usually get better healthcare? What do you wish more people understood about the intersection of health and wealth? What are the biggest mistakes you see people make related to health care?  In the United States, a healthcare crisis often comes with a big bill. What steps do you recommend people take to protect their wealth before an emergency arises? How is health insurance related to financial planning? Having health insurance options once you've sold or left a company in a W2 environment Bridging the gap to Medicare Elder Care (and my rule of thumb of 1 Tuition / parent / year as a way to flesh out costs) Managing (or outsourcing) the paperwork Finding the right instiutions and the right people in the institutions to get the correct care What is the definition of "concierge medicine" How do you manage HIPAA and privacy concerns? How does one build a team of advisors to deal with the legal and financial impacts around these issues? The importance of having a centralized repository for one's medical information. HOW DO WE STAY IN TOUCH WITH JOHN? BETTER HEALTH ADVISORS JOHN SAMUELS LINKEDIN HEALTH ADVICE RESOURCES FOR ADVISORS ADVISOR ISSUE SPOTTING GUIDE HEALTH VS WEALTH FUNCTIONS https://www.amazon.com/Wealth-Actually-Intelligent-Decision-Making-1-ebook/dp/B07FPQJJQT/

Super excited to have Dr. Carmen Fong on the show. We asked all the tough questions, like what kinds of things do you pull out of patients' butts. And let me tell you it's wide and varied and somehow always a mistake. Dr. Carmen Fong earned a Doctor of Medicine in 2013 from Michigan State University College of Human Medicine, where she was inducted into the Gold Humanism Honor Society. She completed a general surgery residency at Mount Sinai Beth Israel in 2018, after which she completed a fellowship in colon and rectal surgery at Stony Brook University Hospital/NYU Winthrop. Her academic interests are in surgical education, colon cancer in young people, and medical technology. She mentors trainees and wants more women to be surgeons. Outside of medicine, she is a writer and an artist. She writes for Medium and for Baseline Med, a website for BIPOC pre-health students. She is on Twitter @carmenfong_MD, on Instagram and on LinkedIn. 

Host note: Just a quick note that we'll be taking a breather until the fall to enjoy the rest of the short Canadian summer.   Have comments or feedback?   You can reach the show at oicbtpodcast@gmail.com.  Finding the show adds value for you?  A rating (and especially review) on Apple podcasts would be greatly appreciated (and, we really like to hear how the content is landing for you, helping you in your practice, life etc).  Take care and enjoy the episode - one of our favourites to date!Personality disorders can present a significant challenge from the lens of assessment & treatment.  Psychologist, professor, researcher & author, Dr. Lisa Cohen, returns to discuss core themes in her new book The Psychotherapy of Personality Disorders.  In this discussion we cover:  why Dr. Cohen wanted to take on such an ambitious model of personality pathology that includes elements of emergent systems theory, schema therapy, biological psychiatry, evolutionary psychology, attachment theory (among others)her model's very unique conceptualization of differential diagnosis (frequently a great challenge in the context of personality disorders)the central role and utility of emergent systems theory in Dr. Cohen's model of personality pathologyhow her model compares and contrast with other models of personality pathology exploration of the notion that personality pathology reside at the level of interpersonal representations a brief consideration of the evidence for this model of personality pathologyan in-depth consideration of the role of processes related to integration, differentiation & articulation related to managing interpersonal nuance and complexity that can become dysfunctional in the context of personality pathology (with examples to illustrate these principles)discussion of the 5 level model of the mind-brain including examples of specific treatment treatment that map to different levels of the modelhow Dr. Cohen's model informs assessment, diagnosis and treatment personality pathologyspeaking compassionately and realistically about personality pathology through the lens of this modelthe importance of evaluating personality psychopathology in the context of environmental demands (especially those related to the family system).  Dr. Lisa J. Cohen is clinical professor of psychiatry at the Carl Icahn School of Medicine at Mount Sinai, working at the Mount Sinai Beth Israel location.  Dr. Cohen has long been involved with clinically relevant research in a wide range of topics relevant to psychiatry and psychology.  Her more recent research domains have included the risk assessment and psychological correlates of suicide, risk factors for and differential diagnosis of personality pathology, the adult psychological sequelae of childhood maltreatment, as well as the childhood antecedents, psychological correlates, subjective experience and psychological burden of individuals with pedophilia.  She has previously researched opiate addiction, bipolar disorder, and obsessive compulsive disorder. She has also written on psychological assessment.  Dr. Cohen is an author on over 100 peer-reviewed journal articles and two books. Here third book, The psychotherapy of personality disorders was published in 2022.  Dr. Cohen received her PhD in clinical psychology from the City University of New York and performed her pre-doctoral internship at St. Luke's Hospital in New York City.  She received her undergraduate education at the University of Michigan, obtaining a bachelor's degree in psychology and another one in Fine Arts.Buy Dr. Cohen's book here

Dr. Richard Amerling is board certified in Internal Medicine and Nephrology. From 1990-2016, Dr. Amerling was a full time Attending Nephrologist at the Beth Israel Medical Center (now Mount Sinai Beth Israel). There he developed the peritoneal dialysis program, and a program for continuous renal replacement therapy in the ICU setting. In October 2016, Dr. Amerling accepted a position as Professor at St. George's University School of Medicine and taught there until July 2021, when he was placed on administrative leave for non-compliance with their vaccine mandate. He volunteered as a nephrologist at NYU/Bellevue during the early part of the Covid-19 pandemic from April-August, 2020. Dr. Amerling is Past-President of the Association of American Physicians and Surgeons. TOPIC: The Nazification of American Medicine!! Robert Charles is also a spokesman for Association of Mature American Citizens, AMAC, as well as former Assistant Secretary of State. He also served in the Reagan and Bush 41 White Houses, and counsel to the U.S. House National Security subcommittee for five years. Additionally, he ran a major portion of the U.S. House Oversight Committee for five years during which time he ran the joint committee in the Waco investigations. TOPIC: When Seeds Bloom –Conscience of a Nation!!

Unfortunately, many mental health clinicians will experience a client's suicide in the course of their career.  The loss of a client to suicide often reflects  a life changing experience which can require considerable processing to reconcile and reach some kind of understanding.  In parallel, risk assessment can reflect a major source of distress, not only for clinician trainees but likewise for seasoned clinicians.  Clinical psychologist, professor and author, Dr. Lisa Cohen, joins us for a very important discussion around novel ways of conceptualizing suicide and suicide risk assessment which focus on when a client may be at most risk for suicide as opposed to who is at most risk over the course of their lives.  This novel way of conceptualizing suicide may allow for more effective, well-placed interventions as well as augment clinician confidence in their risk assessments.  In this conversation we cover:      the prevalence rates of suicide and how the risk stratifies by age & genderthe most common mental disorder comorbidities of suicidewhat is known about individuals who complete suicide with little to no apparent warning "out of the blue"a brief review of some of the proposed constructs that have emerged for characterizing pre suicidal mental state  (e.g., Suicidal Behaviour Disorder, Suicide Crisis Syndrome, Acute Suicidal Affective Disturbance)how these constructs differ from “longer-term” considerations of predictive risk around suicidality that most clinicians would be familiar with (e.g., hopelessness etc.)how assessment of risk should be undertaken as a function of what is known about shifts in cognitive, behavioural and emotional patterns in the days leading up to a suicide attemptthe kinds of psychotherapeutic or psychiatric interventions that flow from perhaps a higher resolution picture of what the days or hours leading up to a suicide crisis look likemeasures that are available to assess acute riskan overview of the Narrative Crisis Model how clinicians can emotionally relate in a healthy, balanced and sustainable way to the ongoing risk of losing a client to suicidethe value of safety plans/contracts misconceptions that clinicians may be laboring under with respect to the risk assessments they are undertaking Dr. Lisa J. Cohen is clinical professor of psychiatry at the Carl Icahn School of Medicine at Mount Sinai, working at the Mount Sinai Beth Israel location.  Dr. Cohen has long been involved with clinically relevant research in a wide range of topics relevant to psychiatry and psychology.  Her more recent research domains have included the risk assessment and psychological correlates of suicide, risk factors for and differential diagnosis of personality pathology, the adult psychological sequelae of childhood maltreatment, as well as the childhood antecedents, psychological correlates, subjective experience and psychological burden of individuals with pedophilia.  She has previously researched opiate addiction, bipolar disorder, & obsessive compulsive disorder. She has also written on psychological assessment.  Dr. Cohen is an author on over 100 peer-reviewed journal articles and two books.  Her third book presenting an integrative model of the psychotherapy of personality disorders will be published in 2022.  If you are experiencing thoughts of suicide please go to your local emergency room.  The following resources are also available:  Canada Suicide Prevention Service: 1-833-456-4566 (24/7), National Suicide Prevention Lifeline (United States): 1-800-273-8255, https://www.opencounseling.com/suicide-hotlines

In this week's special interview, I had the pleasure to discuss and dive deep into COVID with American Frontline doctor, Dr. Richard Amerling.   Dr. Amerling brings a wealth of knowledge on this topic and we discuss all aspects of COVID, treatments for COVID, the vaccine, the risks vs the benefit, standard of care for those who end up being hospitalized for COVID and so much more. This information is not what you normally hear on mainstream media and based upon popular demand from our Mindful Experiment community, this was a topic that came up strongly to be discussed and I am very glad and honored to have Dr. Amerling on the show.   Share with your loved ones...  There is a lot of truth in this episode...   Who is Dr. Richard Amerling? Dr. Amerling is a native New Yorker. He graduated from Stuyvesant High School, earned a Bachelor of Science degree from the City College of New York, and a medical degree at the Catholic University of Louvain in Brussels, Belgium.   Dr. Amerling completed his Internship and Residency in Internal Medicine at New York Hospital, Queens in Flushing, N.Y., and a Nephrology Fellowship at the Hospital of the University of Pennsylvania in Philadelphia.  From1990-2016, Dr. Amerling was on staff at the Beth Israel Medical Center (now Mount Sinai Beth Israel). There he developed the peritoneal dialysis program and a program for continuous renal replacement therapy in the ICU setting.    He served as Director of Outpatient Dialysis from 1995-2012.   In October 2016, Dr. Amerling accepted a position as Professor at St. George's   University School of Medicine and taught there until July 2021.   Dr. Amerling is board certified by the American Board of Internal Medicine for Internal Medicine and Nephrology. He is Past-President of the Association of American Physicians and Surgeons.    He is on the editorial board of Blood Purification.   Dr. Amerling has presented at numerous medical conferences, both nationally and internationally. Dr. Amerling's work has been published as chapters in textbooks and in peer-reviewed medical journals.   He is currently Associate Medical Director of America's Frontline Doctors.   How to Help and Connect… American Frontline Doctors - www.AFLDS.org Frontline Critical Care Contortion - www.Covid19CriticalCare.com Association of American Physicians and Surgeons - www.aapsonline.org/ Truth for Health Foundation - www.truthforhealth.org/   Contact Local Rep: https://www.house.gov/representatives/find-your-representative   --------------------------------------------------------   Connect with Dr. Vic... Website: www.EmpowerYourReality.com Facebook: www.Facebook.com/drvicmanzo Instagram: www.Instagram.com/drvicmanzo LinkedIn: www.LinkedIn.com/in/drmanzo   Check out my books: https://amzn.to/3gzr9XT   About Dr. Vic... I'm Dr. Vic Manzo Jr., a Business Mindset Coach, Self-Mastery Expert, Influential Author, Inspirational Speaker, and the host and creator of The Mindful Experiment Podcast and The Mindful Chiropractor Podcast.   I teach entrepreneurs and Chiropractors how to DOUBLE their profits while working less and leading a SOUL-FILLED Life...   If you want to create this in your life for 2022, CLICK HERE or visit: TinyUrl.com/LevelUpWithDrVic

On today's episode, meet Dr. Ana Velázquez Mañana. Dr. Velázquez is a medical oncology fellow at UCSF Helen Diller Family Comprehensive Cancer Center. Prior to moving to the Bay Area, Dr. Velázquez completed her Internal Medicine residency at Mount Sinai Beth Israel in New York City, where she also was a former Chief Resident. She received her Masters Degree in Biomedical Sciences at the Mayo Clinic Center for Clinical and Translational Science, and her Medical Degree from the University of Puerto Rico School of Medicine. She has a long-standing commitment to serving vulnerable, underserved, and minority populations.

Rana Awdish, MD, FCCP is the author of In Shock, a critically acclaimed, bestselling memoir based on her own illness. A critical care physician and faculty member of Wayne State University School of Medicine in Detroit, Michigan, she completed her medical degree at Wayne State in 2002 where she was inducted into the Alpha Omega Alpha national medical honor society, her residency at Mount Sinai Beth Israel in New York, and her fellowship training at Henry Ford Hospital where she serves as the current Director of the Pulmonary Hypertension Program. She also serves as Medical Director of Care Experience for the entire Health System. Dr. Awdish’s mandate as well as her passion is to improve the patient experience across the system and speak on patient advocacy at health care venues nationally. After suffering a sudden critical illness, herself, she has devoted much of her career to improving empathy through connection and communication. She lectures to physicians, health care leaders and medical schools across the country. Her book has been integrated into the curriculum of medical schools and universities across the US and Europe. She was awarded the Speak-Up Hero award in 2014 for her work establishing a workshop-based program called CLEAR (Connect, Listen, Empathize, Align, Respect), which trains faculty and trainees in relationship-based communication skills utilizing improvisational actors. She was named Henry Ford Hospital’s Critical Care Teacher of the Year in 2016. She was named the National Compassionate Caregiver of the Year by The Schwartz Center as well as Physician of the Year by Press Ganey in 2017. She has been interviewed by The Times, The Telegraph, The BBC, NPR, the Today Show online, MedPage, Health Leaders Media, and Beckers Hospital Review. She has written for Harvard Business Review, the Huffington Post, as well as the New England Journal of Medicine. Her NEJM Perspectives article, A View from the Edge, went viral garnering over 120,000 views and is ranked in the 99th percentile for reach.

Yvette Calderon, MD, MS, understands why vaccine hesitancy remains stubbornly high in communities of color. Growing up in New York City’s projects, she heard stories of forced sterilization in Puerto Rico and saw the medical system put other families first. Now Dr. Calderon finds herself on the flip side of the coin, trying to persuade reluctant colleagues and community members to take the COVID-19 vaccines. With the United States passing 500,000 pandemic deaths, including her father, Dr. Calderon argues that the vaccines are key to our resilience and shares advice for meeting hesitancy with compassion, enthusiasm, and science. Dr. Calderon is Chair of Emergency Medicine at Mount Sinai Beth Israel.Also in this episode: Justine Sarkodie, 17, talks about how COVID-19 transformed her West Bronx community and what she's learned about neighbors' attitudes toward the vaccines. Ms. Sarkodie is a senior at the High School for Health Professions and Human Services.LinksYvette Calderon, MS, MD official bioCOVID-19 Vaccination Information and ResourcesJustine's survey on vaccination hesitancy (for New York City residents)Road to Resilience listener survey"COVID Vaccination in Pregnant and Breastfeeding Individuals" (Dr. Calderon refers to this YouTube video)Mount Sinai Beth Israel Emergency DepartmentMount Sinai Office for Diversity and InclusionHigh School for Health Professions and Human Services (HPHS)

My name is Lionel Stpierre, aka Fatherhyness from KingCrown. I’m of Haitian descent and have been playing music since the ages of 15,16. I work as an anesthesia Technician at Mount Sinai Beth Israel. I learned that this music has positive and negative energy surrounding it. If you don’t pay attention, you won’t know who’s real and who’s not in my journey of playing music. I learned that there’s a power that comes with it. You can teach if you are up to it. Many will love you, and many will hate you. But if you love what you do, then that’s motivation to proceed. In my musical journey, I was able to play at most of all the top upstate schools like Binghamton, Buffalo state university of buffalo Albany SUNY Oswego Syracuse, locally Medgar Evers Hunter, and a few others. I have internationally toured Japan about five times played in Jamaica twice. I played in places like Georgia yearly, Charlotte, Redding PA, Nova Scotia, and many more. I have done a lot of local clubs, weddings, showers, etc. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/atomics-travels/support

Super excited to have Dr. Carmen Fong on the show. We asked all the tough questions, like what kinds of things do you pull out of patients' butts. And let me tell you it's wide and varied and somehow always a mistake. Dr. Carmen Fong earned a Doctor of Medicine in 2013 from Michigan State University College of Human Medicine, where she was inducted into the Gold Humanism Honor Society. She completed a general surgery residency at Mount Sinai Beth Israel in 2018, after which she completed a fellowship in colon and rectal surgery at Stony Brook University Hospital/NYU Winthrop. Her academic interests are in surgical education, colon cancer in young people, and medical technology. She mentors trainees and wants more women to be surgeons. Outside of medicine, she is a writer and an artist. She writes for Medium and for Baseline Med, a website for BIPOC pre-health students. She is on Twitter @carmenfong_MD, on Instagram and on LinkedIn. 

Dr. Gupta is the Founder and CEO of Tembo Health, a telemedicine startup seeking to revolutionize healthcare delivery, and is an Assistant Professor of Emergency Medicine at both the Icahn School of Medicine at Mount Sinai and the Zucker School of Medicine. He received his MMSc in clinical informatics from Harvard Medical School, earned his MD and MBA degrees from the University of Michigan and, after training in emergency medicine at Mount Sinai Beth Israel in NYC, completed a postdoctoral NIH/NLM research fellowship at Brigham and Women's Hospital in Boston. He is board certified in both emergency medicine and clinical informatics, and board eligible in addiction medicine.A practicing emergency medicine physician, Dr. Gupta brings clinical insight along with business acumen to provide impactful solutions to healthcare systems and organizations. Within his tenure at BWH, he developed multiple clinical decision support algorithms to impact real-time clinical care, resulting in improved utilization of healthcare resources; funded by the NIH, led to numerous publications. During his time at Northwell Health, Dr. Gupta led transformation teams on several initiatives improving efficiency, quality, and cost across 20 hospitals. While at the Boston Consulting Group, Dr. Gupta focused on healthcare strategy across Pharma, MedTech, and Providers, working with C-level executives to help shape long term strategic initiatives (e.g., growth strategy, organizational transformation, M&A, etc.). While at Imagen, a medical device startup building radiology artificial intelligence algorithms, Dr. Gupta served as both Head of Clinical Operations and Head of Strategic Partnerships, driving product development, managing a physician team of 30, collaborating with engineering and AI scientists on research development, and supporting FDA regulatory pathways.Dr. Gupta's passion for innovation and curious nature have led to entrepreneurial projects, peer-reviewed publications, and speaking engagements.Topics:Seniors' lack of access to healthcare resourcesTelemedicine services for seniorsSpecialty care versus emergency careCOVID-19 impact on seniors and telemedicineDr. Gupta’s LinkedIn: https://www.linkedin.com/in/anuragmdmba/Twitter: https://twitter.com/igupta03

Impulse control disorders in Parkinson’s disease (PD) are more common than originally thought, affecting an estimated one in six people with PD taking dopamine agonists. They may appear as unhealthy or compulsive levels of shopping, gambling, eating, sexual activity, or involvement in hobbies. They appear to be related to dopamine replacement therapy, so finding the right level of medications can be a challenge to manage symptoms without incurring impulsivity issues. It is important that people with PD, their care partners, and health care professionals be aware of and recognize these activities so that they can be addressed promptly to avoid, for example, social, emotional, economic, and health issues that may result from these disorders. The harm often goes beyond the person with the disorder and can affect family, friends, and others around them. Once recognized, impulse control disorders can often be managed or eliminated by working with a doctor to change dopamine agonist medications or dosage, or in some cases, even going on to deep brain stimulation.   Dr. Mark Groves, Consultant Psychiatrist at the Parkinson’s Foundation’s Center of Excellence at Mount Sinai Beth Israel in New York City, discusses the problem of impulse control disorders, what forms they may take, approaches to recognizing them, and the need to acknowledge them as a biologic condition and not a character or personality flaw.

For part nine of our No Barriers Alchemy Series our host Dave Shurna and guest host, Tom Lilig, interview Dr. Rana Awdish. Rana is a critical care physician operating on the front lines during COVID-19 at Henry Ford Hospital in Detroit, MI. Her own serious illness in 2008 has informed her belief in the power of compassion, sacred listening, and community. As medical director of the Care Experience for the Henry Ford Healthcare System, she is training staff to practice empathy in critical care. She completed her medical degree at Wayne State in 2002 where she was inducted into the Alpha Omega Alpha national medical honor society, her residency at Mount Sinai Beth Israel in New York, and her fellowship training at Henry Ford Hospital where she serves as the current Director of the Pulmonary Hypertension Program. She is a fellow of the American College of Physicians and The American College of Chest Physicians and was inducted into the Gold Humanism Society in 2019.She was named Henry Ford Hospital’s Critical Care Teacher of the Year in 2016, and the National Compassionate Caregiver of the Year by The Schwartz Center as well as Physician of the Year by Press Ganey in 2017. Her articles have appeared in the New England Journal of Medicine, the Harvard Business Review, and the Proceedings of the Mayo Clinic. A New York Times book review called Awdish’s book, In Shock, based on her own critical illness. “the one I wish we were given our first year of medical school, alongside our white coats and stethoscopes.” Her book has since been integrated into the curriculum of medical schools and universities across the U.S. and Europe.Resources:https://www.ranaawdishmd.com/Sign up for our No Barriers Summit

For part nine of our No Barriers Alchemy Series hosts Erik and Dave interview Dr. Rana Awdish. Rana is a critical care physician operating on the front lines during COVID-19 at Henry Ford Hospital in Detroit, MI. Her own serious illness in 2008 has informed her belief in the power of compassion, sacred listening, and community. As medical director of the Care Experience for the Henry Ford Healthcare System, she is training staff to practice empathy in critical care. She completed her medical degree at Wayne State in 2002 where she was inducted into the Alpha Omega Alpha national medical honor society, her residency at Mount Sinai Beth Israel in New York, and her fellowship training at Henry Ford Hospital where she serves as the current Director of the Pulmonary Hypertension Program. She is a fellow of the American College of Physicians and The American College of Chest Physicians and was inducted into the Gold Humanism Society in 2019.She was named Henry Ford Hospital’s Critical Care Teacher of the Year in 2016, and the National Compassionate Caregiver of the Year by The Schwartz Center as well as Physician of the Year by Press Ganey in 2017. Her articles have appeared in the New England Journal of Medicine, the Harvard Business Review, and the Proceedings of the Mayo Clinic. A New York Times book review called Awdish’s book, In Shock, based on her own critical illness. “the one I wish we were given our first year of medical school, alongside our white coats and stethoscopes.” Her book has since been integrated into the curriculum of medical schools and universities across the U.S. and Europe.Resources:https://www.ranaawdishmd.com/Sign up for our No Barriers Summit

Life for Doctors/Healthcare Professionals in New York with Dr. Lina Miyakawa, Pulmonary & Critical Care physician and Deputy Medical ICU Director at Mount Sinai Beth Israel

New York needs ventilators, and quick. Lina Miyakawa of Mount Sinai Beth Israel is one of the doctors who operate those lifesaving breathing machines, working almost around the clock as COVID-19 patients begin to crowd hospital beds. She describes how the machines work and outlines one experimental technique doctors are being driven to in order to meet this moment: putting more than one patient on a machine. This is the fifth episode of “Life Under Coronavirus” about the region’s helpers during the current health crisis.

Hey everyone, we got a special episode here. My friend Dr. Lina Miyakawa is with us today live from New York City. She’s a pulmonary ICU specialist and is treating coronavirus cases in Mt. Sinai hospital in Manhattan. She went to NYU for her undergraduate degree, received her medical degree from John A. Burns School of Medicine at University of Hawaii, completed her Internal Medicine residency training at Santa Clara Valley Medical Center, affiliated with Stanford University in California and her specialty fellowship training in Pulmonary and Critical Care Medicine at Mount Sinai Beth Israel in New York City. Let’s get straight to the episode - I think it’s really interesting to get to hear this inside scoop from someone dealing with this on the front lines. She’s been working nonstop treating patients and spared a few minutes to talk with me. Just to give you an idea of what we’re dealing with, she had to cancel our interview yesterday because she lost another patient.  If you’re new to this show make sure to start back at episode 1. I’ve spent the last 2 years finding the brightest minds in the world to interview and people continually report how life changing the information presented has been for them. Here’s Dr. Lina. Find her here: https://www.mountsinai.org/profiles/lina-miyakawa Or on IG: http://instagram.com/linalinalina ________ BUY THE MEAT NosetoTail.org Support me on Patreon! http://patreon.com/peakhuman Preorder the film here: http://indiegogo.com/projects/food-lies-post   Film site: http://FoodLies.org YouTube: https://www.youtube.com/c/FoodLies   Follow along: http://twitter.com/FoodLiesOrg http://instagram.com/food.lies http://facebook.com/FoodLiesOrg  

In this episode of the Get Healthy 360 Podcast, Dr. Ferguson speaks with urologist Aaron Grotas, MD about ED and men's reproductive health. Everything you ever wanted to know about the various medication, procedures, implants, pumps, and even shockwave therapy that is used to treat ED. Dr. Aaron Grotas, MD is a board certified urologist in New York. He is affiliated with South Nassau Communities Hospital, Mount Sinai Beth Israel, and Mount Sinai Hospital. Website: newyorkuro.com. Twitter: @draarongrotas Facebook: @New York Urologist

The Medical Society of the State of New York invites you to listen to Dr. Matthew Weissman talk about the importance of Tetanus, Diphtheria and Pertussis (TDaP) vaccine. Dr. Weissman, Site Chair of Medicine at Mount Sinai Beth Israel and an Associate Professor of Internal Medicine and Pediatrics at the Icahn School of Medicine at Mount Sinai (twitter: @drmweissman; Instagram: @drmattweissman) discusses the nature of these three infections and the importance of vaccinating against them. Dr. Weissman also reviews the differences between the Td (tetanus and diphtheria alone) vaccine and TDaP vaccine as well as age recommendations for these vaccines and what else people should watch for.

This week, we are replaying five interviews that MDedge Psychiatry editor in chief Lorenzo Norris, MD, conducted at the 2019 American Psychiatric Association annual meeting. Dr. Norris spoke with Igor Galynker, MD, (Mount Sinai Beth Israel, N.Y.) about identifying suicide crisis syndrome; Jonathan M. Meyer, MD, (University of California, San Diego) about prescribing clozapine for treatment refractory schizophrenia; Robert M. McCarron, DO, (University of California, Irvine) about psychiatry and primary care; Cam Ritchie, MD, MPH, about preparing patients for disruptions in psychiatric medications; and Richard Balon, MD, (Wayne State University, Detroit) about overcoming resistance to prescribing benzodiazepines for patients with serious mental illnesses. *  *  *   Help us make this podcast better! Please take this short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *  *  *     For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych  

Dr. Costas Hadjipanayis, Director of Neurosurgical Oncology for Mount Sinai Beth Israel Hospital discusses his experience working with the advanced robotically-controlled digital microscope, Modus V, from Synaptive Medical and how this technology was used recently to successfully remove a 19-year old woman's rare brain tumor.  Dr. H talks about the advantages to using this technology prior to surgery and during surgery, and how doctors need to think about embracing new devices and techniques to more accurately address medical challenges. @SynaptiveMed #BrainSurgery  #Neurosurgery  #PrecisionMedicine  #RoboticSurgery  #ModusV Synaptive Medical Download the transcript here.

Dr. Costas Hadjipanayis, Director of Neurosurgical Oncology for Mount Sinai Beth Israel Hospital discusses his experience working with the advanced robotically-controlled digital microscope, Modus V, from Synaptive Medical and how this technology was used recently to successfully remove a 19-year old woman's rare brain tumor.  Dr. H talks about the advantages to using this technology prior to surgery and during surgery, and how doctors need to think about embracing new devices and techniques to more accurately address medical challenges. @SynaptiveMed #BrainSurgery  #Neurosurgery  #PrecisionMedicine  #RoboticSurgery  #ModusV Synaptive Medical Listen to the podcast here.    

 Show Notes Last week, Igor Galynker, MD, PhD, spoke with Lorenzo Norris, MD, host of the MDedge Psychcast and editor in chief of MDedge Psychiatry, about how to identify suicide crisis syndrome. This week, he explores the kinds of “gut feelings” that clinicians can access to help them identify when a patient might have the syndrome.   Dr. Galynker has been a guest on the Psychcast twice before, once to discuss the impact of suicide on physicians and a second time to talk about his research on the arguments for adding a suicide-specific diagnosis to the DSM-5. He is associate chairman for research in the department of psychiatry at Mount Sinai Beth Israel in New York. In addition, Dr. Galynker is founder and director of the Richard and Cynthia Zirinsky Center for Bipolar Disorder, and professor of psychiatry at the Icahn School of Medicine, both at Mount Sinai. Later, Renee Kohanski, MD, discusses the ability of psychiatrists to help patients realize that they can choose what matters in their lives. Dr. Kohanski, a member of the MDedge Psychiatry Editorial Advisory Board, is a psychiatrist in private practice in Mystic, Conn. Show Notes by Jacqueline Posada, MD, who is a consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va. The “gut feelings” -- emotional reactions to the patient in suicide risk assessment -- also will elicit behaviors from a clinician. Behavioral signs of the four emotions are pertinent for clinicians who are burned out or may have limited emotional awareness. Examples include: Anxious overinvolvement manifested as going above and beyond for a patient; doing things that are out of character, such as answering phone calls/texts on the weekend; reluctance to set boundaries. Dislike and distancing: The patient in suicide crisis syndrome will be the last one the clinician sees on the inpatient unit or the one he/she postpones or forgets to see; the clinician experiences dread tied to the prospect of seeing a patient all day, shortens sessions, or does not answer phone calls. How to combine emotional response and the suicide crisis syndrome. New research from Dr. Galynker and colleagues suggests that the predictive validity for suicide risk doubles if the patient meets criteria for suicide crisis syndrome and the clinician has an emotional response as described above. The emotional response is elicited not just from the suicide crisis syndrome but also from the suicidal narrative. The narrative of a suicidal person describes an intolerable present with no future. This type of aberrant narrative triggers an emotional response in the clinician. One could argue the electronic medical record makes it difficult to understand the patient’s narrative, which can impede the clinician’s ability to have an emotional response to the patient’s suffering. Why has psychiatry not focused on suicide over other mental health diagnoses? As a transdiagnostic phenomenon, one could argue that suicide must be a primary focus of assessment and treatment by psychiatrists. Suicide elicits a variety of cultural responses, ranging from shame, disgust, and a sense of weakness to empathy for the pain and suffering of a suicidal person. It is difficult to connect with someone who is suffering from a desire to die, but this might be what the patient wants. Clinical excellence is the ability to connect with a variety of patients in different settings, and it’s about demonstrating how one cares.   References Olfson M et al. Short-term suicide risk after psychiatric hospital discharge. JAMA Psychiatry. 2016 Nov 1;73(11):1119-26. Galynker I et al. Prediction of suicidal behavior in high-risk psychiatric patients using an assessment of acute suicidal state: The suicide crisis inventory. Depress Anxiety. 2017 Feb;34(2):147-58. Cohen LJ et al. The suicide crisis syndrome mediates the relationship between long-term risk factors and lifetime suicidal phenomena. Suicide Life Threat Behav. 2018 Oct;48(5):613-23. Suicide rising across U.S. Centers for Disease Control and Prevention. Vital Signs. 2018 Jun. Oquendo MA and E Baca-Garcia. Suicidal behavior disorder as a diagnostic entity in the DSM-5 classification system: Advantages outweigh limitations. World Psychiatry. 2014 Jun;13(2):128-30. Fawcett J. “Diagnosis, traits, states and comorbidity in suicide” in The Neurobiological Basis of Suicide. Boca Raton, Fla.: Taylor & Francis, 2012.   For more MDedge Podcasts, go to mdedge.com/podcasts   Email the show: podcasts@mdedge.com   Interact with us on Twitter: @MDedgePsych  

  Show Notes Igor Galynker, MD, PhD, talks with Lorenzo Norris, MD, host of the MDedge Psychcast and editor in chief of MDedge Psychiatry, about suicide crisis syndrome.   Dr. Galynker has been a guest on the Psychcast twice before, once to discuss the impact of suicide on physicians and a second time to talk about his research on the arguments for adding a suicide-specific diagnosis to the DSM-5. He is associate chairman for research in the department of psychiatry at Mount Sinai Beth Israel in New York. In addition, Dr. Galynker is founder and director of the Richard and Cynthia Zirinsky Center for Bipolar Disorder, and professor of psychiatry at the Icahn School of Medicine, both at Mount Sinai. Show Notes by Jacqueline Posada, MD, who is a consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va. Later, in the “Dr. RK” segment, Renee Kohanski, MD, tells the story of a patient who found a way to rediscover his value system against great odds. Dr. Kohanski, a member of the MDedge Psychiatry Editorial Advisory Board, is a psychiatrist in private practice in Mystic, Conn. Suicide crisis syndrome: A suicide-specific mental state Until recently, there was no differentiation between the mental state associated with lifelong suicide risk versus the mental state associated with imminent suicide risk. Jan Fawcett, MD, distinguished these mental states for the first time by differentiating acute risk of imminent death and lifelong risks and traits of suicidal behavior. Lifetime suicide risk factors include mental illness, history of suicide attempts, depression, and substance abuse. Imminent suicidal behavior risk factors include panic, acute anhedonia, agitation, and insomnia. Dr. Galynker and colleagues have identified a condition they call suicide crisis syndrome, which they define as a mental state that predicts imminent suicidal behavior in days to weeks. The predictive validity has been replicated across several cultures and populations. Suicide crisis syndrome: To be identified as having suicide crisis syndrome, the patient must meet both criterion A and two criteria of B. Criterion A: Frantic hopelessness or state of entrapment defined as being stuck in a life situation that is painful and intolerable, and a feeling that all routes of escape are blocked. The risk of suicide within 1 month is 13% for people who meet criteria for suicide crisis syndrome. Criterion B: Affective dyscontrol, including emotional pain or mental pain; severe panic with agitation, and dissociation; rapid mood swings that can include happiness; and acute anhedonia. Cognitive dyscontrol, which can include ruminative flooding associated with headache or head pressure; cognitive rigidity; and inability to suppress the ruminative thoughts. (For example, you might assess by asking: “Do you control the thoughts or do the thoughts control you?”) Overarousal with insomnia and agitation. Social withdrawal and isolation, and evading communication. Why are suicide-specific diagnoses necessary? 75% of people who die by suicide do not report suicidal ideation to a clinician, psychiatrist, or primary care physician. Notably, suicide crisis syndrome does not include suicidal ideation in the criteria, because not all people within imminent risk feel suicidal until the moment strikes. Some patients will hide their suicidal ideation from their clinician to prevent having their plan foiled. Suicide crisis syndrome creates a fuller picture of patient risk. Assessment of the criteria help a clinician consider more risk factors for imminent risk than simply a patient’s self-report about suicidal ideation. Approach suicidality with a different framework Suicide-specific diagnoses represent a profound shift in approach, because suicide is a transdiagnostic phenomenon for depression, bipolar disorder, and schizophrenia. A person can be at imminent risk for suicide without meeting criteria for other DSM diagnoses. Other suicide-specific diagnoses: Maria A. Oquendo, MD, PhD, and colleagues have put forward “suicidal behavior disorder,” which is a diagnosis that captures the propensity of suicidal behavior and urges to kill oneself. Suicidal behavior disorder and suicide crisis syndrome provide clinical targets for treatment of suicide. Without a diagnosis, clinicians cannot test treatment or teach the assessments.   Use emotional reactions to the patient in suicide risk assessment Clinicians can identify “gut feelings” that help hone their assessments. Galynker and colleagues have identified four emotions that can help clinicians identify suicide risk: Distress. Dislike with distancing. Anxious overinvolvement, with a paradoxical combination of hope and distress. Collusion/abandonment/rejection, which includes a type of hopelessness and calm. Clinicians can be trained to identify these emotions, which they may have been taught to suppress. Recognition of these emotions can be cultivated through “emotional awareness rounds.”   Dr. Fawcett is a professor of psychiatry at the University of New Mexico, Albuquerque. Dr. Oquendo is the Ruth Meltzer Professor of Psychiatry at the University of Pennsylvania, Philadelphia.   References Olfson M et al. Short-term suicide risk after psychiatric hospital discharge. JAMA Psychiatry. 2016 Nov 1;73(11):1119-26. Galynker I et al. Prediction of suicidal behavior in high-risk psychiatric patients using an assessment of acute suicidal state: The suicide crisis inventory. Depress Anxiety. 2017 Feb;34(2):147-58. Cohen LJ et al. The suicide crisis syndrome mediates the relationship between long-term risk factors and lifetime suicidal phenomena. Suicide Life Threat Behav. 2018 Oct;48(5):613-23. Suicide rising across U.S. Centers for Disease Control and Prevention. Vital Signs. 2018 Jun. Oquendo MA and E Baca-Garcia. Suicidal behavior disorder as a diagnostic entity in the DSM-5 classification system: advantages outweigh limitations. World Psychiatry. 2014 Jun;13(2):128-30. Fawcett J. “Diagnosis, traits, states and comorbidity in suicide” in The Neurobiological Basis of Suicide. Boca Raton, Fla.: Taylor & Francis, 2012.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych  

Lets Talk about skin cancer... On this week's episode of the Lunch and Learn with Dr. Berry we have Dr. Candrice Heath. Dr. Heath is a board-certified dermatologist and actually comes tripled boarded in Pediatrics, Dermatology and Pediatric Dermatology. She is a nationally recognized best selling author, and speaker and this week she lends her expertise to the Lunch and Learn Community for National Skin Cancer Awareness Month. Dr. Candrice gives us the ABCDs of skin cancer, teaches us what to expect when we go see the dermatologist and helps me try to break down some of the misconceptions associated with skin cancer and people of color. Dr. Candrice also lets us in on some exciting upcoming news about her company My Sister’s Beauty. Remember to subscribe to the podcast and share the episode with a friend or family member. Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify Sponsors: Lunch and Learn Community Online Store (code Empower10) Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you) Dr. Pierre's Resources - These are some of the tools I use to become successful using social media Links/Resources: Facebook – https://www.facebook.com/drcandriceheath/ Instagram – https://www.instagram/drcandriceheath Dr. Candrice’s Clinical Pearls - www.drcandriceheath/clinicalpearls Skin Care Line – www.mysistersbeauty.com Social Links: Join the lunch and learn community - https://www.drpierresblog.com/joinlunchlearnpod Follow the podcast on Facebook - http://www.facebook.com/lunchlearnpod Follow the podcast on twitter - http://www.twitter.com/lunchlearnpod - use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drpierresblog.com/lunchlearnpodcast/ If you are looking to help the show out Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod Introduction Dr. Berry: And welcome to another episode of the Lunch and Learn with Dr. Berry. I’m your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com and as well as Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy. This week we bring you an episode with Dr. Candrice Heath, who is an amazing person and most importantly is going to be talking to us about skin cancer. And you know, just to kind of caveat before we get into her bio and how amazing this person is. For those who may be listening, especially Lunch and Learn community. I've kind of referenced this before on a previous episode where we talked about skin cancer. I felt like this time I wanted to bring an expert and kind of get their expert opinion on to disorder, right? And if you want to know why this topic is so important, we're actually in skin cancer awareness month and when we talk about the number of cases of skin cancer that occur per year, it outnumbers the number of cases of lung cancer, breast cancer, prostate cancer, colon cancer combined, right? So it's an extremely important topic that I think a lot of times doesn't really get the fan fair especially because a lot of times when we think about dermatology tend to think about the aesthetic aspect of dermatology. But we really don't think about the fact that they are really in high demand when it comes to pathology and disease process and education, which is why I felt, you know what, let me bring this amazing guest here. And again. I just want to kind of read her bio just so you guys can understand, how important and how specialized this person is, Dr. Heath. She is a highly respected dermatologist. She's board-certified in Dermatology, Pediatrics and Pediatric Dermatology. And ladies and gentlemen, I mean she is triple certified in her specialty, right? Just so you can guys can get an idea of how amazing, especially she is. She got her undergrad degree at Wake Forest University. Her medical degree at the University of Virginia and her pediatric training at Emory. And then she ended up getting her dermatology training at Mount Sinai Beth Israel in New York City. She was elected to achieve dermatology resident during her final year of training and she went on to serve a role at John Hopkins University, Department of Dermatology. And as well as a pediatric dermatology fellow as well as a dermatology instructor. If you didn't get that right, just understand that this is definitely a very highly specialized person that we're bringing onto the podcast, really to educate the Lunch and Learn community. And most importantly, and this is what I love. She’s the founder of My Sister's Beauty, the official skincare line of the woman of color and founder of a vibrant online community associated with skincare and beauty tips for women of color. So amazing person, Dr. Candrice Heath. Again, she is a personal friend of mine as well. And she has blessed us with the opportunity to talk to us today just about skin cancer. And really, you know, what we should be thinking about when it comes to skin health, right? Because I think when we talk about empowering ourselves for better health, right? We got to understand that the whole body has to be working in unison, right? And I think a lot of times we forget about the skin. Again, I talked about the numbers, more cancer cases worldwide and the majority of these cancers put together. So you know, ladies and gentlemen, get ready an amazing episode. Again, I have Dr. Candrice Heath and we're going to be talking about skin cancer and skin cancer awareness. If you have not had a chance, remember, subscribe to the podcast, leave me a five-star review. And you know, when we leave the links for Dr. Candrice, go ahead and follow her and let her know how she did an amazing job this week. Episode Dr. Berry: All right, Lunch and Learn community. Again, thank you for joining us for another amazing episode. Again, this month being, you know, skin cancer awareness month. I was thinking long and hard and I said, you know, who can I get to really educate you to get us on far, to get us, get those bad thoughts that really shouldn't be in our mindset when we talk about skin cancer but really educated us and you know, kind of go through a lot of the fluff that I know that's out there. So of course if you listened to the bio, you know, we have Dr. Candrice here who is an amazing person in general. This is just an amazing person, an amazing physician. And I was just glad that, you know, she was able to give us some time to talk to us today, Dr. Candrice thank you. Dr. Candrice: Oh, thank you so much for having me today, Dr. Berry. Dr. Berry: We did a little bit of your bio in the introduction, but you know, for people who may not know you and you know, this is their kind of first entry into your world. Who is our Dr. Candrice? How are you going to get us together today? Especially when we talk about this discussion of skin cancer that even when I was doing like, you know, the little research that I did on skin cancer, I didn't realize how serious it was. Still the people a little bit about you that, you know, they may not have gotten from your bio, but you know, they will get, just have to listen to this episode today. Dr. Candrice: So I guess, I mean there are lots of things out there about Dr. Candrice, but what people really want to know or need to know is that I truly love being a dermatologist. I've learned on my journey that not a lot of people can say that they're passionate about what they do. They love it. But I truly love being a dermatologist and I enjoy all aspects of that from the education to what happens in the exam room, with the patients. And I realize that not only am I providing a diagnosis, treatment education but that I am actually impacting how someone feels about themselves. And that is a huge win for me. Dr. Berry: I love it. I love that. And of course, especially for Lunch and Learn community who may not realize, like when we talk about medical specialties, dermatology is one of those upper echelon specialties that if you're able to get through the rigors of medical school and conquer and do what you need to do, right? Like you can attain it, right? So again, this isn't a specialty that people just kind of walk into. Like they really have to put some work in. And again, I know Dr. Candrice as a person. I know her, I noticed she's an amazing person. I do want to really illuminate the fact that we got really a special person to talk to us today about skin cancer, right? Which again is, first of all from the numbers. Just from a sheer numbers standpoint, it was common cancer in the world, right? Boom. Like if that alone doesn't get your ears up and ready to educate yourself on this topic, I'm not sure what is. But Dr. Candice again, I’m an internist. I'm a hospital physician and you know, they've kind of heard the back story of how I got into there. What made you fall in love with dermatology? Like what was the path that kind of led you here to be able to grace us today? Dr. Candrice: Growing up, my older sister has something called nevus of Ota and it's actually a green birthmark that covers one side of her face. And so not only did we spend time going to our regular checkups with our pediatrician. We also would yearly visit our dermatologist in our local town. And I can still recall how excited and with anticipation. We would anticipate these visits because we would hope that they would have something to share that could take this birthmark away. And year after year, appointment after appointment, we were met with disappointment because there were, the technology hadn't really caught up so people with skin of color were not able to use the laser devices that were coming out to take away things on the skin such as my sister's birthmark without leaving significant scarring. But despite the answer being, "no, not yet," there's no solution yet, the dermatologist would take time to address my sister's self-esteem. And those few minutes actually really made the difference to me. And I said, wow, you know, dermatology, that is true, this is a different kind of doctor’s experience. So I could definitely experience what it was like to have a family member that had an ailment on the skin that everyone can see. So it's not like diabetes or having a heart problem where people may not be able to tell from your exterior that you're having issues inside of your body. But to be able to walk around with something that the general public can see. Man, that is an experience. Okay. So I took those observations and thoughts and also that experience that we had in the exam room. And then that's when I became interested in this whole dermatology, this skin disease. So if you can imagine, you know, 10-year old walking around and saying, hey, I want to be a dermatologist. That was me. I did not know about the uphill battle that we're following at it, know about how challenging it would become. And yes, I did set that goal based on my personal experience and I persevered to cross the finish line, but it wasn't easy. So people have to continue to follow me as I share more about that story. The great news is that yes, I am a dermatologist today and I'm so grateful for that so that I can live in my passion. But it was definitely a journey of perseverance to get here. Dr. Berry: I think that's telling because I think a lot of times when I think the common person, kinda hears about dermatology. I think they get kind of skewed, right? Because, they kind of think of more of the aesthetic, the Botox, that type of feel not realizing like no, there’s a lot more things that you know, it's scary. Right? You know, it can be disheartening especially from a self-esteem standpoint. So the pathology alone, right? Like and when we were talking about mythology, we talk about like disease courses, right? The amount of diseases that either originates from the, that show up on the skin is so vast. Again, I'm always impressed that you know, by my dermatologist because I know how much work, when did they put to get there as well as how much work they got to do while they there. Right? Like it's not a nine to five, you just chilling your junior year injecting people and then you're kind of keeping them, you know, a beautiful and healthy whole day. Right? There's a lot of clinical diagnostic procedures and treatment and discussions that go on a day to day basis. Right. Which is why I'm definitely such a fan of the field in general. Not so much offended. I wanted to be a dermatologist but enough that I can appreciate it from the outside. Dr. Candrice: And I definitely, thank you so much for highlighting that I think our other physician colleagues understand the scope of what we do. Yes. I do have colleagues who only do aesthetics, the only botox and fillers and things like that, but there is a large breadth of things that we do under the dermatology umbrella and I'm happy that our physician colleagues are excited that we can actually help them with their patients. Now the general public may just see us as, you know, a skin doctor or pimple popper or something like that, but in actuality, on a day to day basis, I am taking care of people who have severe disease and like brought up Dr. Berry as a dermatologist. It's amazing. I can go into the exam room, I can look at someone's skin and I can say, hmm, I wonder if this patient has diabetes. I wonder if this patient has thyroid disease. I know this patient has an autoimmune disease. And so it's amazing because, you know, the medical students are thinking, how would you know all of this stuff? My mind is trained to look at the skin, look at the hair, look at the nails, and come up with conclusions based on the patterns of recognition that I've seen over the years. So it is amazing. And yes, we do more than just acne and dry skin. We do lots of things and we take care of patients who have a serious disease. Dr. Berry: That was interesting. I know, and I know we're definitely gonna talk about it, you know, a little bit late on this show is the fact that you were introduced to the field very early. Cause I'm being honest, right? Like I've never been to a dermatologist, right? Like I'm 35 years old. No, don't hate me. Don't hit me. Right? I know, I know. I'm bad. I know. Trust me. You know, doctors make the worst patients, right? But I've always felt like, well, what am I going to do it here? This my skin looks okay. Right? So, I'm actually very happy that, you know, you guys were very introduced very early because I think a lot of times we hear, well, you know, let's say, skin color, you know, your dark skin, it is really nothing after you to do, there isn't nothing that he can tell you. I read the books, right? A lot of times when I'm reading books and I'm trying to get the description and I'm like, well what does this look like on a black person? Right? What does it look like on me? I don't know what this rash would look like on myself. Right? So I always kind of struggle with that. And again, we're definitely gonna talk about that later on. But I'm definitely kind of happy that, you know, you got introduced very early. Dr. Candrice: Yes, it is. It definitely has been a passion for a long time and yes, we do need more educational resources that highlight people with skin of color who had these specific things that we're trying to educate our colleagues about and the general public about. Dr. Berry: So with, with me, right, obviously we're recording this right? This is a skin cancer awareness month. I'll kind of all wrapped into one when we talk about skin cancer awareness. Like why for one. Right. Because this is the question I always get when we have these like health-related month. I like why does it stay made a whole month? Right? So like that I, I post you, right? Like why does skin cancer really need a whole month for us to be aware of? And what kind of says, you know what, I need to take this mantle and make sure I'm educating everyone about like skin cancer. Not to say that all your packages are nothing but skin cancer. I, but why is this like particular subjects such an important, I think for everyone to kind of know about it. Dr. Candrice: Skin cancer awareness month is a very important topic and yes, it should span the entire month of May and as a dermatologist, every day is skin cancer. Well you know, I could be a little biased. I mean, the thing is we all have skin and so sometimes we have been ingrained with these things that say, Oh, if you have brown skin, you don't have to worry about, you know, getting skin cancer. You don't have to worry about these things. So you just kind of tune it out. But I hope that every year when the month of May rolls around that people, regardless of their skin tone, learn something new about something that can potentially affect them, which is skin cancer. So it's all about educating, educating, educating. And if we only get 30 days out of the month to do that, or 31 days out of the month and do that, I say, let's go forward. We all have skin and we can all be infected regardless of skin tone. Dr. Berry: When we talk about just like the sheer numbers, right? I kind of alluded to it being the most common type of cancer in general, which is funny, right? Because me being an internist, I hear a lot about long, right? I hear a lot about the prostate, right? I hear a lot about breasts, I hear a lot about those things, but then when I'm looking at the numbers and they're like, whoa, those skin cancers, like I was pulling it out of water. Like I think that was more shocking to me. Obviously, you're in the field so we're probably not gonna be a shocking you. But like I thought that kinda hit me. I was like, oh I have this many people like dealt with like skin cancer. What are some of like the numbers, the stats, you know, Lunch and Learn community loves numbers from a statistic standpoint. Like, like how many people like are dealing with cancer and especially on a worldwide basis. The United States, you know, black folks, some women. Like what are some of the numbers that you kind of run across? Dr. Candrice: So I'm really, the numbers are usually broken down into the number of cases of melanoma that are diagnosed every year, which is a specific type of skin cancer than the most deadly type of skin cancer. There is the other group which is non-melanoma skin cancers. And often non-melanoma skin cancers, you're going to probably get about 5.4 million cases that had been treated in an average year. So that is a lot of cases of cancer. And then if you dive deeper into the statistics, you will find that one in five Americans by the time that their age 70 they're going to develop skin cancer that's taking all comers, all ages, all races of people putting them in the pot and you're coming up with the one in five Americans. So yes, it is definitely way more common than you think. And even when we really dissect out to the most deadly type of skin cancer, which is melanoma, it is predicted that there will be an increase in the year 2019 unfortunately by almost 7.7% so this is something that is not going away and it is definitely increasing. So we have to be on the lookout for it. The prediction of the number of cases for 2019 is over 190,000 cases are predicted to be diagnosed this year. So we definitely enough to be on the lookout for this. Dr. Berry: And what's interesting especially, and I am not sure if it's because it doesn't get the fanfare right? Like again I know we talked about breasts, we were talking about lung and just for Lunch and Learn community just from a number of sake, you know she was talking in the millions, right? When we talk about cases I'm like lung cancer, breast cancer, those are like in the 150 to 200 thousand. Just to give you an idea from a sheer numbers standpoint. How much more common it is right to have skin cancer than it is the other cancers, right? Not to say that no one is better than the other, but just when we talk about media and we talk about the influence of it, but then we had Dr. Amber Robins talked about the influence of media on our health care. This is one of the things that we see, right? Like we, we see like this is an issue that probably should get like more than a month if this many people, right. Ideally, with a skin cancer wet, you know, we got a month so we're gonna focus on and kind of do it here. And you talked about the different types of skin cancer, right? Like especially in your training when you're dealing with the melanoma and again, melanoma, we, you know, I know as an internist, you know, that's a bad word for us, right? We were as the one that's kind of scary for us as one, we tend to see exhibit an in a lot of different functions and especially when we're talking about when it starts spreading everywhere. When you're talking about melanoma versus the non-melanomas type skin cancers, right. And you just kind of start breaking those down. What is it that people should be doing? Right? Like again, what should I do? Should I start like scan to my skin now? Because now I'm getting kind of scared, right? All these people are against cancer, I'm getting kind of scared. I need to be worried about it. Dr. Candrice: Well definitely really the first step is to educate yourself. So you landed in the right spot. So we talked about melanoma being the most aggressive, a type of skin cancer. And then there are also those types which include Basal Cell Carcinoma, Squamous Cell Carcinoma, and even a rare to very rare type that we don't talk about that often called Merkel Cell Carcinoma. So there are various types. And the best thing that you can do is to definitely see a dermatologist once a year to get a head-to-toe, a skin check. But then right in your home you can actually go ahead, advocate for yourself, taking a mirror and looking at your own skin. The first step is to really get to know what is living on your skin already. You know, time and time again, I may ask a patient, how long has this been there? And they, so I don't know. I haven't seen my back in two years. That’s unacceptable. I want you to get to know what is on your skin regularly. That way you can be a better, this hectic just in case something changes or comes up, you can say hey you can go to your primary care doctor and say look I need a referral to a dermatologist because this is changing. This was not there before I'm concerned. Dr. Berry: Okay, get in tune with what your skin is so you know what their baseline is and you do recommend just like once a year? Like I said clearly I'm overdue. Right? So you're just saying just like you're doing your regular annual checkup, you should be seeing your skin screening as well? Dr. Candrice: Yes, I do recommend that people get skin checks and definitely you know if you had lesions on the skin, moles, etc. They should be checked. And people with skin of color, of course, we have to be very very careful because skin cancer can happen on areas of the body that you may not expect. So for people with skin of color that means anyone with non-Caucasian skin, non-white skin, the risk of your skin cancers are going to be higher. When we were talking about melanoma on the soles of the feet, the palms of the hand inside of the mouth. So those are areas that people may not even think about that can be effect by skin cancer. And yet that's where we find the most deadly type of skin cancer in people of color. Dr. Berry: Are we've already dealing with more aggressive types of skin cancer or is it our lack of, you know, just being aware and following up on the skin cancer? Like what would you, if you had to lean one way or the other? Dr. Candrice: The number one thing for skin cancer and people with skin of color is late detection and delayed diagnosis. The patient doesn't believe that they can ever have skin cancer, so that may delay treatment. Also, there are some primary care physicians who are uncomfortable with things on the skin and that stems from just, you know, how physicians are taught and what they're exposed to. So they may not actually get a lot of teaching in dermatology during their training. So it's an area that they may not feel as comfortable with. So it may not be on their radar to even look at the hands and feet of someone with the skin of color and to refer that patient. So basically, usually by the time that patient with the skin of color lands in my office, regardless of the cancer type, it is usually at a higher stage. So it is going to be the worst case scenario I'm walking in. So versus someone else who may have been trained from a child to say, you know, we can get skin cancers, you have to protect your skin from the sun, you have to do this, you have to do that. So they're more aware that things can go wrong on the skin. But if you have no clue that 'that' could happen, you have definitely, there's a long time lapse between when that appeared on the skin when you can actually get your diagnosis. And that definitely affects your prognosis. Dr. Berry: Wow. Okay. All right. Dr. Candrice, she's getting us together. So yeah, I'll know until right now, next week, I am scheduling my dermatology exam because it is clearly serious. And again, this is if, if you, if you had one month to choose to like do your routine skin screening exams, why not let it be in the month of May when you know, skin cancers around us. The spotlight is on from a media standpoint is on it. So this is definitely the month you should be thinking about, you know, calling your primary care doctor like right now. And if you're in Florida, fortunately in Florida, you don't even have to get a referral. You can go straight to your dermatologist. Thank you for Congressman Wasserman for that standpoint there. That's great. So I taught, I hear about skin cancer, I read Baskin cancer a lot. And I always see this is the A, B, C, D, E of the skin cancer. Right? What is that? And you know, how could my Lunch and Learn community, you know, derive and be educated and you know, get on the ball with, in the car and in regards to at ABCD’s of skin cancer. Dr. Candrice: The ABCD’s are really A, B, C, D, E. Now we've actually added E to that as well. (Okay.) It is a reminder for you when you're looking at your skin, what are some of the things that I should look for as warning signs or things that are going wrong on the skin? So let's say you have a mole on the skin and if you were to look at, if you were to imagine splitting the mole in half with, you're just with your eyes a little line. If one side does not look exactly like the other side, we say that that is asymmetrical and that is a warning sign. That lesion should be checked. So A stands for asymmetrical. One side doesn't look like the other, that could be significant. The B stands for border. So if it has a round, nice, crisp border, then we're not going to worry as much. But at the borders brace squiggly and not a very crisp, that could be a problem. Also, the C stands for color. So if your mole all of a sudden goes from being brown to having brown, gray, pink, white, basically changing in color, that could be a problem. So that's something that could trigger you to get that checked out. D stands for diameter. So typically, melanomas are in other things that are going to be problematic are the greater than this, the head of an eraser. Now I've definitely diagnosed things that were smaller than that. But anyway, it's part of the warning signs. So that may be something else that can prompt people to come in. And then the last E has been added in the last several years and that stands for evolving. So basically what that means is even if you don't remember the A, the B, the C, the D with those things stand for if you have a mole that is evolving or changing in any way that may be one that we need to look at more promptly. Dr. Berry: Okay. All right. They added E. I've been out of school for a few years. So when it was my time and they just stopped that d and maybe even add something new. Again, this is why, Lunch and Learn community I tell you all the time I get just as educated from my guest as you guys also. Like I said, I'm getting myself together, get myself mentally prepared, to see this dermatologist, right? So when I do not, again, just like when I go to see this dermatologist, like what happens? Right? I know what happens when I go and get my wellness check and I talked to my doctor about the flu. But what happens when I go to see different charges? I've never been to. So what happens when I go to the dermatologist for the first time? Dr. Candrice: Well, you have to expect to show your skin. I was not born with x-ray vision. So we have to get you out of those clothes and into a gown. Now they usually will ask you, you can leave your undergarments on if you like to make you feel more comfortable and then you will be placed in a gown. And during that visit with my patients, what I do in a very systematic way is that I look over the entire surface of the skin from head to toe looking for anything that stands out. That could be something that is an abnormal and abnormal lesion on the skin. So I definitely will take a look at every area in the extremities, the back, the chest, the scalp, the face, all of that looking to take a look to see if there's anything that looks unusual that needs to be biopsied. So yes, number one is to do expect to actually get out of your clothing, including your shoes and socks and get into a gown. And I think some people… Dr. Berry: Is that something you run into, like people in that really unexpected that part? Dr. Candrice: Yes. Roll up the sleeve, will pull up the pant leg and I said, look, I'm a dermatologist. I need to see the complete picture. You know, that part is very helpful because everybody's moles may not be textbook the same as someone else's. So I need to know your body is making molds and that can actually help me to determine. Is that something that needs a biopsy? Is this just how your body's making them? I need to get a sense of all of that. So I need to see your entire body surface area. Dr. Berry: Okay. I like that. And anything, out there, tips and tricks, get our patients to have it? To get them a full dermatology evaluation? Dr. Candrice: Sure. You know, don't ever be afraid to ask or you know about things that you may be concerned about. Sometimes dermatologist, you know, we lay over the completely benign things, but I often use that as a teaching moment. So I do give those things names and I educate the patient about what those lesions are. But it is important that you get your questions answered as well about specific things that you're concerned about. I think, you know, one of my, some of my favorite instances as a dermatologist is to walk in and you know, there's a someone there for an exam and I start to examine their skin. I see like five circles on their skin with a marker and I'm thinking, hmm. Basically, every time I inquired, basically it's usually a wife that has circles, these lesions because she wants to know exactly what those are and what's the, make sure that those species are okay. So even if you don't have a wife, this makes circles on your skin and there are a few things that you are concerned about. It’s okay to make a list of those things so that we can make sure that we address those specifically so that you leave feeling empowered about your skin. Dr. Berry: I love it. We love empowering here. Because especially when they come to see, you know, the general family practitioner or internist and they're asking a lot of questions. Like I do wonder like what type of leeway do they have when they go in to see their dermatologist? Right? Because again, obviously, you're the expert, right? And you know, if something's like, oh no, that's nothing, but they just want to know, right? Like they read it in a book, they read a blog, they've heard a podcast and they say, oh no if it looks like this, you're supposed to do something about it. Do you run into a lot of that where patients are, you know, they're empowering themselves to be an advocate for themselves. But sometimes you almost have to educate them away from doing extracurricular things that you wouldn't necessarily need to do. Dr. Candrice: Absolutely. I think that's our job as physicians to provide the education and say, this is by all accounts, this is a something that it's benign. It's something that can be observed, you know, you don't have to remove it. So I think just spending time to educate also can be helpful for them as well. Dr. Berry: All right. So I'm in the dermatology again and just kind of preface it. Because again, I remember when I was studying in dermatology type questions for boards and everything else and my number one question was always, well you know what? Like yeah, I understand like how it looks, raised, bordered, redness. Like I already understand how that looks. But like for a person that looks like me, right? Like how does that look? Does it look the same? Should I be worrying? Like is it different? Is it the opposite? I don't know. Do you, when you take care of patients of color and they're coming to you with skin related issues as well, do you tend to find that more difficult or is that just feed your training? You're aware of it? Like I always, because I always want to know, cause obviously when I'm reading a book I don't tend to see too many skin colors and I looked like mine that is examples. Dr. Candrice: Yes. I have specifically sought out training in the skin of color. So I was excited to be able to do my dermatology training with some skin of color experts. And actually my program had a skin of color center as well, so we were known for that. So that allowed me to be able to see dermatology on multiple different skin types. And you're right, yes. Some things do not follow the descriptions in the book at all. So you have to go to someone if you do have the skin of color, go to someone familiar with your skin type so that you can get a more expert exam when it comes to that. Dr. Berry: And when we talk about this is skin cancer in general, especially for skin of color. I know you talked about us 10 being caught later. So does that mean like we're from skin cancer total wise, we're dealing with it a lot more frequently or we just happen to catch it at a much later stage? What are some of the numbers especially for skin color and people with skin of color when we talk about skin cancer and diseases of alike? Dr. Candrice: And this is actually really sad, but people of color, we are less likely to get skin cancers. But for an example with melanoma, the one that is the deadliest tight. When we think about the five-year survival rate after someone has cancer, they, you know, was always these statistics. They go out to say, well, in five years, you know, what's the likelihood this person being alive for an example. So for melanoma, when you compare black patients to white patients, white patients have, you know, it's like over 91% of those patients will have a five-year survival rate. And for blacks, it's only a little over 60% or about 65% or so. So that is drastic, a very drastic difference. And so that goes back to the point of late diagnosis. Particularly when we talk about the most deadly type of cancer. Yes, we don't get skin cancer that often, but man, when we do get it, the prognosis is horrible because it's often caught very late and it has spread beyond just the skin at that point. Dr. Berry: And I can tell you from an internist standpoint, some of the patients I've taken care of, unfortunately in a hospital, you know, we've had skin cancer shows up in the lungs, we've had skin cancer show up on the GI system, we’ve had skin cancer show up in the brain, you know, Lunch and Learn community, give you an idea like this isn't a benign disease that you know a little, you know, biopsy cuts and get outta here. Like once if it does what it's, you know, set to do, it can really cause some problems. Dr. Candrice: Yes, it is very devastating and it definitely will be called metastasizes, which is what you definitely explained. It can go all over the body. Dr. Berry: So, and when we talk about this, some of the reasons why we're coming late, right? The reason why we're not seeing Dr. Candrice earlier, basically for people of color. Like I honestly, I was like, oh, what do I need? Like I'm protected, right? Like, well, you know, I'm protected from the sun, like from it from my peers and my skin color. But what are some of the biggest misconceptions that are out there? People like me, it's getting people of color really need to like kind of erased from their mind when it talks about, you know, just skin cancer and skin disease in general. Dr. Candrice: Please erase the fact that your brown skin and your melanin can embrace all potential harm. Is not true. You can get skin cancer. Let me just hit on my mic to make sure they heard me. Look with brown skin, yes, you too can get skin cancer. Take it from me. If you don't believe the statistics. I am triple board certified dermatologist that looks exactly like you. And yes, I see devastating cases. So please, please, please. It's just, it's not true when people say that it doesn't affect us, it's just not true. Dr. Berry: Lunch and Learn community I hope you I heard that. She’s a triple boarded, right? So again, this is, this isn't just you're running the mill like a physician who was trying to like, no, this is a person who really knows what they're talking about and especially for, I have a lot of listeners of color. You know, if you have not, right, again, don't be like me, right? Like, get just skin check done ASAP. Right? The month of May, get it done by the end of this month. Like, make sure that happens like today. And then make sure you bring family members too right. We didn't talk about, but make sure you bring your family members and get them some chopped too. Because I know a lot of us, a lot of y'all don't already like coming to see us for the world has visited. Right? So if y'all already not seeing us for the wellness visit, I know. Yeah. Not going to see yourselves for that, the skin can visit. So please do that. And you know, kind of get out of that mindset. Right. So, you know, Dr. Candrice can kind of help get us together and get us earlier. Again, that's sad though. 60% of us on a little bit over two-thirds of us are actually making it within five years once we're diagnosed just because we're not being seen early and it has a problem. Dr. Candrice: Yes. Devastating statistic. Dr. Berry: So let's talk about skincare, self-care and I wanna know, right? Like I wanted to know because obviously again for Lunch and Learn community even those who don't know, Dr. Candrice and I, we've been friends for about, like three years now. You know, medical always together. I know how amazing this person is and as she does so much education. That's why I wanted to bring her on the show. Right. So Dr. Candrice tell us about skincare, self-care, and why we need to be with it ASAP? Dr. Candrice: You know, I see so many manifestations of stretch in the skin, in hair disorders, lots and lots of things. And so what I thought about was sometimes for people the moment in the morning before the day gets crazy and they're in the bathroom doing whatever they need to do, that may be their only time for self-care. So I developed this concept, this really kind of mindset that yes, skincare is self-care. So focusing on your skin is a way of taking care of yourself. You walk around with your skin all day, every day, so why not take a few minutes to take care of your skin in those moments of the day when you actually have time to do it. So that really was the impetus to all of this. Just, you know, people stressing out and a lot of, and seeing all these diseases on the skin that all you have to do is cleanser or moisturizer. It's like a really quick fix, right? But people were not taking those few minutes of the day because they said, oh, that takes too long. I don't have time for that. I'm busy. I'm this, I'm that. Well, you at least can you give me three minutes a day to be able to care for your skin? And man, what I saw happening was that yes, people, skin disease improved, but also their attitudes improve. Once I started to pitch it as a self-care, their self-care moments of the day, things began to change. They saw it from being something that was cumbersome that they had to do to something that they actually look forward to doing. Dr. Berry: A highlight of their day to take care of this again. Dr. Candrice: Right, exactly. And you say that with some hesitation, but it’s dermatologist, yes. Dr. Berry: Oh no, my way, she’s about to make up that now. So I already know that when she's in that mood. I don't even mess with her. Go ahead, do whatever. I'll wait. I'm in no rush. I ain't going nowhere anyway. She got a whole routine. It's funny because she's got a morning routine, she's got to go on the bed routine as I'm like, wow. Oh, and of course I'm naive, right? And like I gotta ask you a question like, especially when it comes to men, I'm naive, right? And I'm like, why can't you just wash your face? And they're like, no, you gotta do this and this and it's so it's too funny. That's good care. So can we definitely here for that. I got to ask, right? Because I know obviously Lunch and Learn community what about the men, right? Like how much men are you seeing in your practice? How can we get, and we just, we have this issue just getting them to do their wellness checks, right? Like how are you getting them to come to check their skin out? Dr. Candrice: I see men all the time in the office and as soon as I walk in, I know whether they are there by choice or force. I don't care how you land in there. I'm just happy to see the men when they do come in because it is important for me to have those conversations with them. And then we talk about some of the things that they don't really like. People talk about how, Oh, if I wear sunscreen and, and I'm working out or doing something, and I sweay, it gets in my eyes and this, that and the other. So we have conversations about, okay, well how can we overcome some of those things? Some have been cumbersome for you to get around to kind of get on the bandwagon of protecting your skin. So I really enjoy those conversations. And so I had that segment of men that come in for skin checks. But then also what I'm finding is that even just for general skincare things that men actually care about the way they look. They may not tell you or emphasize it and you know, but they do care about it. They may be coming in for ingrown hairs on the face or a little bit of dry skin here, there. Just you know, things that cap into, to happen to come up. And I've definitely given my male patients permission to actually ask about those things. I'm very active on social media and when I look at the statistics and some of my followers, I was surprised that like 20 to 30% of my followers are men. And no is not because I'm so fabulous myself. Right? (Part of it, maybe.) No, it does not because I am definitely an, I make it a point to really give tips along the way about really, really realistic, you know, short steps that you can do to really take care of your skin. And I said, wow, you know, the guys are actually benefiting from this as well. And they make me feel good that my information can be valuable for both women and men. Dr. Berry: Okay. I love it. Before we get you out of here, I always ask my guest, how can what you do really help empower people to take better control to skincare? Dr. Candrice: I understand that my words are powerful. I understand that my interaction with every patient is important. I can remember being a child in the exam room with my physician and if that physician gave some words of encouragement to me. Oh, you want it to be a doctor? Oh, that's great. Blah, blah, blah, blah. You may have understood that depending on where on the neighborhood that you work in, that you may be the only physician of cover that this patient ever sees. I may be the only physician that ever takes a second to encourage a child, encourage their child. And that one piece of information can be the thing that drives them through their entire schooling to become a doctor because somebody told them that they could. So I always had that in my mind. So I know that I'm empowering that way. And then also empowering beyond the exam room currently. So I know that when I'm giving information to women who come in with hair loss and brown spots and this and that and the other, that I encouraged them to talk to their families about it, talk to their girlfriends about it, talk to other people at the hair salon about it so that my words can travel just beyond, beyond well beyond just my patient, but also to a community. And so I love it when patients come in and say, oh so and so referred me or Oh I heard about you at the hair salon. Oh, I heard about you at church. I love it when that happens because it means that I've done a great job of taking something that can be very scientific and complex and making it very simple enough or just my patients to be able to say, look I saw this dermatologist and she told me x and you should get into. That to me is super empowering. I have now turned my one to one patient experience into a one to many experiences. Dr. Berry: Oh, I love it. Absolutely love it. So Dr. Candrice, how can someone follow you, get educated. Like I said, again this is just one episode but this isn't, this is more of like a blip. Like cause you're doing this all the time and I want to make sure my Lunch and Learn community kind of follow along with you. Where can people find you? When's your next speaking engagement? Let us know some details so we can make sure we get you right. Dr. Candrice: I can be found @drcandriceheath on all social media platforms. That's @ D, R, C, A, N, D, R, I, C, E, H, E, A, T, H, that's @drcandriceheath on all social media platforms. Also. I have launched a beauty line called My Sister's Beauty. So I hang out there a lot as well www.mysistersweetie.com. What we really focused on simple skincare. That is also of course self-care. You know my motto, love that. Very simple. You have to tell your wife about that. And then for my people in the medical community who are always asking me about how do you get these speaking gigs, how do you do that exactly? Why are you so comfortable? How do you do that? I finally put everything into a portal. Okay. So I am debuting very soon, www.drcandriceheath.comf/clinicalpearls. So that you can actually be able to go right there. www.drcandriceheath.comf/clinicalpearls to find out what I am doing in the speaker realm for medical professionals. Dr. Berry: And Lunch and Learn community, all of this link will be in the show notes. So you know, if you're driving, take a shower, whatever you do it, you'll be able to get access to it. And I was just about, I let you go, but you gotta tell us you gotta you can't just like a drop that, you know, beauty line comes and just let you go. Right? What about that right? I know we're talking about skin cancer, were on the self-care now. Let's get us right. Dr. Candrice: I am so, it brings tears to my eyes because this has a long journey to launch this line. And really the primary focus is based on all these experiences that I've had with women. Like I told you before, you know, people feeling overworked, too busy to, you know they have the kids hanging off of one arm, the job doing this and you know the taking care of the home depot, all of these things but yet and still they want to look great, they want to feel great. And one of the main things that people often come in about it, they talk about brown spots on the skin. So I know I wanted to develop something that could definitely help to brighten the skin, give people more, even skin tone. All those things they look for so that they do look refreshed and feel refreshed. So I'm excited about the cleanser that we have. It is amazing. I cannot wait for you all to try it and it is packed with a fruit acid called Mandelic Acid and it definitely helps address those dark spots. And I'm really thrilled about it. It's packed full of botanicals so you will see ingredients that you recognize and like in the line including bringing tea. But moisturizer is my group, My Sister’s beauty. Recovery cream is packed full of aloe and it is just amazing. Like I'm so super excited about this. I have a launch party coming up in my city. I cannot wait. So it's, it's been amazing. It has definitely been a long journey and amazing journey and basically, the best is yet to come and I am just excited to finally be able to birth the thing that has been, working on for so long. And yes that really the focus of all of this is about self-care and that's the most amazing part of this whole thing. So I'm ecstatic. Dr. Berry: I love it. Whenever the launch date we'll make sure we promote. We'll make sure we let the world know Lunch and Learn community where they can get that because that's awesome. Absolutely amazing. Dr. Candrice: I would love that. Thank you so much, Dr. Berry. I would love that. Dr. Berry: So again, Dr. Candrice thank you for really enlightened us, educate as getting us together. I'm like, I said next week this skin care is being made. I'm not sure I'm going to see. I know dermatologist is busy. I might not see off for a month, but the appointment will be made at least. So we were going to get us together. Dr. Candrice: Wonderful. Wonderful. Dr. Berry: And again Lunch and Learn community, you know, this person's amazing. Please. Her information will be in the show notes. Please follow her again @drcandriceheath at all social media outlets. Wherever she's at, wherever you're at, she's likely at as well. Or she'll get there so you know, please make sure. This is a person, a friend that I value her opinion or her expertise or knowledge. And now she's about to drop a line and we're going to make sure we get some from the wife because we're going to get everyone together. Dr. Candrice: Yes. Wonderful. Thank you so much Dr. Berry and your awesome Lunch and Learn community. You really know who I am at this point. I am Dr. Candrice, your favorite fun board-certified dermatologist. I am your go-to girl for everything - healthy hair, skin and nails. Dr. Berry: I love it. Thank you. Have a great day. Dr. Candrice: Thank you.   Download the MP3 Audio file, listen to the episode however you like.

Disclaimer: This is the unedited transcript of the podcast. Please excuse any typos. Jeff:  Welcome back to Emplify, the podcast corollary to EB Medicine's Emergency Medicine Practice. I'm Jeff Nusbaum, and I'm back with my co-host, Nachi Gupta. This month, we'll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. We have a special  episode for you this month… We've brought Dr. Jeremy Rose, one of the peer reviewers, and a sepsis expert, on with us to talk through the content this month. Jeremy: Dr. Jeremy Rose here. Thanks for having me in on this conversation.  I'm always happy to talk about this topic because it's clearly important.  There's a great deal of confusion around sepsis and I hope that in the next couple minutes we can clarify things in a way that really help your average front line doc trying to get it right. Nachi: So Dr. Rose, before we get started, tell us a bit about your background and your interest in sepsis… Jeremy: I'm the Assistant Medical Director and Sepsis Chair at Mount Sinai Beth Israel in Manhattan.  For those listening, my hospital probably looks a little bit like yours.  We're busy, interesting, and just a little rough around the edges.  We like it that way.  More importantly, though, we mirror the national averages regarding sepsis.  Roughly half of in-hospital mortality is associated with septic  in some fashion.  Pretty incredible when you think about it.  Half. Jeff:  Sepsis chair... clearly this is an important topic if it warrants it's own chair at a major hospital in NYC. But getting back to the article this month. This month's issue was authored by Faheem Guirgis, Laurent Page Black, and Elizabeth DeVos of the University of Florida, Department of Emergency Medicine. Nachi: And it was peer reviewed by Michael Allison, Assistant Director of the Adult ICU at Saint Agnes Hospital, and Jeremy Rose and Eric Steinberg of Mount Sinai Beth Israel. Jeff: So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis?  It seems that every month or so we have a new guideline, bundle, definition, or whatever… I think it's best to start with the basics -  At its core, sepsis is a dysregulated response to infection that can be life-threatening. Nachi: Right and it's the combined inflammatory with immunosuppressive features of sepsis that lead to the devastating organ dysfunction and even death. Optimal management of septic patients has been a source of intense research, stemming from the landmark study by Rivers in 2001. Jeremy, can you give us a little historical context there? Jeremy: Rivers was a real pioneer.  He found a 16% mortality reduction with randomization to an early aggressive care bundle.  Amazing work.  That being said, many components of that bundle have since been disregarded.  For example, Manny Rivers would measure CVP in all of his patients, something we rarely do. Nachi: Not to cut you off and steal your thunder there, but we'll get to the most recent updates in management shortly. Let's first talk definitions and terminology, and specifically, diagnosis, which is definitely a big elephant in the room. As Jeff mentioned a few minutes ago, diagnostic criteria have undergone so so so many changes. Jeff: Yes it has! 1991 marked the first standardized definition.  Then in 2001, sepsis-2 was introduced.  In 2014, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine started a task force, and by 2016, updated definitions were out again! Sepsis-3!! A lot of this came after the realization that SIRS was just too broad and was overly sensitive and non-specific. Jeremy, why don't you take us through Sepsis 3. Jeremy: So just to back up a little and frame this: Here's the fundamental problem:  As we likes to say, “there's no troponin for sepsis.”  And if you look at our patients, we tend not to miss the hypotensive, tachycardic, febrile patient.  We know they're septic.

Disclaimer: This is the unedited transcript of the podcast. Please excuse any typos. Jeff:  Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. We have a special  episode for you this month… We’ve brought Dr. Jeremy Rose, one of the peer reviewers, and a sepsis expert, on with us to talk through the content this month. Jeremy: Dr. Jeremy Rose here. Thanks for having me in on this conversation.  I’m always happy to talk about this topic because it’s clearly important.  There’s a great deal of confusion around sepsis and I hope that in the next couple minutes we can clarify things in a way that really help your average front line doc trying to get it right. Nachi: So Dr. Rose, before we get started, tell us a bit about your background and your interest in sepsis… Jeremy: I’m the Assistant Medical Director and Sepsis Chair at Mount Sinai Beth Israel in Manhattan.  For those listening, my hospital probably looks a little bit like yours.  We’re busy, interesting, and just a little rough around the edges.  We like it that way.  More importantly, though, we mirror the national averages regarding sepsis.  Roughly half of in-hospital mortality is associated with septic  in some fashion.  Pretty incredible when you think about it.  Half. Jeff:  Sepsis chair... clearly this is an important topic if it warrants it’s own chair at a major hospital in NYC. But getting back to the article this month. This month’s issue was authored by Faheem Guirgis, Laurent Page Black, and Elizabeth DeVos of the University of Florida, Department of Emergency Medicine. Nachi: And it was peer reviewed by Michael Allison, Assistant Director of the Adult ICU at Saint Agnes Hospital, and Jeremy Rose and Eric Steinberg of Mount Sinai Beth Israel. Jeff: So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis?  It seems that every month or so we have a new guideline, bundle, definition, or whatever… I think it’s best to start with the basics -  At its core, sepsis is a dysregulated response to infection that can be life-threatening. Nachi: Right and it’s the combined inflammatory with immunosuppressive features of sepsis that lead to the devastating organ dysfunction and even death. Optimal management of septic patients has been a source of intense research, stemming from the landmark study by Rivers in 2001. Jeremy, can you give us a little historical context there? Jeremy: Rivers was a real pioneer.  He found a 16% mortality reduction with randomization to an early aggressive care bundle.  Amazing work.  That being said, many components of that bundle have since been disregarded.  For example, Manny Rivers would measure CVP in all of his patients, something we rarely do. Nachi: Not to cut you off and steal your thunder there, but we’ll get to the most recent updates in management shortly. Let’s first talk definitions and terminology, and specifically, diagnosis, which is definitely a big elephant in the room. As Jeff mentioned a few minutes ago, diagnostic criteria have undergone so so so many changes. Jeff: Yes it has! 1991 marked the first standardized definition.  Then in 2001, sepsis-2 was introduced.  In 2014, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine started a task force, and by 2016, updated definitions were out again! Sepsis-3!! A lot of this came after the realization that SIRS was just too broad and was overly sensitive and non-specific. Jeremy, why don’t you take us through Sepsis 3. Jeremy: So just to back up a little and frame this: Here’s the fundamental problem:  As we likes to say, “there’s no troponin for sepsis.”  And if you look at our patients, we tend not to miss the hypotensive, tachycardic, febrile patient.  We know they’re septic.  But how do we find the ones who don’t look as sick.  Frequently elderly, possibly with normal-ish vitals and no fever.  Those can be a lot harder to spot, but they may indeed be septic.  Also, for research purposes we have to have a common definition, so Sepsis 3 came up with something called the SOFA score. The problem with the SOFA score is that its difficult to perform in the ED.  It has parameters like bilirubin that often aren’t available when we want to screen out very sick patients.  Fortunately there is the abridged version qSOFA, which identifies non-icu patients who are at high risk of inpatient mortality. So here it is, and if you get one thing from this episode, this is it: There are ONLY 3 criteria to the qSOFA.  3 Criteria. RR > 22; AMS; SBP 2. So quite a few changes! Jeff: And Jeremy, sticky topic coming up here. Center for Medicare and Medicaid Services (or CMS) quality measures - They haven’t really caught on to and adapted to Sepsis-3 yet, have they? Jeremy:  The CMS mandate is based on the presence of SIRS criteria. Sepsis 3 is based on SOFA.  This is definitely confusing.  Part of the challenge in discussing this topic is separating out the QI guidelines from what is actually relevant to patient care based on the latest evidence-based medicine. Nachi: That seems fair.  We’re really going to put you in an uncomfortable spot for a second and push you here Jeremy. Do you have any insight into why CMS isn’t interested in following the mountains of research that have led to sepsis-3? Is there a reason they are sticking to their current criteria? Jeremy:  I think some of it is the slow pace of bureaucracy and the time that it takes to develop a consensus on management.  Even if we can agree on who is septic, it’s really hard, if not impossible to link the care to a pay-for-performance metric which is what CMS ultimately would like to see.  That’s not how Sepsis-3, or for that matter, SIRS, was designed to be used.  You’re trying to take a tool which was originally designed for research and mold them into a tool used for pay for performance. Nachi: What a struggle. The CMS metrics are slightly different from the 2001 sepsis guidelines also. Take a look at Table 2 of the article for a quick comparison of sepsis-3, 2001 sepsis, and cms side-by-side. And for those on twitter, we’ll be sure to tweet this table out too for your review. Jeff: With so many different scores and definitions, I think that adequately sets the stage for the challenge this month’s authors faced coming up with real evidenced based guidelines. Nachi: Oh absolutely.  And to make matters worse - this is a HUGE problem. We’re talking up to 850,000 ED visits annually in the US, and 19 million cases worldwide. Compounding this, sepsis results in death in approximately 1 out of 4 cases. Not only is it lethal, it is also very costly -- 17 billion dollars per year in the US alone! Jeff: And don’t forget importantly the 30-day hospital readmission rate. Sepsis is coming in at a higher readmission rate and cost per admission than acute MI, CHF, COPD, and PNA. Nachi: Let’s speak briefly on the etiology and pathophysiology of sepsis: we all know that sepsis is due to local infections that then become systemic. Previously, it was believed that the bacterial infection itself was the cause of the clinical syndrome of sepsis. However, we now know now that the syndrome of sepsis is due to the inflammatory and immunosuppressive mediators that were triggered by the infection. Normal immune regulatory safeguards fail and this leads to the syndrome. And interestingly, several studies have shown that critically ill septic patients experience reactivations of specific viruses that were previously limited to patients with severe immunosuppression. Jeff: Definitely something to look out for in your critically ill septic patients.  We should talk  briefly about the most common inciting infections that lead to sepsis. In order, these are: pneumonia, intra-abdominal infections, and urinary tract infections. No surprises there! Nachi: Yeah, that basically parallels my own experience, so that’s reassuring!  That takes us to our next potentially controversial topic - blood cultures.  Jeremy - we’re going to punt this one back to you Jeremy: This is another interesting topic that has received plenty of attention.   CMS loves blood cultures.  It’s an easy metric to track.  That doesn’t mean they’re always helpful.  We looked at our patients with lactates between 2.1 and 4.0 which had “severe sepsis.”  These patients were normotensive though, In other words, the ones that aren’t that sick.  We found that blood cultures are useful about 20% of the time.  That’s not bad.  So what do we do? We draw cultures before pushing antibiotics.  Is that helpful? Sometimes yes, does it waste money?  Debatable.  Does it help us meet our metrics, yes. Jeff: And I think that gets at the crux of the problem here: we don’t want to delay antibiotics on anybody, but we must balance this with the potential harm of further increasing the drug resistant bacterial population via sound antibiotic stewardship.  Remember also that there is a broad differential for sepsis, with several “sepsis mimics”. To name a few, we have PE, MI, CHF, acute pulmonary edema, DKA, thyroid storm, GI bleeds, drug intoxications, and withdrawal syndromes, just to name a few.  In case that wasn’t enough check out Table 3 of the article. Nachi:  And we already mentioned the leading causes of sepsis, that’s pneumonia, intra abdominal infections, and uti’s. But remember the source can be anywhere. Be sure to also think of pyelonephritis, central line associated bloodstream infections, prosthetics, endocarditis, necrotizing fasciitis, and meningitis. Jeff:  I don’t think we need to dwell on this much longer - basically the differential is huge.  Let’s move on to my favorite section - prehospital care. Jeremy: 20 pages of evidenced based recommendations and your favorite is the prehospital section, what’s up with that? Jeff: I’m an EMS fellow, what can I say… Anyway, on to my favorite section -- prehospital care.  This is always a hot topic because the prehospital period is a special opportunity to get early interventions in for septic patients  as 40 - 70% of all severe sepsis hospitalizations arrive via EMS. Nachi: And in one study taking place in a large metropolitan area, prehospital care time was over 45 minutes, and less than  37% arrived with IV access. Of course, these numbers would vary significantly based on where you practice. Jeff: So get this -- one study showed that out-of-hospital shock index and respiratory rate were highly predictive of ICU admission. So clearly early recognition and therapy may play a role here. Another study, however, showed knowledge gaps by advanced EMS providers in diagnosis and management of sepsis. And yet another study showed that only 18 to 21% of confirmed septic patients were suspected of having sepsis by EMS. Out of hospital fluids were started in only half of patients with severe sepsis. In essence, there is likely a strong role here for pre hospital protocols for identifying and treating sepsis. Nachi: In terms of pre hospital treatments though, prehospital IV fluids haven’t been shown to improve mortality, but have been associated with shorter hospital stays. Prehospital sepsis protocols have been described, but in general more research is needed in this area. Jeff: While prehospital care hasn’t yet been shown to improve the prognosis of septic patients, those presenting via EMS do have shorter delays to initiation of antibiotics, IV fluids, and early care bundles. EMS should focus primarily on stabilizing vital signs and providing efficient transport. If it’s possible to establish an IV and initiate fluids without delaying transport, EMS should do that as well. Nachi: And of course, oxygen for the hypoxic patients! Moving on to history and physical for your presumed septic patient. Jeremy, what are the big hitting things here that you always ask and check for, and that you make sure your residents are doing? Jeremy:  After ABC’s and glucose, AMS is really important, it’s in the QSOFA SCORE.  Unfortunately, this can be hard in many septic patients where they’re baseline mental status is less than perfect.  The other thing is to try and find the source.  Finding the source lets you make wise choices about therapy. Jeff:  Great point about the mental status - so many of our older population have an altered baseline, but recognizing changes from that baseline is key. Nachi:  Absolutely, with that in mind, let’s talk diagnostic studies, especially lactate.  Where I trained, basically everybody was getting a lactate, even tired looking residents seemed to be having their lactates checked, and trust me, they weren’t looking that good... Jeremy:  Brace yourself: lactate is really important in septic patients.  That being said, not every cause of elevated lactate is sepsis.  There is this animal called Type B lactic acidosis can come from numerous drugs like albuterol. Just because you see elevated lactate doesn’t mean you can forget about the other causes.  That being said, we know that patients with sepsis do better when they clear lactate. Jeff: Seems like the evidence is definitely in favor of serial lactate testing… Jeremy: For sure.  At least until you have a reasonable trend towards improvement.  We know lactate clearers do better.  We’ve looked at our own lactate numbers.  Interestingly, the takeoff point for sepsis seems to be around 2.5.  Meaning that patients with altered vitals and lactates above 2.5 tend to do worse.  But, there is a broad ddx to elevated lactate.   What is true, though, is that lactate is a marker for badness.  If your patient’s lactate is rising, yours should be too. Nachi: I bet I’m a “lactate clearer”. I may add “lactate clearer to my CV,” sounds impressive.  But I digress…  Next up we have Procalcitonin.   Since procalcitonin becomes elevated in those with bacterial infections, intuitively, this should be a valuable marker to assess in potentially septic patients.  Unfortunately procalcitonin lacks negative predictive value so most literature supports its use in diagnosing pulmonary infections and for antibiotic de-escalation. Jeff: Good to know, I’ve seen it being used a lot more recently and wondered how evidence based this test was. Jeremy:  Honestly, I don’t see Procalcitonin changing ED management at the moment.  If you’re   waiting for Procalcitonin to start antibiotics or fluids, you’re waiting too long. Nachi: Moving on, let’s talk imaging.  Based on current studies, the authors recommend focused imaging only.  In addition, they also note that our good friend, the point of care ultrasound, likely plays a role, as in one study, POCUS demonstrated a 25% improvement in sensitivity from clinical impression alone. Jeremy:  I think there are two ways POCUS comes in.  One, lung ultrasound can be really useful to find that occult pneumonia or differentiating pneumonia from CHF.   Two, your ultrasound is your best tool for assessing volume status.  I try to look at the IVC of all my septic patients and echo them when possible. Nachi: Right.  So now we’ve examined, drawn labs and cultures, checked a lactate, may be obtained imaging… next up we should probably start treating the patient. Whether you like it or not, we have to discuss CMS. Jeremy: Just to clarify before we start.  CMS defines “severe sepsis” as SIRS + infection with a lactate of 2.1-4.0. Septic shock is SIRS + infection with hypotension or a lactate > 4.0. That’s where we’re at. Jeff:  Good point.  Back to treatment: within the first 3 hours, for any patient with sepsis and septic shock, you must measure a lactate, obtain 2 sets of blood cultures, administer antibiotics, and give an isotonic fluid challenge with 30 cc/kg to patients with hypotension or a lactate greater than 4.   Then, within the first 6 hours, you must apply vasopressors to achieve a MAP of at least 65, re-assess volume status and perfusion, and remeasure a lactate. Nachi: This begs the question - are these recommendations evidenced based? Jeremy…. Jeremy: I’m so glad you asked that . Let’s start with fluids. Patient’s need adequate fluid resuscitation.  Interestingly there are 3 large RCT’s, PROMISE, PROCESS and ARISE,  that compared a Rivers type bundle to usual care.  Surprisingly, they showed no difference.  But when your drill down into these 3 trials, you see that “the usual care,” now generally includes at least 2 liters of fluid. Jeff: Ok, so it seems that there is some pretty good data to support a rapid fluid challenge of at least 30 cc/kg.  But how do we determine who needs more fluids and how much more they need.  There must be an endpoint to all of this? Jeremy: Another million dollar question. 30cc/kg is probably a good place to start.  How much is too much?  I think we need to be smart about our fluids.  Some patients will need less and some will need much more.  So, I remind my resident’s to be smart about fluids.  Sono an IVC, trend a lactate, follow a urine output, do a passive leg raise, even check JVP.  I mean just because you haven’t seen a unicorn doesns’t mean they’re not real.  Do something to monitor volume status. Nachi: Very important. Put your ultrasound skills to work here. They’ll only improve as you practice more.  Jeff, let’s get started on the ever important topic of antibiotics. Jeff: Sounds good.  Current guidelines recommend that broad spectrum antibiotics be administered within the first hour of presentation for those with sepsis or septic shock, ideally with blood cultures being drawn beforehand. In one study, every hour of delayed abx administration was associated with an 8% increase in mortality.  Since this 2006 study, other studies have had mixed results - with studies showing increased odds of death with delays in abx administration and others showing only a benefit in those with septic shock with or without hypotension with no benefit to those without shock. Nachi:  In terms of antibiotic coverage - you need to consider the site of infection, local resistance patterns, the presence of immunosuppression, and the patient’s age and comorbidities.  Table 5 of the article is very thorough and should be kept as a quick reference. Jeremy do you have any specific recommendations for our listeners on how we should approach antibiotic usage in the septic patient? Jeremy: I like to think about antibiotics a little more simply than referencing a table.  I ask a couple questions.  Does my patient need MRSA coverage ?  Does my patient need Pseudomonal coverage?  If the answer is no and no, then narrow your coverage.  You don’t necessarily have to use a bunch of Vanco, or a big gun antipseudomonal like Pip/tazo.  Also, have a look at your local antibiogram.  I can’t tell you how many times this changes prescribing habits for even things like simple UTIs.  I’m going to stray into some controversial territory here. The benefits of sepsis protocols are measured one patient at a time, but the harms are only measured in the aggregate.  What does that mean?  CMS metrics have caused us to  use to use more broad spectrum antibiotics.  As a result, we’re seeing more resistance.  My resident’s tell me to make it easy, give em VZ (that’s vanco/zosyn) and it kills me.   Every time you put a Z-pack into the world a pneumococcus gets it’s wings. So think more about your antibiotics, and know your local biograms. Jeff: That’s a great way to think about it, I fear I’ve given a lot of pneumococci wings during my training…  Next we’re on to vasopressors.  The data is pretty clear on this one - norepinephrine is the recommended first line vasopressor for septic shock.  In numerous trials comparing Norepi to dopamine, NE was far superior, with dopamine increasing arrhythmias in one trial and associated with an increased risk of death as compared to NE in another trial. Jeremy:  So here’s a question I get all the time: How can I give Norepi without a central line.  Let’s use Dopamine, its safe peripherally.  Ok, so follow that through.  We’re going to give a drug to increase blood pressure by constricting blood vessels, but don’t worry, it’s safe peripherally.  What does that mean?  It means it doesn’t work!!  It doesn’t give much blood pressaure.  Dopamine is a lousy pressor.  It causes a lot of tachycardia, which is not what you want in failing septic hearts.  So what do we do if we don’t have a central line?   We start norepi peripherally into a large bore IV for the time it takes us to get a central line.  That’s where the evidence is.  There’s a mortality benefit to NE over dopaine in septic shock. Jeff:  Right, this month’s authors note peripheral pressors may be safe for brief periods in settings with close monitoring.  While this is commonplace in some hospitals, others haven’t yet jumped on that bandwagon. I think it’s important to mention that this is becoming more and more commonplace, even in the prehospital realm.  With the service I fly for, we routinely start peripheral vasopressors without hesitation.  But this isn’t limited to the air.  Many ground 911 services have also adopted peripheral vasopressors in a variety of settings. Nachi: I’m sure there are many trials to come in the future documenting their safety profile, but moving on to the next pressor to discuss... vasopressin. This should be your second line vasopressor for septic shock.  In the VASST trial, low-dose vasopressin was found to be noninferior to NE.  In other trials, vasopressin also appeared to show a potential benefit in those with AKI and sepsis, although the subsequent VANISH trial (perhaps the best name for a clinical trial so far) failed to demonstrate a benefit to vasopressin titration with regard to renal outcomes in septic shock. Vasopressin has also been shown to reduce NE dosing when administered at a fixed dose of 0.03-0.04 units/min. Jeff: Next we have epinephrine.  In one study epinephrine and NE were equivalent in achieving MAP goals in ICU patients with shock, however several of those receiving epi developed marked tachycardia, lactic acidosis, or an increased insulin requirement.  The increasing lactic acidosis could confound the trending of lactates, so in those requiring inotropy in addition to some peripheral squeeze - the authors recommend adding dobutamine to norepinephrine instead of starting epinephrine. Although, keep in mind, this can lead to some hypotension so remember to start at low doses. Nachi: Phenylephrine, a pure alpha adrenergic agent, is next and should be considered neither first nor second line, but it may have a role as a push dose agent while preparing other vasoactive agents. Jeff: And lastly, we have angiotensin 2.  One recent 2017 study examining the role of angiotensin 2 in those with septic shock already on 0.2 mcg/kg/min of NE found that those receiving AT2 had significant improvements in MAPs as well as cardiovascular SOFA score at 48h with no difference in mortality.  Unfortunately, these benefits do not come without risk as AT2 may increase risk of arterial and venous thrombosis and potentially thromboembolism.  Clearly, one study isn’t enough to change practice, but it’s certainly food for thought. Nachi: So that wraps up vasopressors. Jeremy, we’re on to corticosteroids -- another hotly debated topic. When do you give steroids in sepsis? Jeremy:  Hmmm steroids, this is an age old question.  No study has clearly supported the blanket use of steroids in septic shock. Several like CORTICUS and ADRENAL showed no difference.  I will use hydrocortisone for pressor refractory shock. Meaning, you’ve tried everything else, so you might as well try.  Also, I do tend to avoid Etomidate, given the possibility of adrenal suppression and that there are several other induction agents, notably Ketamine  that don’t have this problem. Jeff: Those trials are certainly important, thanks for bringing them up - Especially with all the FOAM content out there, it’s incredibly important to look back at the data to understand where certain recommendations are coming from.   Anyway… one quick note on blood transfusions before we move on to special populations - Although part of the original early goal directed therapy, thanks to data from the TRISS trial which showed no difference in outcomes with a transfusion goal of 7 vs 9, transfusions are reserved for those with a hbg of less than 7. Jeremy:  One population we should make sure to mention and be careful with is end stage liver disease.  In the ER, we tend to miss SBP alot.  Mostly because these patients have lots of reasons to be sick and they already have elevated lactate because of their deceased clearance.  My practice is to give a dose of Ceftriaxone and sent a diagnostic tap to patients who are sick and have ascites. Nachi: Alright Jeremy, let’s talk controversies in sepsis. We’re giving you all the big questions this month! Jeremy:  We’ve already talked about fluids and how much to give.  Just a reminder that a history of CHF doesn’t preclude proper fluid resuscitation.  I think broad spectrum antibiotics for relatively well patients is a big controversy.  Our national rates of antibiotic resistance are terrible, and yet we’re using more antibiotics all the time.  There are very few if any antibiotics coming down the pharma pipeline and we’re going to have to face the music eventually.  Finally, we need national metrics that mirror clinical evidnece.  Protocols should be a tool and not a crutch.  You know what’s best for the patient in front of you, so don’t let metrics or protocols make you do things you think are not in your patient’s best interest. Nachi: So how do you escape the hospital protocols and CMS and do what’s best for your patient without “getting in trouble”? Jeremy: Here’s how I deal with it as the one who reads and QI’s all of our sepsis charts. I tell my colleagues to do what’s right, and if you need to deviate from the protocol tell me why.  As long as you can explain your decision, I’ll support it.  Explaining your thinking is good clinical practice and is good medico-legal practice. CMS has been unable to link these metric  to payment, simply because no hospital can meet them with any regularity.  It’s important that we advocate for our patients or nothing will change. Make them respect you for the highly educated professional that you are, and your patients will ultimately benefit. Jeff: Preach!! And before we close out with disposition, there are a few new therapies and trials on the horizon to keep a lookout for. The RACE trail examined the role of L-carinitine.  The VICTAS trial is looking at vitamin C, thiamine, and steroids in sepsis.  The CLOVERS trial is looking at early vasopressors vs a crystalloid liberal strategy.  And lastly, IL-7 is also being investigated.  All really cool stuff that could change how we manage sepsis in the future.. Nachi  A few quick notes on disposition before we close this episode out.  Certainly not all patients meeting SIRS require admission, but many do.  Those with qSOFA of 2 or higher represent a sick population and an ICU admission should be considered.   Even for those with a qSOFA of 1 but a lacate over 2 -- they have a mortality approaching that of patients with a qSOFA of 2.  Be careful just sending a patient who is on the fence to the floor because several studies have demonstrated that patients who are later upgraded have worse outcomes. Jeff: That’s in line with the general themes we’ve laid out today - definitely better to start early with aggressive care rather than play catch up later.  Jeremy - in 30 seconds or less, what are the most salient points in the management of sepsis that you would like our listeners to take with them from this episode. Jeremy:  Here are my take aways: qSOFA, RR, AMS SBP < 100 Norepi, not Dopamine - it doesn’t work! Be smart about fluids!! Be smarter about antibiotic use! You are the best advocate for your patient, despite what anyone else says! Jeff: Excellent, so that wraps up the October 2018 episode of Emplify. A big thanks to Jeremy Rose for joining us. Jeremy: Thank you for having me!!! It was great talking with you. Nachi: For our listeners -- additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at www.ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credits. You’ll also get enhanced access to the podcast, including the images and tables mentioned. You can find everything you need to know at ebmedicine.net/subscribe. Jeff: And the address for this month’s credit is ebmedicine.net/E1018, so head over there to get your CME credit.  As always, the ding sound  you heard throughout the episode corresponds to the answers to the CME questions. Nachi: Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at emplify@ebmedicine.net with any comments or suggestions. Talk to you next month!

On todays podcast we interview Nathan Goldstein, MD, Chief of the Division of Palliative Care for Mount Sinai Beth Israel. We discuss his experiences and research focused on improving communication and the delivery of palliative care to patients with advanced heart failure.

What do the musical compositions of Bach, Gershwin, and the Beatles all have in common? Besides being great pieces of music, according to Andrew Schulman, they promote healing in intensive care (ICU) settings. Schulman is a classical guitar player and performer and author of Waking the Spirit: A Musician’s Journey Healing Body, Mind, and Soul (Picador, 2016). Schulman did not receive training as a music therapist and only began working in ICUs after he had a near-death experience at one. Waking the Spirit offers a gripping account of his medical journey and his decision to give back to others. As a result of his collaboration with his former doctors, Schulman became what he terms, a “medical musician.” During the podcast, Schulman briefly describes his journey and reflects upon what he has learned about music from working in the ICU. He also talks about how his work in the ICU has made him a better concert performer. In our conversation, we explore how music heals, what forms of music seem most suited for healing, and the role of musicians and music therapists in ICUs. Andrew Schulman is the resident musician in the Surgical Intensive Care Unit at Mount Sinai Beth Israel hospital in New York City and Berkshire Medical Center in Pittsfield, Massachusetts. He is the founder and artistic director of the Abaca String Band. He is also a solo guitarist and has appeared at Carnegie Hall, the Improv Comedy Club, and the White House. He lives in New York City with his wife, Wendy. Learn more about your ad choices. Visit megaphone.fm/adchoices

What do the musical compositions of Bach, Gershwin, and the Beatles all have in common? Besides being great pieces of music, according to Andrew Schulman, they promote healing in intensive care (ICU) settings. Schulman is a classical guitar player and performer and author of Waking the Spirit: A Musician’s Journey Healing Body, Mind, and Soul (Picador, 2016). Schulman did not receive training as a music therapist and only began working in ICUs after he had a near-death experience at one. Waking the Spirit offers a gripping account of his medical journey and his decision to give back to others. As a result of his collaboration with his former doctors, Schulman became what he terms, a “medical musician.” During the podcast, Schulman briefly describes his journey and reflects upon what he has learned about music from working in the ICU. He also talks about how his work in the ICU has made him a better concert performer. In our conversation, we explore how music heals, what forms of music seem most suited for healing, and the role of musicians and music therapists in ICUs. Andrew Schulman is the resident musician in the Surgical Intensive Care Unit at Mount Sinai Beth Israel hospital in New York City and Berkshire Medical Center in Pittsfield, Massachusetts. He is the founder and artistic director of the Abaca String Band. He is also a solo guitarist and has appeared at Carnegie Hall, the Improv Comedy Club, and the White House. He lives in New York City with his wife, Wendy. Learn more about your ad choices. Visit megaphone.fm/adchoices

What do the musical compositions of Bach, Gershwin, and the Beatles all have in common? Besides being great pieces of music, according to Andrew Schulman, they promote healing in intensive care (ICU) settings. Schulman is a classical guitar player and performer and author of Waking the Spirit: A Musician's Journey Healing Body, Mind, and Soul (Picador, 2016). Schulman did not receive training as a music therapist and only began working in ICUs after he had a near-death experience at one. Waking the Spirit offers a gripping account of his medical journey and his decision to give back to others. As a result of his collaboration with his former doctors, Schulman became what he terms, a “medical musician.” During the podcast, Schulman briefly describes his journey and reflects upon what he has learned about music from working in the ICU. He also talks about how his work in the ICU has made him a better concert performer. In our conversation, we explore how music heals, what forms of music seem most suited for healing, and the role of musicians and music therapists in ICUs. Andrew Schulman is the resident musician in the Surgical Intensive Care Unit at Mount Sinai Beth Israel hospital in New York City and Berkshire Medical Center in Pittsfield, Massachusetts. He is the founder and artistic director of the Abaca String Band. He is also a solo guitarist and has appeared at Carnegie Hall, the Improv Comedy Club, and the White House. He lives in New York City with his wife, Wendy. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/medicine

What do the musical compositions of Bach, Gershwin, and the Beatles all have in common? Besides being great pieces of music, according to Andrew Schulman, they promote healing in intensive care (ICU) settings. Schulman is a classical guitar player and performer and author of Waking the Spirit: A Musician's Journey Healing Body, Mind, and Soul (Picador, 2016). Schulman did not receive training as a music therapist and only began working in ICUs after he had a near-death experience at one. Waking the Spirit offers a gripping account of his medical journey and his decision to give back to others. As a result of his collaboration with his former doctors, Schulman became what he terms, a “medical musician.” During the podcast, Schulman briefly describes his journey and reflects upon what he has learned about music from working in the ICU. He also talks about how his work in the ICU has made him a better concert performer. In our conversation, we explore how music heals, what forms of music seem most suited for healing, and the role of musicians and music therapists in ICUs. Andrew Schulman is the resident musician in the Surgical Intensive Care Unit at Mount Sinai Beth Israel hospital in New York City and Berkshire Medical Center in Pittsfield, Massachusetts. He is the founder and artistic director of the Abaca String Band. He is also a solo guitarist and has appeared at Carnegie Hall, the Improv Comedy Club, and the White House. He lives in New York City with his wife, Wendy. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/psychology

What do the musical compositions of Bach, Gershwin, and the Beatles all have in common? Besides being great pieces of music, according to Andrew Schulman, they promote healing in intensive care (ICU) settings. Schulman is a classical guitar player and performer and author of Waking the Spirit: A Musician’s Journey Healing Body, Mind, and Soul (Picador, 2016). Schulman did not receive training as a music therapist and only began working in ICUs after he had a near-death experience at one. Waking the Spirit offers a gripping account of his medical journey and his decision to give back to others. As a result of his collaboration with his former doctors, Schulman became what he terms, a “medical musician.” During the podcast, Schulman briefly describes his journey and reflects upon what he has learned about music from working in the ICU. He also talks about how his work in the ICU has made him a better concert performer. In our conversation, we explore how music heals, what forms of music seem most suited for healing, and the role of musicians and music therapists in ICUs. Andrew Schulman is the resident musician in the Surgical Intensive Care Unit at Mount Sinai Beth Israel hospital in New York City and Berkshire Medical Center in Pittsfield, Massachusetts. He is the founder and artistic director of the Abaca String Band. He is also a solo guitarist and has appeared at Carnegie Hall, the Improv Comedy Club, and the White House. He lives in New York City with his wife, Wendy. Learn more about your ad choices. Visit megaphone.fm/adchoices

What do the musical compositions of Bach, Gershwin, and the Beatles all have in common? Besides being great pieces of music, according to Andrew Schulman, they promote healing in intensive care (ICU) settings. Schulman is a classical guitar player and performer and author of Waking the Spirit: A Musician’s Journey Healing Body, Mind, and Soul (Picador, 2016). Schulman did not receive training as a music therapist and only began working in ICUs after he had a near-death experience at one. Waking the Spirit offers a gripping account of his medical journey and his decision to give back to others. As a result of his collaboration with his former doctors, Schulman became what he terms, a “medical musician.” During the podcast, Schulman briefly describes his journey and reflects upon what he has learned about music from working in the ICU. He also talks about how his work in the ICU has made him a better concert performer. In our conversation, we explore how music heals, what forms of music seem most suited for healing, and the role of musicians and music therapists in ICUs. Andrew Schulman is the resident musician in the Surgical Intensive Care Unit at Mount Sinai Beth Israel hospital in New York City and Berkshire Medical Center in Pittsfield, Massachusetts. He is the founder and artistic director of the Abaca String Band. He is also a solo guitarist and has appeared at Carnegie Hall, the Improv Comedy Club, and the White House. He lives in New York City with his wife, Wendy. Learn more about your ad choices. Visit megaphone.fm/adchoices

From white sugar and brown sugar, to raw sugar and sugar cane… Not to mention agave, simple syrup, and molasses, there's an abundance of options when it comes to choosing an agent that’s going to make your desserts and drinks pop. But which are the best for what purpose… and which are the healthiest?  Joining us to talk about all things sweet is Shauna Sever, author of three cookbooks, including Real Sweet:More Than 80 Crave-Worthy Treats Made with Natural Sugars. We'll also find out how sugar and sweeteners affect our health with Rebecca Blake, a nutritionist, registered dietitian, and Administrative Director for Medicine at Mount Sinai Beth Israel.