Podcasts about scripps clinic

Medical science is advancing at an astonishing rate. Today we talk with leading expert Eric Topol about two aspects of this story. First, the use of artificial intelligence in medicine, especially in diagnostics. This is an area that is a perfect match between an important question and the capabilities of machine learning, to the point where AI can out-perform human doctors. And second, our understanding of aging and what to do about it. Eric even gives some actionable advice on how to live more healthily into our golden years.Blog post with transcript: https://www.preposterousuniverse.com/podcast/2025/05/05/episode-313-eric-topol-on-the-changing-face-of-medicine-and-aging/Support Mindscape on Patreon.Eric Topol received and M.D. from the University of Rochester. He is currently the Gary and Mary West Chair of Innovative Medicine in the Department of Translational Medicine at Scripps Research. He is also the Founder, Scripps Research Translational Institute, and Senior Consultant, Scripps Clinic, Division of Cardiovascular Diseases. Among his awards are the Hutchinson Medal from the University of Rochester and membership in the National Academy of Sciences. His books include Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again, and Super Agers: An Evidence-Based Approach to Longevity.Web siteScripps web pageGoogle Scholar publicationsWikipediaSubstackBlueskySee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Our next AAOS 2025 Annual Meeting poster is titled Mid-term Follow-up of Patellofemoral Osteochondral Allograft Transplantation. This study was performed by Dr. Bill Bugbee and his team at the Scripps Clinic. Dr. Bugbee was a guest on our show back in November 2023.  That is episode 59 and 60, if you want to go check it out.  In that episode, we discussed osteochondral allograft transplantation for various cartilage defects of the knee, including medial and lateral tibiofemoral, which are the more common locations for OCA transplantation.  This study focuses specifically on outcomes of OCA transplantation for patellofemoral cartilage defects.This study identified 127 patients undergoing OCA transplantation in the patellofemoral compartment – 51 to the patella, 47 to the trochlea and 29 bipolar patella and trochlea.  The most common indication was a degenerative cartilage lesion at 47%, followed by a traumatic cartilage injury at 25% and osteochondritis dissecans at 15%.  All patients had a minimum follow-up of 2 years.  OCA failure was defined as any reoperation that involved removal of the allograft.  Patient reported outcomes were also assessed pre-op and post-op, including the IKDC score and KOOS score.So, what did this study find?  First, reoperations occurred in 39% of the knees.  Rate of reoperation was not statistically significant between patella, trochlea and bipolar grafts.  Second, OCA failures occurred in 16% of the knees at a median 4.4 years following the index surgery, and the most common revision procedure was arthroplasty.  Although it did not reach statistical significance, trochlear grafts had a lower failure rate of 9% compared to patellar grafts at 20% and bipolar grafts at 21%.Overall, graft survivorship at 5 and 10 years was 91% and 82%, respectively.  Patients with patellar, trochlear and bipolar grafts all had significant improvement in IKDC scores and KOOS scores from preop to the latest follow-up and no statistically significant differences were observed between the groups.  Overall, 77% of patients reported being satisfied with the results of the OCA transplantation with no statistically significant differences in satisfaction between the groups.Also check out:Episode 91: Dr. Tom DeBerardino 0n Advances in Patellofemoral Cartilage Restoration

Finding out a pregnancy is high-risk can understandably bring a mix of emotions. But a highly skilled perinatology team can ensure that high-risk moms-to-be receive the very best care and have the healthiest pregnancy possible. In this episode of San Diego Health, host Susan Taylor and Sean Daneshmand, MD, medical director of the department of maternal-fetal health at Scripps Clinic, and Scripps prenatal genetic counselor Caitlin Grandfield, discuss what constitutes a high-risk pregnancy and how physicians care for high-risk moms-to-be. Dr. Daneshmand also explains what prospective parents can do to lower their risk even before getting pregnant. 

An estimated one in eight men will develop prostate cancer at some point in their lives. For the roughly 300,000 men who are diagnosed with prostate cancer every year, early detection and treatment can help ensure to a successful outcome. And as prostate cancer often has no symptoms in its early stages, regular screenings are key to early diagnosis. In this episode of San Diego Health, host Susan Taylor and Scripps Clinic urologist Ramsey Chichakli, MD, discuss prostate cancer, how it's diagnosed, and treatment options. Dr. Chichakli also explains how surgery for prostate cancer has advanced over the years to become more precise and less invasive. 

Send us a textDr. Bret Scher is a board-certified cardiologist and lipidologist with over 20 years of experience, specializing in preventive cardiology and metabolic health. He earned his B.S. in Biology from Stanford University in 1994 and his M.D. from The Ohio State University College of Medicine in 1998. Dr. Scher completed his internal medicine residency at Mercy Hospital in San Diego in 2001, where he also served as Chief Resident in 2002. He then pursued a fellowship in general and preventive cardiology at Scripps Clinic, completing it in 2005. Throughout his career, Dr. Scher has focused on preventing and reversing heart disease through natural methods, emphasizing the importance of lifestyle interventions and metabolic therapies, including ketogenic diets. He has obtained specialized certifications in functional medicine, nutrition, personal training, and behavior modification. Dr. Scher has served as the Medical Director at DietDoctor.com and currently hosts the Metabolic Mind YouTube channel and podcast, where he educates the public on the benefits of metabolic therapies.“Change your food, change your life!”Dr. Eric Westman and his Adapt Your Life Academy team are on a mission to empower people around the world to transform their health through the science-backed benefits of low-carbohydrate and ketogenic diets.Dr. Westman is an obesity medicine specialist and trusted expert in the therapeutic power of carbohydrate restriction, and clinical research, and has treated patients using low-carb keto diets for over twenty-five years. He makes keto SIMPLE, so that YOU can LOSE weight, REVERSE chronic disease and GET the RESULTS you want.Get started NOW by grabbing our FREE GUIDE – 10 Tips for Starting Keto Right. 

Heart failure is a life-threatening condition that affects more than five million people in the U.S. each year. However, the “failure” part can be a little misleading. It doesn't mean that the heart has ceased to function; it means that, while the heart is still pumping, it can no longer effectively pump enough blood to meet the body's needs. In this episode of San Diego Health, host Susan Taylor and Rola Khedraki, MD, a heart failure and transplant cardiologist at Scripps Clinic, discuss the causes of heart failure, its symptoms, treatment options, and who's at risk. Dr. Khedraki also outlines what people can do now to help prevent heart failure in the future.

Just about everybody gets a headache from time to time. But for the 45 million Americans who suffer from chronic headaches, it can seem like frequent pain is just a part of life. Having a headache seemingly all the time isn't normal. Fortunately, treatment is within reach. In this episode of San Diego Health, host Susan Taylor and Scripps Clinic neurologist Emily Rubenstein Engel, MD, discuss the different types of headaches, what causes them, and how they're treated. Dr. Engel also outlines what happens during a doctor's appointment for a chronic headache diagnosis and when further investigation is needed.

Colorectal cancer is the fourth most common cancer diagnosed in the U.S. and kills roughly 53,000 people each year. It's understandably not something people like to talk about, but initiating the conversation with your doctor about your risk for colorectal cancer could end up saving your life. In this episode of San Diego Health, host Susan Taylor and guest Walter Coyle, MD, he head of gastroenterology at Scripps Clinic, discuss the signs and symptoms of colorectal cancer, who's at risk, how it's diagnosed, and treatment options. Dr. Coyle also touches on the environmental factors that could be behind an increase in colorectal cancers in younger people.  

CardioNerds Dan Ambinder and Dr. Devesh Rai join cardiology fellows and National Lipid Association lipid scholars Dr. Oby Ibe from Temple University and Dr. Elizabeth Epstein from Scripps Clinic. They discuss a case involving a patient with elevated Lp(a). Dr. Jessica Pena provides expert commentary. Drs. Oby Ibe and Elizabeth Epstein drafted notes. CardioNerds Intern Christiana Dangas engineered episode audio. This episode is part of a case reports series developed in collaboration with the National Lipid Association and their Lipid Scholarship Program, with mentorship from Dr. Daniel Soffer and Dr. Eugenia Gianos. This is a 63-year-old man with hypertension, hyperlipidemia, and active tobacco smoking who presented with acute dyspnea. He was tachycardic but otherwise initially hemodynamically stable. The physical exam demonstrated warm extremities with no murmurs or peripheral edema. Chest X-ray revealed diffuse pulmonary edema, and the ECG showed sinus tachycardia with T-wave inversions in the inferior leads. A bedside echocardiogram revealed a flail anterior mitral valve leaflet. The patient was taken for cardiac catheterization that revealed nonobstructive mid-RCA atheroma with a distal RCA occlusion, which was felt to reflect embolic occlusion from recanalized plaque. PCI was not performed. Right heart catheterization then demonstrated a low cardiac index as well as elevated PCWP and PA pressures. An intra-aortic balloon pump was placed at that time. A TEE was performed soon after which showed the posteromedial papillary muscle was ruptured with flail segments of the anterior mitral leaflet as well as severe posteriorly directed mitral regurgitation. The patient ultimately underwent a successful tissue mitral valve replacement and CABG. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Little (a), Big Deal – National Lipid Association You are never too young to see a preventive cardiologist! The field of preventive cardiology is shifting focus towards the identification of early upstream risk and intervention before the development of clinical ASCVD (1,5). Patients who have a strong family history of cardiovascular disease, a personal history of CVD at an early age, multiple risk factors, or genetic disorders such as familial hypercholesterolemia especially benefit from early cardiovascular risk assessment and reduction. Female-specific risk factors to incorporate into a young woman's cardiovascular risk assessment include polycystic ovarian syndrome, hormone contraceptive use, early menarche (age 5 pregnancies), early menopause (age

For the roughly 40 million Americans living with diabetes, it's critical to maintain healthy blood sugar levels. Continuous blood sugar monitors may be able to help. The devices track blood sugar levels 24/7—no finger pricks required. In this episode of San Diego Health, host Susan Taylor and guest, Athena Philis-Tsimikas, MD, a Scripps Clinic endocrinologist and corporate vice president of the Scripps Whittier Diabetes Institute, discuss the benefits of continuous glucose monitors for patients with diabetes. Dr. Tsimikas also explains how continuous glucose monitors can work in tandem with an insulin pump to automatically control blood sugar levels.   

  Years of exposure to the San Diego sunshine can lead to uneven skin tone, dark spots, and spider veins on the face. Fortunately, dermatologists have a variety of laser treatments at their disposal to safely reverse the damage and restore the look of healthy skin. In this episode of San Diego Health, host Susan Taylor and Edward Ross, MD, a Scripps Clinic dermatologist and director of the Scripps Clinic Laser and Cosmetic Dermatology Center, discuss how lasers work to rejuvenate skin and what conditions can be treated. Dr. Ross also explains how newer lasers can be used to effectively treat acne.  

More than 6.7 million Americans suffer from Alzheimer's disease. The condition most often strikes those ages 65 and up, but can affect younger people as well. Early-onset Alzheimer's disease can develop as early as age 40 to 50. In this episode of San Diego Health, host Susan Taylor and Scripps Clinic neurologist Leonard Sokol, MD, discuss early-onset Alzheimer's disease, how it's diagnosed, who's at risk, and treatment options. Dr. Sokol also explains how the symptoms of early-onset Alzheimer's may not always be what older people experience.

David Savage, MD, a hematology-oncology fellow at Scripps Clinic in California talks about the process of transferring residency programs. Dr. Savage draws from personal experience to offers insights on how those considering a transfer should approach that decision.✶✶✶✶ 

Dr. Robert Bonakdar is the Director of Pain Management at the Scripps Center for Integrative Medicine and a member of the Scripps Green Hospital Pain Management and Physician Wellness Committees.  He also serves as an Assistant Clinical Professor at the University of California, San Diego, School of Medicine and is the current president of the American Academy of Pain Management. After completing his family medicine residency he completed a fellowship in integrative medicine at Scripps Clinic with a focus on integrative pain management.  He has additionally completed the UCLA Acupuncture Course for Physicians and a Richter Fellowship in Southeast Asia, where he studied acupuncture, Tai Chi, and mind-body practices. His clinical and research interests include integrative approaches to chronic disease management with a focus on pain management and metabolic disease.   Together Dr. Robert and I examine all things migraine.  From the most common triggers and demographics of main sufferers to the importance of education as a tool to help patients combat migraines, Dr. Robert shares a host of information that practitioners can use to empower their patients.  He shares a wide variety of supplements and dietary recommendations that can be used in treatment and underscores the importance of optimizing eye health, prioritizing exercise, limiting caffeine, and other pearls of proactive care for optimal migraine and pain management.   I'm your host, Evelyne Lambrecht, thank you for designing a well world with us.   Episode Resources: Dr. Robert Bonakdar - https://www.scripps.org/physicians/5903-robert-bonakdar   Designs for Health - https://www.designsforhealth.com/   Research Blog: Predictors of Progression to Chronic Migraine - https://www.casi.org/node/1235   Nutrition Blog: New Ways to Think About CoQ10 Supplementation - https://www.casi.org/node/1362   Nutrition Blog: Topical Uses for Magnesium - https://www.casi.org/node/1389   Research Blog: Ginger for Healthy Muscle Recovery - https://www.casi.org/ginger-for-healthy-muscle-recovery   Educational Webinar: Modernizing Migraine Care: Innovations in Migraine Management - https://www.designsforhealth.com/research-education/library/webinar/modernizing-migraine-care-innovations-in-migraine-management Visit the Designs for Health Research and Education Library which houses medical journals, protocols, webinars, and our blog. https://www.designsforhealth.com/research-and-education/education   Chapters: 00:00 Intro. 02:26 Dr. Robert recalls the experiences that first piqued his interest in integrative pain management.  3:47 Key differentiators between tension headaches and migraines and the hormonal connection to women sufferers. 6:01 Drugs that are commonly used for migraines and concerns about their mechanisms of action. 9:16 Compounds that routinely affect the gut and brain in accentuating headaches and natural approaches that work for migraines. 11:50 Hormones, cycles, and life events that have the greatest impact on headaches, and genetic SNPs that are connected to headaches. 13:55 The role of central sensitization in pain management for headaches. 16:51 Supplement treatment and dosing for common micronutrient deficiencies that trigger headaches. 24:33 Dietary recommendations that are beneficial in treating migraines and Dr. Robert's approach to common food sensitivities. 30:38 Overconsumption of caffeine is a common migraine trigger; Dr. Robert offers suggestions on appropriate servings. 32:44 Ketogenic dietary considerations, timelines, and recommendations. 34:55 Compounds, supplements, and herbs that Dr. Robert regularly recommends for migraine treatment. 40:10 The correlation between eye health and migraines, and acute herbal supplement recommendation. 43:10 The power of educating patients about migraines in addition to offering remedies and treatments. 45:12 Dr. Robert's personal favorite supplements, top wellness practices, and the leaky gut link to migraines that he has changed his mind about.

The lymphatic system has an important job: it helps the body fight off infection. But when the body's lymph system is damaged or blocked, fluids can build up in the body's soft tissues and cause swelling, typically in the extremities. The condition is called lymphedema. There's no cure for lymphedema, but it can be managed with help from your health care team. In this episode of San Diego Health, host Susan Taylor and guests Manish Champaneria, MD, a Scripps Clinic plastic surgeon who specializes in lymphedema surgery, and certified lymphedema therapist Maryam Rahnema discuss what causes lymphedema, how it's diagnosed, and treatment options. The experts also discuss what can happen if lymphedema is left untreated and why early intervention is optimal.

Unlock the secrets to peak brain health and athletic performance with Barton Bryan on the Mindset Forge Podcast, featuring insights from the renowned Justin Franson. Ever wondered how the devices we cherish might be affecting our well-being? Franson lays bare the hidden costs of our high-tech lifestyles, explaining how EMFs disrupt our brain's natural rhythms and sleep patterns. But it's not all about the problems; we also bring you solutions. Learn an invaluable fascial stretch to boost thoracic mobility—a game-changer for anyone striving for physical excellence.As we navigate the complex interplay between environment and elite performance, our conversation takes a deep dive into the invisible forces shaping our health. From EMF pollution to the fundamental role of hydration and diet, we unearth practical strategies that foster an optimal state for achieving a coveted flow state. Beyond the field, we implore medical students and avid listeners to look at the bigger picture, to embrace the holistic significance of fascia, and to engage with the profound effects of grounding practices. This episode isn't just a playbook for athletes aiming high; it's a blueprint for anyone dedicated to elevating their life to a state of optimal well-being.Find out more about Justin's concepts:http://athleticism.comIn early 1998, Justin Frandson read an article in the newspaper about one of the greatest pioneers of Sports Performance, Dean Brittenham at Scripps Clinic, La Jolla California, making athletes better athletes through the most creative approaches. The article raved about the track-based speed and power program with stretching, coordination drills, ambidexterity, balance, strength, and more. Justin visited the prestigious location, and started his passion and gifts of facilitating athletic development with athletes and teams of all ages and levels. The article spoke of high school  athletes becoming D1 athletes and D1 athletes turning pro. Justin's past and current clientele list consists of many of the highest ranked professional athletes in the US.The results are instant and tangible in every athlete, no matter their sport. The workouts take even the best athletes in the world out of their coordination comfort zone, to develop more neuroplasticity, in-turn developing more pathways from the brain to the body. This infinite flow consistently brings athletes and performers to their ideal Alpha brainwave state for superior performances. This nerve work and brain coordination entrainment to develop performance is the essence of ATHLETICISM.In addition to Justin being blessed with an exceptional mentor who was one of the foremost pioneers in Sports Performance, Justin has the innate gifts of developing human performance and seeing things others don't. He has the gifts of intuition and healing to facilitate in optimizing nerve health for injury prevention, recovery, and performance. His sensory nerve treatments for vision and spatial awareness double as concussion protocol. He is known for facilitating getting sports concussions back faster than ever.Email: Barton@bartonguybryan.comWebsite: http://bartonguybryan.comUse this link to get a 30 minute discovery call scheduled with Barton regarding the Team Bryan Wellness Concierge Fitness Programhttps://calendly.com/bartbryan/conciergecoachingcallMy 3 Top Episodes of the first 100: 7 Essentials to Building Muscle after 40 3x Olympic Gold Medalist Brendan Hansen MMA Strength and Conditioning Coach Phil Daru

More than 40 percent of adults in America are considered obese, which comes with an increased risk for conditions like heart disease, stroke, and type 2 diabetes. It's no surprise that the popularity of weight loss drugs that curb cravings and slow digestion is soaring, but are they for you? In this episode of San Diego Health, host Susan Taylor and Scripps Clinic endocrinologist Samantha Harris, MD, who specializes in weight management and diabetes care, discuss how weight loss drugs work, who is an ideal candidate, and potential side effects. Dr. Harris also explains why the new class of weight loss drugs may require a much longer commitment than you may think.

Chronic back pain can make everyday activities difficult. Exercise, putting away groceries, or simply twisting or turning can cause muscle and spinal pain. Back pain affects eight out of 10 people at some point in their lives, and for many, it goes away on its own. But for those with lasting or recurring back problems, minimally invasive surgery may be the solution that stops their pain for good. In this episode of San Diego Health, host Susan Taylor and Scripps Clinic orthopedic surgeon Robert Eastlack, MD, discuss common causes of back pain and how minimally invasive back surgery works to bring patients relief, often with less downtime than traditional open surgeries. Dr. Eastlack also shares tips to protect your back.

Pregnancy is an exciting time, but it can also be tough on your heart. Your heart is working overtime to support you and your baby, and it's surprisingly common for women to develop some type of heart problem during pregnancy or exacerbate an existing condition, such as hypertension or high blood pressure. In this episode of San Diego Health, host Susan Taylor interviews Scripps Clinic cardiologist Poulina Uddin, MD, and Sean Daneshmand, MD, a Scripps Clinic OB-GYN and medical director of the Scripps perinatology program. They discuss how being pregnant can affect the heart, common heart problems that can develop in pregnancy, and how those conditions may affect the baby. They also explain how doctors can treat heart conditions while protecting the pregnancy.

More and more women are waiting until their mid- to late 30s to have children. Advanced maternal age pregnancies come with higher risks, but health care providers are prepared. Scripps has expert perinatologists and support staff who specialize in high-risk pregnancy care. In this episode of San Diego Health, host Susan Taylor interviews Daniela Gomez, MD, a Scripps Clinic obstetrician and gynecologist (OB-GYN) specializing in maternal and fetal medicine, and Alex Fite, a prenatal genetic counselor at Scripps Clinic. They discuss the factors that may make it harder to conceive as a woman gets older, conditions that occur more often in babies born to moms over 35, and what health care providers can do to help ensure babies are born healthy.

On this episode, we're going to continue our discussion with Dr. William Bugbee and focus on OCA surgical technique and then discuss clinical outcomes including return to sports.Our conversation picks back up with a recent paper from the July issue of Cartilage this year titled “Young Age and Concomitant or Prior Bony Realignment Procedures are Associated with Decreased Risk of Failure of Osteochondral Allograft Transplantation in the Knee.” This retrospective nationwide database study represents the largest OCA cohort study to date and found that less than 2% of patients required salvage surgery. Young age, less than 29, and having a bony realignment procedure were associated with a significantly lower rate of salvage surgery – include revision cartilage procedures and arthroplasty.We finish up today with an article from the June 2017 issue of AJSM titled “Return to Sport and Recreational Activity after Osteochondral Allograft Transplantation in the Knee.” Dr. Bugbee and colleagues at Scripps Clinic in La Jolla California reported that at a mean follow up of 6 years, 75% of patients were able to return to sport or recreational activity. Patients who did not return were more likely to be female and have a large graft size. 25% of knees underwent further surgery and 9% were considered allograft failures. Of the patients without OCA failure, 91% were satisfied with the results of surgery.

On today's episode we're focusing on osteochondral allograft transplantation or “OCA” with Dr. William Bugbee. We have some great articles for you that contribute well to our conversation on OCA, including allograft preparation and storage, graft choice, surgical technique, clinical outcomes of OCA and return to sport. We'll start off our discussion today with an article authored by our guest, Dr. William Bugbee, from the May 2022 issue of AJSM titled “Fresh Osteochondral and Chondral Allograft Preservation and Storage Media: A Systematic Review of the Literature.” There was significant variability in experimental designs and incomplete reporting across the studies, so no real conclusions could be drawn regarding optimal storage conditions. While 60% of animal model studies suggest storage time may impact outcomes and 80% indicate inferior outcomes with frozen OCA compared to fresh OCA, the authors note that 75% of clinical studies reported no correlation between storage time and outcomes. So, we have a lot left to learn here.Then, from the March 2022 issue of AJSM, we review an article titled “Association of Sex Mismatch Between Donor and Recipient With Graft Survivorship at 5 Years After OCA Transplantation.” Dr. Gomoll and colleagues at Brigham and Women's reported that a significantly lower rate of graft survival was observed after different sex donor-recipient transplant compared to same sex donor-recipient OCA – 63% compared to 92%. Patients who received a donor-recipient sex-mismatch transplantation were 2.9X more likely to fail. Male donor to female recipient demonstrated the highest likelihood of failure compared to all other combinations.We are joined today by Dr. William Bugbee, a board-certified orthopedic surgeon specializing in joint reconstruction and cartilage restoration at Scripps Clinic in La Jolla, California. Dr. Bugbee received his medical degree from UC San Diego and remained at UC San Diego for his orthopedic surgery residency.  He then went on to complete a fellowship in joint reconstruction at the Anderson Orthopaedic Research Institute. Dr. Bugbee has published extensively on the topic of osteochondral allograft transplantation, so we're very excited that he is joining us today to share his expertise with all of you!

In 2021 Chase's wife Keri was diagnosed with with a life altering illness that would change the course of theirs and their kids lives. Today's episode Burner and Felipe talk to Chase about Keri's journey from that day through her treatments and beyond. This very honest and difficult story is one of love, community, friendships and most of all family.Support the show

Beginning January 1, 2024 Scripps Clinic and Scripps Coastal will stop accepting Medicare Advantage plans. This leaves all Scripps patients on Medicare Advantage are facing some kind of change, and that change must be decided on by December 7, 2023.This 30-minute interview is with Sophie Exdell of HICAP – Health Insurance Counseling and Advocacy Program, a division of Elder Law & Advocacy, a non-profit organization. Sophie explains some of the ins and outs of Medicare Advantage and some options for people wishing to stay with their Scripps doctors or willing to move to another health plan.Scroll down to see links for more information from Elder Law & Advocacy – webinars and resources specific to the situation with Scripps and Medicare Advantage.For links to more infomation about Medicare and Scripps, and the video version of this podcast, please click here:https://parkinsonsassociation.org/medicare-advantage-and-scripps/

Description: Co-host Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and co-host Mary Jo Strobel, APFED's Executive Director, speak with Dr. Jenny Huang, an allergy and immunology fellow at Scripps Clinic, who has a unique perspective of also living with eosinophilic gastritis (EoG). In this episode, Ryan and Mary Jo interview Dr. Jenny Huang about various EGIDs, her allergy and immunology fellowship, her EoG diagnosis, and the elimination diet she follows to treat her EoG. Dr. Huang speaks about patients she sees, and how her experience of following an elimination diet gives her passion for helping people and guiding them to a treatment plan that works for their lifestyle. She advises patients to ask their doctors lots of questions and tell all their family and friends about their condition so they can be supportive.   Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:49] Co-host Ryan Piansky welcomes co-host Mary Jo Strobel. Mary Jo introduces Dr. Jenny Huang, an allergy and immunology fellow at Scripps Clinic living with eosinophilic gastritis (EoG). Dr. Huang is passionate about gastrointestinal disorders and spreading awareness about EGID. She recently published a commentary about her experiences.   [2:20] Dr. Huang explains that eosinophilic gastrointestinal disorders (EGIDs) are diseases of the GI tract that result from eosinophils, a type of white blood cell causing inflammation. Depending on where the eosinophilic inflammation occurs, you can have different symptoms.   [2:43] The role of the esophagus is to get food from the mouth to the stomach. When there is eosinophilic inflammation, you have eosinophilic esophagitis (EoE) that can cause difficulty swallowing or food getting stuck. If you have inflammation in the stomach, that is eosinophilic gastritis (EoG). This can cause abdominal pain or nausea.   [3:31] Dr. Huang is an allergy and immunology fellow. She trained in internal medicine. Even in medical school, she knew she wanted to be an allergist. In her second and third years of residency, she began having symptoms that she thought were related to the stress of putting together her fellowship application while working in the hospital.   [3:56] One day, Dr. Huang had a terrible episode of vomiting and she knew she needed to get medical advice rather than trying to treat herself.   [4:17] Dr. Huang learned about EoG for the first time after she was being evaluated for it. During her residency, she had learned about EoE, but not other eosinophilic gastrointestinal disorders (EGIDs). Her allergist brought it up. Dr. Huang did a lot of reading and research after that.   [4:48] Dr. Huang says there were times when she couldn't finish breakfast because of so much nausea and abdominal pain. She started carrying around TumsⓇ, which was something she had never done. Those things made her realize that something was wrong.   [5:11] Dr. Huang was treated by the assistant director of the allergy fellowship program where she is now training. She says he is one of the nicest, smartest people she knows. Dr. Huang had done her internal medicine residency in the same program, so she knew all of the allergists. Dr. Huang had no doubt the doctor would figure out her problem.   [5:49] Dr. Huang remembers the day she had her appointment with him. The intake nurse seemed to recognize Dr. Huang from when she had done rotations in the office, but she couldn't quite place her and didn't ask. [6:19] Dr. Huang describes her difficulties in following the six-food elimination diet that she and her GI doctor decided were the best option for her to manage EoG. Deciding on a treatment plan is a personal decision that should fit the needs of the patient. Dr. Huang decided on the elimination diet with no idea how difficult it would be.   [7:02] Dr. Huang went to the grocery store the same day and was overwhelmed trying to read all the labels. She had never really read nutritional labels before. She stopped going to a lot of restaurants because she had to ask so many questions before ordering.   [7:27] Ryan shares childhood experiences of going from an elemental diet to a strict elimination diet. He relates to Dr Huang's experiences at the grocery store and cooking.   [8:15] When Dr. Huang first began the elimination diet, most of her allowed foods were fruits, vegetables, and meats. She was able to add back most foods within a year but the hardest food for her to avoid in the beginning was soy. Her favorite food is tofu. Soy was the first food she added back and she was so happy when she was okay.   [8:44] When she started reading labels for her elimination diet, Dr. Huang learned that some soy sauce has wheat in it. So, she started buying soy sauce that doesn't have wheat in it.   [8:57] Dr. Huang did the elimination diet as an adult and found it incredibly difficult. She applauds Ryan for doing it as a child. Ryan is grateful to his parents for helping him navigate that along the way.   [9:20] In Dr. Huang's article, she recommended that providers try living on an elimination diet for a week. It's challenging! She has not been able to convince anyone to try it. When she suggests it, the look on their face is telling! It's so hard. If people don't see a reason to do it, it's just not done.   [10:15] An anecdote from Dr. Huang's article was about eating at the American College of Gastroenterology conference. She asked the waiter to help her find something free of milk, wheat, eggs, soy, seafood, and other ingredients she could not have. Ryan felt it was so relatable. Ryan was at a conference this summer where he could not eat.   [11:13] Dr. Huang brings a lot of snacks with her when she travels. She sticks to brands that she knows are safe for her. She searches ahead of time for restaurants with allergen menus. At restaurants, she always shares what foods she is avoiding so they can help her with choices.   [11:42] Mary Jo mentions that the APFED conferences provide appropriate menu choices for people on elimination diets.   [12:17] Dr. Huang's partner is a gastroenterologist specializing in esophageal diseases. He was in general GI fellowship training when Dr. Huang was diagnosed. He has been supportive of what Dr. Huang has been through with the diagnosis. He did the elimination diet with her, helped her cook, and supported her.   [13:27] The elimination diet is the only way Dr. Huang has managed her EoG. She has had repeat endoscopies with biopsies and the diet has been working so far. She's keeping her fingers crossed.   [14:00] When Dr. Huang was first diagnosed, she wasn't sure how bad her disease was or how much worse it would get and it frightened her. Fortunately, her symptoms have been controlled so it hasn't impacted her career that much. But she feels like this diagnosis has given her a calling and a direction for her career.   [14:33] Dr. Huang plans to study EGIDs. She has been doing EGID research studies during her fellowship. She wants to help people with it. She wants people to know that they're not alone and even though we don't have all the answers now, we will one day.   [15:08] Dr. Huang gets excited when she sees that someone is coming in with EoE or EGIDs because she automatically feels a special connection to them. She spends a lot of time counseling on the diagnosis, making sure the treatment plan fits their lifestyle and is something the patient can realistically do.   [15:29] Dr. Huang thinks back to when she would recommend dietary changes without understanding what that meant for the patient. Having gone through it, now she can better counsel patients.    [16:38] Dr. Huang discusses quality of life issues of treatment with her patients. She explains how difficult an elimination diet is. Currently for EoE, the only FDA-approved treatment is dupilumab by injection.    [18:02] Dr. Huang's advice for those with a new diagnosis of EoG is to talk to your doctor and ask a lot of questions. Make follow-up in-person appointments. Make a list of all the questions you have and talk through it with your doctor. If you pursue an elimination diet, get with a dietician to help navigate that. It's confusing in the beginning.   [18:36] Patients, talk to your family and friends. They can help support you at medical appointments and procedures. They can call ahead to restaurants and make sure your dietary restrictions can be met there. They can accommodate your dietary restrictions at home. Don't hide your diagnosis from the people around you. Hiding makes it more difficult.   [19:05] Mary Jo thanks Dr. Jenny Huang for joining them to share her experience and ask for additional thoughts.   [19:18] Dr. Huang wants people with EoG to know that they're not alone. EoG is rare but it's an increasingly recognized and diagnosed disease. It's easy to feel alone when your doctor tells you that you have a rare disease. Someone else out there knows how you feel.   [19:48] Ryan thanks Dr. Huang for sharing all of her experiences today.   [19:51] To connect with others impacted by eosinophilic diseases, join APFED's online community on the Inspire Network at apfed.org/connections.   [20:04] To learn more about eosinophilic gastritis, visit apfed.org/eog. To find a specialist, visit apfed.org/specialists. Ryan recommends reading Dr Huang's article linked below. Ryan and Mary Jo thank Dr. Jenny Huang again for joining them and thank APFED's education partners, linked below, for supporting this episode.   Mentioned in This Episode: “Becoming the Patient” Commentary Published in Gastroenterology Scripps Clinic American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of AstraZeneca, Bristol Myers Squibb, Sanofi, and Regeneron.   Tweetables:   “If you have [eosinophilic] inflammation in the stomach, that is called eosinophilic gastritis or EoG. That can cause symptoms like abdominal pain or nausea.” — Dr. Jenny Huang   “Deciding on a treatment plan is a personal choice and it needs to fit someone's lifestyle and their individual needs. What's right for one person may not be right for someone else.” — Dr. Jenny Huang   “Did you know that soy sauce has wheat in it? I had no idea until I started reading all the labels. So, we started buying soy sauce that doesn't have wheat in it!” — Dr. Jenny Huang   “When I was first diagnosed, I wasn't sure how bad my disease was or how bad it was going to get. I read a lot about the possible outcomes and it really scared me. … I couldn't imagine what it would be like if my symptoms progressed.” — Dr. Jenny Huang   About Dr. Jenny Huang Dr. Jenny Huang is an allergy and immunology fellow at Scripps Clinic. She is passionate about eosinophilic gastrointestinal disorders and has made it her mission to spread awareness about what it is like to live with EGID.  Dr. Jenny Huang “Becoming the Patient,” by Jenny Huang, MD  

A startling stat: According to the Centers for Disease Control and Prevention, 42 percent of adults and nearly 20 percent of children are obese—that's around 115 million people. Weight loss medication and/or bariatric surgery may be options for some of those whose health is at risk due to their weight and lifestyle. In this episode of San Diego Health, host Susan Taylor and guests Scripps Clinic endocrinologist Jennie Luna, MD, and Scripps Clinic bariatric surgeon Mark Takata, MD, discuss the genetic and societal causes of obesity, why diet and exercise just aren't enough for some people, and how weight loss medication and bariatric surgery work to help people lose weight when other methods are ineffective. Dr. Luna and Dr. Takata also outline the health risks that come with obesity.

Life can take a toll on the skin in the form of sun damage, acne scars, wrinkles, and sagging—and believe it or not, volume loss can start at just 28 years old. But it's possible to look younger without resorting to invasive surgery. Cosmetic procedures, such as injectables and laser treatments, can freshen up your look with minimal downtime. In this episode of San Diego Health, host Susan Taylor and Scripps Clinic dermatologist and cosmetic surgeon Rawaa Almukhtar, MD, discuss what causes your skin to age in the first place, how to soften and fill in fine lines, the types of cosmetic injectables on the market, and the latest trends in cosmetic dermatology. Dr. Almukhtar also explains how visiting a board-certified dermatologist for your cosmetic treatments can help you avoid a frozen, overdone look.

Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery, and being in a solo practice within a group practice. I'm your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients, more profits and stellar reputations. Now, today's episode is called "Solo Practice Within Group Practice — with Sam Jejurikar, MD". Some surgeons dream of complete autonomy. They want to do whatever they feel like doing without having to answer to executive boards or other surgeons they work under.  They want to set their own hours, hire and fire staff and buy equipment if they feel like it.  They also want to make more money and assume they will in solo practice since they keep all of the profits and not just a percentage.  However, the flip side of that autonomy means they also get to handle their own books and inventory, while also marketing to attract cosmetic patients.  The business and marketing side of plastic surgery can be fun, daunting, uncertain and confusing.  So, is Solo or Group practice better? Here's a unique business model that allows you to run your solo practice as you want, but also enjoy the perks of being under the umbrella of a much bigger practice. Very interesting! This week's Beauty and the Biz Podcast was an interview I did with Sam Jejurikar, MD, a board-certified plastic surgeon and a member of the Dallas Plastic Surgery Institute that includes 10 surgeons, 4 ORs, 40 staff in a 45,000 square foot facility. We talked about their unique business model to buy into the practice but run as a solo practitioner and how they make decisions with so many surgeons involved. Visit Dr. Jejurikar's website P.S. Want Catherine's book for free? Just leave us a review, text (415) 851-0172 and her book is on the way!

Justin Frandson is a new face to the pod, but as always I already have an amazing connection with him through our dear brother Cal Callahan. Justin was an athlete in high school and still balls out whenever he can. His love for athletics and an article by Dean Brittenham at Scripps Clinic, La Jolla California got him into the idea of stacking the many different athletic components of physical, mental, energetics. This stack known as, Athleticism Neuro Stacking, brings the health of our nervous system into the equation to increase performance instantly.  In this convo Justin takes us through his journey, to his book, “Athleticism”, some of the science behind his approach to athletic performance optimization, and we even get into the f*ckery behind EMF's, 5+G and really treating your nervous system with the utmost care. As always, listen up, enjoy, and share it with a friend!   ORGANIFI GIVEAWAY Keep those reviews coming in! Please drop a dope review and include your IG/Twitter handle and we'll get together for some Organifi even faster moving forward.   Connect with Justin: Website: Athleticism.com  Instagram: @athleticismneurostacking    Show Notes: "Deep Survival" -Laurence Gonzales  John Vervaeke YouTube  The Great Unlearn #96 w/ Del Bigtree Spotify Apple   "The Invisible Rainbow" -Arthur Firstenberg “The Kybalion” -The Three Initiates Amazon Free Online Audio   Pose Method for Running Living 4D #240 Robb Wolf: The Big Picture Spotify Apple   The Creepy Line(doc) The Dimming(doc)     Sponsors: Ra Optics Better sleep, more melatonin, blue blocking… These guys and Matt Maruka are the best around when it comes to blue blocking glasses that look sharp. Head to RaOptics.com and use code “KKP” at checkout for 10% off.  Organifi Go to organifi.com/kkp to get my favorite way to easily get the most potent blend of high vibration fruits, veggies and other goodies into your diet! Click that link and use code “KKP” at checkout for 20% off your order! PaleoValley Some of the best and highest quality goodies I personally get into are available at paleovalley.com, punch in code “KYLE” at checkout and get 15% off everything! Bioptimizers To get the 'Magnesium Breakthrough‘ deal exclusively for fans of the podcast, click the link below and use code word “KINGSBU10” for an additional 10% off. magbreakthrough.com/kingsbu  To Work With Kyle Kingsbury Podcast   Connect with Kyle: Fit For Service Academy App: Fit For Service App  Instagram: @livingwiththekingsburys - @gardenersofeden.earth  Odysee: odysee.com/@KyleKingsburypod  Youtube: Kyle Kingbury Podcast  Kyles website: www.kingsbu.com - Gardeners of Eden site    Like and subscribe to the podcast anywhere you can find podcasts. Leave a 5-star review and let me know what resonates or doesn't.

Technology with DBS, or Deep Brain Stimulation, is advancing as fast as any tech these days. In this episode we speak with Shawn McMenamin of Abbott Pharmaceuticals and Nurse Practitioner Sherrie Gould of Scripps Clinic about some of this new technology, including Abbott's "Virtual Clinic," also known as remote programming. Hear about the benefits and challenges from Shawn and Sherrie.For more on Abbott DBS, click here.To contact the Parkinson's Association of San Diego, click here.

It turns out there's some truth to the adage “You are what you eat.” Replacing the foods we eat with healthier alternatives and removing processed foods can help detoxify the body and improve health. And perhaps the best part is, making healthier choices doesn't have to be hard or time-consuming. In this episode of San Diego Health, host Susan Taylor and Scripps Clinic internist Mitch Biermann, MD, discuss how food can be used as medicine, the top healing foods, and how to structure your daily diet for the most bang for your caloric buck. Dr. Biermann also shares the top five foods that should be on everybody's grocery list.

Childhood obesity is a serious problem in the US. According to the Centers for Disease Control and Prevention, 14.7 million kids and teens—roughly 20 percent—are obese, which can put their health at risk if left untreated. Childhood obesity has been linked to numerous health conditions, including high blood pressure, diabetes, sleep apnea, and joint and back problems. In this episode of San Diego Health, host Susan Taylor and Scripps Clinic pediatrician Ann MacQuarrie, MD, discuss the possible causes of the childhood obesity epidemic in America, factors that increase a child's likelihood of developing obesity, and what parents can do to help keep their child healthy. Dr. MacQuarrie also outlines what kids and teens can do to create healthy habits and take charge of their health.

Autism spectrum disorder affects 1 in 59 children in the US. Symptoms of the neurodevelopmental disorder develop in very early childhood and can include limited eye contact, not smiling, not responding to their name, and difficulty speaking. ASD is a lifelong condition and can also trigger issues with social interactions, communication, and behavior. In this episode of San Diego Health, host Susan Taylor and Scripps Clinic pediatrician Megan Craig, MD, discuss autism spectrum disorder in children, how it's diagnosed, and treatment options. Dr. Craig also and debunks some common misconceptions about autism and outlines the importance of early intervention.

For minor health problems like muscle aches or slightly elevated blood pressure, lifestyle changes may be more beneficial than medication. Lifestyle changes, which can include adopting a healthier diet, getting regular exercise, and managing stress, may also have the power to prevent chronic diseases, such as type 2 diabetes, heart disease, and obesity, before they start. In this episode of San Diego Health, host Susan Taylor and guest Kosha Nathwani, MD, a Scripps Clinic family medicine doctor, discuss how physicians use lifestyle medicine to improve patients' health and quality of life, and how meaningful and long-lasting changes can treat, reverse, and even prevent lifestyle-related diseases. Dr. Nathwani also outlines the roles of specialists and support personnel like dietitians, physical therapists, social workers, and mental health professionals, in a comprehensive lifestyle medicine team.

Knee injuries are exceedingly common—even in younger people who stay active. This includes ligament sprains, meniscus tears, and patellofemoral instability. Injuries can happen both through trauma or wear and tear over time. Though an injury can sideline a young, active person, physicians and orthopedic surgeons have many treatment options. In this episode of San Diego Health, host Susan Taylor and Scripps Clinic orthopedic surgeon Tianyi “Tim” Wang, MD, discuss common knee injuries that affect active people, how they're treated, and how people can prevent common injuries from happening in the first place. Dr. Wang also outlines an innovative new treatment, called Bridge-Enhanced ACL Restoration, that uses an implant to heal torn ligaments.

For many people, getting rid of belly fat can be harder than it seems. Those last few pounds tend to hang around despite a healthy diet and exercise. Those with stubborn belly fat do have options though. Physicians can guide patients to beat belly fat for good via lifestyle changes, medication, or surgery. In this episode of San Diego Health, host Susan Taylor and Scripps Clinic endocrinologist and weight-management specialist Samantha Harris, MD, discuss what causes fat to accumulate around the waistline, what belly fat can mean for your health in the long run, and various ways to get rid of it. Dr. Harris also shares why supplements that claim to burn belly fat aren't all they're cracked up to be.

Eric Topol is a cardiologist, scientist, and author. Many twitter users will know Eric from his voice-of-reason tweets related to the covid pandemic. While Eric's exceptionally broad scientific work includes genetics and clinical trials, his main focus is on the ways in which artificial intelligence may change medicine as we know it. Creativity in this field, Eric explains, lies in exploring applications of AI that no one thought possible before, such as predicting the risk of heart disease from an image of the retina. In our conversation, Eric encourages any scientist to think big, to be counterintuitive, to go against the dogma. To find exciting new ideas, he suggests to think about how cool new tools could be used in ways that are not obvious – and then to test-market your crazy ideas by discussing them with experts in the relevant fields.Eric Topol is the founder and director of the Scripps Research Translational Institute, a professor of Molecular Medicine at the Scripps Research Institute, and a senior consultant at the Division of Cardiovascular Diseases at Scripps Clinic in San Diego.For more information on Night Science, visit https://www.biomedcentral.com/collections/night-science .

Local health officials have issued a warning that three viruses will likely impact San Diego County this winter. They're calling the impending influx of influenza, COVID, and respiratory syncytial virus(RSV) a “tripledemic” and are asking residents to protect themselves and their families with vaccines and other preventive measures. In this episode of San Diego Health, host Susan Taylor and guest Siu Ming Geary, MD, an internal medicine specialist at Scripps Clinic, discuss the viruses that comprise the tripledemic and the potential impacts of a simultaneous spike on this threatening trio. Dr. Geary also outlines the effectiveness of vaccines against the flu and COVID, and why an ounce of prevention is truly worth a pound of cure.

Epilepsy is a neurological condition marked by recurring seizures. Aside from bouts of uncontrollable jerking movements, its symptoms can include temporary confusion, inability to respond to sound or visual stimuli, and unusual emotional or physical sensations. In this episode of San Diego Health, host Susan Taylor and guest Scripps Clinic neurologist Michelle Van Noord, MD, discuss epilepsy, how it's diagnosed, who's most at risk, and treatment options. Dr. Van Noord also outlines what exactly happens during a seizure. Epilepsy is a treatable disorder and physicians have many tools available to help patients control seizures. For more information on epilepsy, click here. https://www.scripps.org/7521p

In this episode of San Diego Health, host Susan Taylor and guest, Scripps Clinic urogynecologist Varuna Raizada, MD, discuss what causes UTIs, whose most at risk, and treatment options. Dr. Raizada also outlines what steps women can take to prevent UTIs.

Joseph Weiss, MD Joseph B. Weiss, M.D. is Clinical Professor of Medicine in the Division of Gastroenterology, Department of Medicine, at the University of California, San Diego. Accepted to university at age fifteen, he attended the University of Michigan, University of Detroit, and Wayne State University. Reflecting his broad interests, he majored in Medieval English Literature, Astrophysics, and Invertebrate Zoology. Following his graduation from the Wayne State University School of Medicine in Detroit, Michigan, he completed his internship and residency in Internal Medicine at the University of California, Irvine Medical Center in Orange, California. Under the auspices of the World Health Organization and others, he has pursued interests in Tropical & International Medicine and Public Health with extended stays in Africa, the Middle East, and Latin America. Subsequently completing a clinical and research fellowship in Gastroenterology at the University of California, San Diego, he has remained active on the clinical faculty of the School of Medicine. Dr. Weiss is a Fellow of the American College of Physicians, a Fellow of the American Gastroenterological Association, and a Senior Fellow of the American College of Gastroenterology. Double board certified in Internal Medicine and Gastroenterology, Dr. Weiss has over forty years of clinical, administrative, and research experience. He has also served on the Board of Directors of the Scripps Clinic Medical Group, Clinical Board of Governors of the Scripps Clinic and Research Foundation, and Chancellor's Associates of the University of California, San Diego. He is the author of more than two dozen books on health (www.smartaskbooks.com) and has had numerous papers published in prestigious national and international medical journals, as well as in the mainstream press. As a medical consultant he continues to lecture widely, as well as provide personal guidance and advocacy to achieve optimal personalized health- care, with a focus on proactive preventive health for wellbeing, vitality, and longevity. Dr. Weiss is also an accomplished humorist and professional speaker having given over three thousand presentations nationally and internationally. He has presented at international conferences and conventions, universities, medical schools, hospitals and medical centers, Fortune 500 companies, YPO/WPO, Bohemian Grove, Esalen Institute, Renaissance Weekend, Aspen Brain Forum, international destination spas & resorts. Co-hosting a popular health care radio program on a major network affiliate in California showcased his skills as an articulate compassionate communicator with a mellifluous voice and calming presence. You can learn more about Dr. Weiss at http://www.smartaskbooks.com/.

https://www.lifestylelocker.com/Athleticism I bet you never thought about how your performance can be impacted by things you can't see. In today's show, we talk about just that.  Justin Frandson is a proponent of helping people unleash their human potential by being HUMAN POWERED.  You're going to love the tools he uses with his clients.  I actually have the EMF Rocks in my office, my travel bag, and in my bedroom! Here's more about him! In early 1998, Justin Frandson read an article in the newspaper about one of the greatest pioneers of Sports Performance, Dean Brittenham at Scripps Clinic, La Jolla California, making athletes better athletes through the most creative approaches. The article raved about the track-based speed and power program with stretching, coordination drills, ambidexterity, balance, strength, and more. Justin visited the prestigious location and started his passion and gifts for facilitating athletic development with athletes and teams of all ages and levels. The article spoke of high school athletes becoming D1 athletes and D1 athletes turning pro. Justin's past and current clientele list consists of many of the highest-ranked professional athletes in the US. He has recently rolled out numerous successful products to complement this incredible program. Whether you pick up his ATHLETICISM book, MCT Palm Oil, Grounding Bags, JumpBand, or do his program, your performance and health will exponentially improve. His creative approach garners longevity, and fun with undeniable results. The results are instant and tangible in every athlete, no matter their sport. The workouts take even the best athletes in the world out of their coordination comfort zone, to develop more neuroplasticity, in turn developing more pathways from the brain to the body. This infinite flow consistently brings athletes and performers to their ideal Alpha brainwave state for superior performances. This nerve work and brain coordination entrainment to develop performance is the essence of ATHLETICISM. In addition to Justin being blessed with an exceptional mentor who was one of the foremost pioneers in Sports Performance, Justin has the innate gifts of developing human performance and seeing things others don't. He has the gifts of intuition and healing to facilitate optimizing nerve health for injury prevention, recovery, and performance. His sensory nerve treatments for vision and spatial awareness double as concussion protocol. He is known for facilitating getting sports concussions back faster than ever. Justin is one of the only Performance Coaches in the country doing hands-on nerve treatments for performance. These treatments called, Athleticism Neuro Stacking, quantifiably get your motor nerves to fire faster equating to about a 20% increased strength instantly. The Primal Reflex Release Techniques rid pain and stiffness. The assisted stretching sessions are your warm-up, recovery, and a new lease on life and anyone's career. Sound, light, and frequency are his go-to modalities. You will find more in-depth information in his ATHLETICISM Whole Body + Whole Brain = Performance book. Every component, product, exercise, and protocol has been proven and is so thought out at the deepest level to build upon a solid, aware foundation. It is fun, challenging, and feeds your soul. Connect HERE with Justin: GET 10% off your order with code: HUMANPOWERED https://athleticism.com/humanpowered https://emfrocks.com/humanpowered   CONNECT WITH US: https://www.lifestylelocker.com/Athleticism Proucts we like>  https://www.amazon.com/shop/lifestylelocker https://www.LifestyleLocker.com/ www.NewYorkChiropractic.com www.Facebook.com/lifestylelocker www.facebook.com/NewYorkChiropractic www.instagram.com/drjoshhandt www.Rumble.com/DrJoshHandt www.linkedin.com/drjoshhandt  

In this episode we are talking to Prof Eric Topol. Eric is a cardiologist by training, a basic scientist in the areas of personalized genomic medicine at the interface between genetics and digital health and is the author of the leading textbook in interventional cardiology in addition to authoring books on AI in medicine. He is the founder and director of the Scripps Research Translational Institute, a professor of molecular medicine at the scripps research institute and a snr consultant at the division of cardiovascular diseases at Scripps Clinic in La Jolla CA. Finally, he is editor in chief of Medscape and theheart.orgSince the COVID pandemic hit Eric has been an outspoken advocate of basic research and optimized paths for COVID drug discovery and development. He has written numerous pieces on COVID and our response to the pandemic in addition to calling out and correcting mis and dis information. His most recent piece, an editorial in the LA Times, continues to draw attention to the low vaccination and booster rates here in the US.Today we discuss the evolution of COVID virus and the most recent BA5 variant. The data continues to be sobering with the increased emergence and dominance of new variants. Eric highlights the importance of the vaccine, boosters and the need to develop a universal vaccine to tackle this pandemic. We also discuss Paxlovid and the rebound that is being observed in around 20% of patients. Finally we touch on the issue regarding disinformation around scientific discoveries in todays world and the need to build systems to actively call this out and quickly correct before it becomes “fact”.To lighten the mood, or so I thought,  at the end we turn to AI and its role in our health system. Touching on some key considerations around AI consciousness that has been in the news of late.

Welcome to The Sports Docs Podcast with Dr. Catherine Logan and Dr. Ashley Bassett. On each episode we chat about the most recent developments in sports medicine and dissect through all the noise so you know which literature should actually impact your practice.On today's episode we're focusing on cartilage defects of the knee with Dr. Clayton Nuelle, Assistant Clinical Professor at the University of Missouri and team physician for Mizzou athletics. His current research focuses on improving cartilage restoration and joint preservation techniques, so we are very excited to have him join us for our discussion today.We have some great articles for you that contribute well to our conversation on the surgical treatment of knee cartilage disease.We start with a discussion of osteochondral lesions in the pediatric population. Will Bugbee and his team at Scripps Clinic in California authored a case series titled “Osteochondral Allograft Transplantation of the Knee in the Pediatric and Adolescent Population”. They reported 90% graft survivorship at 10 years post-op. Of the five grafts that failed, four successfully underwent a salvage surgery with another osteochondral allograft. 88% of knees were rated as good to excellent with an 89% satisfaction rate. The authors deemed OCA to be a safe and effective procedure for pediatric patients with large osteochondral defects.Then, from the December 2021 issue of Cartilage, we discuss the comprehensive review article by Andreas Gomoll and colleagues titled “Algorithm for Treatment of Focal Cartilage Defects of the Knee: Classic and New Procedures.” This paper nicely details a treatment approach based on cartilage lesion size, location and presence of underlying bone involvement. We finish up our conversation with a focus on rehab and returning to play after cartilage restoration procedures. The last article we reference is a systematic review published in AJSM 2009 titled “Return to Sports Participation After Articular Cartilage Repair in the Knee.” Kai Mithoefer et al reported an overall return to sports rate of 73%, with the highest return rates following OATS. Yet, the highest durability to continue playing at the preinjury level of play was following ACI at 96%. There were numerous factors that impacted an athletes ability to return to sport. Younger patients, those with pure cartilage lesions rather than osteochondral lesions, duration of symptoms less than 12 months pre-op, smaller lesions under 2 cm, lesion location at the lateral femoral condyle, no prior surgeries and no concomitant procedures were all associated with increased return to play.

Riz Hatton delivers the latest news on the Spine and Orthopedic industry.

Carpal tunnel syndrome or CTS results from pressure on a nerve that passes through the wrist area on the palm side of the hand. It causes numbness and tingling in the thumb, index, middle finger, and sometimes half of the ring finger. In this video, San Diego Health host Susan Taylor and guest Lorenzo Pacelli, MD, an orthopedic surgeon at Scripps Clinic, discuss treatments for carpal tunnel syndrome as well as causes, risk factors and symptoms. Learn more: www.scripps.org/7406p        

Justin Frandson is an Athleticism Performance Coach that has worked with amateur and professional athletes for over the past two decades. He saw his athlete breaking down from the excessive levels of EMF from their SMART watches, wireless earbuds, and electric cars. He has tested hundreds of homes and clients. He sells the Grounding and Faraday Bags at doctor clinics throughout the country. The Grounding Bags are hand mined crystals with moisture and magnetic properties to ground and repel EMF, all for a deeper night's sleep. This is Mother Nature's way of protecting us from the excess rollout of man-made radiation, not a man-made device attempting to keep up with the other man-made levels.    Justin is also the Founder of Athleticism.com. He is one of the most respected, nationally certified, Health/Performance Coaches in the country. His career started over 22+ years ago at Scripps Clinic, La Jolla, CA. This seasoned industry experience and learning has exposed him to many of the greatest systems in human performance.  Justin graduated from the University of Southern California (USC) in 1994. He holds a Bachelor of Science Degree from the School of Business (Entrepreneur) and studied Exercise Science as Minor. He also was a certified Emergency Medical Technician (EMT) from UCLA in 1994. He is an Aaron Mattes Active Isolated Stretching Therapist (AIS). He is certified in the Gonzalez Muscle Reset Technique (GMRT). He is an Athleticism Performance Coach (APC). He completed three intensive levels of John Iams, P.T., Primal Reflex Release Techniques (PRRT) courses. He is well versed in The LifeLine Technique. He is Certified in CPA, First Aid and AED. He is American College of Sports Medicine Nationally Certified as a, CPT. He was featured in the Documentary Movie ‘Vitality'. Just sells his EMFRocks.com Grounding Bags to doctor clinics across the country. He is an expert in Nerve Health. He can stabilize an individual instantly and get rid of that injury state, especially when it won't go away. Justin has been deemed many things over his career by Doctors and experts; Neuro Reflex Consultant, Coordination Mentor, Olympic Lifting Coach, Speed Coach, Jump Coach, Biomechanics Expert, EMP Expert and more. Hist focus now is stabilizing an individual faster than ever and getting rid of injuries, discomfort and stiffness in record time… all through Nerve Health and his ATHLETiCiSM Neuro Stacking programs.  On this episode, Celeste and Justin deep dive into:  + What is EMF and how to protect yourself from it  + Why EMF is so dangerous for our health and overall wellbeing  + Natural ways to ground yourself  + Why he created his EMF rocks  + Detoxing the body  + Signs and symptoms from too much EMF exposure    For more on Justin:  Instagram Athleticism website  & to purchase his book Purchase EMF Rocks 

Heart failure, the life-threatening condition that affects more than 5 million people in the US. Dr. Ajay Srivastava, a cardiologist with Scripps Clinic, discusses how to diagnose heart failure, the different types of heart failure, symptoms and treatment. Learn more: https://www.scripps.org/7361p 

In this episode of San Diego Health, host Susan Taylor and Mark Takata, MD, a Scripps Clinic surgeon who specializes in minimally invasive bariatric surgery, discuss life after weight loss surgery, including long-term effects, required lifestyle changes and more. Learn more: www.scripps.org/7347p

In this episode of “Keen On”, Andrew is joined by Dr. Eric Topol, Substack's newest writer in residence. Eric Topol is an American cardiologist, scientist, and award winning author. He is the founder and director of the Scripps Research Translational Institute and a senior consultant at the Division of Cardiovascular Diseases at Scripps Clinic in La Jolla, California. He is editor-in-chief of Medscape and theheart.org. He was also commissioned by the UK 2018–2019 to lead planning for the National Health Service's future workforce, integrating genomics, digital medicine, and artificial intelligence. Dr. Topol has received hundreds of millions of dollars in research grants from the National Institute of Health. Visit our website: https://lithub.com/story-type/keen-on/ Email Andrew: a.keen@me.com Watch the show live on Twitter: https://twitter.com/ajkeen Watch the show live on LinkedIn: https://www.linkedin.com/in/ankeen/ Watch the show live on Facebook: https://www.facebook.com/lithub Watch the show on YouTube: https://www.youtube.com/c/LiteraryHub/videos Subscribe to Andrew's newsletter: https://andrew2ec.substack.com/ Learn more about your ad choices. Visit megaphone.fm/adchoices

There is nothing more exciting and life-changing than finding out you're expecting – and when you're expecting more than one, the joy is magnified. If you are expecting twins, triplets or more children, you may need a higher level of prenatal care. On this episode of San Diego Health, host Susan Taylor speaks with Sean Daneshmand, MD, medical director of the Perinatology Program at Scripps Clinic, about what to expect with multiple pregnancies. Learn more: LINK

CardioNerds (Amit Goyal and Daniel Ambinder) join CardioNerds Ambassadors Dr. Pablo Sanchez (FIT, Stanford University) and Dr. Christine Shen (FIT, Scripps Clinic) for a discussion with Dr. Bob Harrington (Interventional Cardiologist, Professor of Medicine, and Chair of the Department of Medicine at Stanford University) about diversity and inclusion in the field of cardiology. This episode discusses Dr. Harrington's broader approach to mentorship, sponsorship, and allyship; and particularly how (and why) he used his position as the president of the American Heart Association to advocate against all-male panels, or “manels.” Listen to the episode to learn the background and motivations behind his evidence-based efforts to make Cardiology a more inclusive field. Special message by California ACC State Chapter President, Dr. Jamal Rana. The PA-ACC & CardioNerds Narratives in Cardiology is a multimedia educational series jointly developed by the Pennsylvania Chapter ACC, the ACC Fellows in Training Section, and the CardioNerds Platform with the goal to promote diversity, equity, and inclusion in cardiology. In this series, we host inspiring faculty and fellows from various ACC chapters to discuss their areas of expertise and their individual narratives. Join us for these captivating conversations as we celebrate our differences and share our joy for practicing cardiovascular medicine. We thank our project mentors Dr. Katie Berlacher and Dr. Nosheen Reza. Video Version • Notes • References • Production Team Claim free CME just for enjoying this episode! There are no relevant disclosures for this episode. The PA-ACC & CardioNerds Narratives in Cardiology PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Video version - Diversity and Inclusion https://youtu.be/SnUadVRhH70 Quotables - Diversity and Inclusion “If senior men don't change the field, it's not going to change. We have the senior positions. We have to change it.”“You're missing talent. You're missing talent of the women who have decided not to go into Cardiology. I say to a lot of my male colleagues...don't you care about the health of our specialty? Don't you want the very best people going into it?”“How great is that--to open up an artery in the middle of the night?... What could be better than that?...Why would you not want to be a cardiologist? Frankly, maybe the field is not so friendly to women...And that bothers me greatly because I love the specialty.”“To those who have been given much, much is expected. That's what people like me should do.”Dr. Bob Harrington Show notes - Diversity and Inclusion What are the gender disparities in the field of Cardiology? 45.8% of residents and fellows in ACGME-accredited programs are women. 14.9% of cardiologists are women. 8% of interventional cardiologists are women [1]. 30.6% of male faculty were full professors, while 15.9% of female faculty are full professors [2].Men are more likely to be influenced by positive attributes of a field, while women are more likely to be influenced by negative attributes [3].3% of percutaneous coronary interventions in the United States are performed by female operators [4]. What is mentorship, sponsorship, and allyship? A mentor provides advice and helps someone develop a skill.A sponsor is an advocate who helps someone secure career advancement opportunities.An ally partners with people, utilizing their power and influence to champion the rights of others [5].According to some studies, women report less sponsorship experiences than men. Additionally, in women it seems to translate less frequently into experiences that further their career (speaking engagements, serving on editorial boards, etc) [6].“I'm a mentor to a few people, I'm a sponsor to many, and I'm an ally to all.” - Dr.

In this episode we discuss low carb diets.  A simple Google search or jaunt through social media will show you that low carb diets are getting a lot of attention, both as an effective approach to weight loss and a means to maintain good overall health. But what does a low carb diet actually mean? What can you eat and what should you avoid? Are there risks involved? Who should avoid these diets? And are low carb diets sustainable for the long haul?  To answer these questions, we turned to an expert on low carb diets.  Dr Bret Scher is a board certified and licensed cardiologist.  He completed his undergraduate studies at Stanford University and earned his medical degree from Ohio State University.  He subsequently completed his residency training in internal medicine at Mercy Hospital in San Diego and a fellowship in cardiology at the Scripps Clinic. Aside from his busy private cardiology practice, Dr Scher is also the medical director of dietdoctor.com and hosts the Diet Doctor Podcast.

Dr. Nagourney discusses how, in January of 1985, while a fellow at Scripps Clinic in La Jolla, California, he conducted the original laboratory experiments that tested 2-CdA against hairy cell leukemia, showing for the first time that this drug was highly active in this disease.

Dr. Marvin Singh is the founder of Precision Clinic, and one of only a few integrative gastroenterologists in the United States. After graduating from Virginia Commonwealth University School of Medicine, he went on to do his internal medicine training at the University of Michigan Hospital. After which he completed a gastroenterology hepatology fellowship at Scripps Clinic, Torrey Pines. He then went on to fulfill a fellowship in integrative medicine and was trained by Dr. Andrew Weil at the Andrew Weil Center for Integrated Medicine in Tucson, Arizona.  In addition to being a sought-after speaker and consultant, Dr. Singh had been featured on ABC News, Readers Digest, Sirius XM, radio, and many other platforms. And here today to talk about the keys to a healthy lifestyle and his new book, Rescue Your Health, is Dr. Marvin Singh. Dr. Singh, how are you today? Dr. Marvin Singh: I'm all right, how are you? Good morning. Vincent Ferguson: Before we talk about the keys to a healthy lifestyle and your new book, Rescue Your Health, tell my listeners and viewers where did Doctor Singh grow up and when did you know you wanted to be a medical doctor? Dr. Marvin Singh: Well, I'm an east coaster actually. So that's why I actually know what fall feels like. I was born in Virginia and grew up in Northern Virginia and lived there most of my life, all the way through college and medical school even. And then I started moving around a bit after I finished medical school and went on to residency at the University of Michigan. So, that's where I grew and I guess I always knew I wanted to be a doctor from a very young age. Dr. Marvin Singh: I always tell the story that our sixth grade elementary graduation had a theme and the theme was hopes and dreams. And I remember we had to draw our own silhouette. I don't even know how I drew that because I'm a terrible drawer, but I guess I did it one way or the other, my parents still have it. And basically you have your shadow and you draw your silhouette and then on the bottom you had to write, "My hopes and dreams are" ... and everybody had to fill that in. And way back then I wrote, "To become a doctor." So I guess from a very early age, I've always known that I wanted to do something that was able to help people and help people feel better. Vincent Ferguson: Wow. So do you have role models though, who basically gave you the feeling that you want to be just like them? A lot of us have role models that we want to be like. Dr. Marvin Singh: Yeah. I mean, throughout my career, I guess I've had different kinds of role models. But from an early age, obviously my parents are role models for me and taught me about work ethic and doing good things for people. I have a few doctors in my family, an uncle and an aunt who were role models to me early on. I guess that helped get me excited about medicine. My aunt and uncle both, I remember, I don't remember how old I was, but I must've been really young. I remember, you have to do these little reports or book reports and things like that on different topics when you're in grade school. I remember they used to send me little medical pamphlets and look at my reports and help me write them and stuff like that. So, from a very young age, I guess I had some influence from medicine, I guess. Vincent Ferguson: Oh yeah. But you know, you're not just an average, regular, conventional doctor. You practice integrative medicine. What's the difference between the two? Dr. Marvin Singh: Well, as Dr Weil says, "Integrative medicine is just good medicine." And that's what I learned along the ways. When I started my career as a gastroenterologist, I realized that something was missing from how we practice medicine and in what we do for people. We were really good at saving lives and doing things like that when somebody is really sick, but what about the majority of people who have ongoing recurrent symptoms or issues? What about them? Why do they keep going from doctor to doctor, to doctor all the time? That was frustrating to me early in my career. I'm just realizing that you don't get that kind of exposure when you're learning or training or anything like that. But once you're out in the real world and you get a taste of what it's really like out there, I felt a little lost, actually. Dr. Marvin Singh: I found Dr. Weil and integrative medicine and started learning a little bit and then enrolled myself in the fellowship and learned a lot about a lot of different things that I hadn't known about before or really appreciated before. That really made a big difference on me personally, and on how I take care of patients, in general. Integrative medicine allows you to do whatever you're going to do normally as a regular conventional doctor, but then also have an understanding that the person in front of you, the person you're taking care of is a human. It's a real person with emotions in an environment, with a family, with stressors, with dietary issues. Dr. Marvin Singh: I don't think we really ... I mean, I think we know this as doctors, but I don't think we appreciated or paused to think about it. We just usually are more in the go, go, go mode. Patient X is in front of you with X,Y,Z symptoms, so you're going to respond with A,B,C solution and that's the end of the story. "Adios, see you later." But that's the reason why a lot of people continue to have problems is because the actual problem is not addressed. And so integrative medicine allows us to do that. Vincent Ferguson: Wow. I know that in conventional medicine, I was always told, 'There's a pill for every I'll." But with what you're doing, it seems like you're looking to address the person holistically and really get down to the root cause of the problem. Dr. Marvin Singh: Yeah. Even if you need a pill for your I'll, right now, let's find out where that ill is coming from so you don't need the pill anymore, maybe. Vincent Ferguson: Yes. Very good. Very good. Now here at Six Weeks of Fitness, we normally talk about the importance of exercise and nutrition if you want to achieve optimal health. But is that really the definition of optimal health, exercise and nutrition, or is it more to it than that? Dr. Marvin Singh: There's more to it than that. I think that's also part of the place where we get lost. I mean, as a gastroenterologist, we see people who have issues with their weight or fatty liver. I remember in my notes in the early days, the default is diet, weight loss, exercise, diet, weight loss, exercise. You just write that down and you say, "Hey, you need to get on a better diet, lose some weight and exercise." And that's literally what you tell people. And they're like, "Okay, I already knew I was fat. So, that doesn't really get me anywhere." Vincent Ferguson: Very true. Dr. Marvin Singh: You know, I'm big on personalization. So personalizing that approach is one part of it. But diet, what kind of diet? How are you going to lose the weight? Diet is important, obviously, exercise and movement is important, but somewhere a lot of other things. Your sleep hygiene, how you're reducing stress, how you're mitigating toxins in your environment and even how much fun you're having in life and what the status of your social relationships are. These all, believe it or not, can influence our gut health, our microbiome and our overall wellbeing. And these are all risk factors for a lot of chronic inflammation that many of us have. Dr. Marvin Singh: And so addressing those is also important and if you don't, you're missing the piece. I mean, I tell people, if you say, "Okay, I'm going to change my diet. I'm going to go vegan. I'm going to lose weight and for breakfast, lunch, and dinner, I'm just going to eat broccoli." Dr. Marvin Singh: And, "Okay you went vegan, you're eating vegetables, good job, good job." But first of all, your diets not diverse so, that's not really good. And there's more to it than that. Because if you talk to the person and you find out that they're only sleeping four hours a night and they have anger management issues and a lot of built up frustration and stress over the years, they're not going to lose weight. It doesn't matter if they're only eating broccoli all day long. This is only part of the puzzle. Vincent Ferguson: Wow. So that, to me, you're giving me a list of things that you need to do in order to achieve a healthy lifestyle. So it's more than just diet and exercise. You said, it's sleep, it's social interaction, it's stress relief, all kinds of things. Dr. Marvin Singh: Because remember, what are we trying to lose weight from? Our body. What is our body? Our body is not just a singular issue. There are so many things happening inside of our body. I tell people what's happening inside of your body, just imagine you get a snow globe, right? And the snow globe has many snowflakes in it. And you say, weight loss, just like, what do they have those magic eight balls, when you say something and you shake it? You say weight-loss, and you shake this snow globe. You see all the snowflakes flying around everywhere. If you want to know how to lose weight, the answers are in all those snowflakes and how those snowflakes are interchanging with each other. Dr. Marvin Singh: So how could it just be diet as the only thing. Diet may be one snowflake, but there are other things going on there too. There are mineral, vitamin issues. There may be stress issues. There may be medications that you're taking or not taking. There's a lot of things involved and the relationship and the interchange between all of those snowflakes, that's what creates that new balance you're looking for. If you're not looking at all those things, you're missing part of the puzzle. Vincent Ferguson: Right. So you look at a diverse amount of things to come up with a conclusion of what it is, the problem with the patient. Dr. Marvin Singh: Right. Vincent Ferguson: Is that what you do at Precision Clinic? Dr. Marvin Singh: That's exactly what we do at Precision Clinic. We look at as many different elements of health and life as we can to try to personalize a program for somebody for optimal health. Vincent Ferguson: What is the connection between your gut and chronic disease? Dr. Marvin Singh: That's a great question. There's a big connection because our immune system is obviously the big controller of inflammation and a lot of chronic disease comes from chronic, low grade inflammation. And where does a majority of our immune system sit? The majority of our immune system sits in the digestive tract. At least 70% of our immune system is in the digestive tract. When we say digestive tract, we're not necessarily just referring to the organ itself, but what lives inside the organ? That's what the microbiome is called. The gut microbiome is the forest or ecosystem of trillions of bacteria that live inside of our digestive tract. And these little guys are the ones that manage all of these things. And so we take care of them in the proper way, and they'll take care of us back in the proper way. Vincent Ferguson: So how do we take care of them, Dr? I want to know, man. Dr. Marvin Singh: That's the magic question, right? So understanding what's going on with them and who they are and what their balance is, is part of the process, because it's hard to build a house without a blueprint, unless you're some genius or something. But you still need to know what parts you need and you have to order those parts and put them together in the right way, assemble them the right way. So, investigating your body and some of the different elements is part of the process. And then sometimes it's not really that complicated of a process. The body is very complicated, yet simple at the same time. That's what makes it cool. The microbiome responds to stress reduction, to optimal diet, to sleeping properly, to exercising. All of these things are associated with microbiome balances. So if you do these things, nicely, in accordance with what your body needs, then your microbiome will find a way to more of what we call a homeostasis or an even balance. When that happens, then good things happen to your body. Vincent Ferguson: Hmm. What are your feelings about probiotics? Dr. Marvin Singh: So probiotics are bacteria that we can take as a pill or a supplement form that could help keep or create a balance or improve the balance in your microbiome. Different probiotics may be appropriate for different people and sometimes probiotics are not necessarily the right answer at the moment for somebody. It really depends on what their symptoms are and what's going on. But I often do use probiotics to help create a balance in patients, in their microbiome, if their microbiome suggests that. Dr. Marvin Singh: The other thing is, you don't always necessarily have to take a pill of a probiotic, you can eat probiotic foods. And I like that as an option often, because not only do you get to fill your belly and eat something healthy and get the nutritional value of that food, but then you also give yourself a dose of good bacteria at the same time. So, sometimes that's a really good option as well. Vincent Ferguson: I remember reading a quote from Hippocrates that said, "Let food be your medicine and medicine your food." So is that what he was alluding to? Dr. Marvin Singh: Exactly, he also said all disease begins in the gut and, and I always joke and say he probably didn't know what in the world he was talking about, but he was totally spot on. This guy was way, way ahead of his time. Vincent Ferguson: Way ahead of his time. That's amazing. Now, and speaking of health nutrition, all that good stuff, can you determine what nutrition needs a patient has by their genetic makeup? Dr. Marvin Singh: We can start to do that now, yeah. We can do a genetic test that can help us understand what potential deficiencies you might be prone to, compared to the average person or somebody who doesn't have a particular genetic mutation. And if we have an understanding of that, then we can try to eat accordingly so that we can avoid those nutritional deficiencies. That's really one of the main things to underscore with regards to precision medicine. That it's really designed to help you prevent getting a problem or developing an issue later on. If you know that, "Hey, I have a gene that that's going to give me a higher risk for vitamin D and calcium deficiency," and, you know you may be at higher risk for osteoporosis or osteopenia later in life, then you're going to want to eat accordingly. You may want to make sure you really stay on top of your vitamin levels. You want to make sure you do weight bearing exercises. You can do all those things and then you can try to prevent and avoid developing osteoporosis later on in life. Dr. Marvin Singh: But if you never knew about it, then you're just going to go about doing whatever you were going to do. And then it's rolling the dice in whether something happens or not. Vincent Ferguson: Exactly, and speaking of vitamin D, I understand that's very important to immune health. What other supplements do you recommend? Dr. Marvin Singh: Vitamin D is very important. A lot of us actually do have vitamin D deficiency. Doing a lot of genetics, a lot of people actually have a genetic mutation for vitamin D deficiency too. So perhaps there's a common thread in a lot of people there. Dr. Marvin Singh: What supplements somebody takes really depends on who they are, what their purposes are, what their goals are, what they need, what medicines they're on, what diagnosis they have. Because you have to take a lot of that into consideration because you want to make sure that you give proper treatment. I tell people, "Supplements, yes, they're natural therapies. Yes, they're available over the counter. Yes, you don't need a prescription for them, but you should treat them like medicines too." That's, I think, one of the things that sometimes, maybe people don't appreciate as much. Dr. Marvin Singh: You may just go to the aisle in Whole Foods where all the supplements are and be like, "Oh yeah, look, this says vitality. Let me grab one of those. Oh yeah. This says digestion. Let me grab one of that. Let me grab one of this." And then you walk out with five, six different things. And I see people all the time, it's not any wrongdoing on their side, it's just that maybe we don't appreciate it as well, and some of these things can actually cause problems to your body. Some of these things, when you combine them together, can actually cause problems. You may not have known that. Dr. Marvin Singh: For example, you may say, "Oh, I have anxiety, so I'm going to drink this kava tea. But I'm going to go out for some drinks later on this evening and I had my kava tea earlier this morning and I feel great." But you know what? Kava and alcohol don't mix together. You can really hurt your liver that way. So really, it's important to make sure you are taking something for the right reason. Just like you wouldn't go to the store and say, "Oh, let me grab some Lipitor while I'm there because I think my cholesterol is high." You want to make sure that you need it, right? Vincent Ferguson: Yeah, most definitely, most definitely. So how does one determine what supplements are good for them? Dr. Marvin Singh: Well, a lot of times it's good to do an evaluation with a doctor and see. Do you need particular kinds of vitamins? Do you have inflammation? Do you have joint aches or pains? It all depends on what's going on there. For general health, taking a multivitamin or a B complex vitamin, sometimes is helpful. A lot of people take vitamin C and vitamin D and things like that for their immune system. So those are some of the basics. A lot of times people may take turmeric supplements if they have arthritis or they're concerned about inflammation. So there are different kinds of things that people may use based on what their issues are, or priorities are. Vincent Ferguson: Excellent. Excellent. Now, if someone has, let's say cancer or heart disease in their family, does that mean that they are going to be predisposed to having heart disease and cancer themselves down the road? Dr. Marvin Singh: Well, it's a risk factor and life's all about risk and understanding the risks. Sometimes there's a genetic basis to things and sometimes there's not. Sometimes people can sporadically develop a malignancy and maybe there is no genetic basis. Or maybe they're the first person in the family who's going to have the problem, we don't know. But family history is important to look at because it helps us understand what your potential risks might be. If your dad had a heart attack at 40 and your dad's dad had a heart attack at 40, and his dad had a heart attack at 40, then it's probable that you have a family history or some genetic mutation in this family history that is contributing to this risk coming down the male line in your family for heart disease. And so if you understand that gene, if you do a test and you understand that gene, what the problem is with that gene, and then try to do some research or understanding, has anybody done any investigations into what things could be done in people who have that gene defect, then maybe you can try to mitigate that problem. Dr. Marvin Singh: And you can also understand what you can do to prevent that problem from happening. Because I tell people, "Just because your dad and your granddad had a heart attack at 40 does not mean that you have to have a heart attack at 40. It's not a life sentence." Our genes are basically our blueprint, but they're not our destiny. They don't dictate what must happen to us. There's more to it than that, interestingly enough. Dr. Marvin Singh: On top of our DNA is what we call the epigenome. And the epigenome is you can think of it as light switches on the genes. And just because the gene is there, just because you have the light switch on your wall, doesn't mean the lights on. Doesn't mean the light has to be off either. There are things that can turn these genes on and off and understanding the gene and understanding what you can do to switch the gene off or not, contributes to the development of a certain problem. That's the important part. Vincent Ferguson: Now let's talk about your book, Rescue Your Health, because even talking about now, I'm sure your book probably goes into more detail about it. What can my listeners and viewers learn from reading your book? Dr. Marvin Singh: Well, I wrote Rescue Your Health because I wanted everybody to know that precision medicine, number one, doesn't have to be a scary topic. I think people think, "Oh, DNA and imaging tests and microbiome. This is too much for me. It's hard enough for me to navigate regular doctor visits, but I can't do this one." Dr. Marvin Singh: So I really try to make it simple and help people understand that it doesn't have to be a scary topic. It can be very useful. It can be more useful than a lot of other types of things that we may do in medicine. And a lot of the tests that you can do to understand your body a little bit better, they're not necessarily these multi thousand dollar tests and some of these are quite affordable. Dr. Marvin Singh: One of the chapters in the book is My Top Five Tests and the reason why I have My Top Five Tests, I made a chapter on that, is because I wanted to show people that all these tests that are there are within a couple or $200-$300 range. And so you can do a lot of things for a pretty affordable price. We often go out and go to dinner and spend $200-300 on maybe a good meal, but may leave you bloated in with heartburn, but it might've been good when you ate it. But you could spend that $200 and learn about your genes and learn how to eat for your life and that could make a huge impact on how you live your life for the whole time moving forward. Dr. Marvin Singh: And so, you know, it's really about bringing realization to that process. I wanted to really simplify it and not make it scary. This book is for everybody. This is what I say in the opening chapters. If you're a human and you're able to hold this book, then this book is for you. There is something in it for everyone. I really help try to explain what are some of the different tests and then give some real life examples about different kinds of people who've come to see me over the years. What their issues were and how we're able to apply some of the principles that we're talking about here and earlier in the book and what happened with them as a result. So, that was really the main point in the book, is really to help people understand that there are ways that we can understand our bodies on a more meaningful level. The science is there, that we can now start understanding our health from a little bit of a different viewpoint and make some big impacts. I tell people that there's two kinds of doctors. There's the kind of doctor that if you're in a burning building, this doctor is a firefighter. He'll run into that building, he's the first responder. Doctors were first responders too, on the healthcare front. And he'll go into that burning building and he will save you, he or she, will go and save you, pull you out of that building. And we need those doctors. We will always need those doctors because life happens. I practice that kind of medicine too. But then there's the other kind of doctor that'll say, "Hey, look buddy, why in the world were you anywhere near that building in the first place, man? You shouldn't be there. And this is how I'm going to help you understand how not to be there. And this is how we're going to help you avoid being in this situation, in the future." Now, which way do you think is probably better for your longevity? I think it's better to understand how you can avoid those burning buildings because the more burning buildings you're in, eventually over time, it puts a little extra wear and tear on your body too, right? Vincent Ferguson: Exactly. Yes, yes, yes. So, that is the key. How does your family feel about you practicing integrative medicine as opposed to conventional medicine? Dr. Marvin Singh: Well, first of all, I do both actually. I still practice as a general gastroenterologist. Go to a hospital and take care of sick patients there. People need that kind of help too. But the part that I am most passionate about, obviously, is the preventive medicine and the integrative part. They're very supportive, actually. Without my wife, I probably wouldn't have ever made it to this part because she's the one who helped me realize that the something that I was missing in the way that we practiced medicine was this. She was a little bit more forward-thinking earlier than I was. Vincent Ferguson: Ah, nice. That's how you know you married right. How can we order the book? Dr. Marvin Singh: Yeah. So the book is out. It's called Rescue Your Health and it's on Amazon. It's also on Barnes and Noble and a couple other places as well. But Amazon is one of the main places that the book is available on and it's out now. You can get on Kindle also. Vincent Ferguson: Okay, excellent, excellent. It just seems like a book that the timing couldn't be better. It couldn't be better than right now. Dr. Marvin Singh: Exactly. Yeah. I mean, I think COVID-19 has been real terrible on everybody in the whole planet. I think moving forward in the years to come, it's very important for people to understand that there are certain things in our body, risk factors that can potentially make us sick or be more prone to be sick. Not just for COVID, but for other things. But I think if you try to look at, was there anything that maybe came out of COVID that we can learn from, this is one of those lessons. One of those lessons is that, what's going on inside our body is a risk factor for who gets sick or how sick they could get. Vincent Ferguson: Yes, yes. We've taken it for granted, it seems for many years. Dr. Marvin Singh: Yeah. In many of us, integrative and preventative medicine doctors have been talking about this for a long time, but I think that this was just a rough lesson that helped bring the understanding to the whole world, all at the same time. I think everybody knows now that vitamin D deficiency and antioxidants and these kinds of things, being overweight and diabetes and heart disease and your diet and exercise levels and all those things, I think we all know, universally essentially, that these things are risk factors for getting sick at the most basic level. Because we're seeing it in real life, in front of us. Vincent Ferguson: Yes and it's time to do something about it. Dr. Marvin Singh: Have to do something about it. Vincent Ferguson: Yes. I also understand, Doc, that you do some charity work for an organization in New York, my hometown. Talk about that. Dr. Marvin Singh: Yeah. So this is really fun. There's a wonderful organization called Bottomless Closet in the city. They help women who are coming out of tough, difficult situations. Women who are in need of assistance in getting a job and getting back on their feet. I became the health advisor for Bottomless Closet, and I do free webinars for groups of these wonderful women and teach them about health and wellness and what they can do to get back on their feet as far as being healthy. Because it's hard to get a job, be successful at a job and try to turn your life around if you're not feeling well and you're sick. So health is very important part of that process too. Dr. Marvin Singh: And then also, if there's somebody who needs help from a doctor, I also donate my time to help that person as their doctor, free of charge and I help them get these precision medicine testing done through various different companies. I give a shout out to Microbiome Labs and Nutrogenomix, helping donate free testing kits to these patients. Several different companies have also helped me get free supplements for these wonderful women, as well. Enzymedica I have to give a shout out to as well, because all I have to do is just type out a list. This person needs this, this, this, this, and this, and they mail it to them. Vincent Ferguson: Wow. So that's amazing. Now you do this virtually? Dr. Marvin Singh: Yeah. Vincent Ferguson: That's amazing, but that's also wonderful that you do that. That you give back like that, I know you're very busy with your schedule, with so many people in need. Just showing how much humanity matters. Dr. Marvin Singh: Yeah. Everybody deserves to have access to this level of care, to understanding their body this way. And if certain people really need it and they can't afford it because of their personal situation, I mean, if they can barely afford to eat, you know, we want them to not spend all their money on that. They need to focus on their life and getting back on track because all that other stuff will follow. But to help them be healthy, I can at least do that part. That's the part that I can play. If they get on track and start feeling better, then they will do better.  So you feel better, you're more motivated, you have more energy, you're less stressed, you're sleeping better, than you're going to perform better at your job. You'll be able to excel in your position and you can climb the ranks that way. So if I can help somebody do that, that makes me feel good because that's what being a doctor and a healer is all about. Vincent Ferguson: Yes, it is, amazing. How can my listeners, find out more about you and Precision Clinic? Dr. Marvin Singh: I'm pretty accessible online. So a website for Precision Clinic is precisionclinic.com. Our contact information, email, phone number is all on that website. Instagram, Facebook, Twitter, my handle is @Dr. Marvin Singh, so I'm pretty accessible that way, as well. Vincent Ferguson: Well, we need to access you, that's for sure. Dr. Marvin Singh, on behalf of Body Sculpt of New York, my nonprofit and Six Weeks of Fitness, I truly want to thank you for coming on this show today. Dr. Marvin Singh: No problem. Thank you for having me. Vincent Ferguson: And to my listeners and followers and viewers, I truly hope this program was informative, encouraging, and inspiring. And you will continue watching and listening in to our Six Weeks of Fitness program. And if you have any questions or suggestions for the show, please leave them in the comment section below. And don't forget to subscribe so you don't miss any future episodes. And remember “you don't stop exercising because you grow old, you grow old because you stop exercising.” You can reach Vince Ferguson at vince@sixweeks.com. You can also visit his website at www.6weekstofitness.com.

I first met Dr. Colwell when I came west to interview for a fellowship at Scripps Clinic. I had the pleasure to sit down and ask him some questions about orthopedics and his career. We talked for an hour and a half and I could have spent all day listening to his stories. We didn't have time to get to every question that I had for him so I hope we can sit down again soon for a second Dr. Colwell interview.Support the show (https://www.patreon/TotalKneeTips)

The paleo and keto diets are two of the most popular diets on the market for weight loss. While they take work and commitment, they can lead to improved health in the long run. In this episode of San Diego Health, host Susan Taylor interviews Dr. Samantha Harris, a Scripps Clinic endocrinologist who specializes in weight management. They discuss key differences and similarities between the keto and paleo diets, how each diet works, what foods you can eat and more. Learn more about the keto and paleo diets and download a free guide: http://www.scripps.org/7268p

In this fifth installment of the Fortress and Frontier series on Discourse Magazine Podcast, Robert Graboyes, a senior research fellow at the Mercatus Center, speaks with Dr. Eric Topol about the slow progress of medicine, how machine learning will improve healthcare, the importance of the doctor-patient relationship, the triumph of the mRNA vaccines and much more. Topol is a cardiologist, scientist and author of several books, including “The Patient Will See You Now” and “Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again.” He is the founder and director of the Scripps Research Translational Institute, a professor of molecular medicine at the Scripps Research Institute and a senior consultant at the Division of Cardiovascular Diseases at the Scripps Clinic.Previous installments of the Fortress and Frontier series include two conversations between Robert Graboyes and Temple Grandin. The first can be found here, and the second can be found here. The third installment is a conversation with Pradheep Shanker on COVID-19 data. The fourth is a discussion with Devi Shetty on India's Narayana hospital system and innovations in healthcare.For more helpful links and resources from this conversation, please visit DiscourseMagazine.com.

Dr. Matthew Price, of Scripps Clinic, La Jolla, California, discusses with Dr. Ron Waksman 1-year clinical outcomes after transcatheter left atrial appendage occlusion (LAAO) for stroke prevention in patients with atrial fibrillation (AF). This report from the National Cardiovascular Data Registry (NCDR) LAAO Registry, which was presented as a late-breaking trial at ACC.21 Virtual, found that thromboembolic events were infrequent in patients implanted with the Watchman (Boston Scientific) LAAO device. Study investigators did recommend that clinicians should incorporate risks of bleeding and death unrelated to thromboembolism in the early post-discharge period when selecting a stroke-prevention strategy for AF patients who are unable to take long-term oral anticoagulation.

Don't miss Episode #18 of Soul Stories- Dr. Randall speaks to  Dr. Mimi Guarneri.Board-certified in cardiology, internal medicine, nuclear medicine and holistic medicine, Dr. Guarneri is the founder and the medical director of the Scripps Center for Integrative Medicine. Dr. Guarneri was an English Literature major as an undergraduate at New York University. Her medical degree is from SUNY Medical Center in New York, where she graduated number one in her class. Dr. Guarneri served her internship and residency at Cornell Medical Center, where she later became chief medical resident. She served cardiology fellowships at both New York University Medical Center and Scripps Clinic. Dr. Guarneri served as an attending in interventional cardiology at Scripps Clinic, where she placed thousands of coronary stents. Recognizing the need for a more comprehensive and more holistic approach to cardiovascular disease, she pioneered the Scripps Center for Integrative Medicine where she uses state-of-the-art cardiac imaging technology and lifestyle change programs to aggressively diagnose, prevent and treat cardiovascular disease. She is a fellow member of the American College of Cardiology, Alpha Omega Alpha, the American Medical Women's Association, and a diplomat of the American Board of Integrative Holistic Medicine. In 2009, Dr. Guarneri was honored as the ARCS scientist of the year. Dr. Guarneri has authored several articles that have appeared in professional journals such as the Journal of Echocardiography and the Annals of Internal Medicine. Dr. Guarneri participated as a member of the writing committee for the American College of Cardiology Foundation Complementary Medicine Expert Consensus Document. This expert consensus statement on integrating complementary medicine into cardiovascular medicine was published in 2005. She is the author of The Heart Speaks, a poignant collection of stories from heart patients who have benefited from integrative medicine approaches. The Heart Speaks and her clinical work have been featured on NBC Today and PBS's To the Contrary and Full Focus. In her book Dr. Guarneri takes the reader on a journey of the heart - exploring the emotional heart, able to be crushed by loss; the intelligent heart, with a nervous system all its own; and the spiritual heart, which yearns for a higher purpose. With groundbreaking new research and unparalleled experience, Dr. Guarneri skillfully weaves the science and drama of the heart's unfolding. Her work was also featured in a two-part PBS documentary, The New Medicine. Dr. Guarneri is regularly quoted in national publications such as the Yoga Journal, Body+Soul, Trustee magazine and WebMD. She has been recognized for her national leadership in integrative medicine by the Bravewell Collaborative and now serves as chair of the Bravewell Clinical Network for integrative medicine. In 2008 she was honored by Project Concern International for her work in Southern India, and she currently serves on the International sub-committee for Direct-Relief International. Dr. Guarneri also served on an advisory panel for the Institute of Medicine to explore the science and practice of integrative medicine for promoting the nation's health. The summit's findings were released Feb. 25-27, 2009 in Washington, D.C. Most recently, she was elected president of the American Board of Integrative Holistic Medicine. Dr. Guarneri's book, “108 Pearls to Awaken Your Healing Potential,” was published by Hay House in 2017, and she is the professor of “The Science of Natural Healing,” a top-selling 24-lecture video set from The Great Courses. She is the author of “The Heart Speaks,” 2006, Simon & Schuster, and co- author of “Total Engagement: The Healthcare Practitioner's Guide to Heal Yourself, Your Patients & Your Practice,” 2014. Get inspired by these two legendary doctors on this episode!

Eric Topol is an American cardiologist, scientist, and author. He is the founder and director of the Scripps Research Translational Institute, a professor of Molecular Medicine at The Scripps Research Institute, and a senior consultant at the Division of Cardiovascular Diseases at Scripps Clinic in La Jolla, California. He is editor-in-chief of Medscape and theheart.org. He has published three bestseller books on the future of medicine. The Creative Destruction of Medicine (2010), The Patient Will See You Now (2015), and Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again (2019). He was also commissioned by the UK 2018–2019 to lead planning for the National Health Service's future workforce, integrating genomics, digital medicine, and artificial intelligence. In 2016, Topol was awarded a US$207 million grant from the National Institutes of Health to lead a significant part of the Precision Medicine Initiative (All of Us Research Program), a one million American prospective research program. This is in addition to his role as principal investigator for a US$35 million grant from the National Institutes of Health to promote innovation in medicine and the education and career training of future medical researchers. Lyrics to the song that was inspired by the interview: DOCTORS UNITE We need the doctors to lead the fight We need the doctors to combine their might We need the doctors to lead every campaign We need the doctors to take this on We need the doctors to be strong We need the doctors to stand up in our name Obesity is killing people It's an epidemic Heart disease is deadly And it's become endemic Who can end the nightmare What can stop the pain? Dieticians? Or marketing campaigns? No, the remedy is Universal Doctors unite Doctors are stressed to breaking By unnecessary work Tied down to their keyboards They are data entry clerks Who can end the nightmare? What can stop the pain? Medical Administrators, this is their terrain No, the remedy is Universal Doctors unite We need the doctors to lead the fight We need the doctors to combine their might We need the doctors to lead every campaign We need the doctors to take this on We need the doctors to be strong We need the doctors to stand up in our name There are so many issues So many fights From inequality to poverty Don't mention gun rights But if one million doctors Were together in one lane Imagine their power How much they could change Opioids are overused A crisis now exists Doctors serve as drug dispensers For big pharma lobbyists Who can end the nightmare? What can stop the pain? Possibly new legislation? Or something in that vein? No, the remedy is Universal Doctors unite We need the doctors to lead the fight We need the doctors to combine their might We need the doctors to lead every campaign We need the doctors to take this on We need the doctors to be strong We need the doctors to stand up in our name We need the doctors to unite We need the doctors to aim a strike We need the doctors to get us out of this The remedy is Universal Doctors unite

Sheila Friedlander, Scripps Clinic, San Diego, to discuss recent developments in tinea capitis, including epidemiology, diagnosis, and treatment.

In this podcast, Dr. Matthew Levine, practicing endocrinologist and the Endocrinology Fellowship Program Director at Scripps Clinic in San Diego, California, speaks with Dr. Mike Tuttle, acting chief of endocrinology at Memorial Sloan Kettering Cancer Center about the decision making process a practicing endocrinologist may face when managing patients with thyroid cancer.

In this episode, we are honored to listen to Dr. Evan Muse. Dr. Muse is the lead for cardiovascular genomics at the Scripps Research Translational Institute, and he's a cardiologist and assistant program director for research of the Cardiovascular Disease Fellowship Program at the Scripps Clinic in La Hoya. Today, Dr. Muse talks about leveraging existing technologies to shape the future of prevention and treatment. He discusses cardiovascular genomics and offered some specific examples of how it impacts patients and populations. He shares his thoughts on how genomics can be fully utilized, how education can enable people to find the best applications for this technology and the need for patient involvement in clinical trials. We covered some great topics in this fascinating conversation with Dr. Muse, and we hope you'll enjoy it as much as we did. https://outcomesrocket.health/evanmuse/2020/08/

Live longer and die healthy. Dr. Shadi Vahdat is the Chief Medical Officer for the Create Cures Foundation. Board Certified in Internal Medicine and holds additional certifications in Functional and Integrative Medicine. Dr. Vahdat graduated from UC Berkeley with a degree in Molecular and Cell Biology. She attended medical school at Albert Einstein College of Medicine and did her residency training in Internal Medicine at the Scripps Clinic and Green Hospital. She has extensive experience in caring for hospitalized patients at academic institutions and has taken care of patients in all stages of health and illness. She has completed training in acupuncture from UCLA East West Medicine and Helms Institute and holds additional certifications in yoga teacher training, Urban Zen Therapies, and Breath-work meditation.   In today's show Dr. Vahdat explains the foods and nutrients that are proven to speed up aging. How “genetics loads the gun, but environment pulls the trigger” with regard to aging. The common types of fasting and corrects some common misconceptions. The role fasting plays in increasing longevity and decreasing your risk of chronic disease through autophagy. Introduces the Fast Mimicking Diet and outlines how it can be used to help healthy adults, as well as individuals suffering from cancer improve their health and condition. She explains the role and importance of integrative medicine to treating the whole body.   Mentioned In the Show: Books: The Longevity Diet: Discover the New Science Behind Stem Cell Activation and Regeneration to Slow Aging, Fight Disease, and Optimize Weight. By Dr. Valter Longo Create Cures Foundation website: https://www.createcures.org/   Follow The Professional Athlete Podcast with Ken Gunter: Instagram: @the_professionalathlete Website: https://www.kengunter.com/ YouTube: Ken Gunter https://www.youtube.com/channel/UCRhgjkoSiJXAbS_MIasvvzQ/ Facebook: https://www.facebook.com/kengunterpodcast Produced By: Justin Gunter, Ken Gunter Music By: Justin Gunter, Ken Gunter

Please join me tonight on the Segment as I am joined by Dr. Mike Welch as I get a chance to ask him some questions about the Covid-19 Vaccines. As many of you know I was vaccinated a few days ago and thought I would Vlog about it. For me I didn't have any of the scary side effects people talk about. In fact I didn't even feel the shot but I know that I got it because I watched it go in. My anxiety about the vaccine went down as the days moved forward. So I thought I would bring an expert in the field of Allergy and Immunology on the show to give us the unbiased clinical data around the Covid 19 vaccines. My hope is that this episode will give you enough information to make the best choice for you around the vaccine. Dr. Michael Welch is a physician in the Allergy/Immunology Division of Rady Children's Hospital-San Diego, co-director of the Allergy and Asthma Medical Group and Research Center in San Diego and a clinical professor in the Division of Allergy and Immunology in the Department of Pediatrics at UC San Diego. Dr. Welch earned his medical degree from UC Los Angeles before completing an internship and residency in pediatrics and a fellowship in allergy/immunology at the same institution. He then conducted an extra year of clinical immunology research at the Scripps Clinic and Research Foundation in La Jolla. Board-certified in allergy and immunology, Dr. Welch is a fellow of both the American Academy of Pediatrics and the American Academy of Allergy, Asthma and Immunology. He is involved in numerous professional organizations, having served as president of the San Diego Allergy Society and the California of Immunology and chair of the American Academy of Pediatrics Section on Allergy and Immunology. He is also certified by the Academy of Pharmaceutical Physicians and Investigators. An active author, editor and lecturer, Dr. Welch has been published in numerous scientific medical journals and is the editor-in-chief of the book Guide to Your Child's Allergies and Asthma, directed to families affected by allergies and asthma. His research center has been involved in over 650 clinical trials investigating pharmacotherapeutics for allergic disease. Dr. Welch has been honored as Physician Citizen of the Year by the San Diego County Medical Society for his volunteer contributions to the community, and noted in San Diego Magazine as "Top Doctor in San Diego" for 11 out of the last 13 years. For specific questions about reactions to the vaccine: Clinical Immunization Safety Assessment Project phone 800 CDC-INFO or https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/cisa/index.html www.cdc.gov for any need for info about the vaccine. Use the CDC - they have all the info you need in one place!! To follow me on my other platforms and get discounts from my sponsors please click this link: https://linktr.ee/TheSegment

"Every major health challenge is directly attributed to a lot of EMFs." Listen as Cayla and her guest, Justin Frandson, an Athleticism Performance Coach, talk all about your health and how to live your best life every single day, plus much more on this episode of the https://www.mommymillionaire.co/podcasts (Mommy Millionaire Podcast). Justin graduated from USC in their Entrepreneur program; he studied exercise science as a minor and got his EMT certification from UCLA. Justin started https://athleticism.com/ (Athleticism.com) out of Scripps Clinic in La Joya, doing incredible sports performance work through the nerves with impressive amateur and professional athletes. Athleticism is currently in Newport Beach, where he does cutting edge performance, stretching therapy, and treatment; he even gets sports concussions back in record time. He also founded https://emfrocks.com/ (EMFRocks.com,) and his grounding bags are sold at doctor clinics throughout the country and specialty locations. Justin discusses why he went into performance coaching, why smart meters are a bad thing, and the research he did on https://www.niehs.nih.gov/health/topics/agents/emf/index.cfm (EMF) to help his clients. Justin talks about circulation challenges and how having TVs and other electronics in your children's rooms can affect their health. Listen as Justin shares his EMF bags and how they can help you lower the EMFs in your home and help you sleep better. Justin is giving the Mommy Millionaire listeners a 5% discount on his EMF bags; just go to his website and enter the code MMEMF to get the lower rate. *Cayla has opened The Mommy Millionaire Mastermind one last time* Cayla has found that by being a part of a mastermind, she got in the right room with the right people who caused her to uplevel. What she found is that she wanted to create a special group of women because she believes when you get females together, we can learn how to harness our feminine energy to build powerful empires. Head over to http://www.mommymillionaire.co/mastermind (www.mommymillionaire.co/mastermind) to fill out an application to join today. In This Episode: [01:37] Hello, mommy millionaires! [02:27] Boymom92 gives Cayla a five-star review. [04:20] Cayla introduces Justin. [05:30] Welcome to the show, Justin! [05:40] Justin shares why he wanted to get into performance coaching. [06:35] Justin talks about when he felt the increase in EMF. [07:45] Why are smart meters a bad thing? [09:43] Justin talks about the research he did to determine how to help his clients. [11:01] Justin believes he was a pioneer of gluten-free diets. [12:38] Listen as Justin speaks about circulation challenges and what they are. [15:13] Justin shares what having TV's and other electronics in our kids' rooms can affect their health. [18:07] Cayla talks about what happened to her before she had her implants removed. [21:10] How does drinking alcohol every day affect your body along with the EMF? [23:58] Justin speaks about how important breathing is for relaxing. [27:59] Justin discusses how his EMF bags are made and what they are made of. [30:59] Cayla shares some things you can do at night to lower EMFs in your home. [33:59] Converting your smart meter to analog is one of the best things you can do. [35:55] Justin leaves the listeners with one thing to help them become their own healers. [39:24] Justin offers a special deal to Mommy Millionaire listeners to use code MMEMF for 5% off the bags. [40:16] Thank you for being on the show! Find Cayla: https://www.mommymillionaire.co/ (Mommy Millionaire) https://www.mommymillionaire.co/mastermind (Mastermind) https://www.facebook.com/CraftCayla/ (Facebook) https://www.instagram.com/cayla.craft/ (Instagram) https://www.pinterest.com/caycraftisa/ (Pinterest) Find Justin: https://athleticism.com/ (Justin Frandson) https://www.instagram.com/justinfrandson/?hl=en (Instagram) | https://twitter.com/athleticism1?lang=en...

CardioNerds (Amit Goyal & Daniel Ambinder) join Scripps cardiology fellows (Christine Shen and Andrew Cheng) for some Cardiology and California Burritos in San Diego! They discuss an informative case of Wet Beriberi and Stiff Left Atrial Syndrome. Dr. Thomas Heywood provides the E-CPR and program director Dr. Malhar Patel provides a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident Tommy Das with mentorship from University of Maryland cardiology fellow Karan Desai. Jump to: Patient summary - Case media - Case teaching - References Episode graphic by Dr. Carine Hamo The CardioNerds Cardiology Case Reports series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an “Expert CardioNerd Perspectives & Review” (E-CPR) for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus. We are teaming up with the ACC FIT Section to use the #CNCR episodes to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an E-CPR segment and a message from the program director. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademySubscribe to our newsletter- The HeartbeatSupport our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza Patient Summary A woman in her mid-60s with history of rheumatic mitral stenosis s/p mechanical mitral valve replacement, HFpEF, and paroxysmal atrial fibrillation s/p ablation presents with subacute worsening dyspnea despite escalating diuretic doses. TTE shows an EF of 62%, normal gradients across the mitral valve without mitral regurgitation, and a dilated IVC. She is admitted with a presumed diagnosis of decompensated heart failure, and started given IV furosemide. Her symptoms slightly improve though do not resolve, and her creatinine increases from 1.4 to 2.1.   In light of the unclear hemodynamic picture, a RHC is done, showing a RA pressure 9, RV pressure of 80/10, PAP 70/25 with mPAP 40, PCWP 30, SVR 872, CO 11 (by thermodilution), and CI 5.2. Notably, large V waves are noted on the RHC. Given concern for mitral regurgitation in the setting of large V waves, a TEE was pursued, which confirmed the lack of MR seen on TTE. Thus, her large V waves were felt to be due to stiff left atrial syndrome, and a cardiac CT showed a severely calcified "coconut left atrium". Labwork revealed a profoundly low thiamine level (21, with LLN of 70), raising concern for wet beri beri syndrome.   The patient's unifying diagnosis was indolent left atrial syndrome that was exacerbated by high outout heart failure due to Wet Beri Beri syndrome. The patient received thiamine supplementation, and was diuresed to euvolemia with dramatic improvement in symptoms. A repeat RHC after thiamine replacement showed a CO of 5.7 and CI of 2.74 by thermodilution, demonstrating resolution of her high output heart failure.   Case Media ABCDEFClick to Enlarge A. CXRB. ECGC. RHC: large V waves are noted on the RHCD. CO 11 and CI 5.2 by thermodilution pre-treatment E. Cardiac CT showed a severely calcified "coconut left atrium"F. Repeat CO of 5.7 and CI of 2.74 by thermodilution after thiamine replacement TTE 1 TTE 2 TEE 1 - Mitral Valve TEE 2 - Mitral Valve Cardiac CT Episode Schematics & Teaching Click to enlarge! The CardioNerds 5! – 5 major takeaways from the #CNCR case

In an atmosphere as technologically savvy as today, it’s only natural to seek out new advancements and ways to build on existing products to further improve the lives of others. As a serial entrepreneur, John Burd, co-founder and previous CEO of Dexcom, and current CEO of Lysulin and Wonder Spray, is no exception, in that he started his entrepreneurial journey as early as the 70s and is still going strong to this day, with WonderSpray being his newest invention.  Listen in as host, Neal Bloom, chats with John Burd about his extensive entrepreneurial history and the impact his products have had on millions of lives. 3:05 John discusses his journey leading up to co-founding Dexcom, today a $40 billion continuous glucose monitoring device maker. Out of grad school, John worked at a company that developed at-home diabetes products, a market that was growing at the time. He then joined Miles Laboratories, where he worked in a lab and developed clinical chemistry testing products. After that role, John moved west to Indiana to experience startup life at a company that developed a doctor’s office blood allergy testing system, but the startup, unfortunately, proved unsuccessful. At this startup, John was introduced to the business side of medicine. Following this, he moved to sunny San Diego in the mid 80s and joined Quidel, a facility renowned for pregnancy, ovulation, and allergy testing. After about eight years in that role, John left Quidel and founded his first diabetes company, LXN Corporations, which allowed diabetics to check their blood sugar with a single at-home test per week. LXN was eventually sold to a company that was subsequently acquired by Johnson & Johnson. After the acquisition, John joined a local venture capital firm and decided to start a diabetes-focused venture. Soon enough, he found the technology that would become Dexcom.   10:01 After leaving Dexcom in the hands of his successor, Andy Rasdal, John put time into working with chronic kidney diseases; he noted a correlation between those with kidney problems and those with diabetes. Studies conducted in the late 2000s showed that lysine, an amino acid used to make medicine, helped reduce blood sugar levels, but because it was already easily available in stores, it was a commodity they did not want to pursue selling. After doing further research, John learned of two other powerful supplements that helped those same problems. So in 2018, they launched Lysulin, a combination of zinc, vitamin c, and lysine. Lysulin is available for sale on online platforms such as Amazon, Walmart.com and the company’s website. 16:21 John details the process of releasing his product in the market without FDA approval. Because Lysulin is a product designed to be used therapeutically rather than medicinally, the FDA is not required to approve it.  18:00 Neal shares his personal connection to diabetes, as his father has type 1 diabetes and, in the 70s, he had to make long drives multiple times per week just to get blood sugar readings. Since then, technology has allowed diabetics to access these readings within seconds. 21:43 With San Diego slowly growing into becoming one of the nation’s big tech hubs, John discusses whether he could see companies like Tandem, Medtronic, and others make the region a diabetes tech hub. Many doctors at Scripps Clinic have dedicated decades to diabetes research, with several doctors piggybacking off of recent developments. John reminisces, for a moment, on Dexcom’s humble beginnings. The company’s first headquarters was located in a basement below a dentist’s office. John also shares that his current venture, Lysulin, has a small but mighty team. 30:21 When he initially launched Lysulin, John reached out to professionals in the diabetes space to share his solution with them. One of these prospects introduced John to a wound-healing product he had developed, which took the form of a saline-infused gun that sprays onto wounds. John learned the product had potential but it was incredibly expensive. The duo considered working together to create a low-cost version of the product to make it more accessible but that didn’t work out. John later found hypochlorous acid (HOCl), which is non-toxic and 100 times stronger than bleach. John looked into using this for wound-healing. After collaboration with teams from various countries and obstacles along the road, John founded Wonder Spray, a spray-on product meant for treating wounds and any skin problems (bites, itches, burns, etc). John’s primary mission with this product is to help thousands of people with his products while alleviating the total cost required by the consumer. HOCl is also on the EPA list of approved disinfectants for use against COVID-19, which gives Wonder Spray another use. Anyone who wants a sample of Wonder Spray can send an email to jburd@jburd.com.    John’s favorite local tacos:  Taco Bell   Connect with John: LinkedIn   Keep up with Lysulin Website: lysulin.com LinkedIn Facebook: @lysulin Twitter: @lysulin   Keep up with WonderSpray Website: https://thecraftersbox.com/ thewonderspray.com  Facebook: @thewonderspray   Keep up with Dexcom Website: dexcom.com LinkedIn Facebook: @Dexcom   Thanks to our partners at Cox Business for their support in enabling us to grow the San Diego ecosystem.

Jodi Stolove is the queen of joyful exercising. A fractured foot forced her to conduct her dance and aerobic classes from a chair and The Chair Dancing® Fitness concept was born. Creativity born of necessity resulted in her developing unique seated fitness programs combining the pleasure of exercise, dance, and music. While she “sat down” to bring exercise to meet the needs of anyone wanting to embrace exercise, the fitness industry took notice. Prominent health care facilities, including Kaiser Permanente Medical Centers, Scripps Clinic, and The Mayo Clinic offer this fitness alternative. Jodi taught dance to the cast of “The Days of Our Lives” as well as Joan Rivers. Find out more at https://www.chairdancing.com/. Find out more about the Zestful Aging Podcast at ZestfulAging.com.

In this episode, we are honored to listen to Dr. Evan Muse. Dr. Muse is the lead for cardiovascular genomics at the Scripps Research Translational Institute, and he's a cardiologist and assistant program director for research of the Cardiovascular Disease Fellowship Program at the Scripps Clinic in La Hoya. Today, Dr. Muse talks about leveraging existing technologies to shape the future of prevention and treatment. He discusses cardiovascular genomics and offered some specific examples of how it impacts patients and populations. He shares his thoughts on how genomics can be fully utilized, how education can enable people to find the best applications for this technology and the need for patient involvement in clinical trials. We covered some great topics in this fascinating conversation with Dr. Muse, and we hope you'll enjoy it as much as we did. https://outcomesrocket.health/evanmuse/2020/08/

Dr Zieve discusses the genetic factors in breast cancer and the decisions women face in responding to elevated risk with researcher and author Dina Roth Port and oncologist Dr Dwight McKee.Journalist, and author Dina Roth Port is a former health editor for Glamour magazine. Previvors: Facing the Breast Cancer Gene and Making Life-Changing Decisions is her first book. Read more at previvors.com.Dwight McKee MD has been a member of the Internal Medicine staff at Scripps Clinic, and practiced medical oncology and hematology at the San Diego Cancer Center in Vista, CA. for 3 years, where he also served as medical director for the Sharp Hospice. He continues to serve as a consultant for the San Diego Cancer Research Center, and serves as Scientific Director of Life Plus International in Batesville, Arkansas. His experience in medical research, nutritional science, immunology, chemistry, oncology, and complementary medicine make him one of the most knowledgeable researchers and clinicians worldwide. If you cannot see the audio controls, your browser does not support the audio element

Dr Zieve talks with Dr Dwight McKee about how various supplements work in the body, possible conflicts with pharmaceuticals, and how supplements are tested.Dwight McKee MD has been a member of the Internal Medicine staff at Scripps Clinic, and practiced medical oncology and hematology at the San Diego Cancer Center in Vista, CA. for three years, where he also served as medical director for the Sharp Hospice. He continues to serve as a consultant for the San Diego Cancer Research Center, and serves as Scientific Director of Life Plus International in Batesville, Arkansas. His experience in medical research, nutritional science, immunology, chemistry, oncology, and complementary medicine make him one of the most knowledgeable researchers and clinicians worldwide. Read more at dwightmckee.com. If you cannot see the audio controls, your browser does not support the audio element

Justin Frandson, is the Founder of Athleticism.com. He is one of the most respected, nationally certified, Health/Performance Coaches in the country. His career started over 22+ years ago at Scripps Clinic, La Jolla, CA. This seasoned industry experience and learning has exposed him to many of the greatest systems in human performance.

Chairman of Mohs & Dermatologic Surgery at Scripps Clinic & Unofficial Patron Saint of BIGHORN

Scripps Clinic family medicine specialist Dr. Samar Rashid discusses the different ways food can be used as medicine to help the body stay well and fight disease. Learn more: www.scripps.org/6758p Want to learn more? Follow us @ScrippsHealth! Facebook: www.facebook.com/scrippshealth/ Twitter: twitter.com/ScrippsHealth YouTube: bit.ly/ScrippsYouTube Instagram: www.instagram.com 0:37 - What does it mean to use food as medicine? 1:02 - How do you detox your body? 1:40 - What are some of the top healing foods? 2:18 - How much healing food should you have each day? 2:54 - How can you get energy from food? What food can give you energy besides caffeine? 3:43 - What healthy ingredients should you add to your meal? 4:24 - Should I avoid from processed foods? 4:45 - Should I eat raw sugar instead of white sugar? 5:27 - Is read meat bad for you? 6:41 - What is a good food for arthritis? 7:03 - What are dark chocolate health benefits? 7:33 - Are there any good fad diets? 9:15 - Is it better to eat fruit than drink fruit juice? 9:39 - What are good salad recipes? 10:29 - What is a healthy butter substitute? 11:07 - How can you make healthy cooking easy and fun? 11:49 - What are the top foods that should be on your grocery shopping list every week? 12:46 - Can you eat kale raw? 13:29 - What are microgreens? 15:12 - Is there such a thing as healthy fast food? 16:06 - What small changes in diet can improve your health?

Scripps Clinic cardiologist Matthew Price explains how a hole in the heart is formed, what health risks can occur and what procedures can help close the hole to lower risk of stroke. Learn more and download a free heart guide: www.scripps.org/6607p Want to learn more? Follow us @ScrippsHealth! Facebook: www.facebook.com/scrippshealth/ Twitter: twitter.com/ScrippsHealth YouTube: bit.ly/ScrippsYouTube Instagram: www.instagram.com What is patent foramen ovale (PFO)? (1:16) How does PFO increase the risk of stroke? (2:01) At what age can you get a PFO-related stroke? (2:32) What are the warning signs of a stroke? (2:59) How is testing for PFO done? (3:23) What is a cryptogenic stroke? (4:27) How do you close a PFO? (6:14) What are PFO closure devices? (7:34) PFO closure vs. blood thinners (9:57) Will you still need blood thinners after closing PFO? (11:26) Any physical restrictions with a PFO closure device? (11:52) Does the closure device need to be replaced? (12:28) What are some underlying conditions for cryptogenic stroke? (13:08) What are the pros and cons of blood thinners? (14:09)

Gary Malkin – What the Future of Healthcare Sounds LikeAired Thursday, November 14, 2019 at 4:00 PM PST / 7:00 PM ESTAccording to award winning media composer, public speaker, and music and health innovator, Gary Malkin, the very first sense we humans develop, at roughly 16 weeks in utero, is our listening sense. on the other end of life’s spectrum, hearing is the VERY last sense to go before we die. This suggests that vibrations – and our ability to be affected by them- can serve a meaningful role to keep us healthy and vital throughout our lives.Gary Malkin joins Sandie this week to discuss not what the future of healthcare looks like, but what it sounds like. Topics include:How research is showing that sound and music interventions can lessen physical pain and emotional and spiritual sufferingEngaging the unified field through the power of musicWhy loss assimilation really significant in the context of promoting optimal health, and the role that music can play in thisHow music, and the emotionally vibrant genre of film scoring can help reconnect us to who we truly are and what matters mostHow music can be utilized to address society’s and the planet’s challenges… and moreGARY MALKIN is a seven-time Emmy Award-winning composer, performer, public speaker and music and health innovator who empowers the world to embrace music and sound strategies as catalysts for health, wellness, and a connection to what matters most. He is dedicated to redefining music’s role in healthcare, with a particular focus on developing listening tools to support patients, care providers and families who are facing life transitions at both the beginnings and endings of life. He’s also dedicated to creating resources that generate inner “heart coherence” with musical tools that catalyst “heart-centered mindfulnessTM. His globally acclaimed palliative classic, Graceful Passages, co-created with award-winning filmmaking team Michael and Doris Stillwater, has touched nearly a million people worldwide, offering psycho-spiritual support for patients and caregivers engaged in all phases of the life-threatening illness and end-of-life processes.Gary Malkin received a Best Soundtrack Award from the Hollywood Music in Media Awards for the groundbreaking documentary, THRIVE, seen by 90 million people in 40 languages since 2011. He has presented at places such as Stanford Health, UCSF, Houston Methodist, Google, Harvard’s Conference on Spirituality and Health, Scripps Clinic, and Kaiser Permanente – and is frequently asked to speak and perform for integrative health, wellness, and life-affirming communities all throughout the world.WisdomoftheWorld.com

In Functional Medicine, we put a heavy emphasis on gut health. We know that a strong gut is not just essential for digesting food and absorbing nutrients, but that it plays a vital role in the immune system and affects the health of the entire body. On today’s Broken Brain Podcast, our host, Dhru, talks to Dr. Marvin Singh, an integrative gastroenterologist. Dr. Singh graduated from the Virginia Commonwealth University School of Medicine, and completed his residency training in internal medicine at the University of Michigan Health System, followed by a fellowship training in Gastroenterology at Scripps Clinic and Green Hospital. Dr. Singh was also trained by Dr. Andrew Weil, a pioneer in the field of integrative medicine, at the University of Arizona Center for Integrative Medicine. Dr. Singh uses cutting-edge tests and personally designed protocols to develop a truly individualized plan for his patients based on their genetics, microbiome, metabolism, and lifestyle.In this episode, Dhru and Dr. Singh talk about the cutting edge research of DNA methylation PhenoAge, which can predict things like aging, inflammation, and heart disease. They discuss how changes in the gut microbiome can impact gene expression, how our microbiome influences the dietary choices we make, and how our gut health can have a significant effect on healthy aging. They also talk about the implications of diet and the gut microbiome in neuroinflammatory and neurodegenerative disease. In this episode, we dive into:-How DNA methylation can predict age and age-related outcomes (2:24)-How our gut microbiome influences our food choices (9:35)-The gut-brain connection (13:22)-The gut microbiome and neurodegenerative diseases (17:35)-Dr. Singh’s personal health journey (21:51)-Why personalization is so important when it comes to our gut health (43:29)-Food sensitivity testing (46:56)-Gut microbiome testing (54:05)-Probiotics (59:49)-How exercise impacts our gut health (1:07:12)-Prebiotics (1:09:59)-Digestive enzymes (1:13:05)-Fecal transplants (1:20:33)-Colon hydrotherapy (1:26:39)-How social connections impact our health (1:32:19)-Learn more about Dr. Singh and his work (1:38:16)For more on Dr. Marvin Singh, be sure to follow him on Instagram @DrMarvinSingh, on Facebook @DrMarvinSingh, and on Twitter @DrMarvinSingh. Check out his website https://drmarvinsingh.com, and download his FREE 4 Week Gut Reset e-book, right here. Dr. Singh was also featured in the Interconnected Docu-series which you can watch here. If you’re looking to work with an integrative practitioner you can search for one here:-The Institute for Functional Medicine: https://www.ifm.org/find-a-practitioner/ -The Andrew Weil Center for Integrative Medicine: https://integrativemedicine.arizona.edu/alumni.htmlLastly, check out the article Dhru referenced during the interview from Anahad O’Connor: Is There an Optimal Diet for Humans?Sponsor: This episode is sponsored by our partnership with the AirDoctor Air Filter. To get exclusive access to this deal visit www.brokenbrain.com/filter See acast.com/privacy for privacy and opt-out information.

Angie Alt joins us today as we’re digging into the link between Inflammatory Bowel Disease and Infertility. ANGIE ALT, CHC, NTC, is a Nutritional Therapy Consultant, Certified Health Coach and author of The Alternative Autoimmune Cookbook and co-author of The Autoimmune Wellness Handbook. She is the creator of SAD to AIP in SIX, an online coaching program that has helped thousands of people on the path to wellness, teaching them how to transition their diets and lifestyle over a six-week period. Angie also partnered with Dr. Gauree Konijeti, Director of the Inflammatory Bowel Disease Program at Scripps Clinic in San Diego, to run a medical study entitled, “Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease” which had amazing results published in 2017. In 2015, Angie partnered with Autoimmune-Paleo.com founder, Mickey Trescott. Together, Mickey and Angie, transitioned Autoimmune-Paleo.com to AutoimmuneWellness.com in 2017, best reflecting their vision for AIP as a mainstream option for those with autoimmune disease in the near future. Angie lives in the Washington, D.C. area. Check out her website at: www.autoimmunewellness.com Success Story with POI/POF: https://sadtoaip.com/ -- Book your Free Supercharge Your Fertility Discovery Call here: https://intakeq.com/booking/cZ7XW6 -- Download your free fertility yoga video. In this 20-minute intro video, we focus on a calming and peaceful practice to connect back to our heart. These simple yoga poses can help quiet negative thoughts and make you feel more in control. www.yogafreebie.com -- Don't forget to check out my Resources page for more information and products that will help you on your fertility journey.

  Dr Carolyn Lam:                Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center, and Duke National University of Singapore. And I am joined today by our Editor of Digital Strategies, Dr. Amit Khera from UT Southwestern, as well as three wonderful fellows in training. Yes, you've guessed it, it's our FIT Podcast and I'm just so thrilled to be here again. Dr Carolyn Lam:                Amit, any words of introduction before we start? Dr Amit Khera:                  Thank you Carolyn. I think, for both of us, this is our favorite podcast, or two podcasts, that we do, a year. It reminds us of how bright the future is, with superb cardiology fellows in training around the country, and it really is a testament to how important we find fellows in training, to Circulation, to our mission, and how much we learn from them.                                                 So we're really excited about this group, today, and thank them for participating. Dr Carolyn Lam:                Absolutely. So, why don't we start, now, with ladies first? Let's hear from Dr. Elizabeth Hill. Dr Elizabeth Hill:                Thanks for having me today. My name is Beth Hill, and I'm a first year cardiology fellow at Scripps Clinic, in La Jolla, California. I've a particular interest in sports and exercise cardiology, which brings me to the article I picked today about sudden cardiac death and hypertrophic cardiomyopathy, hot topics in the field and in general.                                                 And so, today, I'm excited to be discussing the EVIDENCE HCM study, looking at the hypertrophic cardiomyopathy of risk, sudden cardiac death model. Dr Carolyn Lam:                Nice. So tell us a little bit about what really struck you about the paper and, perhaps, how that may apply to where you practice? Dr Elizabeth Hill:                What I really liked about the paper is that, when I see patients in clinic with hypertrophic cardiomyopathy, prior to having this risk stratification tool, we didn't really have a way to objectively risk stratify our patients with hypertrophic cardiomyopathy and really guide the discussion about who may benefit from an implantable cardiac defibrillator or ICD. And so, I've been using this a little bit with my patients. While it hasn't made it fully into the AHA or ACC guidelines yet, I'm using it as a tool. Dr Carolyn Lam:                Great. You know, these are seven risk factors, isn't it? I'm always struck by that survival curve that really shows that those with a predicted 6% risk stand out. Is that what you use, as well, to guide your decisions? Dr Elizabeth Hill:                Yeah. I think, as the authors noted, they picked this somewhat arbitrarily so that they could study their risk model. But I think what they found is that it seemed to fit well with the observed high risk of sudden cardiac death cohort, such that those that were seen and observed, about 9% risk of sudden cardiac death in five years, were in that greater than 6% cohort. So I think that population should receive ICDs, and that is one factor that I used to guide my decision making as well. Dr Amit Khera:                  Beth, this sort of interest that you've had for a long time, in sports cardiology, I've noted you've done some prior work in EKG screening and other screenings. In terms of this article specifically, as you pointed out, this is a really helpful tool because I still remember back when I was a fellow in training, there was, sort of, this thought that everyone was high risk with hypertrophic cardiomyopathy, and I think we realized that's not true at all. The overall incidence of sudden death was only 2.4% in this cohort.                                                 The question I have for you, in terms of application, is, as Carolyn pointed out, these are reasonably simple variables, but as we sometimes are now using cardiac MRI and genetics and other more advanced tools, where do you think they fit in, in the current paradigm, since this is a bit of a more simplistic score? Dr Elizabeth Hill:                The seven risk factors they put into this tool were noted to be independently associated with an increased risk of sudden cardiac death, and those are well known factors, entricular tachycardia, maximum wall thickness. But I really do think that other factors will come into play soon and are part of my discussion, and colleagues' discussions, including the late gadolinium enhancement on MRI, genetic factors, and I really think this may be a place for tools like machine learning. These authors, O'Mahoney and colleagues, they really did, kind of a tour-de-force, going back to the 1970s, but there is still a decent amount of data missing. So maybe we can partner with the machines and help them go back into these records, a little bit more effortlessly, and look at genetics, maybe some wearable device data, and really refine our risk stratification tool moving forward. But that's definitely something I use in risk stratification in some of my intermediate risk patients. Dr Amit Khera:                  Those are great points. I think your point about machine learning and novel algorithms will definitely take foot in the future.                                                 Maybe a follow-up, again, given your background interest, I think it's a trade-off where we're trying to, of course, avoid sudden death, but you also don't want to overtreat. Especially, when you think about athletes getting ICDs and how that changes, or anyone, for that matter, about maybe telling someone they're at high risk, or giving them an ICD when perhaps they don't need it. I guess that comes to, what's the threshold? Here they use 6%, but that ends up being a bit arbitrary, in terms of what threshold we use. And how do we decide, when we talk to our patients, about what threshold's a right threshold to apply an ICD? Dr Elizabeth Hill:                Yeah. That's a great question. Like you mentioned, these devices come with inherent risks, such as unnecessary shocks, increased risks for infection, and sometimes there's restrictions with athletic sport, although that's been changing recently.                                                 But, I think that's where the shared decision-making process comes into play, where you put current data on the table with the patients and, perhaps, their families as well, and have a risk-benefit discussion. Perhaps gather a little bit more data about the patient, maybe follow them over time, but I guess I wouldn't jump to put an ICD in, in every patient and, especially, the lower-risk cohort. And what number that is, I'm not quite sure. Here they say maybe less than 4%, but, again, somewhat arbitrary, I think. Dr Carolyn Lam:                Thanks Beth. I mean, as Amit said, it's just so inspiring to see how the papers are being used in practice. Really loved those perspectives.                                                 Now, from sunny San Diego all the way to snowy New Zealand. We have Dr. Mesfer Alfadhel. And Mesfer, tell us a little bit about yourself, and the paper that you've chosen? Dr Mesfer Alfadhel:        Thank you very much. I'm thrilled to be part of this podcast. I'm a second-year cardiology fellow-in-training at the Needham Hospital, in Needham City, New Zealand, where it's snowing at the moment. I'm also a clinical lecturer at the University of Otago School of Medicine. I do have great interest in general cardiology, as the rest of my colleagues, but also am passionate about interventional cardiology and structural heart disease.                                                 The paper I've chosen is really quite relevant to everyone in cardiology, and perhaps extends to other colleagues in other health professions impacted by automated external defibrillator use on survival and functional outcomes in shockable observed public cardiac arrest. The aim of the study was to determine the association of bystander automated external defibrillator use, the survival and function of outcomes in shockable observed out of hospital cardiac arrests. The study was from 2011 to 2015 and the Resuscitation Consortium prospectively collected detailed information on all cardiac arrests at nine regional centers, six in the United States and three in Canada.                                                 They also found that among nearly 50,000 out of hospital cardiac arrests, 8% were observed public out of hospital cardiac arrest, of which 61% were shockable. Overall, a remarkable one in five of shockable observed public out of hospital cardiac arrest were bystander shocked. Now the bystander automated external defibrillator observed, shockable observed public out of hospital arrests were associated with increased odds of survival and full or near full functional recovery almost 2.6 and 2.7 odds ratio than when compared to emergency medical service defibrillation. What's also interesting is that the longer the wait for the emergency services, the higher the benefits from a bystander observed shock. Dr Carolyn Lam:                You know, Mesfer, I appreciate that you chose this one as well. What struck out to me immediately was that more than 60% of out of hospital cardiac arrests were shockable. And when we think about the number of lives that could potentially be saved, therefore, that's quite astounding, isn't it? But can I ask you something? So these are in the US and Canada, how applicable do you think this is to New Zealand? Dr Mesfer Alfadhel:        We do have a small population, just over four million. The number of cardiac arrests here is around 2,000 out of hospital cardiac arrests. And I think probably half of them in the latest reports were shockable. The emergency response time in the urban areas is around six minutes, which I think is acceptable, but we have about 20% of population living in rural areas. And the emergency response time exceeds 10 minutes almost all the time. I think that probably a group that we need to direct intervention to in New Zealand. Dr Amit Khera:                  It's really an important article. I should say that June for the American Heart Association is AED and CPR month so great choice to remind us of the value of these and especially, the one thing that was amazing, obviously this is an observational study, but the absolute change, not relative, was about 14% meaningful recovery and so that's quite impressive in terms of the number needed to treat if you will. Maybe an adjunct to Carolyn's question is, when we think about strategies to enhance bystander AED use for strategies, essentially get the AED there faster. As you know if the EMT time was not delayed it wasn't necessarily better for the bystander.                                                 We had a paper in Circ sometime last year looking at drones and then also geocoding and other people in some countries have looked at apps where you essentially can train a group of people and then they can be texted for a sudden cardiac arrest in their area. I'm curious about any creative things, there's always training and AEDs, I think in this place it was public areas in industry, but what do you think are some creative things or things that we need to be doing to help enhance the ability for bystander or early AED use. Dr Mesfer Alfadhel:        I think this is one area in medicine in general that where technology is really going to advance how we deal with this problem. There's an app that's available, it was launched in the UK a few years ago and it's become available in New Zealand in the last two weeks called, the Good SAM. SAM stands for smartphone activated medics. And it's become available in New Zealand two weeks ago and I downloaded it and still yet wait for it to be activated. And the way it works is you can activate a medical emergency using the app and it dials the emergency response but what it also does is it activates the nearest three people with CPR training nearest to you and it tells you how far they are from the emergency. Now if you don't have the app and you call 911 or the equivalent, the operator can activate it to the nearby personnel who have that experience. And I think it's going to reduce the time markedly.                                                 Now the other end of the question where some of what strategies could be used I think we had a good report from Denmark where they made changes in 2007 in Denmark and then followed by the rest of the country in 2010 where they made CPR or resuscitation education as compulsory at school but also when getting a driving license they made courses available for free that increased the number of defibrillators available in public places and they shared that information with public. They've redone, audited their work, and compared to prior to intervention prior to 2007 and after that and they found an increase number of using the AEDs increased from somewhere around 2% to 15%, which is really encouraging. I think we are following Denmark in that regard probably at slower rate. Dr Amit Khera:                  Thank you those are excellent insights. Dr Carolyn Lam:                Amit, don't you see that I just love learning from these fellows during these podcasts. We should do more of these. This is awesome. Dr Amit Khera:                  I completely agree. Dr Carolyn Lam:                Thank you Mesfer, enjoy the skiing. But now from snowy New Zealand we're going all the way to Nashville Tennessee. Welcome Dr. Vineet Agrawal. So tell us a bit about yourself and your paper. Dr Mesfer Alfadhel:        So my name is Vineet Agrawal. I'm a second-year cardiology fellow at the Vanderbilt University Medical Center. My background is as a physician scientist and as a general cardiologist. My long-term goals are in understanding mechanisms underlying heart failure with preserved ejection fraction.                                                 With that in mind I was really taken by an article that was recently by Margaret Redfield's group from the Mayo Clinic in Circulation, titled “Global Pulmonary Vascular Remodeling and Pulmonary Hypertension Associated with Heart Failure and Preserved or Reduced Ejection Fraction.” I found this article to be a very interesting, hypothesis-generating article.                                                 In a nutshell what they did was they took an autopsy cohort of patients in the Mayo Registry and those who had heart failure with both preserved and reduced ejection fraction, normal controls, and those who had a primary pulmonary venous occlusive disease, and looked at the lung specimens of these patients. And interestingly what they found was there was a significant amount of pulmonary venous remodeling that had occurred in patients who had both preserved and reduced ejection fraction. This correlated not only with their right heart cath findings, so those who had elevated pulmonary pressures and elevated transpulmonary gradients, but also differed from the primary pulmonary venous occlusive disease in the sense that the histologic appearance of these vessels was quite different.                                                 And while as an autopsy study this is not necessarily an article that would immediately change practice, what I think it does do though is it forces us to think about these conditions in a different context and particularly with an eye towards future therapeutics. Heart failure with preserved EF as a disease, as I'm sure we all know, is sorely missing therapies that could alter the disease progression and potentially even alter mortality in these patients. And this article in my opinion really sheds light on at least anatomically a new location for us to think about as a therapeutic target when we try to better understand this disease and find therapies for these patients. Dr Carolyn Lam:                Vineet, can I just say you're singing to the choir here. I'm such a fan of this work as well for obvious reasons. But hey, could I ask you, in your clinical practice, do you see a lot of these patients with HFpEF and pulmonary hypertension and wonder how to treat them? And along those lines, how has this paper helped you think about these patients more? Dr Mesfer Alfadhel:        I would say when I first started residency as a medical student this was not necessarily a condition that was really something that I had learned much about or felt like I had been exposed to; however, as a resident I felt like most of the patients, or at least half of the patients, I was seeing with heart failure had a component of diastolic heart failure or they had a preserved EF but very symptomatic from the standpoint of heart failure. And I struggled to treat them, particularly in some part due to the fact that many of the risk factors that contribute to HFpEF, diabetes, uncontrolled hypertension, obesity, are chronic problems that are difficult to manage as a clinician regardless.                                                 And second because I feel that there just weren't any data to support any treatments that we were pursuing at the time and so we would try and apply what we had learned in other types of heart failure to these patients with limited results. If I could talk about what I think this article may change in terms of my practice today, one thing that we've always thought about in terms of pulmonary vascular remodeling in heart failure is that it's just a passive process that as fluid builds up you back up into the lungs and as the fluid builds up and backs up into the lungs you get remodeling.                                                 I think one thing that this article shows is that it may actually be a bidirectional process, which would suggest that perhaps we may need to reconsider looking at pulmonary-specific therapies in this population. But more importantly I think it does confirm that chronic elevating filling pressures do have an effect and a deleterious effect on the pulmonary vasculature. Particularly when you look at other trials such as the CardioMEMS trial, the CHAMPION trial in which the data pretty convincingly showed that as clinicians we don't do the best job of reducing left-sided filling pressures in our patients with heart failure as much as we think we do. This article really drives home the point to me that I really need to make sure that when I see these patients that I'm doing everything I can to reduce their left-sided filling pressures because the consequences of not doing so can affect the lungs, which can then in turn affect the heart as well. Dr Carolyn Lam:                Vineet, that's really words of wisdom. Couldn't agree more. And these are the first sort of autopsy, histological evidence that we have, which is so important. I think if I could just add a couple of perspectives too, it makes me think about making sure that I rule out PVOD in these patients sometimes. We now keep thinking about HFpEF we forget that we need to also rule out PVOD and the other thing much as we now think about not just the filling pressures but the remodeling it's good to note that they found it more in the venous than the arterial system, which also comes therefore with a warning message that we can't just extrapolate I suppose all the PAH therapies that we know about. What do you think about that? Dr Mesfer Alfadhel:        I absolutely agree with that. It's really interesting that all of our therapies from heart failure standpoint and from a PAH standpoint have focused on the myocardium, the neural hormonal cascade, and then the arterials. The pulmonary main artery and arterials. I don't think anyone really understands the biology of pulmonary veins and yet they're actually a pretty significant part of our everyday practice in cardiology. Pulmonary veins are thought to be the source of atrial fibrillation. We look at pulmonary vein inflow when we evaluate patients with echoes. And yet we understand so little about the biology and the mechanisms by which pulmonary veins are affected in both diseased and healthy patients.                                                 I think this article for that reason raises a number of very interesting questions and may potentially change the way we think about these patients. Dr Carolyn Lam:                I keep learning, Amit, this is awesome. I could go on forever so you better stop me. Dr Amit Khera:                  I should probably just be a fly on the wall. You must know Carolyn is a HFpEF, HFrEF aficionado and you guys should have a side call for another hour after this. But I do have one, maybe orthogonal question which is, it's interesting because if you look at how insights were made, they're made off areas I would argue at least that we don't, modern environment uses much which is the autopsy and probably to a large degree hemodynamics as much as probably in the old days although that's changing. I'm curious in a fellowship training program your exposure to autopsy and kind of current in-depth hemodynamic-type training, what's your experience? Dr Mesfer Alfadhel:        Our experience with looking at pathological slides, getting under the microscope, seeing tissue first hand, is somewhat limited in our fellowship training program. I would say in certain subspecialties like our heart failure, advanced heart failure subspecialties we do get a chance to see more myocardial biopsy specimens, but I think increasingly the focus has been on noninvasive methods by which we can assess some of these same things that we used to do, use the microscope for. Invasive hemodynamics I think similarly we get a lot of experience in terms of spending time in the cath lab but I do kind of wonder if we don't have the same in-depth training that we used to have in understanding all the nuances of hemodynamics that used to exist in the past.                                                 Certainly, I think that while that's partially a reflection of the way and the direction in which medicine is heading, there is a little bit that's potentially lost there. That said, while we have the benefit of manuscripts like this that does do in-depth hemodynamics and looks at autopsy samples from a clinical standpoint, if we were to ever try and understand this in a larger population I think we would be required to try and find a way to noninvasively or maybe through potentially invasive hemodynamics better study this in live patients. Dr Amit Khera:                  Appreciate that answer and I'm just for all of you, this has been outstanding. You all have served as incredible expert discussants. I know Carolyn already said it multiple times but we've learned a ton about each of these articles and great to see how they come alive and are used in practice and how they're applied in your own thinking and specifically as fellows in training with these have meant to you. We thank you all for joining us and it's really been a fantastic experience. Dr Carolyn Lam:                Amit, I can only echo your thanks and thank you listeners for joining us today. Fellows out there you are so important to us. Please, please apply to join us on the next FIT podcast as you can see it's really fun.                                                 Don't forget to join us again next week.

Our time is precious, and healthcare professionals HATE it when people waste it with meaningless busywork. Dr. Paul Teirstein, Chief of Cardiology at the Scripps Clinic is on a mission to stop these time thieves. Maintenance of Certification (MOC) for medical boards has little convincing evidence to support that it actually improves outcomes, yet the American Board of Medical Specialties (ABMS) and related orgs held a monopoly on forcing physicians to spend money and precious time annually to “maintain” a certification that they already attained through hard work and long study. Go to NBPAS.org to fight the power. http://zdoggmd.com/against-medical-advice-035

Hemlock Society San Diego (619) 233-4418 In this episode, Faye Girsh talks about the Right To Die and why she continues to support the movement.     Faye was the President of the Hemlock Society USA from 1996-2002 and Senior Vice President of End-of-Life Choices (Hemlock's temporary name) from 2002-2004. She had served on Hemlock's national board and essentially succeeded its founder, Derek Humphry. While President of the Hemlock Society she started the Caring Friends program, in 1998, which provided free, personal information and bedside support to Hemlock members considering a hastened death. For the last 25 years, she has appeared in debates and speeches all over the U.S. and has been on national TV and radio, including Court TV, Good Morning America, and Nightline. She was a speaker at the World Federation Conference in Melbourne, Toronto, Tokyo, and Amsterdam and has spoken at law schools, medical schools, civic groups, universities, and to many other audiences in this country, Great Britain, Canada, New Zealand and Australia. Transcript Dr. Bob: Well, hello and welcome to another episode of A Life and Death Conversation. I'm Dr. Bob Uslander, the founder of Integrated MD Care and the host of this series of podcasts. I have a very special guest with me today. All of my guests are special in some way or another, but Faye Girsh is a phenomenal woman. She is truly a ... I don't know. Some people I've heard to describe her as a marvel and an inspiration, so I'm thrilled to introduce you to my dear friend and co-conspirator, Faye Girsh. Faye Girsh: Hello, Bob. If you're looking for a wonder woman, I'm not it, but I'm very happy to expound on our mutually interesting subject. Dr. Bob: Fantastic. And many people would argue that point and would call you a wonder woman, because you've had a fascinating life, and I know a very interesting career, and the things that you've devoted yourself to and committed yourself to are of great importance to many of the people who are listening, because this is a life and death conversation and to me, you have really lived a very inspiring life, and you never shy away from the conversation about death. And you're somebody who has really devoted herself to helping others have the best possible experience of life and as well the best possible experience of death. Faye Girsh: Thank you for all that. Dr. Bob: And thank you for all that you've done, because what I get to do in my career, some of what gives my life and my career a great meaning is a direct result of the work that you've done over the years. Faye Girsh: It's very encouraging now that there are so many people working on this very important issue for all of us. Dr. Bob: And the issue that you're referring to it's called by lots of different things. When you're talking to somebody about what it is that you do and what you've devoted so much of your life to, what are the words that you like to use to describe it? Faye Girsh: I guess choices at the end of life, if I have less than 30 seconds, that people should be able to die the way they want to, in a humane and peaceful way, with their friends and loved ones present, and consistent with their own values and beliefs. That's the 45-second version. Dr. Bob: Actually, I think it was probably closer to 20 seconds, and it's- Faye Girsh: 20 seconds, okay. Dr. Bob: ... very descriptive and appropriate, I think. Faye Girsh: It sounds very simple too, and it's definitely not simple. In fact, the progress towards it is absolutely glacial because many people don't believe that we should have a choice in how we die, which to me is amazing and also very unjust, unfair. Dr. Bob: Yeah. I agree. And you can spend a lot of time exploring how we got here, and I'm sure there's some value in that because it helps those of us who really do believe that people deserve to have that choice in how, where and when they die. It helps us to see where the challenges remain, by looking at the barriers and the things that have been blocking that- Faye Girsh: You know, I'm reading an interesting book now, Bob, called Modern Death. I don't know if you've seen it. By a Pakistani American doctor named Haider Warraich.  I don't know how you pronounce his name exactly. But he talks about how the way we die has changed so much in the last 50 years because of technology, insurance, hospital, everything. It explains a lot to me about how things have changed from when I was a kid, and the doctor would make house calls, and I assume that if we were dying, he would have given us a nice injection and sent us on our way, with the agreement of the family, but it's a long way from that now. It's a little bit back to what you do when you visit people at their homes, which is so unusual these days. Dr. Bob: That does sound like an interesting book, and I'd like to make sure that the listeners have the resources that our very experienced guests are recommending. So "Modern Death" is the name of that book? Faye Girsh: Yeah. Dr. Bob: I'm going to pick up a copy. I appreciate that. Faye Girsh: Subtitled "How Medicine Changed the End of Life". Very interesting. I haven't finished it yet. I don't think he is necessarily a proponent of medically assisted dying, but he certainly leads up to where it should happen. Because I do think that probably 40 years ago, your GP – there weren't specialties then – your GP would come to your house and if you and your family decided that your suffering was unbearable, something in his black bag would help you through to the other side, just to use all these euphemisms. But that's changed, and the laws have changed. The laws are changing for the better for sure, as far as giving you more choice at the end of life, but it becomes very legalistic and formalistic. And maybe that's good because now there are safeguards, but when men safeguard, they're another man's obstacles. It has become cumbersome and complicated sometimes for people to have a peaceful death. Dr. Bob: Well, it seems like it used to be a pact between the doctor and the patient and family. We didn't need all the legislation; people trusted that their physician was going to be there and help them make those difficult decisions knowing it was time. We also didn't have all the other options available. We didn't have all the intensive care units with all of the life-prolonging technology. We didn't have skilled nursing facilities, where people could be housed for months or years- Faye Girsh: Well, actually we didn't even live that long. We didn't live long enough to have a prolonged and agonizing death. We didn't die of these degenerative diseases that we have now. So, yeah. I mean, this book explains a lot of that, but this is something that we've sort of accustomed ourselves to over the years, ways to keep people alive. Faye: I live in a retirement community. I'm 84, and it's getting close myself, and it's very interesting for me to see people, my friends, get old, get disabled, wind up in the care center, or the memory unit at worst, and die quietly.   We really don't know how the end comes for most people unless they are very close friends. And then we get a little picture frame, and a white rose in the mail room and says we died. No telling how we died, or what we went through before we died. And then a little obituary says he died peacefully in his sleep, which is usually a lie. And then a little tombstone says, "Rest in peace," but before that, sometimes there is no peace, and sometimes these steps to getting dead are very difficult. Dr. Bob: Yeah, as I'm aware of through my own experience and career. That's an interesting ... it's really fascinating to think about that, living in these communities, many of which are very nice, right? They're beautiful. They're like luxury hotels or cruise ships. Faye Girsh: They are. Right. Dr. Bob: And then there are all these folks who come to the dining room, or you see them in the common areas, and at the activities, and then you just don't see them anymore. Faye Girsh: That does happen. Or you see them on walkers, and then in wheelchairs, and then you don't see them. Or if they're your neighbors, they move to the care center, which we have a very nice arrangement. And then the next thing, sometimes as you know, is their little picture and white rose are up there in the mail room. It's fine. It's a good way to experience death. We don't talk about it very much here, but I've appreciated knowing that, because in my life I wasn't among people who were dying, but now, that's what happens. And what I hope is that people can die the way they want to. And I know you spend time here too and you know the people who live here. They accomplished a lot. We say our motto in Hemlock Society is, "Good life, good death," which we actually stole from Christian Bernard, I think, who wrote a book. The heart transplant doctor wrote a book, I think, called Good Life Good Death. And many of us here have lived a very good life, but we often don't have a good death... I've only been here four years ... but who went out to [inaudible 00:10:00] parking lot and shot himself because he had early dementia. And other people who've struggled with dementia then wind up in the memory unit here for years. In fact, we're having a situation now with my very good friend, whose wife has been there I think now eight years. And they have treated her without consulting the family, but now the family has put their foot down, absolutely no treatment. So she gets nothing. No vitamins or anything. And she's never been healthier. And finally, the family's decision to withhold food and hydration. And of all the things that have happened, is the caregiver has protested and said she would sue the institution here for murder. So, that's a very interesting development. Dr. Bob: I wasn't aware that was happening. Faye Girsh: Well, if I were at lunch now, which I usually would be, I would be talking to this man whose wife it is and trying to enlist one of his children to speak at one of our Hemlock meetings on this subject, which is the refusal of treatment in dementia. A very complicated subject, because a demented person can't speak for herself or himself, but the loved ones can, the person who's been appointed as health care agent can. But often those wishes are violated. I will have another speaker at our January meeting, whose mother-in-law has been in the institution. Those who know Bonnie, was once a very active, beautiful, intelligent woman, and they had been coerced, shamed I guess is the word, into providing treatment for her twice, because she has to have her hip fixed because she fell. She has to have her ulcer treated. Even though she knows nothing it is has made an advance [inaudible 00:12:18]. She doesn't want treatment. So these things are very complicated, refusing treatment, medically futile treatment that's given so often. And hospice is not saying that they can fix everything, but really they can. They can fix a lot of the pain even, but alone the existential suffering that people have because they can't do what they are used to doing, they don't want to be doped up at the end to alleviate the pain. They want a peaceful way out, and yet they either don't know what's available to them, or they can't find a doctor who will help them use even our California law, The End of Life Option Act. So we have a long way to go. We are about to finish our 30th year as Hemlock Society of San Diego, and we're looking for new directions to go in. And for me, dementia is the direction because it seems so hopeless to be a long-time demented patient with no way out. Dr. Bob: That is just ludicrous, to think about that when there are so many people, there are so many people who, as you say, lived wonderful lives, they raised children, they had careers, they contributed, and if they were able to look at the scenario and to see what's happened to them and what's being done, and you ask them what they would want, we know that they would want to not be there. Faye Girsh: That right. Dr. Bob: They would be ready to ask somebody to mercifully end their lives. And I'm a physician, and I know that there are laws that prohibit that, and we can't just take it upon ourselves. And even if people have indicated that they would never want to be alive in those circumstances, our hands are tied. But it's just a crazy, crazy situation- Faye Girsh: Fortunately, we can look North and see what Canada is doing. And Canada is making much more progress than we are, which is not surprising of course. But the Canadian law that went into effect the same time the California law went into, that is June 2016, permits active euthanasia. That is a patient can ask for a lethal injection. It's so much better than what we have to struggle with, these expensive bad-tasting drugs that you have to be able to swallow, to use. That's not such a good solution.  And also, Canadians have made their laws much more liberal. That is, it doesn't just take a doctor to do it. A nurse practitioner can help you die that way. And in our law in California, you have to have a psychologist or psychiatrist to ascertain that you are mentally competent, and another doctor to determine that you are terminal, in addition to the first doctor. But in Canada, that's not the case. A lot of different people can ascertain that you're mentally competent. And again, it doesn't have to be a doctor to provide the lethal injection. And the criteria is not a terminal illness as ours is, which to me, it is not even relevant to the question of how much you're suffering, and how long you've been suffering, and how long you have got to suffer. A terminal illness means you're going to die within six months, which in some cases is a mercy, but some of these neurodegenerative diseases take years of suffering before death occurs. So, I think we have to look to Canada to change our laws. And we've had the Oregon-type model as our model law now in six jurisdictions, five states in the district of Columbia, but that law has existed now for 20 years. To me, it's inadequate, and it's time to move forward and to look at what other countries are doing.  And then, there's a whole collection of ... No, that's not true. There are some doctors and some organizations, and I'm thinking in particular of Doctor Philip Nitschke, who started in Australia and was the first doctor in the world to give somebody euthanasia at their request, under a law. And that was back in 1996. He's now living in Holland, but he doesn't believe that we should try to change the law at all. He believes that people should be able to do it yourself, get what's necessary, whether it's drugs or mechanical devices or whatever, and do it ourselves because he knows that doctors are resistant to doing this and the law is very slow to change. That's one point of view. I don't totally agree with it. I think it's very helpful to have somebody there, somebody with an organization like Final Exit Network, to be there with you, and certainly a doctor to be there with you if you can find a cooperative doctor like Doctor Bob Uslander to see you through this, because it's not just a one moment decision, you swallow something and you're dead. It's a decision that should be decided over months with consultation with your loved ones. But that is very difficult and complicated in our country. Dr. Bob: All of this is complicated for sure, so I appreciate you sharing your passion, and your viewpoints on this. If it's okay, I want to make one slight correction to one of the things that you indicated, about the process for the End of Life Option Act in California, in that it doesn't actually require a psychiatrist or a mental health specialist to weigh in- Faye Girsh: No. You're right. Dr. Bob: Only if the attending physician or the consulting physician feel that there is a mental health issue or a psychiatric issue that is impacting the person's ability to make a decision. Faye Girsh: You're right. It doesn't happen very often actually- Dr. Bob: No. Faye Girsh: That a mental health professional is required to make the decision about competency. I think in Oregon has happened very few times. We have- Dr. Bob: Yeah, because a physician is- Faye Girsh: Better data from Oregon than we have from many places else. We have 20 years of data that the government of Oregon has collected. No, you're absolutely right about that, Bob. Dr. Bob: Again, thank you for sharing. We definitely have strides to make. I think we both are feeling grateful that we have come to a place in California where people do have more choice and more options, but we do still need to continue pushing forward. There are still some issues and problems with the existing law. It doesn't address the needs of the people with cognitive impairment and dementia, and those are really challenging situations. Faye Girsh: And doctors are not being educated about what this law entails. I have a new primary care doctor that I talked to the other day at Scripps, and she didn't know anything about it. There's never been even, not only a policy described by Scripps but no education about the law at all. She didn't know what to tell me. She's going to find out and tell me later. But this is not acceptable. This is a law now, and even though everything is voluntary, so it's completely voluntary on the part of the doctor, the patient, the hospice, the pharmacist. That doesn't mean that people shouldn't be educated about it, and that's what we try to do in Hemlock. I just gave a speech to bunch of elder law attorneys, and before that to an Episcopal convention. And the more people we can talk to the better, but that's a drop in the bucket compared to the people who don't know what their rights are. And some hospitals have gone all out. Kaiser's very helpful in that respect, but my hospital, Scripps Clinic, they don't seem to know anything. It requires a massive educational effort, and it requires a little more cooperation and enthusiasm on the part of doctors and institutions, and definitely on the part of hospices. I think it's a disgrace that no hospice that we know of in this county will actually provide a doctor to do this for you. Many of them will refer to you, which is fine, but I think hospices should be able to assure a patient who comes for hospice care that if their suffering becomes too great, or they've had enough, that somebody will help them achieve a gentle death, which is what happens in Canada now, especially in Quebec, which has been the leader in this. The formally very Catholic province now, very progressive. And in Belgium and Holland. Their hospices will also provide peaceful death, voluntary euthanasia, but not ours. Dr. Bob: Not ours. Faye Girsh: And ours maintain that they can do everything in make dying fine for you and many of them can. I have no question about that. But for many people, there needs to be another option. Dr. Bob: And I always think about that when we hear from the palliative care and hospice folks, who are all very well-meaning, and compassionate, and they make it very clear that if the suffering becomes too great, then we can medicate people into unconsciousness. It's called palliative sedation, where you get medication so that you're no longer aware of your surroundings, no longer feeling pain, no longer feeling like you're struggling to breathe. And once you get medicated to that level, you will no longer be able to eat or drink, you won't have any nutrition, and eventually, you'll die of dehydration. And I understand that that is possible, and we for years have been doing that for or to patients. And my response to it is, if somebody has another option if somebody has the option of actually taking something on their own that will prevent that from being necessary, that they have the control, they get some of their power back, why wouldn't we want to make that available to them? Faye Girsh: I have debated that with so many hospice directors and doctors and nurses. I can't understand why the answer is not as simple as you make it. I mean, palliative sedation is very nice. I remember debating one hospice director, I guess she was, and she said, "No. Doctors should never help their patients die, never." But later she said, "When I see a patient in intractable suffering ..." well, she said pain, initially, but she was talking about suffering, " ... then, of course, I will administer something that will relieve them, and they won't wake up." Isn't that what I just said? No. Because the doctor has control over the decision, not the patient. Dr. Bob: Exactly. And I believe that's- Faye Girsh: And that's wrong. Dr. Bob: That's where the big divide is. The medical profession has so much ego, and we are unwilling to give control away. So instead of giving the patient and the family the ability to be empowered to have the option to act on their own, to make this determination, we need to do it for them or to them. We don't believe that people have the intelligence or the ability to make this determination of what's in their best interest. Faye Girsh: I'm not a great critic of the medical profession because I was married to one and I have given birth to one, and I like doctors very much in general. I've always liked the doctors I've had. It's some kind of paradox. I guess it's like politicians, you like the one you have, but then generally they're no good. I don't know what they need, education or something, and they need to be assured that they're protected from the law, because even though this law that we have, The End of Life Option Act, is clear that if a doctor does this, he or she is fully protected under the law. Somehow doctors don't believe it, and – again another generalization about what doctors think or do – they don't like to be bothered. There's a lot of paperwork ... you know this ... involved, there is not just, "Let's see. I write the prescription. Goodbye." You really should attend to your patients; you should find out what's going on with them. So they should be involved, and they don't want to be involved because that's not their job. I just saw a cartoon recently that said, "I'm a doctor, and I believe in preserving life at any cost." And the cartoons said, "Make sure you don't get that doctor." I mean, it's very nice. I do like people who are pro-life but up to a point. Up to the point where the patient says, "Okay. Death is not the worst option here. Staying alive under these conditions is worse, and I want to die gently and peacefully. And I don't want it to be a big secret, and I don't want to jeopardize anyone by helping me. Let's do it." And there's certainly more places in the world that are enlightened about this than we are. Dr. Bob: And I believe we're moving in the right direction as we both stated before. We have a lot of work to do, but we don't want to discount the fact that we are certainly in a better position than we were a couple years ago here in California. I try not to be critical of physicians. Many of my very good friends are physicians. I have spent a lot of time with some amazing physicians, and I think in general, doctors really do care a lot about people. They go into the profession because they're caring, and they want to help, and they want to do good. And it's not that they, in general, don't want to be bothered. They don't have the time; they're not allowed to have the kind of time that it takes to do this well. Many physicians are still very uncomfortable with the whole notion of death. When you go to medical school, and in your training, you would assume that there is no such thing as death because it's really never talked about. The textbooks don't mention anything about death. It's all about what we can do, how we can utilize the technology available to us, how we can do the right screening and prescribe people the- Faye Girsh: To prevent this from happening. Dr. Bob: So the training isn't there. A lot of people, I think, have to go through their own personal experience, they have to go through their own personal journey. Maybe have their own epiphany about what their role here is, and how they can best serve their patients. Faye Girsh: Bob, present company excluded, I don't think doctors need to be the agents of a peaceful death. In fact, when I was head of the National Hemlock Society, I started this program called Caring Friends where we educated our peers, older people like us ... I mean, I'm talking about the members of the Hemlock Society now, not you ... to work with people in their homes and tell them what means they could use to achieve a peaceful death, short of getting the drugs necessary. And there are many means. And of course one of them is not eating and drinking, but that's not the one we advocate. I'm talking now about the national organization called "Final Exit Network," which I was one of the founders, and that emanated from the Caring Friends program that I started at Hemlock. And we knew that doctors were not going to help, that we're not going to be able to get these drugs, which is the gold standard, but there are other ways. Now I'm using my Final Exit Network hat here–the guys at Final Exit Network teach people how to die peacefully, not using drugs, but using other means, which essentially lowers the oxygen in the brain, which causes a peaceful death but doesn't require drugs.   And there's an organization, a very loose organization, called Nutech, which has been working on this now for years, maybe 15 years, also started by Derek Humphry who started the Hemlock Society, New Techniques in Self-Deliverance. And I just went to a Nutech meeting in Toronto, where people from all over the world were there. It was a $5,000 reward for people who could come up with the best inventions so that people could do it themselves and die peacefully. So we're a long way from making an ideal situation, but there are situations that people can use, but that's not enough. I always gave the prototype of an 85-year-old woman. I'm about to be that. But an older person who's alone, who's sick, who may be partially blind, who is not mechanically inclined, a limit to what they can do to do this for themselves. So we do think that people should be there with them, and that's what they do in Final Exit Network. The Exit guide is present when people use these methods, and coaches them in how to use them. And we think we're covered under the First Amendment, but there's some litigation going on, which has challenged that assumption. Dr. Bob: Not surprising. Faye Girsh: No. But there are books, and videotapes, and YouTubes telling you how to end your life peacefully. And that certainly has its drawbacks because we don't believe that ... I mean, I am a psychologist by training, and I've worked with a lot of suicidal people, who with therapy have come to realize that suicide is not the answer to their problems. And it isn't. And there's a fine line between assisted dying and suicide, but generally, people who want help in dying would much prefer to live, but because of their disease or condition find that dying is preferable to living that way, whereas suicidal people don't want to live. They want to die. That's the difference. So if you make these methods available, then suicidal people have access to them, and that's arguable too. I mean, maybe it's better that they die peacefully than jump off bridges, as one of my very good friends did, or shoot themselves, as another very good friend did, and they could choose to die peacefully. That's a whole another discussion. Dr. Bob: Yeah. That's a whole another discussion. And I'm just thinking about, as I'm hearing you speak and discussing these topics that are certainly not part of the mainstream conversation that people are having, I'm just imagining that there are going to be people listening to this, who are squirming and feeling uncomfortable about these topics. And you know what? And that's okay. Faye Girsh: No doubt. Dr. Bob: These are things that we all really should explore and try to determine our own comfort level with them, and hopefully become more comfortable engaging in the entire spectrum of conversations about life and death. Faye Girsh: The Hemlock Society of San Diego, which has existed now for 30 years, is at a juncture of where to go next. We can continue having meetings and having speakers and everything else, but we do have to tackle these very naughty issues. And we are tackling them. Maybe we're the only organization in town if anywhere, that is doing it, but it does make people squirm. But we have a lot of people come to our meetings. They're all free. They're all open to the public, and they all deal with different issues about dying. To one meeting we had three veterinarians who talked about how they can help animals dying. It's so nice. Everybody was so jealous they wanted to grow two extra legs and a tail and be one of these animals that die in the arms of their loved one, peacefully and gently. A little shot in the paw and that's it. And then I've been a defender of Jack Kevorkian all these years. I thought, when he showed how his patient Tom Youk died, to 60 million viewers, that was a good thing, that we don't see people actually die and we don't even die on ICUs, or even in hospices. We don't see them junked out with drugs for days on end. We never see how people die except fictional, machine guns and that kind of thing. To see somebody get a lethal injection, keel over and he's dead, and how simple that was, and how desperately he longed for that relief from his ALS. This was the last patient that Doctor Kevorkian helped. And for that, Doctor Kevorkian spent eight years in prison doing a 10- to 25-year sentence that he got. For a doctor to come out and say this is what's important for doctors to do ... and the thing about Jack Kevorkian was there was nobody in the world practically, unless you were in the middle of a jungle somewhere, who hadn't heard of him, who didn't have an opinion about him, and who hadn't heard from his own patients why they wanted to die. And that kind of education thought, at that point, when Jack Kevorkian was I think in his seventh or eighth year of doing this, 75% of Americans believed that people should have assisted dying from a doctor. That's gone down considerably, because people don't hear about this, they don't engage in the dialogue, their doctors don't talk about it certainly, and it's up to us, the Hemlock Society of San Diego, and a few other organizations, to discuss this openly, so people know what the issues are. Dr. Bob: On that note, I think we're going to kind of wrap it up, but I do want to make sure that anybody who is interested in getting more information about anything that we've spoken about, that you've shared, has direction on how to get that information. I want to thank you for being a pioneer and for dedicating so much of your time and energy and money to this effort. There are many, many people who are indebted to you and have gratitude for the work that you and your tribe, your peers have done. Faye Girsh: Thank you very much, Bob. Dr. Bob: You're welcome. Faye Girsh: I'm getting to the point where a peaceful death is becoming more of an immediate issue, so I'm working extra hard, but I'm very glad you're around. Very comforting to me and many other people. Dr. Bob: And seeing you and being around you, you have vital energy, and I don't think it's going to be dissipating anytime soon. How do people learn more about the work that you're doing? Faye Girsh: Well, we have a website that's very informative, HemlockSocietySanDiego.org. And that will give you our phone number, which is 619-233-4418. We have, of course, an email address, which is ... I'm not even sure what it is. Dr. Bob: I'm sure they can get it off of the website, right? Faye Girsh: The website has all this information. And people are welcome to get on our email list to get a notification of our monthly meetings. And they're welcome to come, no charge. Although we will be having special meetings, I think now, for Hemlock members that we don't particularly want to share with the public, but that's another issue. Because we want people to be empowered the best way they can about ways to have a peaceful death. And not only for them, but we're having more young people come because their parents are dealing with this issue, or not dealing with it. Dr. Bob: And I've been to meetings, I've spoken at the meetings, and there's a wealth of information, and really some pretty incredible people there. I find that the level of intelligence and acceptance among the people who are really paying attention to these issues is very high. Faye Girsh: Yeah. And you've gotten to know some of them. Dr. Bob: I sure have. Faye Girsh: The ones that have had a peaceful death with your assistance. Maybe that's not the right word, but I don't know- Dr. Bob: That's fine. Faye Girsh: ... one has to be a very good- Dr. Bob: With my guidance. Faye Girsh: Guidance is a good word. Dr. Bob: And I've shared with our listeners some of the experiences that I've had and how powerful they've been. And the more people that I'm able to support and be with, the more strongly I feel about helping to spread the message and allow more people to understand how they can get this control, how can they be empowered when their life is coming to an end, and they're just like many of the people we've discussed. They're just not okay allowing this natural decline to decimate them further when they have a more peaceful, gentle option available. Faye Girsh: Thank you for doing this, Bob. And thank you for doing the podcast. I appreciate having an opportunity to talk about this. Dr. Bob: Yeah. Well, you're so articulate and passionate, and I look forward to our next conversation together. Faye Girsh: Absolutely. Dr. Bob: This is Doctor Bob Uslander, A Life and Death Conversation, until next time.

In Episode 030 of A Medicinal Mind: Wisdom and Well Being, I share space with one of the visionary hearts behind Autoimmune Wellness, pioneering health coach and nutritional therapy consultant Angie Alt. You may remember in Episode 025, I held an inspiring conversation with the other half of this courageous duo, Mickey Trescott, and in this episode I continue the conversation with Angie as we seek to uncover the secrets behind communal healing, the real roots of wholesome lifestyle change and the hope that is born when we begin to see the past, no matter how troubling, not as something to run from, but as something to grow into.   In this podcast, we begin by exploring Angie's story, a story of suffering, renewal and unfathomable faith, leading her to her current calling as a health coach guiding others through the uncertainty and hurt of autoimmune illness.      Angie highlights her innovative initiative SAD to AIP in SIX, a group coaching program that has lead thousands of folks through their transition to the Autoimmune Protocol and sustainable lifestyle change. Speaking on its early origins and immediate success, into its most recent period of growth, Angie offers us some insights into the structure of the program, who is actually involved in the group and how truly does one support those through the healing journey?   Straying perhaps from the measurable and describable, we ask some curious questions behind the cultivation of community, the opening to vulnerability, and the eventual path to empowered wellness.   Is it really all about food?   We then explore Angie's most recent collaboration with Dr. Gauree Konijeti, MD, MPH, Director of the Inflammatory Bowel Disease Program at the Scripps Clinic in San Diego, California. Together the two partnered to guide 15 patients through a modified version of Angie's revolutionary program, ultimately leading 12 of the 15 participants from multiple years of debilitating illness despite significant pharmacologic therapy into clinical remission and new found health.   I cannot express how much I enjoyed this conversation with Angie, navigating through mild sleep deprivation and a few stumbling sentences to somehow begin to answer the ultimate question:   How do we get well?   And who do we to actually do it?   I hope you enjoy the show.   Keep up with Mickey and Angie on their website using this link: https://autoimmunewellness.com If you would like to read all of the articles I've written here on the blog, click here. If you would like to follow my daily ins and outs, check out my Instagram! If you would like to learn more about becoming a health coach, click here.   Listen to all of A Medicinal Mind's previous podcasts here: https://www.amedicinalmind.com/podcast-wisdom-and-well-being   Disclaimer: The content at A Medicinal Mind and the content of our podcast are educational and informational in nature. They are not intended to be medical advice, spiritual counsel or a substitute for working with a health professional or a trained spiritual counselor. We cannot guarantee the outcome of any of the recommendations provided on our page or by the guests on our podcast and any statements written or made about any potential outcomes are expressions of opinion only.

Thyroid cancer is one of the fastest growing cancers in the United States, especially among women. In Florida, thyroid cancer trails only melanoma skin cancer as the state’s fastest rising cancer. Today’s guest on episode 38 of STEM-Talk has made it his mission to not only treat thyroid cancer, but also raise awareness about the disease. Dr. Mark Lupo is founder and medical director of the Thyroid and Endocrine Center of Florida which is based in Sarasota. A graduate of Duke University, he went on to earn his medical degree at the University of Florida where he worked with the world-famous thyroid expert, Dr. Ernie Mazzaferri. Dr. Lupo also did his internship and residency in internal medicine at Florida and then won a fellowship in endocrinology, metabolism and nutrition at the University of California San Diego and the Scripps Clinic. Dr. Lupo’s research and practice are particularly focused on thyroid nodules, which are abnormal growths of thyroid cells that form a lump within the thyroid gland. Although the vast majority of thyroid nodules are benign, a small proportion do contain thyroid cancer. His practice is centered on diagnosing and treating thyroid cancer at the earliest stage and helping people avoid unnecessary surgeries. He also is very involved in teaching neck ultrasound, thyroid cancer and general thyroid disease to other physicians at the national level.  He has published book chapters and several articles on thyroid disease and thyroid ultrasound.  In addition to his work as the medical director of the Thyroid and Endocrine Center of Florida, he also is a clinical assistant professor on the faculty of the Florida State University College of Medicine. Dr. Lupo also was named the 2017 recipient of the Jack Baskin Endocrine Teaching Award, which is annually presented by the American Association of Clinical Endocrinologists.  You can learn more about the Thyroid and Endocrine Center of Florida by visiting http://www.thyroidflorida.com. Show notes: 3:21: Ken and Dawn welcome Mark to the show and ask him what led him to study medicine at Duke. 4:52: Dawn asks Mark how he ended up choosing endocrinology with a particular interest in thyroid nodules and cancer as a specialty. 6:40: Dawn asks Mark how he found the time to go on incredible adventures, such as climbing Mount Kilimanjaro as he worked to establish a practice. 8:40: Mark provides an overview of the thyroid. 9:46: Dawn asks Mark to clarify about whether a thyroid nodule is the same thing as a goiter. 10:25: Ken comments on how thyroid nodules and cancer seem to be epidemic and how there has been an increase of instances in the United States. He asks Mark if there is a greater incidence of disease or if there is just better detection or a combination of both. 14:33: Dawn asks if we know why thyroid nodules and cancer seems more prevalent in women. 15:01: Dawn inquires about the survival rate for those diagnosed with thyroid cancer, and whether or not it has changed over the years. 17:45: Dawn comments on how she has been looking forward to this interview as a result of a thyroid scare she had in graduate school where there was an inconclusive biopsy. She asks Mark how common it is to have an inconclusive finding and unclear results about a sample. 20:52: Ken comments on his personal experience with thyroid nodules that led to surgery and a positive outcome, and how he met Mark early in this experience after hearing him on a podcast discussing fine needle aspiration. After hearing this podcast, Ken concluded that he most likely needed this procedure. Ken asks Mark to talk about this. 23:37: Dawn asks Mark how often the thyroid nodules are discovered incidentally. 27:34: Dawn asks if there are certain characteristics you can see by ultrasound that give you an idea as to whether you are looking at a benign or malignant nodule. 29:53: Dawn asks what the histological differences are between a benign ...

Dr. Robert Bonakdar and Evelyne talk about how to get rid of your pain, whether it's chronic lower back pain, migraines, or joint pain. Learn what foods are most helpful, which supplements to consider, what the underlying causes of pain are, and more.  Dr. Bonakdar is the Director of Pain Management at the Scripps Center for Integrative Medicine and a member of the Scripps Green Hospital Pain Management and Physician Wellness Committees.  He also serves as Assistant Clinical Professor at the University of California, San Diego, School of Medicine and is the current president of the American Academy of Pain Management. After completing his family medicine residency he completed a fellowship in integrative medicine at Scripps Clinic with a focus on integrative pain management.  He has additionally completed the UCLA Acupuncture Course for Physicians and a Richter Fellowship in Southeast Asia, where he studied acupuncture, Tai Chi and mind-body practices. His current clinical and research interests include integrative approaches to chronic disease management with a focus on pain management and metabolic disease.  He is also editor of the Weil Integrative Guide to Pain Management coming out in the fall of this year, editor of the H.E.R.B.A.L. Guide: Dietary Supplement Resources for the Clinician and a contributing author to the 3rd edition of Integrative Medicine. Download Evelyne's free guide 5 Days to More Energy at elevateyourenergy.com. 

On the Thursday, February 28th 2013 broadcast at 3:30PM Pacific/6:30PM Eastern our concluding special guest in the HiMSS13 Coundown series isJohn Mattison MD, aka @JohneMattison, CMIO of Kaiser Permanente, Southern California. Dr Mattison began his medical career at UC San Diego and Scripps Clinic, where he practiced in many clinical settings including primary care, critical care, preventive medicine, hyperbaric medicine, trauma and helicopter medicine, and held several directorships while at Scripps Clinic, including Quality, Utilization, and Critical Care.   He joined Kaiser Permanente in 1989, and was appointed as Assistant Medical Director and Chief Medical Information Officer in 1992.   John's interest in systems design began as a marine biologist when he created several software applications to model population behavior.  He wrote his first electronic health record in 1984 and used fully automated medical records in his practice until the time he began a fulltime commitment to healthcare informatics.  He has built, designed, or implemented seven different EHR systems, most recently KP HealthConnect.  His team helped build and deploy the first highly scalable version of this system, which today stands as the largest private sector implementation of an EHR in the US.     John was director of the first and largest regional deployment, encompassing 5,000 physicians, 140 clinics, 13 hospitals, and 2.3million members, but he is quick to identify his many colleagues within KP who have provided the support, the resources and the skills necessary for such a monumental achievement. John is also the founder of CDA and CCD international standards for HIE.   Join us!

Guest: Ken Fujioka, MD Host: Steven Edelman, MD Patients with type 2 diabetes struggle to lose or maintain weight, especially with particular therapies. What are some of the successful therapeutic interventions available for overweight patients with type 2 diabetes? What are the potential health effects of the loss of even 5 to 10 pounds for these patients? Join host Dr. Steven Edelman and his guest, director of the Nutrition and Metabolic Research Center and director of the center for Weight Management at the Scripps Clinic in La Jolla, California, Dr. Ken Fujioka, as they discuss the role that weight plays in the aetiology of diabetes and its particular benefits.

Guest: Rachel Kim, MD Host: Steven Edelman, MD Diabetes may affect the musculoskeletal system in a variety of ways. The metabolic perturbations in diabetes result in changes in the connective tissue. What are current recommendations for healthcare providers as an overall strategy in the treatment of patients living with diabetes? Join host Dr. Steven Edelman and his guest, rheumatologist at the Scripps Clinic, Dr. Rachel Kim, as they discuss musculoskeletal complications, intervention and treatment.

Dr. Astrid Pujari, founder of The Pujari Center in Seattle, WA has pursued the integration of Western and Holistic medicine for the past 15 years. Her passion for integrative medicine arose from the belief that no single healing method can meet the health needs of all patients. Instead, each patient must be considered in their entirety and offered the healing options that are most appropriate for their personal, physical and spiritual circumstances. During residency training in Internal Medicine at the Scripps Clinic in La Jolla, California, she pursued integrative medicine training to complement the rigorous internal medicine training. She also pursued a formal degree in herbal medicine from the prestigious college of Phototherapy in London England. After four years of rigorous academic and clinical training, she was awarded a Diplomate in Phototherapy and credentialed by the National Institute of Medical herbalists in Europe, the premier credentialing body for herbalists in Europe.