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On this episode of The Wholesome Fertility Podcast, I am joined by Dr. Nirali Jain (eggspert_md), a board-certified OB/GYN and reproductive endocrinologist at Reproductive Medical Associates (RMA). Dr. Jain shares her expert insights on fertility preservation for individuals undergoing cancer treatment, a crucial yet often overlooked aspect of reproductive care. We explore what options are available for fertility preservation, including egg and sperm freezing, and why it's so important to initiate these discussions before starting chemotherapy or radiation. Dr. Jain also explains the difference between Letrozole and Clomid, the impact of estrogen-sensitive cancers on IVF treatments, and innovative approaches like random-start cycles and DuoStim protocols. Whether you're facing a cancer diagnosis or simply thinking proactively about your reproductive future, this conversation is filled with knowledge and reassurance. Key Takeaways: Why it's essential to discuss fertility before starting cancer treatment. The role of Letrozole in estrogen-sensitive cancers and fertility preservation. Differences between Letrozole and Clomid, and why Letrozole is often preferred. How new protocols like DuoStim and random-start cycles are improving outcomes. Why fertility preservation is important even for those without a cancer diagnosis. Guest Bio: Dr. Nirali Jain (@eggspert_md) is a board-certified OB/GYN and fertility specialist at Reproductive Medicine Associates (RMA) in Basking Ridge, New Jersey. She earned both her undergraduate degree in neurobiology (with a minor in dance!) and her medical degree from Northwestern University, before completing her residency at Weill Cornell/NYP, where she served as co-Chief Resident, and her fellowship in reproductive endocrinology and infertility at NYU Langone. Deeply passionate about women's health and fertility preservation, Dr. Jain blends the latest research and cutting-edge treatments with compassionate, patient-centered care. Her interests include third-party reproduction and oncofertility, and she is especially passionate about supporting patients navigating fertility preservation through a cancer diagnosis. Outside of the clinic, Dr. Jain is a trained dancer, a dedicated global traveler, and an adventurer working toward hiking all seven continents with her husband. Her diverse experiences, from international medical rotations to personal connections with friends and family navigating infertility, have shaped her into a warm, resourceful, and determined advocate for her patients. Links and Resources: Visit RMA websiteFollow Dr. Nirali Jain on Instagram For more information about Michelle, visit www.michelleoravitz.com To learn more about ancient wisdom and fertility, you can get Michelle's book at: https://www.michelleoravitz.com/thewayoffertility The Wholesome Fertility facebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/ Instagram: @thewholesomelotusfertility Facebook: https://www.facebook.com/thewholesomelotus/ Disclaimer: The information shared on this podcast is for educational and informational purposes only and is not intended as medical advice. Please consult with your healthcare provider before making any changes to your health or fertility care. --  Transcript:   # TWF-Jain-Nirali (Video) ​[00:00:00]  **Michelle Oravitz:** Welcome to the podcast Jain.  **Dr. Nirali Jain:** Thanks so much for having me **Michelle Oravitz:** Yeah, so. **Michelle Oravitz:** I'm very excited to talk about this topic, which, um, actually you don't really hear a lot of people talking about, which is how to preserve your fertility if you're going through a cancer diagnosis and if you have to go through treatments. 'cause obviously that can impact a lot on fertility. **Michelle Oravitz:** I have, um, seen actually like a colleague of mine go through. And she also preserved her fertility and, and now she has a baby boy. so it's really nice. **Michelle Oravitz:** to **riverside_nirali_jain_raw-video-cfr_michelle_oravitz's _0181:** so nice. **Michelle Oravitz:** So I'd love for you first to introduce yourself and kind Of give us a background on how you got into this work. **Dr. Nirali Jain:** Of course. Um, so I am Dr. Narly Jane. I am, um, an OB GYN by training, and then I did an additional, after completing four years of residency in OB GYN and getting board certified in that, I did an additional training in reproductive endocrinology and [00:01:00] infertility or otherwise known as REI. So now I'm a fertility specialist. **Dr. Nirali Jain:** Um, I trained at Northwestern in Chicago, so I went to undergrad and medical school there. And then, um, home has always been New Jersey for me, so I moved back out east to New Jersey. Um, I did all my training actually in New York City at Cornell for residency and NYU for fellowship. Um, and then moved to the suburbs. **Dr. Nirali Jain:** Um, and now I'm a fertility specialist in, in Basking Ridge at Reproductive Medical Associates.  **Michelle Oravitz:** Very impressive background. That's awesome.  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** I'd love to hear just really. About what your process is. If a person has been diagnosed with cancer, like what is the process? What are some of the things that you address if they are trying to preserve fertility, and what are some of the concerns going  **Dr. Nirali Jain:** yeah, yeah. All great questions. So, you know, there's a lot of us, uh, the Reis. Are a very small, [00:02:00] there's a very small number of us. So in terms of specializing in fertility preservation, technically we all are certified to treat patients with cancer and kind of move them through fertility preservation before starting chemotherapy. **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** Um, luckily we've been working closely with oncologists in the past several years just to establish some type of streamlined system because having a diagnosis of cancer and hearing all that information. Especially when you're young is so hard. So I think that's, that's where my interest started in terms of being able to speak to and counsel cancer patients. **Dr. Nirali Jain:** I think it is a very specific niche that you really have to be comfortable with in our field. Um, I. So I'll kind of walk you through, you know, what it, what does it look like, right? Um, you go into your oncologist's office suspecting that you have this, this lump. I'll take breast cancer, for example. It could really be any kind of cancer. **Dr. Nirali Jain:** Um, but breast cancer in a reproductive age patient or someone that's in those years where you're starting [00:03:00] to think about building a family, planning a family, um, or if you have kids at home, that's usually the type of patient that we see come in with a breast cancer diagnosis. So. Kinda just taking that, for example, um, the minute that you're diagnosed, it's really your oncologist's responsibility to counsel you on what treatment options are going to be offered to you. **Dr. Nirali Jain:** And then based off of the treatment options, it's important to know how that affects your reproduction. So how does it affect your ovaries in the short term, in the long term, um, in any way possible. So. Once a patient is initially referred from their oncologist to myself or any other fertility specialist, they come into my office and we just have a 30 minute conversation really talking about family planning goals. **Dr. Nirali Jain:** Any kids that they've had in the past either naturally conceived or through um, IVF, and then we talk about where they're at in their relationship. Are they married, are they not? Are they with a partner, [00:04:00] a male partner, a female partner, whatever it might be. It's important to know the social standpoint, um, especially in this sensitive phase of life. **Dr. Nirali Jain:** So patient patients usually spend anywhere from 30 minutes to an hour. Um, just kind of talking through where they're at, how they're feeling, what their ultimate childbearing goals are. And then from there we do an ultrasound and that's when I'm really able to see, you know, the, the reproductive status. **Dr. Nirali Jain:** So what do the ovaries look like? What does the uterus look like? Is there something that I need to be concerned about from a baseline GYN standpoint? Um, and all of those conversations are happening in real time. So. I think one of the things is patients come in and they're like, I'm already so overwhelmed with all this information from my oncologist, and now my fertility specialist is throwing all this information at me. **Dr. Nirali Jain:** Luckily, the way I like to frame it is you come in and you just let go. Like you let us do the work because in the background we're the ones talking to your oncologist. We're the [00:05:00] ones giving that feedback and creating a timeline with your oncologist. Um, and really I think just getting in the door is the hardest part. **Dr. Nirali Jain:** So once patients are here to see us, we go through the whole workup. We do anything that we would do for a normal patient that came in for fertility preservation. And then based off of where they're at in their journey, we talk about what makes sense for them, whether that means freezing embryos, freezing eggs, they're very similar in terms of the, the few weeks leading up to the egg retrievals. **Dr. Nirali Jain:** So I have that whole conversation just at the initial visit. And then from there we talk about the timeline behind the scenes and make sure that it works with their lives before moving forward. **Michelle Oravitz:** So for people listening to this, why, and this might be an obvious question, but to some it might not be,  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** why would somebody want to preserve. eggs or sperm. 'cause I've had actually some couples  **Dr. Nirali Jain:** Yep. **Michelle Oravitz:** come to me where the husband preserved the sperm and they had to go through IVF just because he was going [00:06:00] through cancer treatments. So he had to preserve the sperm ahead of time.  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** people need to consider doing that before doing cancer treatments?  **Dr. Nirali Jain:** So there are certain cancer treatments that do affect the ovaries and the sperm health, and you know, for men and women, it affects your reproductive organs. In a similar way, um, depending on the type of chemotherapeutic agent, there are some that are more dangerous in terms of, um, being toxic to your ovaries or toxic to your sperm. **Dr. Nirali Jain:** And those are the instances where we are really thinking about what's the long-term impact because there's medications that oncologists do give patients, and our oncologists are amazing, the ones that we work with, Memorial Sloan Kettering from Reproductive Medical Associates through RMA, um, and. **Dr. Nirali Jain:** They're just so good at what they do and are so well-trained, so they know in the back of their mind, is this going to impact your ovaries or your sperm health or not? Um, and I [00:07:00] think that any chemotherapy, you know, your ovaries are these, these small organs that are constantly turning over follicles every month. **Dr. Nirali Jain:** So every month we're losing those eggs, and if they don't become. If an egg isn't ovulated, it doesn't become a baby, it's just gonna die off. So I counsel even patients that don't have cancer, I counsel them on fertility preservation as young as possible. You know, between the ages of 28 and 35, that's like the best time to preserve your fertility. **Dr. Nirali Jain:** So in cancer patients, there's an extra level added to that where even if they are a little bit younger, a little bit older. Your eggs are not gonna be the same quality. There's gonna be higher level of chromosomal errors, more DNA breakage, um, and, and bigger issues that lead to issues with conceiving naturally afterwards. **Dr. Nirali Jain:** So I think that it's important to consider how that chemotherapy is going to affect them or how surgery would affect them if it was, for example, a GYN cancer where [00:08:00] we're removing a whole ovary, you know, what, what do we have to do to preserve your fertility in that case? And those are important conversations to have. **Michelle Oravitz:** Yeah. for sure. I know that a lot of people are also concerned, you know, with going through the IVF process, you're taking in a lot of estrogen, a lot of hormones, and many cancers are actually estrogen sensitive. So I wanted to talk to you about that. 'cause I know that the data shows that it's. It's been fine, which some people might find surprising, but I wanted you to address that and just kind of **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** from your perspective.  **Dr. Nirali Jain:** That's so interesting that you asked that question because I actually, my whole I I graduated fellowship last year and my entire, like passion project in fellowship was looking at one of the drugs that we use to suppress the estrogen levels specifically in cancer patients. Um, and I had presented this at a few of our reproductive meetings. **Dr. Nirali Jain:** Um, A SRM is one of our annual meetings where all of the reiss get together. A lot of male fertility [00:09:00] specialists come and we kinda just talk about. Specific things and fertility preservation for cancer patients is, has been an ongoing topic of interest for all of us. Um, and it's important to know that there are different medications that we can offer. **Dr. Nirali Jain:** Letrozole is the one that I, um, have a particular love for and I, uh, you know, I use all the time for my patients, um, for different reasons, but it suppresses the exposure that your body has to estrogen. And there's mixed data, um, out there in terms of, you know, does Letrozole suppression actually impact, you know, does it help or. **Dr. Nirali Jain:** Or does it have no impact on your future risk of cancer after treatment? Um, and that honestly is still up for debate. But what we do know is that there's no increased risk of cancer recurrence in patients that have undergone fertility preservation with or without Letrozole. Um, Letrozole is one of those things that we can give, and the way it works is basically. **Dr. Nirali Jain:** It masks that [00:10:00] conversion. It, it doesn't allow for conversion from those androgens in the male hormones over to estrogen. Um, and so your body doesn't really see that estrogen exposure. It stays nice and low throughout your cycle, and it does help with actually ovarian maturation and getting mature eggs harvested and, um, helps a little bit with, with quality too. **Dr. Nirali Jain:** So I think that it's really nice in terms of having that available to us, but know that. It's not, it's not essential that you have it, really, the data showing plus minus. Um, but there are certain things that we can do to protect the ovaries, protect your exposure to estrogen. Um, and so that shouldn't be top of mind of concern when we're going through fertility preservation, even with an estrogen sensitive cancer. **Michelle Oravitz:** Actually, so, uh, on a different topic, kind of going back to that, so Letrozole versus Clomid, I, it's like a, the questions I personally feel just based on what I've heard and like my own research that Letrozole would be kind of like the more. [00:11:00] Um, the, it's, it's a little better, but I know that it really depends on the person as well.  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** they might do better with Clom, but I'd love to hear your perspective and kind of pick your brain on this.  **Dr. Nirali Jain:** totally. You're choosing all the, all the right questions because these are all of my, my specific interests and niches. So  **Michelle Oravitz:** Oh,  **Dr. Nirali Jain:** Letrozole is basically, you know, we use Letrozole and Clomid in. Patients that don't have cancer and patients that come in for an intrauterine insemination, that's kind of the most common scenario where we're thinking about, you know, which medication is better? **Dr. Nirali Jain:** Letrozole or Clomid and Clomid used to be the, the most common medication that we use, we dose patients, you know, have 50 milligrams of Clomid, give them five days of the medication. It's an oral pill. Feels really easy and. The way it works is really, it recruits more than one follicle, so it really helps with the release of, um, more than one follicle growing more than one follicle in the ovary. **Dr. Nirali Jain:** Um, but it has a little bit [00:12:00] higher of a risk of twins because that's exactly what it's good at. Um, Clomid, not so much in the cancer. In the cancer front, it's not really used there because it's considered, from a scientific perspective, it's considered like a selective estrogen receptor modulator. So it doesn't necessarily suppress your estrogen levels in the same way that Letrozole does versus. **Dr. Nirali Jain:** Letrozole is an aromatase inhibitor, so it really blocks the chemical conversion of one drug or one hormone to the other hormone. Um, the reason we love Letrozole so much, and I don't mean to like gush over Letrozole, but um, it's a mono follicular agent, so it works really well at recruiting one follicle  **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** you know, every OB-GYN's nightmare in a way is having multiples when you didn't intend on having multiples at all. **Michelle Oravitz:** so  **Dr. Nirali Jain:** Um. **Michelle Oravitz:** were saying that, um, there's more of a chance of twins, it's Clomid, not letrozole.  **Dr. Nirali Jain:** Yes, there's a higher chance with Clomid versus Letrozole. And I mean, don't get me wrong, there's a chance of twins with [00:13:00] any type of assisted reproductive technology. Even when we're doing single embryo transfers, there's a chance that it's gonna split. So, um, the chance is always there just like it is in the natural world. **Dr. Nirali Jain:** But we know for a fact that. CLO is really good at recruiting many follicles. It's good for certain patients that don't respond well to Letrozole. Um, but Letrozole is kind of our, our go-to drug these days just because of all the benefits that we've seen.  **Michelle Oravitz:** Awesome.  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** These are all fun things to ask because I, I love talking to our eis 'cause there's so much information that I'm always  **Dr. Nirali Jain:** totally. **Michelle Oravitz:** learn a lot from my patients in my own research, but it's really cool. Picking your guys' brains. So another question I have, and I have actually talked to Dr. Andrea Elli, he's been on,  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** and he does a lot of endometriosis and, and immune related work as well,  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** so. I'd love to know just from your perspective. One thing that I do know from, based on what I've heard is that the, [00:14:00] guess like you were just saying, that breast cancer or estrogen sensitive breast cancer doesn't seem to be affected by IVF cycles, however, and endometriosis lesions do get affected.  **Dr. Nirali Jain:** Yeah. **Dr. Nirali Jain:** that's a great question. So, you know, every, there are so many complex G mind diagnoses that the, that our patients come in with. Um, and endometriosis is a big one because there is clear data that endometriosis is linked to infertility. So we think about, you know, when a patient comes in with endometriosis, we really do think about the different treatment options and what are the short-term and long-term impacts of the hormones that we're giving 'em. **Dr. Nirali Jain:** Um, these days, again, kind of going back to Letrozole, we, letrozole is something that I give all of my endometriosis patients because it helps suppress their estrogen because we know.  **Michelle Oravitz:** interesting.  **Dr. Nirali Jain:** is very responsive to estrogen and leads to this dysfunctional regulation of all the endometrial tissue that can really flare in a, [00:15:00] in a cycle, or shortly after a cycle. **Dr. Nirali Jain:** I. So we really, for endometriosis patients, the, the best treatment is being on birth control because we don't see that hormonal fluctuation. The up and down of the estrogen and the progesterone, that's what leads to those flares. Um, so I really, I watch patients closely after their cycles too, because you definitely can have an endometriosis flare and we say the best treatment for endometriosis is pregnancy, right? **Dr. Nirali Jain:** That's when you're suppressed, that's when you're at your lowest. Um, and patients, my endo patients feel so good in pregnancy because they have. Hormones that are nice in that baseline, they're not getting periods of course. Um, and that's truly, truly the best treatment.  **Michelle Oravitz:** That's interesting.  **Dr. Nirali Jain:** But it is important to consider when you're going through infertility treatments. **Dr. Nirali Jain:** How does my endometriosis affect the short and long-term effects of the fertility medications? And really not to, not to say that they're bad in any way. I think a lot of endometriosis patients go through IVF and have success and do really, really well, and that's kind of the push that they need. [00:16:00] Um, but it's important to be mindful of the bigger picture here. **Dr. Nirali Jain:** It's not just, you're not just a number of. A patient with endo coming in, getting the same protocol. It's really individualized to the extent of your lesions, what symptoms you're having, what grade of endometriosis, where your lesions are. So we're the RAs are thinking about everything before we actually start your protocol. **Michelle Oravitz:** It's crazy how in depth it is, and it's, it, there's just so, it's so multifaceted,  **Dr. Nirali Jain:** Yeah,  **Michelle Oravitz:** when it's females  **Dr. Nirali Jain:** totally. **Michelle Oravitz:** are a little, I mean, they can, you know, there, there's definitely a number of things, but it's not as complicated and interconnected  **Dr. Nirali Jain:** Exactly. Exactly. That's so true. **Michelle Oravitz:** And so one question I actually have, this is kind of really off topic, but something that I was curious about. **Michelle Oravitz:** 'cause I heard about a while  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** a, a type of cancer treatment that was used. I'm not sure exactly what it was, but for some reason it actually caused follicles to grow, [00:17:00] or to multiply. And they were **Dr. Nirali Jain:** Interesting. **Michelle Oravitz:** this definitely. Puts, um, the whole idea of like a woman being born with all the follicles she'll ever have on its head, I thought that was really Interesting. **Michelle Oravitz:** Now I learned a little bit about it. I don't think it really went further than that,  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** one of those things that they're like, Hmm, this is interesting. I don't know, it was kind of a random side effect of this chemo drug. I dunno if it was a chemo drug or a cancer drug.  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** ever heard of that. **Michelle Oravitz:** So I was just **Dr. Nirali Jain:** I haven't, I mean, that's interesting. I feel like I'd have to look into that because that would be definitely a point of interest for a lot of Reis. But it kind of does go back to the point of, you know, women are really born with all the eggs we're ever gonna have. So it's about a million, and then it just goes down from there. **Dr. Nirali Jain:** And the, by the time you start having periods, I like to kind of show my patients a chart, but you have a couple hundred thousand eggs and you ovulate one egg a month. That's, you know. Able to [00:18:00] progress into a fertilized egg and then into a, an embryo into a baby, um, if that's your goal. But otherwise, patients that are having periods and not trying to actually get pregnant, we're losing hundreds of eggs a month. **Dr. Nirali Jain:** So.  **Michelle Oravitz:** Mm.  **Dr. Nirali Jain:** It's important to kind of think about that decline, and it's important to know that that rate can be faster in patients with cancer, patients with low ovarian reserve. And sometimes when you have the two compounded, that's when a fertility specialist is definitely, you know, in the queue to, to have a discussion with you in terms of what that means and how you can reach your family building goals despite being faced with that, with that challenge. **Michelle Oravitz:** Yeah. **Michelle Oravitz:** I mean, 'cause we know oxidative stress is one of the things that can cause, uh,  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** quality eggs, but it's also can cause cancer. **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** um, similar, you know, like things that really deplete the body could definitely impact. Um, and then what are your thoughts? I know I'm asking you all kinds of random questions, **Dr. Nirali Jain:** I love it. **Michelle Oravitz:** are your thoughts about doing low simulation in certain [00:19:00] circumstances versus high stem? **Michelle Oravitz:** Sometimes people don't respond as well to higher stems.  **Dr. Nirali Jain:** Yeah, that's a great point. I think that it kind of all goes back to creating an individualized protocol. If. A patient's going to a practice and basically just getting a protocol saying, this is our standard. We start with our standard of, you know, I, I think about the standard, which is 300 of the FSH or that pen that you dial up, and then 150 units of that powder vial. **Dr. Nirali Jain:** And we have patients mixing powders all the time, and that's kind of our blanket protocol that we give patients. But that's not really what's happening behind the scenes. And if you're given a protocol that's, and being told, you know, this is kind of what we give to everyone, it's probably not the right fit for you. **Michelle Oravitz:** Yeah, I  **Dr. Nirali Jain:** Um, there are certain patients that respond to a much lower dose and do really, really well, and then some patients that need a much higher dose. Um, and I think it's, that's kind of like the fun part of being an REI of being able to individualize the [00:20:00] protocol to the patient. Um, and I know for a fact there are so many, luckily, you know, we have so many leaders in REI that have been. **Dr. Nirali Jain:** Have dedicated their entire careers to researching these different protocols and how they can help different patients. Um, patients with lower a MH, you know, might benefit from a duo stim protocol, for example. That's kind of the first one that comes to mind, but a protocol where we're using those follicles from the second half of a cycle. **Dr. Nirali Jain:** I would've never thought that those were the follicles that  **Michelle Oravitz:** Oh,  **Dr. Nirali Jain:** would be better than the first half of the cycle,  **Michelle Oravitz:** Wait,  **Dr. Nirali Jain:** but, **Michelle Oravitz:** that. Explain that. Um, because I think that that's kind of a unique  **Dr. Nirali Jain:** mm-hmm.  **Michelle Oravitz:** that I haven't heard of.  **Dr. Nirali Jain:** Yeah, so there's this new day. It's still kind of developing, but um, kind of going back to, you know, what's an individualized protocol? Duo STEM is one of the newer protocols that we've started using. I, I've used it once or twice in patients. Um, but it goes back to the research that shows that you might actually have two different periods of time in a menstrual cycle where you could potentially recruit [00:21:00] follicles. **Dr. Nirali Jain:** You could have a follicular phase where there's a certain cohort of follicles recruited, and then you have a follicle that forms creates a corpus glut.  **Michelle Oravitz:** um, protocols  **Dr. Nirali Jain:** Yep. And then you basically go through the follicular protocol and then a few days after a retrieval, instead of waiting for a new follicular cohort or follicular recruitment from the first half of your menstrual cycle, you actually use the luteal phase and you recruit those follicles that would've actually died off or have been prematurely recruited in a prior cycle. **Dr. Nirali Jain:** So **Michelle Oravitz:** that's So  **Dr. Nirali Jain:** yeah, **Michelle Oravitz:** you just do a similar, I guess, um, medicine,  **Dr. Nirali Jain:** go right back into it.  **Michelle Oravitz:** do the same exact thing, but right after ovulation.  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** Fascinating. That's really interesting.  **Dr. Nirali Jain:** Yeah,  **Michelle Oravitz:** has been your experience with that?  **Dr. Nirali Jain:** I think it's, honestly, it's mixed. Um, so far, you know, our data from fertility and sterility and A SRM, it, it shows support for these DUO STEM [00:22:00] protocols, saying that if patients don't have that great quality of eggs or if they have a very low number, maybe they'd benefit from starting the meds earlier and recruiting follicles. **Dr. Nirali Jain:** A little bit earlier. Um, so we've seen positive results so far. A lot of work to be done in terms of really understanding it. Um, and of course, as a new attending, I have a lot more experience to kind of build on. Um, but I, I have seen success from it. **Michelle Oravitz:** That's fascinating. Are there any other new technologies, like new add-ons, um, that you've seen, that you've found to be really cool or interesting?  **Dr. Nirali Jain:** I think the biggest thing, actually, kind of going back to our whole topic for today is fertility preservation cancer patients. One of the biggest things that I've learned recently is that we used to start fertility, um, patients. You know, only in the beginning of the cycle days, two or three is technically like when most. **Dr. Nirali Jain:** Most clinics, um, start patients, but for our cancer patients, sometimes you don't have that time. You don't wanna wait a full month to [00:23:00] restart, um, your, you know, your menstrual cycle and then do the fertility preservation and then delay chemotherapy a full month. So we started doing what we call random starts. **Dr. Nirali Jain:** So you basically start a patient whenever they come in. You know, it could be the day after your consultation, the day of your consultation. I've kind of seen all of the above. Um, and we've seen really good success with random starts, per se. Um, and we've been doing a lot more of that, where it's not as dependent on where you're at in your cycle. **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** Um, obviously there's a difference in outcomes. You might not be a great candidate for it, so definitely it's worth talking to your doctor about it. But it kind of gives relief to our cancer patients where if you have a new cancer diagnosis and you're like, oh, I just finished my period, like, I can't even start a cycle until next month. **Dr. Nirali Jain:** That's not always true. Um, so it's always worth it to go into see a fertility specialist and just get, you know, get the data that you need right away, and then you can make a decision later on. **Michelle Oravitz:** For sure. Um, Yeah. **Michelle Oravitz:** and I wanted to kind of cover a lot of different topics 'cause I know that [00:24:00] some people are gonna wanna hear what you have to say that don't necessarily, or, uh, have cancer. But it is important. I, I think that, you know, if you get to thirties and you haven't gotten married or you don't have a partner, I think it's really important to preserve your fertility in general.  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** important thing. And then if you were going through a cancer diagnosis and you decided to preserve your fertility, um, guess more for women because they're eventually going to be thinking about transfers after they go through treatment. So what are some of the things that they would need to consider as far as that goes? **Michelle Oravitz:** Like after the  **Dr. Nirali Jain:** yeah, **Michelle Oravitz:** then they go through the cancer treatments. Um, and then what, how long should they  **Dr. Nirali Jain:** yeah. Like what does it look like? So I've had patients that come back, you know, in my fellowship training I did a, a couple research projects on patients that came back to pursue an embryo transfer, um, after chemotherapy agent. And basically compared them to how they did, um, [00:25:00] compared to patients that didn't have cancer and just froze their embryos or froze their eggs and then came back to pursue a transfer and. **Dr. Nirali Jain:** I think the, the most reassuring thing from the preliminary data that we have is saying that there's no difference in pregnancy rates and no difference in life birth,  **Michelle Oravitz:** Awesome.  **Dr. Nirali Jain:** of whether they had chemotherapy or not. After freezing those eggs and going through fertility preservation.  **Michelle Oravitz:** Amazing.  **Dr. Nirali Jain:** Um, in terms of where your body needs to be, I think the oncologist, we, we wait for their green light. **Dr. Nirali Jain:** We wait for their signal to say, you know, she's safe to carry a pregnancy.  **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** And then once we do that, we basically treat you like any other patient. So if you're coming in for a cycle, if you're having periods, then it's reasonable to try a natural cycle protocol, wait for your body to naturally ovulate an egg. **Dr. Nirali Jain:** And instead of obviously hoping that egg will fertilize, we, um, use a corpus luteum. We use the progesterone from the corpus luteum to really support this embryo being implanted into the uterus. Um. Yeah. [00:26:00] And then there's also another side. I mean, some patients don't get their periods back and they always ask like, what if I never get my period back? **Dr. Nirali Jain:** What if I'm just like in menopause because of the chemotherapy agents? And for that, we can start you on a synthetic protocol or basically an estrogen dependent protocol where you take an estrogen pill for a certain number of days. We monitor your lining, then we start progesterone, um, to support your hormones from that perspective instead of relying on your ovaries to release the progesterone that they need, um, and then doing the embryo transfer a few, few days after progesterone starts. **Dr. Nirali Jain:** So there's definitely different protocols depending on where your menstrual health is at after the chemotherapy or after the cancer treatment. Um, but it's important to kind of just know that. That there's options. It doesn't mean that it's the end of the road if you all of a sudden stop getting your period. **Michelle Oravitz:** Yeah, for sure. I mean, 'cause you, technically speaking, you can really control a lot of that. More so for transfers  **Dr. Nirali Jain:** Yep. **Michelle Oravitz:** Retrievals really is kind of like what [00:27:00] eggs you have, what the quality is. But people can be in complete menopause and you guys can still control their cycles for transfer, which is kind of. A huge difference  **Dr. Nirali Jain:** Yeah,  **Michelle Oravitz:** in the  **Dr. Nirali Jain:** exactly. That's exactly right. Yeah. **Michelle Oravitz:** interesting. Any other, um, new, new things that you're, you guys are excited about? I always like to hear about like the new and upcoming things  **Dr. Nirali Jain:** Of course.  **Michelle Oravitz:** actually before, which I thought was fascinating. Yeah.  **Dr. Nirali Jain:** I feel like there's always like updates and, and new data and things like that coming out, but just know, I think it's important for patients to know, like we're constantly, we're, the reason I chose to even pursue this field was because it's new. Right. There's something that we are discovering every day, every year, and that's what makes our, our conferences so important to attend, um, to really just stay up to date. **Dr. Nirali Jain:** Um, but we are, uh, constantly updating our embryology standards, the way we thaw our eggs, and the success rate associated with a thaw and [00:28:00] how we treat our embryos and the media that we use, right? Like, so we're really thinking about the basic science perspective every single day, and that's what makes this field so unique. **Michelle Oravitz:** It is really awesome. And so do you guys specialize specifically on, um. Egg freezing and, and I mean specific fertility preservation in patients that do that have cancer that are going through treatments, do you guys specialize specifically in that? I mean, I know you do range  **Dr. Nirali Jain:** Yeah. Yeah, because it's such a small community, we all have our own niches and we all kind of have our own interests and  **Michelle Oravitz:** Yeah.  **Dr. Nirali Jain:** no like specific training. There are a couple courses that you take that I took in in training as well, just to kind of understand what it sounds like to, I. Council of fertility preservation, patient with and without cancer. **Dr. Nirali Jain:** Um, and then, you know, you kind of just learn by experience and you form a niche for something that you're passionate about. 'cause that's what makes you, you know, really thorough in, in your treatment. [00:29:00] So that's one of my interests. Um, and, but I would say,  **Michelle Oravitz:** training for that. It's just like  **Dr. Nirali Jain:** yeah, **Michelle Oravitz:** just know how to treat that in  **Dr. Nirali Jain:** exactly.  **Michelle Oravitz:** especially if you're interested in doing that.  **Dr. Nirali Jain:** Exactly. That's exactly right. It's kind of, it just comes with the experience comes with your mentors and who you're surrounded by, and everyone kind of helps each other get to that point. But there are several specialists in our practice at RMA that specialize specifically in fertility preservation in cancer patients. **Dr. Nirali Jain:** So we have a close communication with our oncologist and they know who to refer to within the practice because everyone has their own little interests.  **Michelle Oravitz:** Amazing.  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** Um, definitely. I, like I said, I really enjoy picking your brain because it's a lot of fun for me. I, I do  **Dr. Nirali Jain:** Totally.  **Michelle Oravitz:** acupuncture, so  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** and I, I think that it's just so crazy that our fields don't work together. I mean, we kind of do, but I think, I just feel like it would be so great  **Dr. Nirali Jain:** exactly.[00:30:00]  **Michelle Oravitz:** the expertise because you guys have immense. Benefits like in, in, uh, technology and incredible innovations and, and then the natural aspect of really understanding the, the body. And I, I just think that it would work so amazing together if it was more of like a thing. 'cause it, I know in China they actually combine the two  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** eastern.  **Dr. Nirali Jain:** Yeah, I mean I think that that's so important and there is data that shows, you know, there's actually a recent study that came out just a few weeks ago on the benefits of acupuncture for fertility patients. And we know that, I mean, I recommend it to all of my patients, specifically the day of the embryo transfer. **Dr. Nirali Jain:** We, luckily, we offer it on site at RMA and we have acupuncturists that come in and, and do a session before and after the embryo transfer, and I think. A lot of that is targeted towards stress relief. But I also think that holistically it's important to feel at your best when we're doing something that's so crucial to your, to your health. **Dr. Nirali Jain:** So to really focus on the diet, focus on stress relief, [00:31:00] focus on meditation, yoga, whatever it takes to get to your best wellbeing when you're going through fertility treatments, um, is so important. So I appreciate  **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** like you that really specialize in the other side of. Of this, because I do consider it still part of the holistic medicine that we need to really maximize success for our patients. **Michelle Oravitz:** Awesome. Well,  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** Jane, this is such a pleasure Of talking to you. You've given us some, so much great information and we've definitely dived into a, do a topic that I don't typically, I haven't yet spoken about. But, um, that being said, it's such an important topic to talk about. And thank you so much for coming on today. **Michelle Oravitz:** Oh,  **Dr. Nirali Jain:** course. **Michelle Oravitz:** I get off, how can people find you?  **Dr. Nirali Jain:** That's a great question. So I have, um, a social media page. I, it's called Expert nc. So like EGG,  **Michelle Oravitz:** I  **Dr. Nirali Jain:** um, expert nc. Try, tried to make it a little bit humorous. Um, but I'm all over social [00:32:00] media and would love to hear from anyone that is listening. I, you know, every, every day I get different, um, dms and I'm happy to respond. **Dr. Nirali Jain:** I love hearing about everyone else's. Stories and things like that. Um, so that is kind of my main, main social media platform. Um, and then through like RMA and Reproductive Medical Associates, we also have a YouTube channel. We have an Instagram page, um, of our office available, um, as well that is public. **Dr. Nirali Jain:** So you can find us pretty easily if you just kind of hit Google. But um, yeah, I'm kind of developing my social media platform as the expert and I hope it grows.  **Michelle Oravitz:** Love it. Great.  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** was such a pleasure talking to you. Thank you. so much **Dr. Nirali Jain:** Thank you. **Michelle Oravitz:** today.  **Dr. Nirali Jain:** Of course. Thank you so much for having me.  [00:33:00]   

In this episode of The No Normal Show, Desiree Duncan and Chris Bevolo highlight the cultural crossfire brands are navigating today. From Nike's controversial “Never Again” billboard to NYU Langone's controversial Super Bowl ad, they explore how even well-intentioned moves can result in backlash in a world of unapologetic commentary and hypersensitive audiences. Fresh from his recent Becker's and HMPS panels to duo recap conference trends and topics — highlighting AI disruption and the marketing ROI challenge that just won't go away. For healthcare marketers trying to lead bold while avoiding missteps, this episode is for you.Subscribe to The No Normal Rewind, our newsletter featuring a mashup of the boldest ideas, sharpest takes, and most rewind-worthy moments from our podcast — right here.

Dr. Christina Prescott, an ophthalmologist at NYU Langone and ocular expert, is helping patients get amazing results from new technologies in lenses. In this episode, Dr. Prescott dives into this under-discussed subject, unveiling the fascinating science behind the eye, and the do’s and don'ts of caring for your own. Screen time, sun protection, diet – which factors really matter? Tune in to learn!See omnystudio.com/listener for privacy information.

How could a single psychedelic treatment cause lasting change? Joshua Siegel, MD, PhD, is on a mission to find out. A leading expert on neuroimaging and neuropsychopharmacology at NYU Langone's Center for Psychedelic Medicine, Dr. Siegel unpacks how psilocybin may spark neuroplasticity and reshape the depressed brain. He also gives us an inside look at the race to develop non-hallucinogenic psychedelic analogs. Dr. Siegel is an assistant professor at NYU Grossman School of Medicine.

What if a simple conversation in the emergency room could reveal who's most at risk for PTSD before symptoms even begin? Katharina Schultebraucks, PhD, shares her innovative work on using machine learning to forecast mental health outcomes and explains how AI could revolutionize how we detect, prevent, and treat psychiatric disorders. Dr. Schultebraucks is Co-Director of the Computational Psychiatry Program and Associate Professor in the Department of Psychiatry and Population Health at NYU Grossman School of Medicine.

Send us a textDr. Anastasia Liapis, Ph.D. is Global Head of Innovation & New Business Creation, HP Health Solutions ( https://www.izb-online.de/en/companies/hp-health-solutions-germany-gmbh/ ), a division of HP ( https://www.hp.com/us-en/home.html ) , that develops technology specifically for the healthcare industry and reimagines healthcare tech for diagnostics and precision medicine of the future.Dr. Liapis' team leads innovation in diagnostics and health-tech, driving the development and commercialization of ultrafast PCR and microfluidic-based diagnostic platforms, as well as focuses on early-stage technology development, partnerships, and business strategy, ensuring breakthrough innovations translate into real-world impact.Previously, Dr. Liapis served as Vice President of Strategic Marketing & Partnerships at GNA Biosolutions GmbH, a molecular diagnostics start up that was acquired by HP, and she played a pivotal role in enhancing the organization's strategic vision, focusing on innovative solutions in the bioscience sector.Before taking her role at GNA Biosolutions, Dr. Liapis made significant contributions to various notable organizations such as TBWA, the healthcare agency creative collective, where she served as a Group Account Supervisor, and as of Vice President of Medical Affairs at Medical Dynamics, developing medical education programs and fostering key opinion leader (KOL) relationships.Dr. Liapis completed her doctoral training in Genetics at the Mount Sinai School of Biomedical Sciences and her post-doctoral fellowship in Immunology at the Skirball Institute of Biomolecular Medicine at NYU Langone. She earned both her Master's and Bachelor's degrees in Biology from Washington University in St. Louis.#AnastasiaLiapis #HPHealthSolutions #HP #HewlettPackard #Healthtech #Biosecurity #LifeSciences #FoodSafety #NucleicAcidAmplification #MolecularAssays #Biotechnology #Nanotechnology #GNABiosolutions #MolecularDiagnostics #Microfluidics #PolymeraseChainReaction #PCR #Bioscience #CarT #LysosomalStorageDisorders #BrandStrategy #ScientificWriting #ProgressPotentialAndPossibilities #IraPastor #Podcast #Podcaster #ViralPodcast #STEM #Innovation #Technology #Science #ResearchSupport the show

With clinician-informaticist collaboration, enterprise-wide governance, and a deep bench of automation use cases, NYU Langone Health is pushing the boundaries of robotic process automation and agentic AI. When a bot at NYU Langone Health identifies a medication reconciliation gap, it doesn't just log an alert. It initiates a secure chat among the attending physician, quality […] Source: NYU Langone Builds Bot-Powered Playbook for Clinical Transformation on healthsystemcio.com - healthsystemCIO.com is the sole online-only publication dedicated to exclusively and comprehensively serving the information needs of healthcare CIOs.

In this episode of Toxic Free with KB, I sit down with the amazing Dr. Judith Joseph! She's a Board-Certified Psychiatrist, clinical assistant professor at NYU Langone, and Chair of the Women in Medicine Initiative at Columbia University. She is the author of the highly anticipated book, “High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy” that was released on April 8th!We go in-depth on what depression really is, how high-functioning depression and anxiety affect our daily lives, and the impact of toxic stress on mental and physical health. She shares insights on breaking unhealthy family patterns, recognizing emotional toxicity in relationships, and practical strategies for managing stress in today's high intensity world!More on Dr. Judith Joseph:Website: https://drjudithjoseph.com/Book: https://highfunctioningbook.com/Instagram: https://www.instagram.com/drjudithjoseph/Follow Us on Instagram: @ToxicFree.KB: https://www.instagram.com/toxicfree.kb/ Follow Us on TikTok: @toxicfreewithkb: https://www.tiktok.com/@toxicfreewithkb Shop some of my favorite products I use everyday!

32: Subway Sanitation, Hochul's Reparation Folly, Albany's Criminal Coddling Democrats, NYU-Langone's Transgender Kerfuffle & Musk's Dangerous Takeover of Treasury's Payment Systems.Welcome to episode thirty-two of David & Stu… Unhinged! As always, we'd like to thank Clara Wang for creating the fantastic artwork for this podcast. In this episode, David and Stu cover the following:1) Stu's encounter with a young lady on the subway on her way to school clipping her nails but redeeming herself by not littering;2) Kathy Hochul's reparation committee and the outrageousness of making any such payments when slavery ended 150 years ago and the victims of which are long dead;3) Albany liberals refused to reform NY's criminal justice reform laws even when asked to do so by state district attorneys, including the pro-criminal Manhattan DA, fat Alvin Bragg.4) NYU-Langone Medical Center's refusal to perform gender-affirming surgery on minors due to Trump's executive order, which threatens to pull funding of providers performing such procedures; and5) Trump's dangerous decision to allow Elon Musk access to US Treasury payment systems could potentially jeopardize our national security and finances since Musk has no legal authority to assume this role or much oversight.Connect with David & Stu: • Email David & Stu: davidandstuunhinged@gmail.com and share your comments, concerns, and questions.The views expressed on air during David & Stu... Unhinged! do not represent the views of the RAGE Works staff, partners, or affiliates. Listener discretion is advised.

In our March episode, we marked Colorectal Cancer Awareness Month with Dr. Renee Williams, a Gastroenterologist and Associate Professor of Medicine at NYU Langone. Dr. Williams talked about the importance of preventive screening for colorectal cancer and walked us through the colonoscopy procedure. In this month's Key Note, she explains what happens if polyps are found during a colonoscopy, what they are and how they're treated. The Takeaway We want to hear from you! Please complete our survey: org/member-feedback. Drop us a line at our social media channels: Facebook// Instagram // YouTube. If you're 45 or older (or have risk factors), make an appointment with your primary care physician to talk about which screening is best for you. Visit the Healthy Living Resource Center for wellness tips, information and resources; 1199SEIUBenefits.org/healthyliving. Get inspired by fellow members through our Members' Voices series: 1199SEIUBenefits.org/healthyliving/membervoices. Stop by our Benefits Channel to join webinars on managing stress, building healthy meals and more: 1199SEIUBenefits.org/videos. Visit our YouTube channel to view a wide collection of healthy living videos: youtube.com/@1199SEIUBenefitFunds/playlists. Sample our wellness classes to exercise body and mind: 1199SEIUBenefits.org/wellnessevents. Guest Bio Renee Williams, MD, MHPE, is a Professor of Medicine in the Division of Gastroenterology at NYU Grossman School of Medicine. Within the Department of Medicine, she is the Associate Chair for Health Equity and the Director of the Saul Farber Program in Health Equity. Institutionally, she is Graduate Medical Education Pillar Lead for NYU Langone's Institute for Excellence in Health Equity. Her interests include health disparities in colorectal cancer screening and medical education with a focus on simulation education. She is a member of the Association of American Medical Colleges' MedEdSCHOLAR Steering Committee, Co-Chair of the New York Citywide Colorectal Cancer Coalition (C5) Risk assessment and Screening Committee, and section editor for the American Society for Gastrointestinal Endoscopy's GESAP (Gastrointestinal Endoscopy Self-assessment Program). She also served on the Board of Trustees for the American College of Gastroenterology from 2018 to 2024.

Egg prices continue to be a pain point for American consumers, as experts say the rise in egg carton costs in January and February are just the beginning of a trend in coming months. The avian flu has been forcing farmers to kill all of their chickens if just one of the birds in their flock is sick with the bird flu. The Department of Agriculture has paid over $1 billion since 2020 to help egg producers who had to cull their flock due to the avian flu. Nebraska Governor Jim Pillen explains what farmers are doing to combat this crisis and continue feeding America. Health and Human Services Secretary Robert F. Kennedy Jr. has been promoting the "Make America Healthy Again" agenda since assuming his position nearly a month ago. During this time, he has focused on improving the nation's diet and emphasized the need for Americans to be better informed about their health. FOX News Senior Medical Analyst and Professor of Medicine at NYU Langone joins to discuss his recent interview with RFK Jr., the importance of being well-informed, and to reflect on the fifth anniversary of the COVID-19 pandemic. Plus, commentary by FOX News Contributor and member of the Wall Street Journal Editorial Board, Bill McGurn Learn more about your ad choices. Visit podcastchoices.com/adchoices

Egg prices continue to be a pain point for American consumers, as experts say the rise in egg carton costs in January and February are just the beginning of a trend in coming months. The avian flu has been forcing farmers to kill all of their chickens if just one of the birds in their flock is sick with the bird flu. The Department of Agriculture has paid over $1 billion since 2020 to help egg producers who had to cull their flock due to the avian flu. Nebraska Governor Jim Pillen explains what farmers are doing to combat this crisis and continue feeding America. Health and Human Services Secretary Robert F. Kennedy Jr. has been promoting the "Make America Healthy Again" agenda since assuming his position nearly a month ago. During this time, he has focused on improving the nation's diet and emphasized the need for Americans to be better informed about their health. FOX News Senior Medical Analyst and Professor of Medicine at NYU Langone joins to discuss his recent interview with RFK Jr., the importance of being well-informed, and to reflect on the fifth anniversary of the COVID-19 pandemic. Plus, commentary by FOX News Contributor and member of the Wall Street Journal Editorial Board, Bill McGurn Learn more about your ad choices. Visit podcastchoices.com/adchoices

Egg prices continue to be a pain point for American consumers, as experts say the rise in egg carton costs in January and February are just the beginning of a trend in coming months. The avian flu has been forcing farmers to kill all of their chickens if just one of the birds in their flock is sick with the bird flu. The Department of Agriculture has paid over $1 billion since 2020 to help egg producers who had to cull their flock due to the avian flu. Nebraska Governor Jim Pillen explains what farmers are doing to combat this crisis and continue feeding America. Health and Human Services Secretary Robert F. Kennedy Jr. has been promoting the "Make America Healthy Again" agenda since assuming his position nearly a month ago. During this time, he has focused on improving the nation's diet and emphasized the need for Americans to be better informed about their health. FOX News Senior Medical Analyst and Professor of Medicine at NYU Langone joins to discuss his recent interview with RFK Jr., the importance of being well-informed, and to reflect on the fifth anniversary of the COVID-19 pandemic. Plus, commentary by FOX News Contributor and member of the Wall Street Journal Editorial Board, Bill McGurn Learn more about your ad choices. Visit podcastchoices.com/adchoices

Let's face it, no one says, “I can't wait to have a colonoscopy!” But with advances in the procedure and easier prep solutions – as well as less-invasive options – there really is no reason to wait to schedule this screening. To mark Colorectal Cancer Awareness Month, we are joined by Dr. Renee Williams, a Gastroenterologist and Associate Professor of Medicine at NYU Langone, who wants everyone to know that colon cancer is preventable, treatable and beatable! Dr. Williams explains risk factors, symptoms and the importance of prevention. She also walks us through the procedure and even shares her own, very candid experience about her first screening.   The Takeaway We want to hear from you! Please complete our survey: org/member-feedback. Drop us a line at our social media channels: Facebook// Instagram // YouTube. If you're 45 or older (or have risk factors), make an appointment with your primary care physician to talk about which screening is best for you. Visit the Healthy Living Resource Center for wellness tips, information and resources; 1199SEIUBenefits.org/healthyliving. Get inspired by fellow members through our Members' Voices series: 1199SEIUBenefits.org/healthyliving/membervoices. Stop by our Benefits Channel to join webinars on managing stress, building healthy meals and more: 1199SEIUBenefits.org/videos. Visit our YouTube channel to view a wide collection of healthy living videos: youtube.com/@1199SEIUBenefitFunds/playlists. Sample our wellness classes to exercise body and mind: 1199SEIUBenefits.org/wellnessevents. Guest Bio Renee Williams, MD, MHPE, is a Professor of Medicine in the Division of Gastroenterology at NYU Grossman School of Medicine. Within the Department of Medicine, she is the Associate Chair for Health Equity and the Director of the Saul Farber Program in Health Equity. Institutionally, she is Graduate Medical Education Pillar Lead for NYU Langone's Institute for Excellence in Health Equity. Her interests include health disparities in colorectal cancer screening and medical education with a focus on simulation education. She is a member of the Association of American Medical Colleges' MedEdSCHOLAR Steering Committee, Co-Chair of the New York Citywide Colorectal Cancer Coalition (C5) Risk assessment and Screening Committee, and section editor for the American Society for Gastrointestinal Endoscopy's GESAP (Gastrointestinal Endoscopy Self-assessment Program). She also served on the Board of Trustees for the American College of Gastroenterology from 2018 to 2024.

In this special live episode of Derms and Conditions, recorded at the 2025 Winter Clinical Dermatology Conference - Hawaii®, host Dr James Q. Del Rosso welcomes Dr April Armstrong, chief of dermatology at UCLA, and Dr David Cohen, dermatologist at NYU Langone, to break down the key takeaways from this year's meeting.   The discussion kicks off with chronic hand eczema, a condition that can be difficult to diagnose and treat due to its multiple causes. Dr Cohen highlights emerging data on new treatment options, including dupilumab, topical JAK inhibitors like ruxolitinib, and upcoming therapies like delgocitinib. They explore whether these newer therapies could be effective across different causes of hand eczema, even when an allergen isn't clearly identified.   Dr Armstrong then shifts the conversation to the next frontier in psoriasis treatment, including new oral therapies that are pushing efficacy to higher levels. They discuss IL-23 receptor antagonists, IL-17 inhibitors, and TNF inhibitors in development, as well as 5-year safety and efficacy data for deucravacitinib, which shows no long-term need for routine monitoring. The group also tackles the evolving treatment landscape for hidradenitis suppurativa (HS), where combination therapy is emerging as a key strategy. Dr Armstrong shares insights into guidance from the HS Foundation and the potential of pairing JAK inhibitors with IL-17 or TNF inhibitors for refractory cases.   They wrap up with practical pearls from the conference, including extended terbinafine treatment durations for fungal infections, pediatric biologic use around live vaccines, and the latest treatment options for molluscum contagiosum.   Tune in to this information-packed episode for expert insights and clinical updates straight from Winter Clinical 2025!

In this episode of Grow Everything, Karl and Erum sit down with Dr. Glennis Mehra, the absolute powerhouse behind BioLabs at NYU Langone, to talk about what it really takes to build a biotech startup in New York City. From how to deal with imposter syndrome to finding funding in a capital-constrained world, Glennis shares hard-earned insights on how founders can survive (and thrive) in one of the toughest, most exciting biotech ecosystems on the planet. They get into the magic of founder-to-founder collaboration, why biology's complexity is finally getting the respect it deserves, and whether AI is about to make lab work obsolete (spoiler: it's not). Plus, Erum debates whether traveling to Mars just to eat lettuce is worth it.Grow Everything brings the bioeconomy to life. Hosts Karl Schmieder and Erum Azeez Khan share stories and interview the leaders and influencers changing the world by growing everything. Biology is the oldest technology. And it can be engineered. What are we growing?Learn more at ⁠⁠⁠www.messaginglab.com/groweverything⁠⁠⁠ Chapters: 00:00:00 – Introduction and Vision for a Better Future 00:00:17 – Unexpected Weather, Birthday Trips, and Giant Malls 00:01:41 – Climate Change, Extreme Weather, and the Reality of Rising Temperatures 00:03:07 – Space Travel, Microbes on Mars, and the Lettuce Dilemma 00:05:12 – Biotech Innovations, Soil Microbiomes, and Engineering Nature 00:07:06 – The Storytelling Gene: Why Scientists Must Be Great Communicators 00:09:02 – Sweet Proteins, Strategic Narratives, and Startup Success 00:10:39 – Young Innovators, Biochar, and Climate Tech Disruptors 00:13:12 – Welcoming Dr. Glennis Mehra: The Biotech Builder 00:15:04 – From Academia to Entrepreneurship: Glennis' Journey 00:17:31 – Imposter Syndrome in Biotech: Why Founders Struggle 00:19:55 – The Secret to Building a Strong Startup Community 00:22:18 – The Founder's Dilemma: Making Big Decisions Quickly 00:25:09 – Why Founder-to-Founder Collaboration is Biotech's Superpower 00:28:46 – Capital Scarcity and the Rise of Smarter Founders 00:32:53 – Building a Biotech in NYC: The Reality Check 00:33:42 – The Toughest Part: Capital, Talent, and Space 00:36:09 – Why NYC is a Risk-Taker's Playground 00:38:56 – The Future of Biotech and the AI Acceleration 00:44:29 – Honest Advice for Biotech Entrepreneurs 00:48:12 – BioLabs and the Startup Survival Toolkit 00:52:48 – Final Words and What Comes NextLinks and Resources: Biolabs@NYULangone NASA Science Payloads Researchers link a gene to the emergence of spoken language Oobli and Ingredion Announce Partnership as Demand for Sweet Proteins Accelerates Sweet Dreams Are Made of Proteins: Oobli's Ali Wing A 16-year-old (Harper Moss) helms this new regenerative farming startupTopics Covered: Biotech, Business, NYC, Innovation, Incubator, Accelerator, Startups, BiomanufacturingHave a question or comment? Message us here:Text or Call (804) 505-5553 ⁠⁠⁠Instagram⁠⁠⁠  / ⁠⁠⁠Twitter⁠⁠⁠ / ⁠⁠⁠LinkedIn⁠⁠⁠ / ⁠⁠⁠Youtube⁠⁠⁠ / ⁠⁠⁠Grow Everything⁠⁠⁠Email: groweverything@messaginglab.comMusic by: NihiloreProduction by: Amplafy Media

Dr. Wilfried Ellmeier is a Co-Chair of the Scientific Planning Committee at the International Union of Immunological Societies (IUIS) and Professor of Immunobiology and Head of the Institute of Immunology at the Medical University of Vienna. Dr. Laurence Zitvogel is a Keynote Speaker at IUIS 2025 and a Professor and Group Leader at Gustave Roussy. Dr. Dan Littman is also a Keynote Speaker at IUIS 2025 and Professor of Cell Biology and Helen L. and Martin S. Kimmel Professor of Molecular Immunology at NYU Langone. This episode features a discussion on  the upcoming IUIS 2025 Congress taking place August 17-22 in Vienna, Austria. They talk about what to expect at the meeting, highlights from this year's program, and where to explore in Vienna.

News outlets are reporting that NYU Langone is cancelling some appointments for gender-affirming care for transgender children -- and that other hospital systems have removed mentions of gender-affirming care from their websites after President Trump issued a related executive order. Caroline Lewis, health care reporter for WNYC/Gothamist, reports on how trans kids and their families are reacting and the New York attorney general's warning to hospital systems that not providing the care would run afoul of state laws.

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: David P. Hudesman, MD Patients with inflammatory bowel disease (IBD) can experience a variety of extraintestinal manifestations (EIMs), including joint and eye pain and skin rashes. Dr. Peter Buch sits down with Dr. David Hudesman to discuss the impacts of these EIMs and explore best practices for patient management. Dr. Hudesman is a Professor of Medicine at NYU Grossman School of Medicine and Co-Director of NYU Langone's Inflammatory Bowel Disease Center.

For centuries, death has been seen as a final, inescapable line—a moment when the heart stops and the brain ceases to function. But revolutionary research asks: What if everything we thought we knew about death was wrong?Sam Parnia, an associate professor of medicine at NYU Langone, is the author of Lucid Dying: The New Science Revolutionizing How We Understand Life and Death. His groundbreaking work explores how science is pushing the boundaries of life and death, uncovering the potential to resuscitate animals—and maybe one day humans—after they've been declared dead. From recalling experiences of consciousness after death (what some call “near-death experiences”) to using AI and advanced techniques to study the brain in its final moments, he explores the profound implications for medicine, ethics and our understanding of what it means to be alive.

Ep. 13 Teaching the Future of Spine: Research, Motion Preservation, & Improving Care, Jeffrey A. Goldstein, MD   In this episode of The Spine Pod, co-hosts Courtney Schutze and Brady Riesgraf sit down with Dr. Jeffrey A. Goldstein, a globally recognized expert in orthopedic spine surgery and Director of the Spine Surgery Fellowship and Education programs at NYU Langone. With over 30 years of clinical and research experience, Dr. Goldstein is a staunch advocate for conservative, patient-first treatment plans. His patient-centered philosophy focuses on functional outcomes and prioritizing long-term health of every patient he treats.   Dr. Goldstein also discusses his commitment to ongoing innovation, especially in the area of motion preservation. Dedicated to advancing the field, he takes on a dual role as a pioneer in new technologies and a teacher, training residents and fellows in the latest techniques to carry his patient-first legacy forward. He has been a key leader across multiple clinical studies, including being a trainer for both cervical and lumbar artificial discs in the commercialization of ProDisc, as well as being the national PI for 3Spine's MOTUS Lumbar Total Joint Replacement IDE study. In addition to motion preservation, Dr. Goldstein continues to drive patient-care forward through the use of supplementary emerging technologies, including minimally invasive surgery (MIS) and robotics.   In this episode, listeners will learn about: The history of how spine care has changed over the past 30 years The entire function spinal unit, and the role of the facets and the disc in the mobility and stability of the spine How motion preserving technologies are becoming mainstream options for treating leg and/or back pain in the correctly indicated patient The convergence of enabling technologies, and how MIS, robotics, and motion preserving implants are coming together to improve patient outcomes The importance of conservative care and exhausting non-operative treatment options prior to receiving spine surgery Where the future of spine care is headed and the newest technologies entering the spine market     Dr. Goldstein has been a leading surgeon across the spine industry for more than 20 years, being recognized as a top doctor in America by multiple institutions, including Castle Connolly, New York Magazine, Becker's, and Newsweek. Aside from being recognized by sources and peers, he has also been the past president of ISASS, one of the largest spine conferences in the world, and also holds the title of professor of both orthopedic and neurosurgery at the NYU Grossman School of Medicine. With his accolades in teaching, leadership, and innovation, Dr. Goldstein has had a remarkable impact across the spine community since his inception into medicine.   This episode explores how Dr. Goldstein's work has not only shaped his practice but also the broader field of spine surgery, primarily through his dedicated contributions to motion preservation and patient-centered innovations. Whether you're a provider, patient, or industry professional, this episode provides vast insights into the technologies improving patient outcomes and what's on the horizon for the future of spine surgery.   Learn more about Dr. Goldstein and NYU Langone Health: Website: https://www.spinesurgerydoctor.com/  LinkedIn: https://www.linkedin.com/in/jeffrey-a-goldstein-md-facs-faoa-917b5b7/     You can find The Spine Pod on all Podcast Streaming Platforms, including: YouTube: / @thespinepod Spotify: https://open.spotify.com/show/0DBzWfV... Apple Podcasts: https://podcasts.apple.com/us/podcast... Amazon Music: https://music.amazon.com/podcasts/98f... iHeart Radio: https://www.iheart.com/podcast/269-th...     Follow The Spine Pod on Facebook to learn more about the latest episodes and happenings in the world of motion preservation: https://www.facebook.com/profile.php?...    

In this highly requested episode, Dr. Geo sits down with Dr. Vikram Rajpurohit, a clinical professor at NYU Langone and an expert in Prostate Artery Embolization (PAE), to dive into the specifics of PAE as a treatment for Benign Prostatic Hyperplasia (BPH). Dr. Rajpurohit explains what PAE is, how it works, and who the ideal candidates are. The discussion covers the procedure's effectiveness in shrinking the prostate and improving urinary symptoms, along with details on expected outcomes, duration, and what patients should consider when choosing between PAE and other treatments.Key Points:Overview of PAE as a minimally invasive alternative to surgery for BPHThe science behind how PAE works and its impact on prostate and urinary healthInsights into patient outcomes, including prostate shrinkage and symptom improvementComparison of PAE with other common BPH treatmentsCandidacy factors for PAE and important questions for patients to askListen in to learn if PAE might be the right choice for you or a loved one facing prostate-related urinary issues.----------------

Can asparagus predict the future? Guest: Jemima Packington, The World's First and Only Asparamancer View From Victoria: What are the demands of the BC Greens? We get a local look at the top political stories with the help of Vancouver Sun columnist Vaughn Palmer Why isn't Parliament investigating Canada Soccer's drone scandal? Guest: Niki Ashton, MP for Churchill—Keewatinook Aski in Manitoba What is ‘pink cocaine'? Guest: Dr. Joseph Palamar, Associate Professor in the Department of Population Health at NYU Langone who Specializes in Party Drugs How did social media impact the provincial election? Guest: Aengus Bridgman, Director of the Media Ecosystem Observatory Is the Federal Liberal Party united or divided? Guest: Mackenzie Gray, Senior Correspondent for Global News National What are Indigo's best books of the year? Guest: Brandon Forsynth, Senior Category Manager of Print Experience at Indigo Learn more about your ad choices. Visit megaphone.fm/adchoices

What is ‘pink cocaine'? Guest: Dr. Joseph Palamar, Associate Professor in the Department of Population Health at NYU Langone who Specializes in Party Drugs Learn more about your ad choices. Visit megaphone.fm/adchoices

Send us a textResources for the Community:___________________________________________________________________https://linktr.ee/theplussidezpodcast Ro - Telehealth for GLP1 weight management https://ro.co/weight-loss/?utm_source=plussidez&utm_medium=partnership&utm_campaign=comms_yt&utm_content=45497&utm_term=55___________________________________________________________________The Provider Spotlight is a new bonus series of shorter episodes featuring doctors and specialists from past sessions—think of it as 'doctor shorts.' With over 25k scripts for Zepbound written weekly, many new subscribers haven't seen our earlier episodes, which helps them catch up quickly. Thanks for your support!On July 17th of 2023 Dr Alexandra set down with the Plus Sidez and discussed the affects of Metabolic Disorders & Mounjaro/GLP1 TreatmentsBIODr. Alexandra Sowa is the CEO and founder of SoWell Health, a consumer metabolic healthcare company. SoWell supports patients at every point of their health and weight loss journey through at-home laboratory testing kits, evidence-based nutraceuticals, and scalable telehealth access to medical weight management.  Dr. Sowa is dual-board-certified physician of internal and obesity medicine and clinical instructor of medicine at NYU Langone. Dr. Sowa has served as a health expert for national media outlets and print publications like SiriusXM, CBS News, NPR, the New York Times, U.S. News, World Report, and more.You them find us at  www.getsowell.com______________________________________________________________________⭐️Mounjaro Stanley⭐️griffintumblerco.Etsy.comUse code PODCAST10 for $ OFF______________________________________________________________________Join this channel to get access to perks:   / @theplussidez______________________________________________________________________#Mounjaro #MounjaroJourney #Ozempic #Semaglutide #tirzepatide  #GLP1 #Obesity #zepbound #wegovy  Support the showKim Carlos, Executive Producer TikTok https://www.tiktok.com/@dmfkim?is_from_webapp=1&sender_device=pc Instagram https://www.instagram.com/dmfkimonmounjaro?igsh=aDF6dnlmbHBoYmJn&utm_source=qr Kat Carter, Associate Producer TikTok https://www.tiktok.com/@katcarter7?is_from_webapp=1&sender_device=pc Instagram https://www.instagram.com/mrskatcarter?utm_source=ig_web_button_share_sheet&igsh=ZDNlZDc0MzIxNw==

SpaceX Crew Completes First Citizen SpacewalkBig news in the world of commercial space flight: On Thursday morning, Jared Iasaacman and Sarah Gillis, members of SpaceX's Polaris Dawn mission, became the first civilians to complete a spacewalk. The mission is a collaboration between Elon Musk's SpaceX and Isaacman, a billionaire tech entrepreneur. While outside the spacecraft, the two crew members conducted mobility tests on their spacesuits.SciFri Producer Kathleen Davis talks with Jason Dinh, climate editor at Atmos Magazine about this and other top science news of the week including deadly cholera outbreaks, germs at 10,000 ft, and Japanese eels that can escape a fish stomach through their gills.The First Successful Whole-Eye Transplant, Over A Year LaterIn May of 2023, there was a massive advance in the world of organ transplantation: the first whole human eye and partial face transplant. The man at the center of this procedure is 46-year-old Aaron James, who sustained significant facial injuries from a high-voltage work accident.At the time, it was unclear just how successful the operation would be. Previous tests in animals had resulted in shrinkage of the transplanted eye, if not outright rejection. But now, more than a year after the transplant, a new paper in the journal JAMA outlines the success of this first-of-its-kind operation. While James cannot see out of his new eye, there is blood flow, normal pressure, and a retinal response to light.Guest host Kathleen Davis speaks with Dr. Daniel Ceradini, director of research at NYU Langone's Department of Plastic Surgery and first author of the JAMA study. They discuss the implications this success could have for the future of eye surgery, and the dramatic improvements in James' quality of life.Transcripts for each segment will be available after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

Academic medicine providers are increasingly depending on their clinical practices to fund their education and research divisions. How do academic medical providers balance financial performance with clinician and community needs amidst competing missions that challenge their business models? In this episode of Value-Based Care Insights, Daniel Marino sits down with Dr. Joseph Bosco, Professor and Vice Chair of NYU Langone's Health Orthopedics, and Jeff Peters, a national expert in growth and service line strategies, to explore how academic medicine is addressing conflicting missions across their enterprise. Gain insight into growth models in academic medicine that prioritize clinician and geographic accessibility to keep patients in-network, while maintaining a strong focus on research, education, and quality care.

Episode 109 Academic medicine providers are increasingly depending on their clinical practices to fund their education and research divisions. How do academic medical providers balance financial performance with clinician and community needs amidst competing missions that challenge their business models? On this episode Dan sits down with Dr. Joseph Bosco, Professor and Vice Chair of NYU Langone's Health Orthopedics, and Jeff Peters, a national expert in growth and service line strategies, to explore how academic medicine is addressing conflicting missions across their enterprise. Gain insight into growth models in academic medicine that prioritize clinician and geographic accessibility to keep patients in-network, while maintaining a strong focus on research, education, and quality care. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

The Park Fire, which is one of the largest in California's history, has destroyed over 60 structures. Meanwhile in southern California, crews are struggling to control the Borel Fire, which has burned close to 50,000 acres.Michigan Gov. Gretchen Whitmer, who serves as the co-chair of Vice President Kamala Harris' campaign, talks about the search for a vice presidential nominee and where the campaign stands, after President Biden dropped his bid for reelection.July marks Fibroid Awareness Month and Dr. Tara Shirazian from NYU Langone's Center for Fibroid Care joined "CBS Mornings" to discuss the condition and alternative treatments.After captivating the world with her drumming skills, Nandi Bushell releases her first book, "The Life Changing Magic of Drumming," and joins "CBS Mornings" to discuss her incredible journey.In her second Olympics, Ilona Maher is teaming up with brands to show young women they can be both strong and feminine, breaking barriers in the world of rugby.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

A Day in the Life of a Pediatric Urologist with Dr. Jordan Gitlin, MDIn this insightful episode, Dr. Jordan Gitlin, Chief Pediatric Urologist at NYU Langone, Long Island, shares his journey and inspiration behind choosing pediatric urology. Dr. Gitlin details his typical day, combining surgery, clinic visits, and teaching. He discusses the challenges of transitioning to robotic surgery, the nuances of treating pediatric patients, and the importance of being available for colleagues and patients. Dr. Gitlin also touches on his mission trips to Guatemala and the impact of maintaining relationships with his patients into adulthood. This episode offers a comprehensive look at the responsibilities and rewards of pediatric urology.00:00 Introduction and Guest Welcome01:06 Journey to Pediatric Urology03:51 A Day in the Life of a Pediatric Urologist08:21 Robotic Surgery in Pediatric Urology12:11 Challenges and Skills in Modern Surgery19:04 Handling Common Pediatric Urology Issues26:06 Reflux and UTI Management in Pediatrics33:47 Kidney Health and Reflux Management34:40 Challenges with DMSA Agent Availability36:05 Debate on Circumcision40:26 Managing Voiding Issues in Children44:01 Complex Pediatric Urology Cases47:14 Transitioning Special Needs Patients to Adult Care49:54 Mission Trips and Global Health54:24 The Importance of Physician-Patient Relationships56:22 The Role of Technology in Modern Healthcare01:00:33 Final Thoughts and FarewellSupport the Show.

Welcome to this special episode of the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. For major FDA decisions in the field of neurology, we release short special episodes to offer a snapshot of the news, including the main takeaways for the clinical community, as well as highlights of the efficacy and safety profile of the agent in question. In this episode, we're covering the recent approval of donanemab as a new treatment for adults with early symptomatic Alzheimer disease (AD). Marketed as Kisunla, donanemab's approval marks the third antiamyloid therapy to get FDA greenlight for early-stage AD, following the controversial approval of aducanumab (Aduhelm; Biogen) in 2021 and lecanemab (Leqembi; Eisai) in 2023. Donanemab, administered as a 350 mg/20 mL once-monthly injection for intravenous infusion, had its approval supported by the phase 3 TRAILBLAZER-ALZ-2 trial (NCT04437511), a large-scale, double-blind, placebo-controlled trial that featured 1736 patients with early-stage AD. Following the approval, NeurologyLive sat down with Joel Salinas, MD, MBA, a behavioral neurologist at NYU Langone and clinical assistant professor in the department of neurology at the NYU Grossman School of Medicine. Salinas, who also serves as the chief medical officer at Isaac Health, discussed the positive impacts of the approval, the importance of patient selection for the medication, and how clinicians should discuss its benefits and harms to patients. In addition, he commented on how approvals like donanemab continue to carry momentum in the AD field going forward.  For more of NeurologyLive's coverage of donanemab's approval, head here: FDA Approves Eli Lilly's Donanemab for Early Symptomatic Alzheimer Disease Episode Breakdown: 2:10 – Positive downstream impacts of donanemab's approval 4:20 – Considerations and caution with prescribing donanemab 6:05 – Salinas on patient-clinician conversations about AD treatments 8:00 – Closing remarks and continued progress in AD field Thanks for listening to the NeurologyLive Mind Moments podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

Nicole Lund is a registered dietitian at NYU Langone's Sports Performance Center. A certified health and well-being coach and certified personal trainer, as a former dancer her love of movement led her into a career as a step aerobics instructor and personal trainer. Through her work, she recognized a need for a discussion about food and its impact on everything from performance to health. She sees medical nutrition therapy patients via insurance and self-pay sports. She is a clinician with the Running Lab and works with athletes on the USA Nordic team. Her expertise is in sports and performance nutrition while her clinical interests include chronic inflammation, weight loss, migraines, and menopause. She has a master's degree in public health nutrition from Hunter College. Part 2 The discussion covered the following topics: complementary and alternative therapies; accuracy of patients' nutrition knowledge; influence of demographic factors on the adequacy of nutritional status; provision of nutritional health care care via telehealth; prevention of health problems related to participating in vigorous physical activities; and how improved dietary practices may help to prevent health problems.    

Nicole Lund is a registered dietitian at NYU Langone's Sports Performance Center. A certified health and well-being coach and certified personal trainer, as a former dancer her love of movement led her into a career as a step aerobics instructor and personal trainer. Through her work, she recognized a need for a discussion about food and its impact on everything from performance to health. She sees medical nutrition therapy patients via insurance and self-pay sports. She is a clinician with the Running Lab and works with athletes on the USA Nordic team. Her expertise is in sports and performance nutrition while her clinical interests include chronic inflammation, weight loss, migraines, and menopause. She has a master's degree in public health nutrition from Hunter College. Part 1 The discussion covered the following topics: how and when she began to develop an interest in performance nutrition; types of patients she treats; the role that diet plays in improving problems involving overweight and obesity; and use of dietary supplements by patients.   

Doctors Vamsi Velcheti, Sandip Patel, and Michael Zervos discuss recent updates on the management of early-stage non-small cell lung cancer (NSCLC), including the optimization of neoadjuvant and adjuvant treatment options for patients and the role of surgery in the era of targeted therapy and immuno-oncology in lung cancer. TRANSCRIPT Dr. Vamsi Velcheti: Hello, I'm Dr. Vamsi Velcheti, your guest host for the ASCO Daily News Podcast today. I am a professor of medicine and director of thoracic medical oncology at the Perlmutter Cancer Center at NYU Langone Health. On today's episode, we'll be discussing recent updates on the management of early-stage non-small cell lung cancer (NSCLC), including the optimization of neoadjuvant and adjuvant treatment options for our patients, and the evolving role of surgery in the era of targeted therapy and immuno-oncology in lung cancer.  Today, I am delighted to be joined by two renowned experts in this space, Dr. Sandip Patel and Dr. Michael Zervos. Dr. Patel is a professor of medicine and a medical oncologist specializing in lung cancer at UCSD. Dr. Mike Zervos is the clinical chief of the Division of Robotic Thoracic Surgery and Director of General Thoracic Surgery at NYU Langone. Our full disclosures are available in the transcript of this episode, and disclosures relating to all episodes of the podcast are available at asco.org/DNpod. Dr. Patel and Dr. Zervos, it's a great honor to have you on the podcast today. Welcome aboard. Dr. Sandip Patel: Great to be joining you.  Dr. Vamsi Velcheti:  Let's get started with Dr. Patel. As you know, over the last decade we've had dramatic advances in systemic therapy options for patients with metastatic non-small cell lung cancer, in both the realms of targeted therapy and immunotherapy. These have significantly improved outcomes for our patients with metastatic lung cancer. What's exciting is that more recently, we've seen the incorporation of these agents, both targeted therapies and immunotherapies, in early-stage non-small cell lung cancer. Dr. Patel, can you tell our listeners about these exciting recent advances and why do you think it's so important to incorporate these personalized systemic therapy options for our early-stage patients? Dr. Sandip Patel: I think it's a great point and a great question. And so, I think one thing to understand is that non-small cell lung cancer is actually multiple diseases. We give it one name based on how it looks under the microscope, but the vast majority of our advances to improve outcomes for patients have come from our ability to understand specific subgroups.  Many of our therapies have had activity in the advanced setting. We have our patients with metastatic or more widespread disease, which naturally led to the thought that could we utilize these therapies in earlier stage disease and potentially increase the rate of cure for many of our patients, lung cancer being the most common cancer killer worldwide. And so to your point, trying to understand how to best treat a patient really involves personalized medicine, typically driven by understanding the genomic profile of their tumor and two of the genes that have graduated from being tested for in the metastatic setting and now in the localized setting are EGFR and ALK. And these in particular are mutations that confer sensitivity to small molecule inhibitors, EGFR with osimertinib, ALK in the localized setting with alectinib based on the data that we've seen.  And so, one of the areas that's been particularly exciting is our ability to maximize a patient's chance for durable remissions by integrating these therapies after surgery, after chemotherapy when appropriate, and continuing generally for a finite amount of time, two to three years depending on the agent in the study we're discussing for these patients. Additionally, immunotherapy, which has revolutionized our treatment of patients with metastatic disease, may be particularly well-suited for the localized setting of non-small cell lung cancer as well. Dr. Vamsi Velcheti: Excellent points, Sandip. You're absolutely right, in the metastatic setting, we've all come to accept molecular testing, sequencing, and biomarker profiling as a standard, but unfortunately, that hasn't quite yet percolated into the early-stage setting. Can you talk about some of the challenges that we face as we have these therapeutic options available now for more early-stage patients? Dr. Sandip Patel: So, I think there are 3 flavors of localized therapy in non-small cell lung cancer. One is the advanced, unresectable stage 3, for which the approach is often concurrent chemo-radiation followed by some form of consolidated therapy. We're about to hear the results of LAURA, which is the study looking at EGFR-mutated non-small cell lung cancer.  For other patients, historically, the treatment has been durvalumab, an anti-PD-L1 directed immunotherapy. The other two are operative treatment of localized cancer: adjuvant treatment after surgery, or neoadjuvant or perioperative, in which chemoimmunotherapy begins before surgery. And testing depends on the settings. For the stage 3 patient who's likely getting concurrent chemo-radiation, they may have a very small amount of tissue, and so often these are done by pulmonary EBUS biopsies and that's how we pathologically confirm that advanced stage 3B. There may not be a lot of tissue available for molecular testing. In fact, if you look at the PACIFIC analysis, just looking at PD-L1, which is just an IHC off a single slide, a third of patients weren't able to even get a PD-L1, let alone a genomic result. And so, I think that's one of the areas of LAURA that's going to be particularly interesting to see as we try to implement it into our practice after seeing the full data.  I think in the adjuvant setting, we're lucky because our surgeons, Dr. Mike Zervos here, will get us a large amount of tissue in the surgical resection specimen, so we tend to get enough tissue to do genomics while they're under chemotherapy, there tends to be time to wait for their genomic result. Where this really gets complicated is in the neoadjuvant or perioperative setting, where time is everything.  The most important thing we can do for a patient in the localized space is get them to the operating room, get them started on radiation, their curative local modality, and that's where we have a time pressure but also a sample pressure because that is a diagnostic biopsy. It's a very small piece of tissue. Initially, there are multiple stains that have to be done to identify this lung cancer as opposed to another tumor. And so that's an area that I think we're going to need additional approaches given that cell-free DNA tends to have lower yield in lower stage disease in giving us a result. Dr. Vamsi Velcheti: Great points, Sandip. How do you deal with this issue in San Diego? The challenge is now we have a lot of trials, we'll talk about those neoadjuvant immunotherapy trials, but we know that immunotherapy may not be as effective in all patients, especially those with EGFR or ALK or some of these non-smoker, oncogene-driven tumors. So, we don't want to be giving patients treatments that may not necessarily be effective in the neoadjuvant space, especially when there is a time crunch, and we want to get them to surgery and all the complications that come with giving them targeted therapy post-IO with potential risk for adverse events. Dr. Sandip Patel: Absolutely. It is a great point. And so, the multidisciplinary team approach is key, and having a close relationship with the interventional pulmonary oncs, interventional radiology surgery, and radiation oncology to ensure that we get the best treatment for our patients. With the molecularly guided therapies, they are currently more on the adjuvant setting in terms of actually treating. But as you mentioned, when we're making a decision around neoadjuvant or perioperative chemo IO, it's actually the absence of EGFR now that we're looking for because our intervention at the current time is to give chemoimmunotherapy. Going back to the future, we used to use single gene EGFR within 24 hours, which was insufficient for a metastatic panel, but it often required five slides of tissue input. ALK can be done by IHC, and so some of these ‘oldie but goodie' pathologic techniques, and that pathologists, if I haven't emphasized, understanding what we're trying to do at a different context is so key because they are the ones who really hold the result. In the neoadjuvant and perioperative setting, which many of us favor, especially for stage 3A and stage 2B disease, understanding how we can get that result so that we can get the patient to the operating room in an expeditious way is so important. There is a time pressure that we always had in the metastatic setting, but I think we feel much more acutely in the neoadjuvant and perioperative setting in my opinion. Dr. Vamsi Velcheti: Fascinating insights, Dr. Patel.  Turning to Dr. Zervos, from a surgical perspective, there has been an evolution in terms of minimally invasive techniques, robotic approaches, and enhanced recovery protocols, significantly improving outcomes in our patients post-surgery. How do you see the role of surgery evolving, especially with the increasing complexity and efficacy of these systemic therapies? How do you envision the role of surgery in managing these early-stage patients, and what are the key considerations for surgeons in this new era? Dr. Michael Zervos: Thanks, Vamsi. Thanks, Sandip. Thank you for having me on the podcast. Obviously, it's an honor to be a part of such a high-level discussion. I have to say, from a surgeon's perspective, we often listen to you guys talk and realize that there's been a lot of change in this landscape. And I think the thing that I've seen is that the paradigm here has also changed. If we were having this discussion 10 years ago, a lot of the patients that I am operating on now, I would not be operating on. It really has been amazing. And I think the thing that stands out to me the most is how all of this has changed with neoadjuvant chemotherapy checkpoint inhibition. I think, for us as surgeons, that's really been the key. Whether it's CheckMate 816 or whatever you're following, like PACIFIC, the data supports this. And I think what we're seeing is that we're able to do the surgery, we're able to do it safely, and I think that the resectability rates are definitely high up there in the 90% range. And what we're seeing is pretty significant pathologic responses, which I think is really amazing to me.  We're also seeing that this has now shifted over to the oligometastatic realm, and a lot of those patients are also being treated similarly and then getting surgery, which is something that we would not have even thought of ever. When you look at the trials, I think a lot of the surgery, up to this point, has been done more traditionally. There's a specific reason why that happens, specifically, more through thoracotomy, less with VATS, and less with robotic. Sandip, I think you guys have a pretty robust robotic program at UCSD, so I'm sure you're pretty used to seeing that.   As you guys have become so much more sophisticated with the treatments, we have also had to modify what we do operatively to be able to step up to the plate and accept that challenge. But what we are seeing is yes, these treatments work, but the surgeries are slightly more complicated. And when I say slightly, I'm minimizing that a little bit.  And what's complicated about it is that the treatment effect is that the chemo-immune check inhibition actually has a significant response to the tumor antigen, which is the tumor. So it's going to necrose it, it's going to fibrose it, and wherever there is a tumor, that response on the surgical baseline level is going to be significant. In other words, there are going to be lymph nodes that are stuck to the pulmonary artery, lymph nodes that are stuck to the airway, and we've had to modify our approaches to be able to address that.   Now, fortunately, we've been able to innovate and use the existing technology to our advantage. Personally, I think robotics is the way we have progressed with all this, and we are doing these surgeries robotically, mainly because I think it is allowing us, not only to visualize things better, but to have sort of a better understanding of what we're looking at. And for that matter, we are able to do a better lymph node dissection, which is usually the key with a lot of these more complicated surgeries, and then really venturing out into more complicated things, like controlling the pulmonary artery. How do we address all this without having significant complications or injuries during the surgery? Getting these patients through after they've successfully completed their neoadjuvant treatment, getting them to surgery, doing the surgery successfully, and hopefully, with minimal to no morbidity, because at the end, they may be going on to further adjuvant treatment. All of these things I think are super important. I think although it has changed the landscape of how we think of things, it has made it slightly more complicated, but we are up for the challenge. I am definitely excited about all of this. Dr. Vamsi Velcheti: For some reason, like medical oncologists, we only get fixated on the drugs and how much better we're doing, but we don't really talk much about the advances in surgery and the advances in terms of outcomes, like post-op mortality has gone down significantly, especially in larger tertiary care centers. So, our way of thinking, traditionally, the whole intergroup trials, the whole paradigm of pneumonectomies being bad and bad outcomes overall, I think we can't judge and decide on current treatment standards based on surgical standards from decades ago. And I think that's really important to recognize.  Dr. Michael Zervos: All of this stuff has really changed over the past 10 years, and I think technology has helped us evolve over time. And as the science has evolved for you with the clinical trials, the technology has evolved for us to be able to compensate for that and to be able to deal with that. The data is real for this. Personally, what I'm seeing is that the data is better for this than it was for the old intergroup trials. We're able to do the surgery in a better, more efficient, and safer way. The majority of these surgeries for this are not going to be pneumonectomies, they are going to be mostly lobectomies. I think that makes sense. I think for the surgeons who might be listening, it doesn't really matter how you're actually doing these operations. I think if you don't have a very extensive minimally invasive or robotic experience, doing the surgery as open is fine, as long as you're doing the surgery safely and doing it to the standard that you might expect with complete lymph node clearance, mediastinal lymph node clearance, and intrapulmonary lymph node clearance. Really, I think that's where we have to sort of drive home the point, really less about the actual approach, even though our bias is to do it robotically because we feel it's less morbidity for the patient. The patients will recover faster from the treatment and then be able to go on to the next phase treatments. Dr. Vamsi Velcheti: In some of the pre-operative trials, the neoadjuvant trials, there have been some concerns raised about 20% of patients not being able to make it to surgery after induction chemo immunotherapy. Can you comment on that, and why do you think that is the case, Sandip?  Dr. Sandip Patel: Well, I think there are multiple reasons. If you look, about half due to progression of disease, which they might not have been great operative candidates to begin with, because they would have early progression afterwards. And some small minority in a given study, maybe 1% to 2%, it's an immune-related adverse event that's severe. So, it's something that we definitely need to think about. The flip side of that coin, only about 2 in 3 patients get adjuvant therapy, whether it be chemotherapy, immunotherapy, or targeted therapy. And so, our goal is to deliver a full multimodal package, where, of course, the local therapy is hugely important, but also many of these other molecular or immunologically guided agents have a substantial impact.  And I do think the point around neoadjuvant and perioperative is well taken. I think this is a discussion we have to have with our patients. I think, in particular, when you look at higher stage disease, like stage 3A, for example, the risk-benefit calculus of giving therapy upfront given the really phenomenal outcomes we have seen, really frankly starting with the NADIM study, CheckMate816, now moving on into studies like KEYNOTE-671, AEGEAN, it really opens your eyes in stage 3. Now, for someone who's stage 1/1b, is this a patient who's eager to get a tumor out? Is there as much of an impact when we give neoadjuvant therapy, especially if they're not going to respond and may progress from stage 1 and beyond? I think that's a reasonable concern. How to handle stage II is very heterogeneous. I think two points that kind of happen as you give neoadjuvant therapy, especially chemo-IO that I think is worth for folks to understand and this goes to Mike's earlier point, that is this concept if they do get a scan during your neoadjuvant chemo immunotherapy, there is a chance of that nodal flare, where the lymph nodes actually look worse and look like their disease is progressing. Their primary tumor may be smaller or maybe the same. But when we actually go to the OR, those lymph nodes are chock-full of immune cells. There's actually no cancer in those lymph nodes. And so that's a bit of a red herring to watch out for.   And so, I think as we're learning together how to deliver these therapies, because the curative-intent modality is, in my opinion, a local modality. It's what Mike does in the OR, my colleagues here do in the OR. My goal is to maximize the chance of that or really maximize the long-term cure rates. And we know, even as long as the surgery can go, if only 2 or 3 patients are going to get adjuvant therapy then 1 in 10, of which half of those or 1 in 20, are not getting the surgery and that's, of course, a big problem. It's a concern. I think better selecting towards those patients and thinking about how to make these choices is going to be hugely important as we go over. Because in a clinical trial, it's a very selective population. A real-world use of these treatments is different. I think one cautionary tale is that we don't have an approval for the use of neoadjuvant or perioperative therapy for conversion therapy, meaning, someone who's “borderline resectable.” At the time at which you meet the patient, they will be resectable at that moment. That's where our best evidence is, at the current time, for neoadjuvant or perioperative approaches.  Dr. Vamsi Velcheti:   I think the other major issue is like the optimal sequencing of immune checkpoint here. Obviously, at this point, we have multiple different trial readouts, and there are some options that patients can have just neoadjuvant without any adjuvant. Still, we have to figure out how to de-escalate post-surgery immunotherapy interventions. And I think there's a lot of work that needs to be done, and you're certainly involved in some of those exciting clinical trials. What do you do right now in your current clinical practice when you have patients who have a complete pathologic response to neoadjuvant immunotherapy? What is the discussion you have with your patients at that point? Do they need more immunotherapy, or are you ready to de-escalate?  Dr. Sandip Patel: I think MRD-based technologies, cell-free DNA technologies will hopefully help us guide this. Right now, we are flying blind along two axes. One is we don't actually know the contribution of the post-operative component for patients who get preoperative chemo-IO. And so this is actually going to be an ongoing discussion. And for a patient with a pCR, we know the outcomes are really quite good based on CheckMate816, which is a pure neoadjuvant or front-end only approach. Where I actually struggle is where patients who maybe have 50% tumor killing. If a patient has only 10% tumor killing ... the analogy I think in clinic is a traffic light, so the green light if you got a pCR, a yellow light if you have that anywhere from 20%-70% residual viable tumor, and then anything greater than that, you didn't get that much with chemo-IO and you're wondering if getting more chemo-IO, what would that actually do? It's a bit of a red light. And I'm curious, we don't have any data, but my guess would be the benefit of the post-op IO is because patients are in that kind of yellow light zone. So maybe a couple more cycles, we'll get them an even more durable response. But I am curious if we're going to start relying more on MRD-based technologies to define treatment duration. But I think it's a very complicated problem. I think folks want to balance toxicity, both medical and financial, with delivering a curative-intent therapy. And I am curious if this maybe, as we're looking at some of the data, some of the reasons around preferring a perioperative approach where you scale it back, as opposed to a neoadjuvant-only approach where there's not a clean way to add on therapy, if you think that makes sense. But it's probably the most complicated discussions we have in clinic and the discussion around a non-pCR. And frankly, even the tumor board discussions around localized non-small cell lung cancer have gone very complex, for the benefit of our patients, though we just don't have clean data to say this is the right path.   Dr. Vamsi Velcheti: I think that the need for a really true multidisciplinary approach and discussing these patients in the tumor board has never been more significant. Large academic centers, we have the luxury of having all the expertise on hand. How do we scale this approach to the broader community is a big challenge, I think, especially in early-stage patients. Of course, not everyone can travel to Dr. Zervos or you for care at a large tertiary cancer centers. So, I think there needs to be a lot of effort in terms of trying to educate community surgeons, community oncologists on managing these patients. I think it's going to be a challenge. Dr. Michael Zervos: If I could just add one thing here, and I completely agree with everything that has been said. I think the challenge is knowing beforehand. Could you predict which patients are going to have a complete response? And for that matter, say, “Okay. Well, this one has a complete response. Do we necessarily need to operate on this patient?” And that's really the big question that I add. I personally have seen some complete response, but what I'm mostly seeing is major pathologic response, not necessarily CR, but we are seeing more and more CR, I do have to say. The question is how are you going to predict that? Is looking for minimal residual disease after treatment going to be the way to do that? If you guys could speak to that, I think that is just tremendously interesting.  Dr. Vamsi Velcheti: I think as Sandip said, MRD is looking very promising, but I just want to caution that it's not ready for primetime clinical decision making yet. I am really excited about the MRD approach of selecting patients for de-escalation or escalation and surgery or no surgery. I think this is probably not quite there yet in terms of surgery or no surgery decision. Especially for patients who have early-stage cancer, we talk about curative-intent treatment here and surgery is a curative treatment, and not going to surgery is going to be a heavy lift. And I don't think we're anywhere close to that. Yet, I'm glad that we are having those discussions, but I think it may be too hard at this point based on the available technologies to kind of predict CR. We're not there.  Dr. Michael Zervos: Can I ask you guys what your thought process is for evaluating the patient? So, when you're actually thinking about, “Hey, this patient actually had a good response. I'm going to ask the surgeons to come and take a look at this.” What imaging studies are you actually using? Are you just using strictly CT or are you looking for the PET? Should we also be thinking about restaging a lot of these patients? Because obviously, one of the things that I hate as a surgeon is getting into the operating room only to find out that I have multiple nodal stations that are positive. Which really, in my opinion, that's sort of a red flag. And for me, if I have that, I'm thinking more along the lines of not completing that surgery because I'm concerned about not being able to provide an R0 resection or even having surgical staple lines within proximity of cancer, which is not going to be good. It's going to be fraught with complications.  So, a lot of the things that we as surgeons struggle with have to do with this. Personally, I like to evaluate the patients with an IV intravenous CT scan to get a better idea of the nodal involvement, proximity to major blood vessels, and potentially even a PET scan. And though I think in this day and age, a lot of the patients will get the PET beforehand, not necessarily get it approved afterwards. So that's a challenge. And then the one thing I do have to say that I definitely have found helpful is, if there's any question, doing the restaging or the re-EBUS at that point to be particularly helpful.  Dr. Sandip Patel: Yeah, I would concur that having that pathologic nodal assessment is probably one of the most important things we can do for our patients. For a patient with multinodal positive disease, the honest truth is that at our tumor board, that patient is probably going to get definitive chemoradiation followed by their immunotherapy, or potentially soon, if they have an EGFR mutation, osimertinib. For those patients who are clean in the mediastinum and then potentially have nodal flare, oftentimes what our surgeons will do as the first stage of the operation, they'll actually have the EBUS repeated during that same anesthesia session and then go straight into surgery. And so far the vast majority of those patients have proceeded to go to surgery because all we found are immune cells in those lymph nodes.  So, I think it's a great point that it's really the pathologic staging that's driving this and having a close relationship with our pathologists is key. But I think one point that I think we all could agree on is the way that we're going to find more of these patients to help and cure with these therapies is through improved utilization of low-dose CT screening in the appropriate population in primary care. And so, getting buy-in from our primary care doctors so that they can do the appropriate low-dose CT screening along with smoking cessation, and find these patients so that we can offer them these therapies, I think is something that we really, as a community, need to advocate on. Because a lot of what we do with next-generation therapies, at least on the medical oncology side, is kind of preaching to the choir. But getting the buy-in so we can find more of these cases at stage 1, 2 or 3, as opposed to stage 4, I think, is one of the ways we can really make a positive impact for patients. Dr. Vamsi Velcheti: I just want to go back to Mike's point about the nodal, especially for those with nodal multistation disease. In my opinion, those anatomic unresectability is a moving target, especially with evolving, improving systemic therapy options. The utilization for chemo radiation has actually gone down. I think that's a different clinical subgroup that we need to kind of think differently in terms of how we do the next iteration or generation of clinical trials, are they really benefiting from chemo-IO induction? And maybe we can get a subset of those patients in surgery. I personally think surgery is probably a more optimal, higher yield to potentially cure these patients versus chemo radiation. But I think how we identify those patients is a big challenge. And maybe we should do a sequential approach induction chemo-IO with the intent to kind of restage them for surgery. And if they don't, they go to chemo consolidation radiation, I guess. So, I think we need to rethink our approach to those anatomically unresectable stage 3s. But I think it's fascinating that we're having these discussions. You know, we've come to accept chemo radiation as a gold standard, but now we're kind of challenging those assumptions, and I think that means we're really doing well in terms of systemic therapy options for our patients to drive increased cures for these patients. Dr. Michael Zervos: I think from my perspective as a surgeon, if I'm looking at a CT scan and trying to evaluate whether a patient is resectable or not, one of the things that I'm looking for is the extent of the tumor, proximity to mediastinal invasion, lymph nodes size. But if that particular patient is resectable upfront, then usually, that patient that receives induction chemo checkpoint inhibition is going to be resectable afterwards. The ones that are harder are the ones that are borderline resectable upfront or not resectable. And then you're trying to figure out on the back end whether you can actually do the surgery.  Fortunately, we're not really taking many patients to the operating room under those circumstances to find that they're not resectable. Having said that, I did have one of those cases recently where I got in there and there were multiple lymph node stations that were positive. And I have to say that the CT really underestimated the extent of disease that I saw in the operating room. So, there are some challenges surrounding all of these things. Dr. Sandip Patel: Absolutely. And I think for those patients, if upfront identification by EBUS showed multi nodal involvement, we've had excellent outcomes by working with radiation oncologists using modern radiotherapy techniques, with concurrent chemo radiation, followed by their immunotherapy, more targeted therapy, at least it looks like soon. I think finding the right path for the patient is so key, and I think getting that mediastinal pathologic assessment, as opposed to just guessing based on what the PET CT looks like, is so important. If you look at some of the series, 8% to 10% of patients will get a false-positive PET on their mediastinal lymph nodes due to coccidioidomycosis or sarcoidosis or various other things. And the flip side is there's a false-negative rate as well. I think Mike summarized that as well, so I think imaging is helpful, but for me, imaging is really just pointing the target at where we need to get pathologic sampling, most commonly by EBUS. And getting our interventional pulmonary colleagues to help us do that, I think is so important because we have really nice therapeutic options, whether it's curative-intent surgery, curative-intent chemo radiation, where we as medical oncologists can really contribute to that curative-intent local therapy, in my opinion.  Dr. Vamsi Velcheti: Thank you so much Sandip and Mike, it's been an amazing and insightful discussion, with a really dynamic interplay between systemic therapy and surgical innovations. These are really exciting times for our patients and for us. Thank you so much for sharing your expertise and insights with us today on the ASCO Daily News Podcast.   I want to also thank our listeners today for your time. If you value the insights that you hear today, please take a moment to rate, review, and subscribe to the podcast wherever you get your podcasts. Thank you so much. [FH1]   Dr. Sandip Patel: Thank you. Dr. Michael Zervos: Thank you.   Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Follow today's speakers: Dr. Vamsidhar Velcheti @VamsiVelcheti Dr. Sandip Patel @PatelOncology Dr. Michael Zervos   Follow ASCO on social media: @ASCO on X (formerly Twitter) ASCO on Facebook ASCO on LinkedIn   Disclosures:  Dr. Vamsidhar Velcheti: Honoraria: ITeos Therapeutics Consulting or Advisory Role: Bristol-Myers Squibb, Merck, Foundation Medicine, AstraZeneca/MedImmune, Novartis, Lilly, EMD Serono, GSK, Amgen, Elevation Oncology, Taiho Oncology, Merus Research Funding (Inst.): Genentech, Trovagene, Eisai, OncoPlex Diagnostics, Alkermes, NantOmics, Genoptix, Altor BioScience, Merck, Bristol-Myers Squibb, Atreca, Heat Biologics, Leap Therapeutics, RSIP Vision, GlaxoSmithKline   Dr. Sandip Patel: Consulting or Advisory Role: Lilly, Novartis, Bristol-Myers Squibb, AstraZeneca/MedImmune, Nektar, Compugen, Illumina, Amgen, Certis, Eli Lilly, Roche/Genentech, Merck, Pfizer, Tempus, Iovance Biotherapeutics. Speakers' Bureau: Merck, Boehringer Ingelheim Research Funding (Inst.):Rubius, Bristol-Myers Squibb, Pfizer, Roche/Genentech, Amgen AstraZenece/MedImmune, Fate, Merck, Iovance, Takeda   Dr. Michael Zervos: No relationships to disclose

For the final episode of Season 2, we're joined by Dr. Samuele Cortese, Professor of Child and Adolescent Psychiatry at the University of Southampton (UK) and Adjunct Full Professor at NYU Langone. Together we explore the intersection of pediatric ADHD and precision psychiatry, including the disorder's genetic underpinnings and evolving treatment options.00:00 Introduction00:54 Dr. Cortese's Research Journey02:11 Global Perspectives and Challenges in ADHD Treatment03:51 Advances in ADHD Diagnosis and Treatment06:41 Role of Genetics in ADHD09:33 Precision Treatment and Stratification12:17 Treatment Adherence and Shared Decision-Making23:55 Connection Between ADHD and Obesity28:39 Non-Stimulant Alternatives and Future Directions in ADHD Treatment32:16 Non-Pharmacological Treatments37:28 Advice for Clinicians and Closing ThoughtsVisit our website for more insights on psychiatry.Podcast producer: Jon Earle

How great to connect with another Sarno OG! Karen, like me, sat across from Dr. Sarno in his iconic office at The Rusk Center for Rehabilitation at NYU/Langone in New York City back in the day when he was still in practice. His confident and unapologetic style was the inspiration for everything I do and teach, and Karen is right there with me. I have been hearing from Karen for years, as although Sarno was her intro to this work, she credits my contributions for taking her to the next level of wellness. Today we talk about her inspiring story, as well as dive into a bit of a Real Time Heal around her persistent symptoms of allergies and nasal congestion. Over the years (and in several interviews here on the pod) I've heard many people recount having terrible allergies only to connect them to TMS and have them resolve completely! It's such good stuff. Enjoy this powerful conversation! XO n. REMEMBER - QUALIFY TO WIN A FREE 1:1 SESSION WITH ME WHEN YOU SIGN UP FOR OMEGA BETWEEN NOW AND 5/1! COME TO OMEGA June 23-28th!!! Click here. Producer: Lisa Eisenpresser If you would like to be part of our Membership Community it's easy to do - just go to my website www.thecureforchronicpain.com and scroll down a bit. You'll see the button to join. PURCHASE LIVE FROM OMEGA (7 HOURS OF ORIGINAL TALKS!) PURCHASE MIGRAINE DEEP DIVE RECORDING! Sign up for my Membership Community on my Website (3 hour ZOOM with me once a month and separate monthly Q&A Hang with me alongside private online community where I answer your personal questions): https://www.thecureforchronicpain.com/ (Scroll down on home page to see the link.) Get 50% off the Curable App: www.getcurable.com/nicole Leave us a message on SpeakPipe! www.speakpipe.com/NicoleSachs New podcast music by the beautiful and talented Danielle Furst. Find her here: Insta - @musicfurst and all her amazing music credits here - https://www.imdb.com/name/nm3895994/ Past virtual retreats recordings available for sale now on my website: https://www.thecureforchronicpain.com/buy-retreat-recordings FREEDOM FROM CHRONIC PAIN course: https://www.thecureforchronicpain.com/course FREEDOM FROM AN ANXIOUS LIFE course: Click here for all the details and to purchase! PLEASE RATE AND REVIEW THE PODCAST HERE TO HELP OTHERS FIND IT! If you are interested in supporting the many free resources I offer to get this message to the global community, please consider donating to my cause on my website, www.thecureforchronicpain.com. Look for the DONATE button on the home page. Thank you so much! ALL MY RESOURCES: Instagram: Follow me on insta @nicolesachslcsw for tons of new content Website: The Cure for Chronic Pain YouTube: The Cure for Chronic Pain with Nicole Sachs, LCSW Book: The Meaning of Truth Online Course: FREEDOM FROM CHRONIC PAIN FB Closed Group:JournalSpeak with Nicole Sachs, LCSW OMEGA General info: OMEGA INSTITUTE Subscribe Apple Podcasts Deezer iHeart RadioPublic RSS Spotify

How great to connect with another Sarno OG! Karen, like me, sat across from Dr. Sarno in his iconic office at The Rusk Center for Rehabilitation at NYU/Langone in New York City back in the day when he was still in practice. His confident and unapologetic style was the inspiration for everything I do and teach, and Karen is right there with me. I have been hearing from Karen for years, as although Sarno was her intro to this work, she credits my contributions for taking her to the next level of wellness. Today we talk about her inspiring story, as well as dive into a bit of a Real Time Heal around her persistent symptoms of allergies and nasal congestion. Over the years (and in several interviews here on the pod) I've heard many people recount having terrible allergies only to connect them to TMS and have them resolve completely! It's such good stuff. Enjoy this powerful conversation! XO n. REMEMBER - QUALIFY TO WIN A FREE 1:1 SESSION WITH ME WHEN YOU SIGN UP FOR OMEGA BETWEEN NOW AND 5/1! COME TO OMEGA June 23-28th!!! Click here. Producer: Lisa Eisenpresser If you would like to be part of our Membership Community it's easy to do - just go to my website www.thecureforchronicpain.com and scroll down a bit. You'll see the button to join. PURCHASE LIVE FROM OMEGA (7 HOURS OF ORIGINAL TALKS!) PURCHASE MIGRAINE DEEP DIVE RECORDING! Sign up for my Membership Community on my Website (3 hour ZOOM with me once a month and separate monthly Q&A Hang with me alongside private online community where I answer your personal questions): https://www.thecureforchronicpain.com/ (Scroll down on home page to see the link.) Get 50% off the Curable App: www.getcurable.com/nicole Leave us a message on SpeakPipe! www.speakpipe.com/NicoleSachs New podcast music by the beautiful and talented Danielle Furst. Find her here: Insta - @musicfurst and all her amazing music credits here -  https://www.imdb.com/name/nm3895994/ Past virtual retreats recordings available for sale now on my website: https://www.thecureforchronicpain.com/buy-retreat-recordings FREEDOM FROM CHRONIC PAIN course: https://www.thecureforchronicpain.com/course FREEDOM FROM AN ANXIOUS LIFE course: Click here for all the details and to purchase! PLEASE RATE AND REVIEW THE PODCAST HERE TO HELP OTHERS FIND IT! If you are interested in supporting the many free resources I offer to get this message to the global community, please consider donating to my cause on my website, www.thecureforchronicpain.com. Look for the DONATE button on the home page. Thank you so much! ALL MY RESOURCES: Instagram: Follow me on insta @nicolesachslcsw for tons of new content Website: The Cure for Chronic Pain YouTube: The Cure for Chronic Pain with Nicole Sachs, LCSW Book: The Meaning of Truth Online Course: FREEDOM FROM CHRONIC PAIN FB Closed Group:JournalSpeak with Nicole Sachs, LCSW OMEGA General info: OMEGA INSTITUTE Subscribe Apple Podcasts Deezer iHeart RadioPublic RSS Spotify

VLOG April 11: Trump trial delay denied again; armed guard who coerced sex from asylum-seeker in 26 Federal Plaza gets 5 year plea deal only to lying to FBI. Trials of crypto Eisenberg and Carmody v NYU Langone. [Forgot to mention: Menendez hearing at 11: delay?]

Dr. Ira Glick is Professor Emeritus of Psychiatry and Behavioral Sciences at Stanford University Medical Center, where he has served as director of the Schizophrenia Research Clinic. On this episode, he discusses his research journey, which began in the 1960s and followed a shift from psychoanalysis to biological psychiatry. He addresses the broken social safety net for schizophrenia patients, including the controversial topic of treating some patients against their will, as well as the challenges of medication adherence, and the stigma surrounding severe mental illness.00:00 Introduction00:49 Evolution of Schizophrenia Treatment04:34 Science Behind Schizophrenia Medications07:39 Addressing the Public Health Challenges of Schizophrenia11:15 Stigma and Misunderstanding of Severe Mental Illness21:44 Innovative Treatment Approaches and the Future of Schizophrenia Care31:36 Importance of Public Health Interventions and Political Will35:45 Closing Remarks and Future DirectionsVisit our website for more insights on psychiatry.Podcast producer: Jon Earle

Dr. Christin Drake is Clinical Associate Professor and Vice Chair of Diversity and Equity in the Department of Psychiatry at NYU Grossman School of Medicine. On this episode, Dr. Drake discusses ongoing efforts to improve mental health equity, including by improving psychiatric services for underserved groups, gathering better data, and boosting diversity among health care providers. She also discusses the importance of integrating mental health care into perinatal services and challenges the conventional wisdom about stigma toward mental health care in the Black community.00:00 Introduction00:55 Dr. Drake's Vision for Equity in Mental Health Care03:46 Addressing Racial Inequities in Psychiatry: A Critical Conversation04:45 The Importance of Representation and Mentorship in Psychiatry10:32 Building Foundations for Health Equity: Data and Systemic Change22:16 Integrating Psychiatric Care into Perinatal Health33:31 Rethinking Mental Health Stigma in the Black Community38:08 Future Projects and Closing ThoughtsVisit our website for more insights on psychiatry.Podcast producer: Jon Earle

Today on the Balancing Chaos Podcast, Kelley sits down with renowned dermatologist and clinical associate professor at NYU Langone, Dr. Doris Day. Her dedication to patient care, lifelong learning, and advancing dermatological techniques has earned her accolades and widespread recognition. Dr. Day is the author of three books, Beyond Beauty: Using the Power of Your Mind and Aesthetic Breakthroughs to Look Naturally Young and Radiant, Forget the Facelift: Turn Back the Clock with Dr Day's Revolutionary Four-Step Program for Ageless Skin, and 100 Questions and Answers about Acne.Through this episode, Kelley and Dr. Day cover a variety of different topics around what is impacting the aging process from the reality of how bad the sun really is for skin to how hormones impact the aging process and how bioidentical hormone replacement therapy can be helpful in maintaining youthful glowing skin. Additionally, through the interview they discuss the real risks of Botox, how weight loss drugs create more fine lines and wrinkles and the right age to get a facelift! Tune in for an insightful episode to get tangible tips on how to get radiant glowing youthful skin that defies time! To connect with Kelley Nemiro click HERETo book Kelley's Lab Review Package click HERETo connect with Dr. Doris Day click HERE

Welcome to the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In this episode, Alcibiades Rodriguez, MD, medical director of the Comprehensive Epilepsy Center—Sleep Center at NYU Langone discussed several sleep-related topics, including the diagnosis of rare sleep disorders and hypersomnias. He spoke on the treatment of obstructive sleep apnea, the importance of adherence to medication, and the ways clinicians can help patients stick to their treatment regimen. Furthermore, he talked about the conversations between patients and clinicians to ensure an accurate diagnosis, as well as the emerging research in the sleep disorder field over the coming years. Looking for more sleep disorders discussion? Check out the NeurologyLive® sleep disorders clinical focus page. Episode Breakdown: 1:40 – Conversations needed to differentiate diagnoses 4:30 – Appearance of sleep disorders and overlap 6:50 – Complications with untreated sleep apnea 8:25 – Neurology News Minute 10:55 – Ways to improve adherence to medication 13:50 – Emerging research in the field This episode is brought to you by Medical World News, a streaming channel from MJH Life Sciences®. Check out new content and shows every day, only at medicalworldnews.com. The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: Glatiramer Acetate Depot Demonstrates Sustained Longterm Safety Profile as Potential MS Therapy Phase 3 DAYBREAK Trial Highlights Long-Term Efficacy of Ozanimod for Relapsing Multiple Sclerosis SRP-9001 Improves Duchenne Muscular Dystrophy Disease Trajectory Despite Failing to Meet Primary End Point in Phase 3 EMBARK Trial Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

Dr. Helen Riess is Associate Clinical Professor of Psychiatry at Harvard Medical School and Director of Empathy Research and Training in the Psychotherapy Research Group at Massachusetts General Hospital. She is also Founder and Chief Executive Officer at Empathetics, a company that provides science-based empathy and interpersonal skills training for healthcare professionals. Her research focuses on improving empathy and relational skills in physicians.00:00 Introduction01:14 Defining Empathy03:38 Empathy and Burnout05:00 Care for the Caregiver07:52 Exquisite Empathy and Burnout09:18 Building Empathy and Avoiding Overburden10:45 Developing Boundaries in Clinical Practice11:45 Training and Teaching Empathy13:42 Model for Recognizing Emotion in Others15:11 Becoming Emotion Detectives19:31 Leadership's Role in Creating Supportive Workplaces23:22 Benefits of Empathy Training29:07 Technology and Empathy Training34:18 Research on MDMA-Assisted Psychotherapy37:43 Building Empathy and Compassion40:07 Taking Small Steps Towards Empathy42:32 Resources for Building Empathy43:28 Future of Empathy TrainingThe Empathy Effect (Dr. Riess's book)The Power of Empathy (TEDx Talk)Visit our website for more insights on psychiatry.Podcast producer: Jon Earle

Dr. Christopher Pittenger is a Professor of Psychiatry at the Yale School of Medicine and Director of the Yale OCD Research Clinic. In this episode, he discusses the neurobiology, symptomology, and treatment of Obsessive-Compulsive Disorder (OCD), including potential new treatments such as psychedelics, neurofeedback, glutamate modulators, and transcranial magnetic stimulation (TMS). 00:00 Introduction00:41 Why is OCD Underdiagnosed?02:19 Impact of OCD on Individuals03:40 Taboo Nature of OCD Thoughts06:10 Biomarkers08:06 Neurobiology14:20 Serotonin16:48 Heterogeneity of OCD24:00 Glutamate Modulators29:33 Ketamine33:13 Psilocybin38:23 Neurofeedback44:01 Transcranial Magnetic Stimulation (TMS)47:22 Relationship Between Depression and OCD50:24 Future of OCD TreatmentVisit our website for more insights on psychiatry.Podcast producer: Jon Earle

Watch Carol and Tim LIVE every day on YouTube: http://bit.ly/3vTiACF.  Antoine Drean, Founder at Triago, shares some of his 10 Outrageous Predictions for PE in 2024. Dr. Ian Lustbader, Clinical Professor of Medicine at NYU Langone, discusses seeing a surge in syphilis cases in the US.Hosts: Carol Massar and Tim Stenovec. Producer: Paul Brennan.See omnystudio.com/listener for privacy information.

Former President Trump has won the New Hampshire primary, beating his last GOP opponent former UN Ambassador Nikki Haley in a closer than expected race. Political pundits and primary polls alike forecast that Trump will handily win the next primary in Haley's home state of South Carolina, which could cement his status as the GOP's nominee for president in 2024. Meantime, President Biden won his primary bid against Minnesota Congressman Dean Phillips, led by a write-in campaign following the DNC's decision to move the first primary of their election calendar to South Carolina. Fox News Radio political analyst Josh Kraushaar and Fox News Audio Political Anchor and Washington Correspondent Jared Halpern join the Rundown to discuss Nikki Haley's decision to speak first following the primary being called for the former President, what the win means for the Trump campaign, and what Haley will do to make up ground going into the South Carolina primary. More than six million American seniors are diagnosed with Alzheimer's disease, and experts say the number will double in the next 25 years. However, a new study released this week shows there may be hope for early detection. Researchers in Sweden discovered that specific proteins found in blood can accurately detect the disease before symptoms arise. FOX News medical correspondent and Professor of Medicine at NYU Langone, Dr. Marc Siegel, joins the Rundown to discuss how Alzheimer's affects the body, share how the new test works, and explain why younger patients may want to take preventative measures. Plus commentary from host of the Jason Rantz Show on KTTH 770AM/94.5 FM Jason Rantz. (Image: Pablo Martinez Monsivais Via AP) Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Sue Varma began her career as the first medical director and attending psychiatrist to the World Trade Center Mental Health Program at NYU Langone, helping survivors overcome trauma and PTSD. She then began using her methods to help people overcome the negative mindset, feelings, and emotions that come from trauma and loss. In this episode, she gives us her top three things to beat pessimism. Learn how to shed a victim mentality, boost oxytocin, manage anger and agitation effectively, and so much more!Guest Links:Website: https://www.doctorsuevarma.com/IG: @doctorsuevarmaSuicide & Crisis Lifeline: 988 For 25% off The Fitness App by Jillian Michaels, go to www.thefitnessapp.com/podcastdealFollow us on Instagram @JillianMichaels and @MartiniCindyJillian Michaels Community: https://www.facebook.com/groups/1880466198675549Email your questions to JillianPodcast@gmail.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Discussing the new 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline, with the joint first authors: Dr. Ariane Lewis, neurointensivist, professor of neurology and neurosurgery at NYU Langone, director of neurocritical care, and chair of the Langone ethics committee, and Dr. Matthew Kirschen, pediatric neurointensivist and associate director of pediatric … Continue reading "Lightning rounds #35: Brain death updates, with Ariane Lewis and Matthew Kirschen"

The holiday shopping season has officially begun with an estimated 130 million people planning to “shop 'til they drop” this Black Friday. But the deals are no longer restricted to Friday, with many retailers rolling out holiday discounts earlier this month. This change is causing some to question whether or not Black Friday is still the best day for discounts. Founder and CEO of Storch Advisors, Gerald Storch, joins the Rundown to explain why he thinks Black Friday is more of a "concept" and not a holiday, why consumers are spending more right now, and share why he believes it will be a slow holiday season for retailers. Nearly forty percent of adults in the United States are considered obese, and many people are looking for a quick and easy way to lose weight. Ozempic, a popular drug used to treat diabetes, skyrocketed in popularity after celebrities began using it for weight loss. Now, doctors fear the long-term effects the drug may have on the world of health and fitness. FOX News Medical contributor and NYU Langone professor Dr. Marc Siegel explains how these drugs work, how overprescription of these drugs will hurt diabetes patients who need them, and how Ozempic became such a sought-after drug. Don't miss the good news with Tonya J. Powers. Plus, commentary by a former investment banker and author of 'You Will Own Nothing,' Carol Roth. Learn more about your ad choices. Visit megaphone.fm/adchoices

We are far too classy for a “Rocky Mountain High” joke. Live from SGIM 2023 in Aurora, Colorado!  We talk to a panel of Addiction Medicine specialists who recap their outstanding talk on all of the exciting developments in treating addiction.  We review major policy changes, trends in drug overdose, outpatient screening for alcohol use, and all of the ways we might be using psychedelics to treat addiction.  We are joined by Stefan Kertesz, MD @StefanKertesz (University of Alabama at Birmingham), Ximena Levander, MD, MCR, FACP @XimenaLevander (OHSU), Kenneth L. Morford MD, FASAM (Yale), and Katherine Mullins, MD, AAHIV @_kmullins_ (NYU Langone). Claim free CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Credits Producer: Carolyn Chan, MD and Paul Williams, MD, FACP Writer: Carolyn Chan, MD and Paul Williams, MD, FACP Show Notes, Infographic, and Cover Art: Paul Williams, MD, FACP Hosts: Carolyn Chan, MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Leah Witt, MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guests: Stefan Kertesz, MD, MSc; Ximena A. Levander, MD, MCR, FACP; Kenneth L. Morford, MD, FASAM; Katherine Mullins, MD, AAHIV