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Brain Talk | Being Patient for Alzheimer's & dementia patients & caregivers
After Deborah Kan's mother, Alvera Kan, died in December of last year, the family donated her brain to UCSF to better understand what type of dementia she had. The answer came back with not just one diagnosis, but three different types of dementia: Alzheimer's disease, vascular dementia, and LATE. Kan and her sister, Susan Whitaker, are joined by Dr. Bruce Miller, director of the UCSF Edward and Pearl Fein Memory and Aging Center, and Dr. David Soleimani-Meigooni, a neurologist at UCSF's Memory and Aging Center and assistant professor focused on precision diagnosis in Alzheimer's and related neurodegenerative diseases. Miller's work has helped shape how clinicians identify and distinguish different forms of dementia, including frontotemporal dementia, while Soleimani-Meigooni's clinical and research work includes using imaging and biomarkers to better understand amyloid, tau and other drivers of cognitive decline.In this conversation with Kan and Whitaker, Miller and Soleimani-Meigooni discuss how dementia diagnosis can remain uncertain during life and how an autopsy can reveal multiple diseases. They underscores how common mixed dementias are, why symptoms such as getting lost or struggling with numbers can point to specific brain changes, and why better diagnostic tools are needed. They also highlight the lasting scientific value of brain donation, showing how one family's decision can contribute to more precise diagnoses, better biomarkers, and, ultimately, more individualized treatment approaches for future patients.---If you loved listening to this Live Talk, visit our website to find more of our Alzheimer's coverage and subscribe to our newsletter: https://www.beingpatient.com/Follow Being Patient: Twitter: https://twitter.com/Being_Patient_Instagram: https://www.instagram.com/beingpatientvoices/Facebook: https://www.facebook.com/beingpatientalzheimersLinkedIn: https://www.linkedin.com/company/being-patientBeing Patient is an editorially independent journalism outlet for news and reporting about brain health, cognitive science, and neurodegenerative diseases. In our Live Talk series on Facebook, former Wall Street Journal Editor and founder of Being Patient, Deborah Kan, interviews brain health experts and people living with dementia. Check out our latest Live Talks: https://beingpatient.com/live-talks/
This episode of EM Pulse dives into a critical intersection of clinical practice: the overlap between objective evidence-based medicine and the subjective influence of implicit bias. In a special collaboration with Don't Forget the Bubbles (DFTB), we are joined by experts from across the globe to discuss a landmark study on how clinical decision rules—specifically the PECARN (Pediatric Emergency Care Applied Research Network) imaging rules—impact disparities in pediatric trauma imaging. The Variables of Bias We often think of medical decision-making as a clean equation, but how much do factors like a patient's perceived race or ethnicity “creep” into our choices? The team explores the concept of equitable care—providing the best possible outcome regardless of factors outside a patient's control—and why awareness alone often isn’t enough to counteract the biases we all carry. Standardizing Equity: The Power of the Rule The core of this discussion centers on a prospective multicenter study titled “Perceived Race and Ethnicity on CT Use in Children with Minor Head or Abdominal Trauma.” * The Question: Do racial and ethnic disparities in CT use still exist in the “PECARN era”? The Twist: Why the researchers chose to look at clinician-perceived race rather than self-identification to capture what is actually happening in the provider's mind during a shift. The Finding: The guests discuss the surprising (and encouraging) results regarding how structured clinical rules can act as “equity builders.” A Global Perspective Bias isn’t just a local issue. With representation from UC Davis, UCSF, Children's National, and Athens, Greece, the panel looks at the international landscape of pediatric emergency care. They discuss: The barriers to implementing decision tools in different healthcare systems. The concept of “pediatric readiness” on a global scale. How these rules—originally developed in the U.S.—are being validated and adapted from Australia to Europe. Moving Beyond the “Black Box” While AI and machine learning are the buzzwords of the day, this episode highlights the beauty of “simple” statistical tools that are transparent and easy to use at the bedside. The guests share how they envision these findings changing their next shift—not by removing the “humanity” of the process, but by anchoring conversations with families in solid evidence. Check the Show Notes: We've included links to the original study and the companion blog post at Don't Forget the Bubbles, which features a deep dive into the data. You can also find the PECARN Pediatric Head Injury and Intra-abdominal Injury (IAI) rules on MDCalc to use on your next shift. We want to hear from you! Connect with us on social media @empulsepodcast or on our website ucdavisem.com. Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children’s National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences Dr. Nisa Atigapramoj, Pediatric Emergency Medicine Physician at UCSF Benioff Children’s Hospital Dr. Spyridon Karageorgos, Pediatric Emergency Medicine Physician at Aghia Sophia Children's' Hospital in Athens, Greece Resources: DontForgetTheBubbles.com: CT Use in Children with Minor Head or Abdominal Trauma Atigapramoj NS, McCarten-Gibbs K, Ugalde IT, Badawy M, Chaudhari PP, Yen K, Ishimine P, Sage AC, Nielsen D, Uppermann JS, Kravitz-Wirtz ND, Tancredi DJ, Holmes JF, Kuppermann N. Perceived Race and Ethnicity on CT Use in Children With Minor Head or Abdominal Trauma. Pediatrics. 2026 Feb 1;157(2):e2024070582. doi: 10.1542/peds.2024-070582. PMID: 41520991. PECARN Spotlight: Tools Validated Excuse Me, Your Bias is Showing PECARN **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.
A confrontation at the California Democratic Party Convention is going viral. During an exchange on the convention floor, activist Beth Bourne questioned a UCSF administrator about policies surrounding gender treatments for minors. A heated moment followed, captured on widely circulated video, including a threat that has now prompted a police report. In this video our experts analyze and educate you on what happened and why with fact based, data based, verified and researched expertise reporting. For free and unbiased Medicare help, dial (656) 218-0931 to speak with my trusted partner, Chapter, or go to https://askchapter.org/nez▶ Reach out to me: https://bio.site/professornez▶ ORIGINAL MADE IN U.S.A 250TH AMERICA DESIGNS: https://professornez.myspreadshop.com/ ▶Support the Channel and Buy us a Coffee: https://buymeacoffee.com/professornezEducational Commentary & Original AnalysisThis channel presents educational, lecture-style analysis created by a university professor and educator. Content focuses on contextual examination, historical background, legal frameworks, and evidence-based analysis of widely reported events, public records, and institutional processes.The approach emphasizes academic methodology, media literacy, and source-driven interpretation rather than advocacy, persuasion, or real-time news reporting. Viewers are encouraged to consult primary sources and form independent conclusions.All content is provided for informational and educational purposes only and does not constitute legal, financial, medical, or professional advice. Views expressed are solely those of the creator.This channel may include references or links to third-party websites or products for informational purposes. Some links may be affiliate links, which may generate a commission at no additional cost to the viewer.All original content is protected by copyright. Fair use applies where permitted by law.
Send a textIn Part Two of “Love Hurts: Leadership, Quality, and the Future of Hospice & Palliative Care,” leaders from the GeriPal podcast and TCNtalks / Anatomy of Leadership, continue a thoughtful discussion on the most pressing issues facing hospice and palliative care today.The conversation explores how waste, fraud, and abuse in isolated cases can tarnish the reputation of an entire field—even when the majority of providers deliver extraordinary care. The panel dives into the evolving landscape of ownership models, from nonprofit and faith-based organizations to private equity–backed providers, raising an important question: does ownership affect quality, or does leadership and accountability matter more? The discussion also examines structural challenges within the healthcare system, including flawed quality reporting tools like Medicare Compare and the unintended consequences of free-market dynamics in healthcare. With over 300 hospices sometimes operating within a single county, leaders highlight the need for transparency, meaningful quality metrics, and thoughtful regulation such as Certificate of Need laws to ensure resources are distributed responsibly and patients receive the best possible care. Finally, the conversation pivots to leadership—arguably the most important ingredient in shaping the future of hospice and palliative care. From the principle of “Go See for Yourself” (Gemba Leadership) to the importance of servant leadership, focus, curiosity, and interdisciplinary collaboration, the panel shares powerful lessons for healthcare leaders navigating complex systems while staying grounded in mission-driven care for patients and families.Key TakeawaysFraud and bad actors can damage the reputation of the entire hospice field. Ownership models matter less than maintaining high-quality patient care. Healthcare markets lack true transparency and informed consumer choice. Many hospices still lack meaningful public quality ratings. Effective leaders stay close to the mission and frontline care. (This episode is a Top News Stories of Month February 2026)TCNtalks:Chris Comeaux, President / CEO of TELEIOSTCNtalks Co-Host:Cordt Kassner, PhD, Publisher of Hospice & Palliative Care Today & CEO and Founder of Hospice Analytics GeriPal Podcast:Dr. Eric Widera, Professor of Medicine and clinician-educator in the Division of Geriatrics at the University of California San Francisco (UCSF) and co-host of Geri-Pal PodcastDr. Alex Smith, UCSF faculty in the Division of Geriatrics and ) and co-host of Geri-Pal PodcastThe Anatomy of Leadership podcast explores the art and science of leadership through candid, insightful conversations with thought leaders, innovators, and change-makers from a variety of industries. Hosted by Chris Comeaux, each episode dives into the mindsets, habits, and strategies that empower leaders to thrive in complex, fast-changing environments. With topics ranging from organizational culture and emotional intelligence to navigating disruption and inspiring teams, the show blends real-world stories with practical takeaways. The goal is simple yet ambitious: to equip leaders at every level with the tools, perspectives, and inspiration they need to lead with vision, empathy, and impact. https://www.teleioscn.org/anatomy-of-leadership
In Part Two of “Love Hurts: Leadership, Quality, and the Future of Hospice & Palliative Care,” leaders from the GeriPal podcast and TCNtalks / Anatomy of Leadership, continue a thoughtful discussion on the most pressing issues facing hospice and palliative care today.The conversation explores how waste, fraud, and abuse in isolated cases can tarnish the reputation of an entire field—even when the majority of providers deliver extraordinary care. The panel dives into the evolving landscape of ownership models, from nonprofit and faith-based organizations to private equity–backed providers, raising an important question: does ownership affect quality, or does leadership and accountability matter more? The discussion also examines structural challenges within the healthcare system, including flawed quality reporting tools like Medicare Compare and the unintended consequences of free-market dynamics in healthcare. With over 300 hospices sometimes operating within a single county, leaders highlight the need for transparency, meaningful quality metrics, and thoughtful regulation such as Certificate of Need laws to ensure resources are distributed responsibly and patients receive the best possible care. Finally, the conversation pivots to leadership—arguably the most important ingredient in shaping the future of hospice and palliative care. From the principle of “Go See for Yourself” (Gemba Leadership) to the importance of servant leadership, focus, curiosity, and interdisciplinary collaboration, the panel shares powerful lessons for healthcare leaders navigating complex systems while staying grounded in mission-driven care for patients and families.Key TakeawaysFraud and bad actors can damage the reputation of the entire hospice field. Ownership models matter less than maintaining high-quality patient care. Healthcare markets lack true transparency and informed consumer choice. Many hospices still lack meaningful public quality ratings. Effective leaders stay close to the mission and frontline care. (This episode is a Top News Stories of Month February 2026)TCNtalks:Chris Comeaux, President / CEO of TELEIOSTCNtalks Co-Host:Cordt Kassner, PhD, Publisher of Hospice & Palliative Care Today & CEO and Founder of Hospice Analytics GeriPal Podcast:Dr. Eric Widera, Professor of Medicine and clinician-educator in the Division of Geriatrics at the University of California San Francisco (UCSF) and co-host of Geri-Pal PodcastDr. Alex Smith, UCSF faculty in the Division of Geriatrics and ) and co-host of Geri-Pal PodcastTeleios Collaborative Network / https://www.teleioscn.org/tcntalkspodcast
Send a textThis episode explores the future of hospice leadership and hospice quality through a collaborative discussion between the TCNtalks and GeriPal podcasts.TCNtalks / Anatomy of Leadership host Chris Comeaux and co-host Cordt Kassner join forces with Dr. Eric Widera and Dr. Alex Smith of the GeriPal Podcast , leaders in palliative care and hospice innovation discuss emerging quality measures, data-driven hospice analytics, research challenges, and the leadership needed to guide healthcare organizations through change. For professionals working in healthcare leadership and serious illness care, the conversation offers valuable insight into the policies, research, and innovations shaping the future of hospice and palliative medicine.This is a thoughtful roundtable discussion on leadership, quality, and the evolving future of hospice and palliative care. Together, they explore the biggest stories shaping the field—from emerging quality metrics and research priorities to the human side of hospice leadership. If you're passionate about improving serious illness care, this conversation is just the beginning. Subscribe to TCNtalks/Anatomy of Leadership and GeriPal to stay informed on the latest trends in hospice leadership, palliative care innovation, and healthcare policy. Share this episode with a colleague, discuss it with your team, and join the movement to strengthen the mission and future of hospice care.(This episode is a Top News Stories of Month February 2026)TCNtalks:Chris Comeaux, President / CEO of TELEIOSTCNtalks Co-Host:Cordt Kassner, PhD, Publisher of Hospice & Palliative Care Today & CEO and Founder of Hospice Analytics GeriPal:Dr. Eric Widera, Professor of Medicine and clinician-educator in the Division of Geriatrics at the University of California San Francisco (UCSF) and co-host of Geri-Pal PodcastDr. Alex Smith, UCSF faculty in the Division of Geriatrics and ) and co-host of Geri-Pal PodcastThe Anatomy of Leadership podcast explores the art and science of leadership through candid, insightful conversations with thought leaders, innovators, and change-makers from a variety of industries. Hosted by Chris Comeaux, each episode dives into the mindsets, habits, and strategies that empower leaders to thrive in complex, fast-changing environments. With topics ranging from organizational culture and emotional intelligence to navigating disruption and inspiring teams, the show blends real-world stories with practical takeaways. The goal is simple yet ambitious: to equip leaders at every level with the tools, perspectives, and inspiration they need to lead with vision, empathy, and impact. https://www.teleioscn.org/anatomy-of-leadership
“We should all be able to look at the numbers and agree that this is not sustainable and that whatever we've been doing is not working. Democrats have had their chance, and Republicans have had their chance, and it's only gotten worse.” — Halle TeccoWarren Buffett called America's healthcare costs “a hungry tapeworm on the American economy.” That tapeworm now devours nearly a fifth of the nation's GDP—and the patient, as always, is on the table. We dedicate today's show to this most perennial of all America's problems, with two guests and two new books that approach the tragi-comedy from different angles.Self-styled innovation wonk Halle Tecco—founder of Rock Health, investor in over fifty digital health companies, professor at Columbia Business School—argues in Massively Better Healthcare that the system is both excessively public and excessively private, a Kafkaesque bureaucracy in which verticalized health plans now own the PBMs, the pharmacies, and increasingly the doctors. The result is monopoly medicine on a scale that would have appalled the original trust-busters.This is ultimately an antitrust story. As we've discussed on the show with Tim Wu, Biden's chief antitrust enforcer, the concentration of corporate power is the great unfinished business of American democracy. Tecco makes the case that Big Med is where the trust busters should go next after Big Tech. UnitedHealth is now one of the largest employers of doctors in the country. So it wasn't exactly shocking when the UnitedHealth CEO was assassinated two years ago. The system isn't broken, Tecco suggests. It's working exactly as designed—just not for patients.Surgeon Robin Blackstone, MD, author of Doctor AI: Reimagining Health. Rebuilding Trust. Delivering Health 4.0, joins us in the second half of the show to offer a view from the front lines. After 30 years as a surgeon, Blackstone confirms everything Tecco diagnoses—and adds a chilling detail of her own: the system is priced entirely for fixing illness, not preventing it. Her prescription is a “triangle of trust” between patient, physician, and AI—with the patient finally owning their own data.Both agree on one thing: every dollar spent on public health saves $14.30 in medical and societal costs. We are all already paying for all the waste. We just need to fix Big Med. But who's going to do it? Tecco says that America is ready for another round of Obamacare politics. But I'm not so sure. Five Takeaways• Healthcare Is a Tale of Two Civilizations: If you're wealthy, you go to UCSF and get the best care in the world. If you're not, you're one of the 100 million Americans without a regular primary care provider. Healthcare debt is the number one cause of bankruptcy. A person earning $30,000 in a rural county can expect to live a full decade less than someone earning $100,000 in an affluent suburb.• The Real Winners Are Monopoly Medicine: Verticalized health plans now own the PBMs, the pharmacies, and increasingly the providers. The ACA's profit cap forced them to grow the pie instead of getting more efficient. United is now one of the largest employers of doctors in the country. Independent pharmacies are closing at the rate of one per day. Rite Aid is bankrupt—the only major chain not owned by a health plan.• Every $1 in Public Health Saves $14.30: We're already paying for the crisis—in emergency room visits, lost productivity, and disability. We just need to move the safety net upstream. Public health is the only part of the system designed for prevention, yet its share of total health spending has dropped 25% in two decades. The economic case is overwhelming. The political will is not.• AI Could Break the Information Asymmetry: Patients are already using ChatGPT to diagnose themselves—and sometimes it's saving their lives. One woman caught her own pneumonia because her doctor couldn't see her for a week. But some doctors want to keep the paternalism: one AI tool built on medical journals is restricted to clinicians only because making it available to patients would “piss off the doctors.”• The System Is Priced for Rescue, Not Health: Everything is loaded to the moment your gallbladder goes bad or your heart gets a blockage. Prevention doesn't get paid for. Both guests agree: we need a massive re-pricing that rewards keeping people healthy, not just treating them when they're sick. That means paying doctors to prevent strokes, not just to fix them. About the GuestsHalle Tecco is the founder of the venture fund Rock Health and an investor in more than fifty digital health companies. She is an adjunct professor at Columbia Business School and a course director at Harvard Medical School. Her new book is Massively Better Healthcare: The Innovator's Guide to Tackling Healthcare's Biggest Challenges (Columbia University Press).Robin Blackstone, MD, is a physician, health systems architect, and founder of Blackstone Health. A surgeon by training with 30 years of clinical experience, she is the author of Doctor AI: Reimagining Health. Rebuilding Trust. Delivering Health 4.0.ReferencesPrevious Keen On episodes and authors mentioned:• Robert Pearl on how AI will be monetized in the healthcare industry• Tim Wu on the extractive economics of platform capitalism• Zeke Emanuel on which country has the world's best healthcare• Warren Buffett on healthcare costs as “a hungry tapeworm on the American economy”About Keen On AmericaNobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.WebsiteSubstackYouTubeApple Podcasts
This episode explores the future of hospice leadership and hospice quality through a collaborative discussion between the TCNtalks and GeriPal podcasts. TCNtalks host Chris Comeaux and co-host Cordt Kassner join forces with Dr. Eric Widera and Dr. Alex Smith of the GeriPal Podcast , leaders in palliative care and hospice innovation discuss emerging quality measures, data-driven hospice analytics, research challenges, and the leadership needed to guide healthcare organizations through change. For professionals working in healthcare leadership and serious illness care, the conversation offers valuable insight into the policies, research, and innovations shaping the future of hospice and palliative medicine.This is a thoughtful roundtable discussion on leadership, quality, and the evolving future of hospice and palliative care. Together, they explore the biggest stories shaping the field—from emerging quality metrics and research priorities to the human side of hospice leadership. If you're passionate about improving serious illness care, this conversation is just the beginning. Subscribe to TCNtalks and GeriPal to stay informed on the latest trends in hospice leadership, palliative care innovation, and healthcare policy. Share this episode with a colleague, discuss it with your team, and join the movement to strengthen the mission and future of hospice care.(This episode is a Top News Stories of Month February 2026)TCNtalks:Chris Comeaux, President / CEO of TELEIOSTCNtalks Co-Host:Cordt Kassner, PhD, Publisher of Hospice & Palliative Care Today & CEO and Founder of Hospice Analytics GeriPal:Dr. Eric Widera, Professor of Medicine and clinician-educator in the Division of Geriatrics at the University of California San Francisco (UCSF) and co-host of Geri-Pal PodcastDr. Alex Smith, UCSF faculty in the Division of Geriatrics and ) and co-host of Geri-Pal PodcastTeleios Collaborative Network / https://www.teleioscn.org/tcntalkspodcast
ACL tears in teenage girls continue to rise. Listen to our latest podcast as we break down the latest NY Times article entitled, "Why Are So Many Teen Girls Still Tearing Their A.C.L.s?" Why is this happening, what are the risk factors, and can we prevent this crisis?
In Hour 1 of the Morning Roast, Joe Shasky and Joe Spadoni discuss the huge weekend in Bay Area sports -- Steph Curry's injury, Porzingis' diagnosis, Kuminga's continued success in Atlanta. They're also joined by UCSF's Dr. Nirav Pandya to discuss the nature of these various injuries haunting the Warriors.
In this powerful episode, longtime HPNA member Linda Blum, APRN shares experiences from the last few years of her rich nursing career in volunteerism —training incarcerated caregivers in a California state prison hospice program. Linda explores the ethical complexity of end-of-life care behind bars, from POLST conflicts and CPR decisions to pain management in a correctional setting where Medicare rules don't apply. Through ELNEC education and interdisciplinary collaboration, she's helping nurses, correctional officers, and incarcerated caregivers reclaim agency and restore dignity at the end of life. This conversation examines moral distress, serious illness communication, and the transformative power of “risking love” in some of the most marginalized settings. A moving reflection on bearing witness, professional courage, and the light within us all. About Humane Prison Hospice Project The Humane Prison Hospice Project is developing a humanitarian, cost-effective, and transformative solution to ensure that those aging and dying in prison receive compassionate care. Since 2017, the Humane Prison Hospice Project has worked to ensure that incarcerated individuals receive compassionate end-of-life care from trained peers. Humane implements a comprehensive 80-hour, 15-module curriculum to train incarcerated individuals as peer caregivers, equipping them with the skills to provide hands-on care and emotional support to their aging and terminally ill peers. Graduates of this program are part of a growing movement to humanize end-of-life care behind bars. Since launching this initiative, we have trained over 150 peer caregivers across California prisons, and are bringing our programming to three states—Michigan, Washington, and Oregon—marking our first step toward national replication. Learn more on their website: https://humaneprisonhospiceproject.org/ For anyone listening who has experience in hospice, nursing, programming in prisons or facilitating, and you live in CA, WA, MI, or OR, Humane is seeking volunteer facilitators who participate in trainings for peer caregivers in prisons across each state. We'd love to hear from you -- please reach out to Camila Ryder at camila@humaneprisonhospiceproject.org with your name, location, and any relevant experience. If you're interested in learning more, register via Zoom for one of our virtual monthly Informational Meetings. Linda Blum, GNP, MSN, RN Linda Blum, GNP, MSN, RN, is a retired gerontological nurse practitioner living in California. Born and raised in New York State, she moved to the Bay Area over 45 years ago. Her early career included work in virology and immunology laboratories before she left a PhD program after the birth of her first child. She later worked as a birth doula and photographer and entered nursing school intending to become a nurse midwife. Instead, her path led her to the care of people with serious illness. She often jokes that she has a poor sense of direction and found end of life, not beginning of life, as she prefers anxious children to anxious parents. Linda worked in home infusion and home hospice as a case manager and manager before returning to school for her at UCSF and then completing a palliative medicine fellowship at the VA in Palo Alto. She was hired as the first clinician to provide palliative care/medicine consultation at California Pacific Medical Center. Since retiring in 2023, Linda has volunteered her time and expertise with the Humane Prison Hospice Project, where she facilitates training for incarcerated individuals serving as peer caregivers. Her passion is helping to train nurses and professional staff in the carceral setting using a modified ELNEC curriculum. Linda enjoys traveling, caring for her grandchildren, and telling silly jokes and puns. Her spirit animal is a penguin—preferably a Gentoo—and if you ask for photos, your inbox may quickly overflow. Brett Snodgrass, DNP, FNP-C, ACHPN®, FAANP Dr. Brett Snodgrass has been a registered nurse for 28 years and a Family Nurse Practitioner for 18 years, practicing in multiple settings, including family practice, urgent care, emergency departments, administration, chronic pain and palliative medicine. She is currently the Operations Director for Palliative Medicine at Baptist Health Systems in Memphis, TN. She is board certified with the American Academy of Nurse Practitioners. She is also a Fellow of the American Association of Nurse Practitioners and an Advanced Certified Hospice and Palliative Nurse. She completed a Doctorate of Nursing Practice at the University of Alabama – Huntsville. She is a nationally recognized nurse practitioner speaker and teacher. Brett is a chronic pain expert, working for more than 20 years with chronic pain and palliative patients in a variety of settings. She is honored to be the HPNA 2025 podcast host. She is married with two daughters, two son in laws, one grandson, and now an empty nest cat. She and her family are actively involved in their church and she is an avid reader.
In this episode of Healthy Wealthy & Smart, Dr. Rachel Zoffness, MS, PhD, a leading pain scientist, discusses the complexities of pain, emphasizing that it is not merely a physical issue but a biopsychosocial phenomenon. She shares insights from her upcoming book, 'Tell Me Where It Hurts,' which aims to debunk myths surrounding pain and provide a comprehensive roadmap for healing. Dr. Zoffness highlights the importance of understanding the various factors that contribute to pain, including emotional and social aspects, and advocates for a multidisciplinary approach to pain management. The discussion also emphasizes the power of hope and the need for improved medical school education on pain science. Takeaways · Pain is not just a physical phenomenon; it is biopsychosocial. · Understanding pain requires knowledge of biological, emotional, and social factors. · 96% of medical schools lack dedicated pain education. · Patients with chronic pain need a roadmap for healing. · There is always a recipe for pain, and it can be changed. · Movement is a crucial ingredient in managing pain. · Engaging in joyful activities can reduce pain perception. · A multidisciplinary approach is essential for effective pain management. · Hope is a central theme in treating chronic pain. · Pain management should focus on empowering patients. Chapters · 00:00 Introduction to Pain Science and Its Misconceptions · 06:03 The Biopsychosocial Model of Pain · 11:43 Understanding the Pain Recipe · 17:50 Transforming Medical Education and Clinical Practice · 23:51 Hope and Empowerment in Pain Management More About Dr. Zoffness: Dr. Rachel Zoffness is a pain scientist, pain psychologist and thought-leader revolutionizing the way we understand and treat pain. She's an assistant clinical professor at UCSF, lectures at Stanford, and consults on the development of pain management programs around the world. She was trained at Brown, Columbia, UCSD, and Mt. Sinai Hospital, and is a Mayday Fellow. Her new book, Tell Me Where It Hurts, drops March 2026 and will be translated into more than 25 languages. Resources from this Episode: Dr. Zoffness Website Dr. Zoffness in Instagram Buy "Tell Me Where it Hurts" on Amazon Jane Sponsorship Information: Book a one-on-one demo here Mention the code LITZY1MO for a free month Follow Dr. Karen Litzy on Social Media: Karen's Instagram Karen's LinkedIn Subscribe to Healthy, Wealthy & Smart: YouTube Website Apple Podcast Spotify SoundCloud Stitcher iHeart Radio
Robin Zander hosted a Snafu webinar for the Sidebar community on non-sales selling—think self-promotion for career transitions, freelancers, entrepreneurs, and product people. The goal: learn to "sell yourself" without the ick factor. Participants shared fears: follow-ups feel intimidating, sales feels slimy, and success seems like a numbers game. Robin reframed it: selling is really about enrollment—being a chief evangelist for your work, not begging for attention. Drawing on stories from his childhood pumpkin patch, his time as a personal trainer (where desperation lost him clients), and opening Robin's Cafe in San Francisco (raising $40k, serving multiple stakeholders, training staff with Danny Meyer's principles), he showed the difference between selling from need vs. service. Long-term success comes from genuine connection, curiosity, optimism, and passion. Attendees explored their "authentic attitude" and reflected on times self-promotion felt good versus slimy. Exercises included mapping all the people who benefit from your work—employees, customers, managers, mentees, community—and practicing generosity in selling (a "Miracle on 34th Street" mindset: help customers even if it means sending them elsewhere). In Q&A, Robin tackled: Asking for promotions as modeling for others, especially women and minorities Persistence in follow-ups (yes, emailing Mark Benioff 53 times counts) Relationship-based enterprise selling Avoiding fear-based AI marketing by knowing who you serve and what problem you solve Recommended reading: Setting the Table (Danny Meyer), Unreasonable Hospitality (Will Guidara), The New Strategic Selling. Robin also shared upcoming Snafu conference details (March 5, Oakland Museum of California) and reminded everyone: Snafu = situation normal; all fucked up. 00:00 Start 01:06 Audience Fears About Selling Robin Zander welcomes 93 participants to the webinar Notes the session is interactive with exercises planned Encourages participants to drop questions in chat or interrupt him Last 15–20 minutes reserved for questions Robin introduces himself briefly Focuses on storytelling as a tool for self-promotion Shares experience as a community builder Runs a conference called Responsive since 2016 (not Snafu) Tools, structures, and company cultures for resilient organizations Two-day event each September on the future of work Focus on building resilience in organizations Observations on rapid change Technology and work-life changes happening at a fast pace Questions about resilience in individuals Traits needed in careers, personal relationships, professional relationships Ability to stay resilient through change Robin frames his expertise Emphasizes his strength in asking questions and fostering honest conversations Labels himself a reluctant salesperson Not the world's leading expert on self-promotion or selling Key lessons from research and interviews Two buckets matter in business and life: Example: Sidebar community forming coalitions for learning and action Operational excellence: being competent and at least as good as others Promotion/enrollment/sales: standing up, saying what you want, building coalitions Started interviewing people about influence and persuasion Started a weekly newsletter called Snafu Written by hand, not AI Shares lessons from his life and others about self-promotion and resilience Focus on courage to take action: raising hand, offering something valuable Core characteristics of self-promotion and selling yourself Connecting with others: art of connection Courage to ask: inspired by Amanda Palmer's TED Talk and book The Art of Asking Opposes traditional "always be closing" sales mentality Advocates for simply asking for what you want Current work mostly involves storytelling for large companies Clients include Supersonic, Airbnb, Zappos, and others 12:25 Service as the Core Principle Robin introduces the concept of storytelling for self-promotion Stories used to: Get promotions Build coalitions Propel career or organizational growth Emphasizes turning personal, career, or company stories into "commercials" Focus of today's talk: self-promotion with impact Core principle: service Showing up from a place of helping others Through helping others, also helping oneself Distinguishes between sleazy salespeople and effective self-promoters Childhood anecdote: Robin's pumpkin patch Tended plants all summer, learned responsibility and care Harvested pumpkins and sold them using a small red tin box labeled "money" Ran "Robin's Pumpkin Patch" for five to seven years At age five, father had him plant pumpkin seeds Engaged neighborhood kids for fun, collaborative promotion Explained product (pumpkins) enthusiastically to potential buyers Used scarecrow costumes and creative gestures to attract attention Lessons learned from pumpkin patch: Authentic enthusiasm creates value Helping people do what they were already inclined to do Early experience of earning and serving simultaneously Self-promotion is most effective when it's service-driven, not manipulative Applying childhood lesson to career and business Asking for a raise Persuading companies to choose one service over another Promoting oneself or others (e.g., Evan, web developer) Key principle: approach self-promotion from delight and service, not need or fear Authentic enthusiasm as foundation for: Interactive exercise for participants Not influenced by sleep deprivation or stress Could be inspired by childhood or adult experiences Opposite of fear; personal and unique for each participant Question posed: what is your authentic attitude when self-promoting? Examples shared from participants: Curiosity Passion Inspiration Service to others Observation Possibility Insight Value Helping others Creativity Belief in serendipity Optimism Key takeaway from exercise and story Promoting from delight, enthusiasm, and service Promoting from need or fear Two versions of self-promotion: Effective self-promotion aligns with authenticity and enthusiasm, creating value for others while advancing oneself 18:36 Gym Job and Needy Selling Robin shares the next story and sets up the next exercise Gym culture is sales-heavy Initial motivation: love of fitness, desire to help people Quickly realizes environment incentivizes personal trainers to sell aggressively Timeframe: ~20 years later, at age 20, moved to San Francisco First post-college job: personal trainer in gyms Early experience at gyms Key lesson from early failure Selling from need feels gross Promoting oneself from fear or desperation leads to poor results Recognizes similarity to unwanted sales calls received personally First authentic success in self-promotion Worked at Petro and World's Gym in San Francisco, Pilates instructor Owner confronted Robin after two weeks: no clients, potential clients being lost to others Threatened termination by Friday if no clients acquired Robin froze under pressure, approached clients but with needy, desperate energy Outcome: fired by Friday, left gym Encounters man in pain on Valencia Street, offers help as personal trainer Approach comes from genuine care, desire to serve Leads to three-year working relationship, consistent sessions, good income Next client: world-famous photographer Michael Light at UCSF swimming pool Client comes from natural connection, not pushy salesmanship Dichotomy observed: Pushy, need-based self-promotion → freeze, poor results Service-oriented self-promotion → natural connections, sustained relationships Exercise for participants Prompt: identify two moments: One time self-promoting felt slimy → what were you doing? One time self-promoting felt good → what were you doing differently? Two-minute reflection / chat participation Participant reflections/examples Slimy examples: Interviewing for a job during layoffs, giving desperate energy Selling P&L at a hyperscaler Selling computers and printers in UK post-college Sales emails getting ghosted Feeling inauthentic or performative, taking advantage of someone Good examples: Offering services out of care and love rather than ROI Showing impact of work to junior child Knowing services add real value and solve a challenge Being clear on what the other person needs Key takeaway Self-promotion feels different depending on intent and knowledge Slimy → desperate, inauthentic, unclear value to recipient Authentic → service-driven, clear value, connection-focused Effective self-promotion combines knowing your value and serving others, not just pushing for personal gain 25:35 Miracle on 34th Street Lesson Feeling good in self-promotion comes from genuinely helping, solving problems, and sharing information Santa Claus hired at Macy's to hold kids and give candy canes, but real goal: persuade parents to buy from Macy's Santa instead sends parents to competitor to truly serve them Macy's manager initially furious Outcome: customers feel genuinely served, return praising Macy's, become loyal fans Robin references Miracle on 34th Street (original version) Key insight: providing real value, even if it benefits someone else, eventually returns value to you "Put enough bread across the water, eventually good things come back" Participant reflections Slimy: knowing audience expects judgment, catering to them for approval Good: giving the gift of knowledge, providing service freely Takeaway: authentic self-promotion is rooted in service, generosity, and sharing expertise, not manipulating for immediate gain 27:45 Starting Robin's Cafe Through Service Robin shares a major professional turning point: opening Robin's Cafe in 2016 No restaurant experience beyond college busing tables Opened in three weeks, eventually grew to 15 employees by 2018 Worked in multiple industries: Pumpkin patch, personal trainer, circus performer Opened a café/restaurant in Mission District, San Francisco Courage and conviction came from clear focus on service to others Employees: create a great workplace, go-giver culture Investors: $40k raised from friends/family, provided value and potential return Landlords (ODC, nonprofit dance center): wanted success of business to support community Customers: diverse—tech workers, kids in dance classes, local community Robin himself: financial sustainability, learning, personal growth Key audiences served by Robin's Cafe Approach to challenges Used Danny Meyer's Setting the Table as a service-focused framework for employees Philosophy: "giving in order to get paid" Examples: spouse, kids, dog, manager, peers, mentees, clients, community, customers, extended family, mentors Served multiple stakeholders during crises: break-ins, flooding, city permitting, neighborhood issues Exercise: identify all the people who benefit from your work or success Key idea: the more stakeholders served, the easier self-promotion becomes, because it comes from service, not need or pressure Show up thinking: does this serve the person I'm talking to? Principle: selling yourself from a place of service Consider multiple stakeholders simultaneously Audience question: elaborate on applying this service mindset specifically to asking for a promotion Tying service to self-promotion in career advancement Result: asking for a raise, applying for jobs, pitching clients—all easier and more authentic 38:11 Promotion As Service Asking for a promotion from a place of service Example: doing the role already, deserving recognition, asking for what you believe you've earned. Personal perspective: advocating for yourself is a form of service to yourself Recognize other stakeholders in the process: Modeling courage and advocacy for the next generation Authority enables ideas to be taken more seriously Stories gained from new responsibilities enhance value to clients or teams People you mentor, especially women or underrepresented groups The organization: your promotion can make it stronger Your family or children: showing them what it looks like to advocate Concrete examples Outcome: trajectory of career positively influenced, demonstrated courage, modeled behavior Asking first time for a manager role Later asking for VP title as a director Courage and small steps Courage = acting despite fear, not absence of fear Practice by taking incremental steps toward what scares you Avoid masking or hesitation; direct action builds confidence and results Persistence and follow-up Busy people require patience and multiple nudges Example: Mark Stubbings emailing Mark Benioff 53 times before a yes Persistence = respectful, consistent follow-ups Role modeling for women and minorities Demonstrates that asking is a normal, expected, and service-oriented act Many don't ask for promotions or raises due to upbringing or cultural norms Modeling advocacy teaches the next generation, including children, to speak up Service mindset in practice Approach self-promotion by asking: is this good for the other person? Keep intention aligned with service, not desperation Books for guidance: Setting the Table – Danny Meyer: service-driven sales and employee culture Unreasonable Hospitality – Will Guidara: lessons from the restaurant world on giving value and delight Key takeaways for promotion and asking Serve yourself, your mentees, your organization, and your broader audience Take small, courageous steps to ask for what you deserve Follow up respectfully and consistently; don't assume silence = no Self-promotion becomes easier and authentic when rooted in service, not fear or need Snafu Newsletter Weekly newsletter written by Robin Covers influence, persuasion, and modern workplace dynamics A resource for ongoing learning and practical insights 56:55 Where to Find Robin Robin's newsletter covers influence, persuasion, and modern work. Snafu Conference Responsive Conference Robin Zander on social medias
Neurologic complications of hematologic disorders are frequently encountered in clinical practice and can involve both the central and peripheral nervous systems. Early recognition and appropriate management in collaboration with a hematologist are essential to reduce morbidity and mortality. In this episode, Kait Nevel, MD, speaks with Lauren Patrick, MD, and Mark Terrelonge, MD, MPH, authors of the article "Neurologic Complications of Hematologic Disorders" in the Continuum® February 2026 Neurology of Systemic Disease issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Patrick is an assistant professor of neurology at the University of California, San Francisco, in San Francisco, California. Dr. Terrelonge is an associate professor of neurology at the University of California, San Francisco, in San Francisco, California. Additional Resources Read the article: Neurologic Complications of Hematologic Disorders Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Full episode transcript available here Dr Nevel: Thick blood, thin blood. These are terms often used by patients and caregivers to describe some of the hematologic disorders that can lead to neurological diseases such as stroke. So, when should we consider a hematologic disorder as a potential cause for neurological conditions, such as stroke or neuropathy. Today I have the opportunity to interview Drs Lauren Patrick and Mark Terrelonge to learn more about neurologic complications of hematologic disorders in their recent article in Continuum. Dr Jones: This is Dr Lyell Jones, editor-in-chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kate Nevel. Today I'm interviewing Drs Lauren Patrick and Mark Terrelonge about their article on neurologic complications of hematologic disorders. This article appears in the February 2026 Continuum issue on neurology of systemic disease. Welcome to the podcast, and please introduce yourself to the audience. Dr Patrick: Thank you for having us. We're both thrilled to be here. I'm Lauren Patrick, a vascular neurologist and assistant professor at the University of California, San Francisco, and program director for the Vascular Neurology Fellowship here. Dr Terrelonge: And I'm Mark Terrelonge, I'm an associate professor of neurology and neuromuscular medicine here at UCSF and one of the associate program directors for the adult neurology residency. Nice to meet you. Dr Nevel: Nice to meet you both. Really looking forward to getting into your article and learning more. So, to kind of kick us off, I always like to ask what do you think is the most important takeaway from your article for the practicing neurologist? And maybe since there are two of you and I suspect you covered slightly different aspects of this article, maybe you could give us two most important takeaways. Dr Patrick: Sure. I think the biggest takeaway is to keep hematologic disorders on the differential when evaluating patients with neurologic symptoms. Conditions like sickle cell disease, myeloproliferative neoplasms, or plasma cell dyscrasias and paraproteinemia can cause strokes or peripheral neuropathies, and many have specific and targetable treatments. The early recognition and collaboration with our hematology colleagues can truly change patient outcomes, whether that's by initiating cytoreductive therapy, managing thrombocytopenia, or optimizing antithrombotic therapy. Dr Nevel: Great. So, this is a really big and diverse topic. As always, I'm going to urge our listeners to read the article because there is a lot of really good stuff in your article that we just don't have time to get into during this interview today. But you cover a lot of different hematological disorders and how they can cause neurological complications. One of the major neurological complications of hematological disorders is cerebral vascular events. So, I'm hoping, Warren, that you can walk us through a little bit. When should we consider workup of potential hematologic disorder as a cause when we see a patient with ischemic stroke, because certainly not all patients with ischemic stroke should be getting a broad hematological disorder work up. So how can we kind of identify early on that there might be something else at play? Dr Patrick: Absolutely, great question. So, in many cases, the underlying hematologic disorder is already known, such as sickle cell disease or polycythemia vera. But sometimes stroke is the initial presentation or manifestation of the disease. So red flags can include young age, recurrent cryptogenic strokes or thrombosis, and unusual locations like the cerebral venous system. Laboratory clues such as unexplained erythrocytosis, thrombocytosis, thrombocytopenia, or hemolytic anemia should raise suspicion for an occult hematologic disorder. In the setting of acute illness, immune-mediated or heparin-induced thrombocytopenia or thrombotic microangiopathies should be suspected in patients that have hemorrhagic and or thrombotic complications, particularly when relevant lab disturbances are present. Acquired thrombophilia such as anti-phospholipid antibody syndrome should be considered in young patients with autoimmune disease, prior venous or arterial thrombotic complications, or pregnancy morbidity. Now, these are rare causes overall, but they're important to catch because the management can differ dramatically from our typical stroke care. Dr Nevel: Great. And what are some of the most common inherited or acquired thrombophilias and when should we be sending these labs? Dr Patrick: The hematologic causes really account for small minority of arterial strokes approximately one to two percent, but among those, sickle cell disease, anti-phospholipid antibody syndrome and the myeloproliferative neoplasms are the most common. Timing of testing is key. So, the genetic thrombophilia panels can be drawn at presentation, but lab values such as protein C, protein S, and antithrombin levels may be falsely low during acute thrombosis, so they're often repeated weeks later. Similarly, for anti-phospholipid antibody testing that should be done at presentation and when positive, confirmed at twelve weeks, since transient positivity can occur with affections or acute events. So, in patients that are already anticoagulated for anti-phospholipid antibody syndrome, testing becomes particularly tricky, especially with lupus anticoagulant assays. Some results need to be interpreted carefully or repeated when feasible. The main message is to collaborate early with our hematology colleagues to guide the timing and interpretation of these studies. Dr Nevel: Yeah, wonderful. Thank you. I'll ask some similar questions about neuropathy. So when should we consider an underlying hematologic disorder as being the cause for someone's neuropathy? Dr Terrelonge: So, luckily for a neurologist, then serum protein electrophoresis or an SPEP is already a part of the first pass evaluation for even the most common neuropathies we see, technically already considered every time we do an evaluation. However, we do know that most neuropathies progress very slowly and don't really lead to significant limitations in patient activities of daily living. And for those, the initial workup step, you may not need to do any additional search for any hematologic diseases after that first step. Within patients who start to have more unusual features with their neuropathy, including a rapid progression, early proximal weakness, significant and extremely painful neuropathies, significant ataxia, or new tremor or anything that's kind of outside of the garden variety neuropathy, then you should start to think about a hematologic cause. Additionally, if a patient already has a known hematologic malignancy or process before their neuropathy, there should be some form of assessment to see through exam or electrodiagnostically if the two are correlated. I do have to add one caveat, though, and that's just because someone has a hematologic malignancy or a paraprotein seen in their blood, their neuropathy and the neurologic syndrome don't necessarily have to be causally related. So, we have to do some additional testing to determine if the patient's presentation of the paraprotein are actually linked. Dr Nevel: Can you walk us through a little bit how we determine if they're associated or just coincidental? Dr Terrelonge: Yeah. So, for some of the proteins, there's a specific phenotype that will come with the specific protein. For example, an anti MAG proteinopathies or MAG standing for a myelin associated glycoprotein, it usually leads to a distal sensor and motor polyneuropathy where the most distal portions of nerves are affected. So, in that case, people might notice that they have numbness and weakness in their toes and their fingers, and it doesn't follow that typical length dependent pattern. So, in that case, if you have the anti mag neuropathy and the electrodiagnostic signature of an anti mag neuropathy along with the symptoms, you're more likely to think that the two are related then if not. Dr Nevel: Great. Thank you. And I was hoping you could speak a little bit more about amyloidosis just because I think that that's one that can be really tricky to diagnose. And I see patients, you know, have sometimes more drawn out evaluations or see multiple providers before a diagnosis is reached. So, can you speak a little bit more to how we diagnose amyloidosis in relationship to neuropathy or other neurological conditions and when we should push for more invasive testing like a nerve biopsy? Dr Terrelonge: So, amyloidosis certainly is a tricky diagnosis. I've been tricked by it and I think most of my neuromuscular colleagues have probably been tricked by it at least once. It's a hard diagnosis to make is it usually requires a pretty high index of suspicion, and also requires a tissue diagnosis to cinch. There're some patients who will come in with a prior history of amyloidosis and they're a little bit easier to figure out if the neuropathy is related. Maybe it's started in their heart or their kidney first and then you can just see if the type of amyloid they have usually deposits in nerve, and that may be enough. But if there's any diagnostic uncertainty, you could go forward with tissue biopsy. But it's patients in which the neuropathy is the first symptom that amyloidosis can be especially tricky to diagnose. It's a primarily light chain disease. So, if you do only an SPEP as a part of your initial neuropathy evaluation, you could miss it. But usually, the patients will have either a severely painful neuropathy, early autonomic dysfunction, or really prominent bilateral carpal tunnel syndrome. So, if they have any of those, usually we'll add in an amyloid workup as a part of that of the rest of the workup, which would include both light chain evaluations to see if there's any increase in Lambda or Kappa light chains and then also biopsy. Biopsy can be of the skin or fat pad first, which have reasonable sensitivity for picking up disease, but they're not necessarily a hundred percent. So if the suspicion remains high in those cases, a nerve biopsy should be considered. And the reason why this is important is that the chemotherapeutic agents that we have now can actually help arrest a lot of these diseases and stop further organ involvement. So, if you think about it, it is important to keep pushing and looking until you find it. Dr Nevel: Thank you so much for that. And a follow up question to that, once patients are started on appropriate therapy, the diagnosis is made, chemotherapy is started, what's the typical clinical course that you see in terms of their neuropathy? Do you ever see improvement or is it arrest of worsening? Dr Terrelonge: Usually for amyloid, there is an arrest of disease, but in some patients, they could have some improvement, not necessarily a dramatic improvement, but some patients could see some reversal of symptoms. That may not necessarily be because nerves injured nerves are regrowing, but because of reorganization of nerves to muscle, they could have some strength increases or at least less pain. Dr Nevel: Yeah, thank you. So, when should we involve a hematologist in aiding in the evaluation of patients we suspect may have an underlying hematological disorder? You guys really outlined very nicely in your article some of the laboratory workup or other workup like you just talked about with amyloidosis. But at what point in that workup should we reach out to our hematology colleagues? Dr Patrick: I would say almost always. So, these disorders are inherently multi-system and benefit from early co-management. In acute sickle cell stroke, for example, hematology helps direct emergent exchange transfusion. For myeloproliferative disorders they guide cyto reduction and long term antithrombotic strategy. And for antibody mediated or plasma cell disorders, hematology determines disease specific therapies. So, neurology may help with identifying the presentation, but the definitive management is almost always shared with our hematology colleagues. Dr Nevel: And as you both have mentioned that a lot of times in these cases, their hematologic disorder may be already known before they present with their neurological symptoms. So, I imagine obviously in those cases that a hematologist hopefully is already heavily involved in their care. What do you think is the most difficult aspect of identifying and diagnosing patients with neurologic illness as having an underlying hematological disorder? Dr Patrick: The hardest part is maintaining a high index of suspicion, especially since hematologic causes account for a very small minority of arterial strokes. Most strokes are from traditional vascular risk factors like you mentioned, or cardio embolism, so it's easy to stop diagnostic evaluation after standard studies have been performed. An example of a challenging case is a patient that's young, they've had recurrent cryptogenic stroke, and they could have antiphospholipid antibody syndrome, but it can be easy to miss if their antibody titers are borderline or if they're already anticoagulated, which would complicate retesting. So, it's about balancing the urge to over-test with recognizing the few cases where identifying A hematologic cause truly changes that management. Dr Terrelonge: And then on the neuropathy side, probably the hardest part is deciding what's causal and what's coincidence. Monoclonal gammopathy of unknown significance, or MGUS, is really common in older adults, so not every M-spike on an SPEP explains a neuropathy. And even sometimes there's times when the neurologic picture will develop a little bit faster than the hematologic one. So, it's hard to put the two together. Dr Nevel: Yeah. What's the most rewarding aspect of taking care of patients with complications from their hematologic disorders? Dr Patrick: It's deeply rewarding when a targeted diagnosis leads to a tangible improvement in that patient's care. For example, identifying A cryptogenic stroke is being due to myeloproliferative neoplasm or an inherited thrombophilia allows us to move from empiric treatment to possible disease specific strategy. It's really gratifying to give patients that clarity, to give them a diagnosis and in some cases prevent future events. Dr Terrelonge: Agreed. And even on the neuropathy side, almost all of the neuropathies that are hematologically related are treatable. So, it's so satisfying whenever you have a patient with say an anti-MAG neuropathy or Waldenström can start the patient on therapy, and you can see someone who's been having a progressive decline to stability and in those cases sometimes even significant recovery. Dr Nevel: Yeah, absolutely. Very rewarding when you can identify the problem and make it better. That's what it's all about. So, what are the future areas of research in this area? What do we still need to learn? Dr Patrick: There's still a lot to learn. I think we need better data on the safety of acute reperfusion therapy and antithrombotic agents, particularly in patients that are at dual risk for bleeding and thrombosis. Other examples, secondary prevention strategies and anti-phospholipid antibody syndrome. What's the best target INR? Do you add aspirin to warfarin or not? All of that is often left up to expert opinion. What's the best management for adults with sickle cell stroke? There are many open questions there. A lot of the protocols that we have in place for sickle cell patients that are adults as derived from pediatric literature and there's vast potential in terms of disease modifying therapies, especially in the fields of sickle cell disease and amyloidosis. And we'll need to reassess how those treatments may change neurologic outcomes. Dr Terrelonge: I think on the neuropathy side that having some form of new biomarkers to help us clearly know of the neuropathy and that hematologic illness are associated would be very helpful. On the treatment side, a lot of this is really being driven by the hematology space, but new therapies that treat hematologic plasma cell disorders, including some of the new BTK inhibitor, may be incorporated relatively soon into the algorithm for how we treat many of our patients. I'm excited to see what's to come from this. Dr Nevel: Wonderful. Thank you so much for sharing your knowledge with us today. I know I've certainly learned a lot by reading your article and through our discussion today. Highly encourage our listeners to read your wonderful article, which is a very thorough review of hematologic disorders and neurological complications. Again, today I've been interviewing Dr Lauren Patrick and Dr Mark Terrelonge on their article Neurologic Complications of Hematologic Disorders, which appears in the February 2026 Continuum issue on Neurology of Systemic Disease. Please be sure to check out Continuum Audio episodes from this and other issues. And as always, thank you so much to our listeners for joining today, and thank you so much to Lauren and Mark. Dr Terrelonge: Yeah, thank you so much for having us. Dr Patrick: Thank you so much for having us and for highlighting this topic. We hope the issue encourages clinicians to think broadly about hematologic causes of neurologic disease and to continue collaborating closely with our hematology colleagues. It's a complex but very fascinating intersection for both of our fields. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.
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In this episode (recorded live), Halle Tecco speaks with Dr. Robert Wachter, Chair of Medicine at UCSF, about their concurrently released books on healthcare innovation and AI.They share thoughts on the dual challenge of innovation in healthcare and the role of AI, covering:Why past waves of tech failed to change healthcare and why AI may finally break throughHow AI is making a difference today in healthcareWhere AI-assisted diagnosis and prescribing could go next, and the risks of over-relying on humans “in the loop” How EHR vendors (like Epic) hold the "poll position" for AI implementation due to workflow integrationWhy innovators must become healthcare "anthropologists"; and clinicians must understand technology and AIPlus, a surprise guest from Prenuvo joins us to chime in. Order Halle's new book, Massively Better Healthcare hereOrder Bob's new book, A Giant Leap here—About our guest: Robert M. Wachter, MD is Professor and Chair of the Department of Medicine at the University of California, San Francisco (UCSF). Author of 300 articles and 6 books, he coined the term “hospitalist” in 1996 and is often considered the “father” of the hospitalist field, the fastest-growing medical specialty in U.S. history. He is a past president of the Society of Hospital Medicine, past chair of the American Board of Internal Medicine, a Master of the American College of Physicians, and an elected member of the National Academy of Medicine. Modern Healthcare magazine has ranked him among the 50 most influential physician-executives in the U.S. more than a dozen times; he was #1 on the list in 2015. His 2015 book, The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine's Computer Age, was a New York Times bestseller. His new book is A Giant Leap: How AI is Transforming Healthcare and What That Means for Our Future.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
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Dr. Abuzaid received his degree in medicine from Ain Shams University, Faculty of Medicine, Cairo, Egypt, 2006. He completed his residency in Internal Medicine at Creighton University, Omaha, Nebraska in 2015 followed by a Fellowship in Cardiovascular Disease, Sidney Kimmel Medical College at Thomas Jefferson University, Christiana Care Health System, Newark, Delaware, 2018 and a Fellowship in Advanced echocardiography and advanced Cardiovascular Imaging, University of California, San Francisco, CA, (UCSF) 2019.
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Love the episode? Send us a text!What happens when a breast surgeon becomes a breast cancer patient—and then faces a second diagnosis years later?In this deeply personal and illuminating episode of Breast Cancer Conversations, host Laura Carfang is joined by Dr. Anne Peled, a board-certified breast, reconstructive, and plastic surgeon who has treated thousands of patients—and also navigated her own early-stage breast cancer diagnosis, followed years later by a new primary DCIS diagnosis.Together, Laura and Dr. Peled unpack what patients are rarely told about DCIS (stage zero breast cancer), the difference between recurrence and a second primary cancer, and how advances in surgery are transforming survivorship—including sensation-preserving mastectomy.This conversation bridges clinical expertise and lived experience, offering clarity, compassion, and permission to choose the path that aligns with your body and values.In this episode: What DCIS really is—and why “stage zero” can be misleadingRecurrence vs. second primary breast cancer: why biology mattersLumpectomy vs. mastectomy and why survival outcomes are often the sameHow guilt and self-blame show up after a second diagnosisBeing diagnosed with breast cancer as a physicianNavigating treatment when your colleagues are your caregiversThe evolution of oncoplastic surgery and patient-centered careWhy loss of breast sensation is under-discussed—but life-changingHow sensation-preserving mastectomy worksWhat questions to ask your surgeon about sensation, nerves, and recoveryMaking decisions based on your priorities—not fear or pressureAbout today's guestDr. Anne Peled is a board-certified plastic, reconstructive, and breast surgeon in private practice in San Francisco and Co-Director of the Sutter Health California Pacific Medical Center Breast Cancer Center of Excellence. Trained at Amherst College, Harvard Medical School, and UCSF, Dr. Peled completed a unique fellowship combining breast oncologic surgery and reconstruction.Her clinical and research work focuses on oncoplastic surgery, preserving and restoring sensation after mastectomy, improving patient outcomes, and breast cancer risk reduction. She is also a breast cancer survivor herself, bringing rare dual insight to patient care. Support the showLatest News: Become a Breast Cancer Conversations+ Member! Sign Up Now. Join our Mailing List - New content drops every Monday! Discover FREE programs, support groups, and resources! Enjoying our content? Please consider supporting our work.
Have you ever wondered what it was like to be in the room when the first pelvic embolization was performed or how the TIPS procedure was pioneered? Dr. Ernie Ring, a legendary figure from UCSF and a true forefather of Interventional Radiology, joins host Dr. Peder Horner to recount the early days of the specialty. Dr. Ring shares fascinating stories from his training at Massachusetts General Hospital under Dr. Stanley Baum, where he witnessed the birth of transformative techniques using angiographic catheters to treat life-threatening bleeding. --- SYNPOSIS From improvising the use of autologous blood clot and thrombin to stop massive hemorrhages to his pivotal role in developing the TIPS procedure and specialized biliary catheters, Dr. Ring's career is loaded with innovation. The conversation explores the "cowboy" era of IR, the evolution of essential tools like the glide wire, and the critical importance of maintaining a "high-touch" clinical practice in the face of emerging technologies like AI. Dr. Ring also reflects on his later transition into hospital leadership as Chief Medical Officer, where he applied his problem-solving mindset to institutional quality and safety. --- TIMESTAMPS 00:00 - Introduction01:58 - Upbringing from Detroit to Mass Gen 06:55 - Early IR with an Embo Case13:50 - Trailblazing Cases in IR16:17 - Penn and Innovation20:00 - Polarizing Procedures24:13 - IR Device Innovation33:00 - Dotter's Separation from Diagnostics37:30 - Fear Finds Cowboys39:08 - AI and Robotics40:08 - Fun Hobbies
During the COVID-19 pandemic, Dr. Bob Wachter was one of the nation's trusted voices, helping us better understand the disease that upended our world and healthcare system. Now he's focused on what he sees as the next great disruption in medicine: Generative AI. Though we need to address its flaws and limitations, Dr. Wachter says AI is essential to a healthcare system buckling under the weight of clinician burnout, staff shortages and astronomical costs. We talk with Dr. Wachter about his new book, “A Giant Leap: How AI Is Transforming Healthcare and What That Means for Our Future.” Guests: Dr. Robert "Bob" Wachter, professor and chair of the Department of Medicine, University of California, San Francisco Learn more about your ad choices. Visit megaphone.fm/adchoices
In this episode of the Brain & Life Podcast, host Dr. Daniel Correa is joined by Dr. Emmanuelle Waubant, professor of neurology at UCSF and Director of the UCSF Regional Pediatric Multiple Sclerosis Center. Together, they explore how diet, microbiome, and environmental factors influence the progression of multiple sclerosis, with a special focus on pediatric cases. Dr. Waubant also discusses the role of dietary patterns and vitamin D and highlights how emotional well-being and physical activity can impact disease outcomes. Additional Resources Expert Insights and Practical Tips for Managing Multiple Sclerosis How Ultra-processed Foods Can Have a Negative Effect on Brain Health Nutrition for kids: Guidelines for a healthy diet Brain & Life Podcast Episodes on These Topics Advocating for a Multiple Sclerosis Diagnosis with Comedian Kellye Howard Embracing Each Day with Author and MS Advocate Lilibet Snellings Kyte Voices from the Multiple Sclerosis Community We want to hear from you! Have a question or want to hear a topic featured on the Brain & Life Podcast? · Record a voicemail at 612-928-6206 · Email us at BLpodcast@brainandlife.org Social Media Guests: Dr. Emmanuelle Waubant @ucsfmedicine Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD
In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Aaron L. Berkowitz, MD, PhD, FAAN, who served as the guest editor of the February 2026 Neurology of Systemic Disease issue. They provide a preview of the issue, which publishes on February 2, 2026. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology in the Department of Neurology at the University of California, San Francisco, in San Francisco, California. Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @AaronLBerkowitz Full episode transcript available here Dr Jones: The human nervous system is so complex. You can spend your whole career studying it and still have plenty to learn. But the human brain does not exist in isolation. It's intricately connected with and reliant on other bodily systems. When those systems go awry, sometimes the first sign is in the nervous system. Today we will speak with Dr Aaron Berkowitz, an expert on the neurology of systemic disease, and learn a little about how these disorders can present and what we can do about it. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr Aaron Berkowitz, who is Continuum's guest editor for our latest issue of Continuum on the neurology of systemic disease. Dr Berkowitz is a professor of clinical neurology at the University of California, San Francisco, and he has an active practice as a neurohospitalist and in outpatient general neurology---and, importantly, as a clinician educator. In addition to numerous teaching awards, Dr Berkowitz has published several books and also serves on our editorial board for Continuum. Dr Berkowitz, welcome. Thank you for joining us. Why don't you introduce yourself to our listeners? Dr Berkowitz: Thanks, Lyell. As you mentioned, I'm a general neurologist and neurohospitalist here in San Francisco, California at UCSF and very involved in resident education as well. And I was honored, flattered and a little bit frightened when I received the invitation to guest edit this massive issue on the neurology of systemic disease. But I've learned a ton, and it's been great to work with you and the incredible authors we recruited to write for us. And I'm excited to have the issue out in the world. Dr Jones: Yeah, me too. And you and I have talked about it before: you're one of a very small group of people who have guest edited multiple issues on different topics, right? Dr Berkowitz: That's right. I did the neuroinfectious disease issue in… was it 2020? 2021? Something like that. Dr Jones: Yeah. So, congratulations, more people have walked on the moon than done what you've done. And I'm looking forward to chatting, Aaron, and really grateful for your work putting together a fantastic issue. I think our listeners will appreciate that the nervous system does not function in isolation. It's important to understand the neurologic manifestations of diseases that originate within the brain, spinal cord, nerves, muscles, etc., but also the manifestations of diseases that begin in other systems and, you know, may masquerade as a primary neurologic disorder. So, it's obviously an important topic for neurologists, since many of these patients are receiving care in another setting, perhaps from another specialist. I almost think of this issue of Continuum as a handbook for the consultant neurologist, inpatient or outpatient. I don't know. Do you think that's a fair characterization of the topic? Dr Berkowitz: Absolutely. I completely agree with you. I think, yeah, many of us go into neurology interested in our primary diseases, whether it's stroke or Parkinson's or neuropathy or particular interest in neurologic symptoms, whether they're cognitive, motor, sensory, visual. And we quickly learn in residency, right? As you said, a lot of what we see is neurologic manifestations of primary diseases. So, I don't know how similar this is to other training programs. But it seemed like, if I'm remembering correctly, my first year of residency was mostly on primary neurology services, general stroke, ICU. And we moved into the consultant role more in the PGY-3 year the next year. And I remember explaining to students rotating with us on the consult services, this is actually much more complex in a way, because the patient has some type of symptom in a much broader and much more complicated context of multiple things going on. And I call it "neurology in the wild." There's, like, neurology of, this patient's had a stroke and we know they have a stroke and we're trying to figure out why and treat it. That's all interesting. But our question here, is there a stroke needle buried in this haystack of all of these medical or surgical complications? And learning what I call neurology of X, which is really what this issue is; as you said, that there's a neurology of everything. There's a neurology of cardiac disease. There's a neurology of the peripartum. There's a neurology of rheumatologic disease. There's every new treatment that comes out in oncology has a neurology we learn, right? There's a neurology of everything. Dr Jones: There's a lot of axes, right? There's the heart-brain axis and the kidney-brain axis. And… I think we cover everything except the spleen-brain axis, which maybe that's a thing, maybe not. I'll probably hear from all the spleen fans out there. So, I want to do a little bit of an experiment. We're going to do something new today on the podcast. Before we get into the questions, we're going to start with a Continuum Audio trivia question. So, this will be a first time ever. Dr Berkowitz, we all know that chronic hyperglycemia, or diabetes, can lead to many neurologic and systemic complications and that optimal glucose control is our goal. For our listeners, here's the question: what neurologic complication can occur from correcting hyperglycemia too quickly? What neurologic complication can occur from correcting hyperglycemia too quickly? Stick around to the end of our interview for the answer. So, Aaron, let's get right to it. You had a chance to review all the articles in this issue on the neurology of systemic disease. What do you think in all of those is the most exciting recent development for patients who fit into this category? Dr Berkowitz: Yeah, that's a great question. I think we talked about when we were putting this issue together, right, a lot of the Continuum subspecialty topics; there should have been updates on particular disease diagnostics, treatments, new phenotypes. Whereas here probably a lot less has changed in primary heart disease, primary cancer. As I'd like to say to our students trying to excite them about neurology, most specialties have new treatments, but I can name a large number of new diseases, right, that have been discovered since we've been out of training. So, a lot of the primary medicine stays the same, and the neurologic complications stay the same. But probably the thing that many readers will want to keep handy and will probably be much in need of update again in three years are the neurologic complications of all the new cancer treatments. So, if we think back to I finished training just over ten years ago when a lot of the fill-in-the-blank-umabs were coming out, CAR T therapy, and we were starting to see a lot of neurology, I remember, related to these and telling the oncologists and they said, oh, you just wait. We are seeing at the conferences that there's a lot of neurology to these. And I feel like that is always a moving target. And I think we are seeing a lot of those and it's hard to keep up with which treatments can cause which complications, which syndromes and which severities require holding the treatment when you can rechallenge longer-term complications of CAR T cell therapies now that we've learned more about the acute complications. So, Amy Pruitt from Penn has written us a fantastic article for this issue that covers a lot of the updates there. And I learned a lot from that. I feel like that's the one that just like every time the carnioplastic diseases are reviewed in Continuum, it seems like the table is another page longer from your colleagues there in Rochester teaching us about new antibodies. And I feel like, for this issue, that's one of the areas that felt like there was a lot of very new content to keep up with since last time. Dr Jones: That's good news, right? It's good that we have new immunotherapies for cancer, but it does lead to neurologic catastrophes sometimes, and it is a moving target, really rapid. So, you mentioned that just over ten years ago you finished your training and now we see a lot more of these complex immunotherapy-related neurologic complications. What about in the other direction? Are there any things that you see less commonly now in your practice than you might have seen ten years ago right when you were finishing training? Dr Berkowitz: I would say no, I think. I think we're seeing a lot of new stuff, and we're still seeing a high volume of the classic consults we tend to get, whether that's altered mental status in a patient who's systemically ill; weakness or difficulty reading from the ventilator in a patient who's critically ill; patient has endocarditis and has a stroke hemorrhage or mycotic aneurysm, what do we do? Yeah, one of the parts that was really fun and educational editing this issue is, I really wanted to ask the experts the questions I find that are really troubling and challenging and make sure we could understand their perspective on things like the endocarditis consult, which I always feel like each time there's some twist that even though the question is what do we do about this stroke and/or hemorrhage and/or aneurysm and is surgery safe? It seems like each time I always feel like I'm reinventing the wheel, trying to really sort out how to think about this. And we have a great article from Alvin Doss at Beth Israel and Steve Feskey from Boston Medical Center. It covers a lot of cardiology, as you know, in that article about a great section on endocarditis where every time it came back for review, I would say, but what about this? This comes up. What about this? Can you explain how you think about this for our readers? I don't know. I'd be curious to hear your perspective. It sounds like we agree on what has become more common. I don't think anything in neurology seems to become less… Dr Jones: Well, no, I guess we haven't really solved anything, I guess we haven't cured any problem. But that's okay, right? I mean, it's building on an established foundation of experience and history in our field. And you know, we mentioned earlier that in many ways this issue is kind of like a neurology consultant's handbook. We did something a little different with it in that sense. In addition to you serving as the guest editor, you have authored an article in the issue. It touches on something that we've talked about a couple of times, and I'd be interested to hear you talk through it with our listeners a little bit on how to approach the neurologic consultation. Tell us a little more about that and your article and how you approached it. Dr Berkowitz: Oh, yeah, thanks. Well, thanks first of all for inviting me to think about a sort of introductory article to this issue. And I was trying to think about what to write about because, as you've said and we've been talking about, no one could know every neurologic complication of every medical disease, treatment, surgery, hospital context. Probably many of us don't even know all the muscle diseases, right, within neurology. So how could we know all this stuff? And we need some type of manual from our colleagues that can explain, okay, I know this patient has inflammatory bowel disease and they've had a stroke. Is that- are these related? Are these unrelated? And I thought the articles kind of answer all of these questions. What would I say beyond this patient has disease X and is on drug Y? Well, look up in this issue disease X and see what the neurology can be, common and rare and how often it's associated, how often it's the presenting feature, how often it means the treatment is failing, etc. I thought, I'm not sure there's much to say there. That's about a paragraph. And I thought, well, let's think even more broadly about neurologic consultation. And as you know, I like to think about diagnostic reasoning and clinical reasoning. And we talk a lot about framing bias right? And I think that is very common in consultative neurology because we'll be told in the consult or in the page or E-consult or whatever it is, this is a blank-year-old blank with a history of blank on treatment blank. And right away your mind is starting to say, oh, well, the patient just had heart disease, or, the patient is nine months pregnant, or, the patient is on an immune checkpoint inhibitor. And whether you want to do it or not, your mind is associating the patient's neurology with that. And it's- even if we know we're framing or anchoring, it's hard to kind of pull away from that. And most of the time, common things being common, a patient with cancer develops new neurology, It's probably the cancer, the treatment, or sometimes a paraneoplastic syndrome. But I've definitely found if you do a lot of inpatient neurology and a lot of consults that you're seeing so much and you have no choice but to apply these heuristics, because you're seeing a lot of volume quickly and the patients are in the hospital or they're being closely followed and outpatient setting by another specialist. You presume if you didn't get it quite right the first time, it's going to come back to you. And there's a little bit of difficulty figuring out, this is a case, actually, of all the altered mental status in acutely ill patients I got today, this is the one I should dig deeper in that I think this could turn out to be a stroke or encephalitis as opposed to delirium. I felt like that I really haven't approached that except knowing that it's easy to fall into traps. And so, I started to think about framing bias. You know, we talked about if we become aware of our biases, right, we're better at not falling prey to them. But it's subconscious. So, we might be applying it without even realizing, or even saying, I might be framing this case the wrong way, you can go right on framing it the wrong way. So, I want to kind of get a little more granular on what types of framing biases actually are relevant, specifically, to the console setting. And so, I tried to come up with a few more specific examples and try to think about ways that we could at least have a quick, if our knee-jerk is to associate primary disease X that the patient has or primary treatment X with neurologic symptom Y, what's at least a quick counter-knee jerk to say, what if it could be something else? So, for example, one of them I call "low signal-to-noise ratio bias." Altered mental status in the acutely ill hospitalized patient. What would you say, Lyell? 99 out of 100- 99.9 out of 100, it's not a primary neurologic disease. Is that fair to say? Dr Jones: Very high, yep. I agree. Dr Berkowitz: Yeah. But could it be a stroke? Could it be non-convulsive status epilepticus, meningitis encephalitis? So, how do we sort of counteract low signal-to-noise ratio bias, acknowledging it exists, acknowledging most of the time there is a low signal-to-noise, that it's not going to be neurology---to just for example, use the time course. This is pretty acute. Have I convinced myself this is not a stroke or a seizure or an acute neurologic infection? And if I'm not sure at the bedside, should I err on the side of more testing? Or the "curbside bias," as I call when your colleague just sends you a text message on your phone, No need to even open the chart, Dr Jones. Patient had a cerebellar stroke. Incidental. They're here for something else. Aspirin, right? Just like a super tentorial stroke. And you might reply thumbs up. And then imagine you open the CT scan and it's a huge cerebellar stroke with fourth ventricular compression- and patient can hide a lot of stroke back there, might just have a little ataxia. You were curbsided and that framed you to think, oh, they asked me, is aspirin okay for a cerebellar stroke and I said yes, without realizing actually the question should have been posed is, how do you manage a huge stroke with mass effect in the posterior fossa? So, these types of biases, I come up with five of them, I won't go through all of them. I'm in the article to sort of acknowledge for the reader, most of the time it's going to be what you look up in this issue, but how to think about the times where it might not be and how to be more precise about what framing is and different types of framing that occur specifically in the consultant arena. Dr Jones: And I think the longer we practice, the more of those low-frequency exceptions that you see. And, you know, and then it sticks in our mind and sometimes the bias swings the other way; people, you know, think primarily about the low frequency. And so, it's tricky. And what I really enjoyed about that article, we started talking about this probably more than a year ago, and more than a year ago, I would say relatively few clinicians were using a now widely popular large language model for clinical decision-making; we won't name the model. And now I think most clinicians are using it almost every day, right? And I think it puts a premium on how to think and how to engage with the patient, and less about the facts and the lists that a lot of conventional medical education really is derived from. So, I really appreciate that article. We can pat ourselves in the back. We had some foresight to put it in the issue, and I think it's a great addition to it. Dr Berkowitz: Thank you. Dr Jones: So, the list of potential topics when we think about the neurologic manifestations of systemic disease, we tend to break it down by organ systems, right? But the amount of things that could end up in the issue is almost infinite. Is there anything that, when you were putting this issue together---either in terms of the topics or editing the articles---is there anything that you wanted to include, but we just didn't have room? Dr Berkowitz: I certainly won't say we covered everything, but I will say we were able to recruit a fantastic team of authors. And as you and I also talked about at the beginning, although you could say, we're doing the movement disorders issue, let's find all the top movement disorders folks who are expert specialists in this field, there's not really a neurohematologist or a neurogastroenterologist out here. So, you and I put our heads together to think of phenomenal general neurologists in most cases, some subspecialists who know a lot about this but were also excited to read a lot more about it and assemble the existing knowledge by the practicing neurologist for the practicing neurologist. And I think with that approach and letting folks have kind of, you know, I asked some specific questions. These are topics I hope you'll cover. These are vexing questions in this area. I hope you'll find some answers to how often can this neurology be the primary feature of this rheumatologic disease with no systemic manifestations and when should we look or as we mentioned, the complicated endocarditis consult. I won't say we covered everything. This could be, and is, textbook-sized, and there are textbooks on this topic. But I think on the contrary, authors came back and had sections on things that I might not have thought to ask- to cover. Dr Sarah LaHue, my colleague here at UCSF, I asked for an article, as traditionally in this issue, on the neurology of pregnancy in the postpartum state and included, I think probably for the first time in Continuum, a fantastic review of neurologic considerations in patients in menopause, which I'm not sure has been covered before. So, things that I wouldn't have even thought to ask for. Our authors came back with some fantastic stuff. And the ICU article by Dr Shivani Ghoshal, instead of focusing just on altered mental status in the ICU, weakness in the ICU---those are all in there---I also asked her to discuss complications of procedures in the ICU. How often do procedures in the ICU cause local neuropathies or vascular injury, these types of things. Dr Jones: Yeah, me too. And I guess that's a great advertisement, that there probably are things that we didn't cover, but if there are, we can't think of them. We've done as best as we can. So now let's come back to our Continuum Audio trivia question for our listeners. And I'll repeat the question: what neurologic complication can occur from correcting hyperglycemia too quickly? And I actually think there might be two correct answers to this one. Dr Berkowitz, what do you think? Dr Berkowitz: Yeah, I was thinking of two things. I hope these are the things you're thinking of as well. One is what I think used to be referred to as insulin neuritis, sort of an acute painful small fiber neuropathy from after the initiation of insulin, I think also called treatment-induced diabetic neuropathy or something of that nature. And then the other one described, defined and classified by your colleagues there in Rochester, the diabetic lumbosacral radiculoplexis neuropathy or Bruns-Garland syndrome or a diabetic amyotropy, I think, can also---if I'm not mistaken---also occur in this context; you should have weight loss in association with diet treatment of diabetes. But how did I do? Dr Jones: Yeah, you win the prize, the first-ever prize. There's no monetary value to the prize, but pride, I think, is a good one. Yeah, those were the two I was thinking of. The treatment-induced neuropathy of diabetes is really nicely covered in Dr Rafid Mustafa's article on the neurologic complications of endocrine disorders. It's a rare condition characterized by the acute/subacute onset of diffuse neuropathic pain and some usually some autonomic dysfunction. And it occurs when you have rapid and substantial reductions in blood glucose levels. And you can almost map it out. There was a study from 2015 which is referenced in the article, which found that a drop in hemoglobin A1c of 2 to 3% over three months confers about a 20% absolute risk of developing this treatment-induced neuropathy of diabetes, and a drop of more than 4%, more than 80% risk. So, very substantial. And then in the other---we see this commonly in patients with diabetic lumbosacral radiculoplexis neuropathy---they have the subacute onset of usually asymmetric pain and weakness in the lower limbs that tends to occur more frequently in patients who have had recent better control of their sugar. We can also see it in the upper limbs too. So, you get a perfect score. Dr Berkowitz, well done. Again, I want to thank you. I want to thank you for such a great issue, a great article to kick off the issue, and a great discussion of the neurology of systemic disease. Today I learned a lot talking today, I learned a lot reading the issue. Really grateful for your leadership of putting it together, pulling together a really great author panel, and I think it will come in handy not just for our junior readers and listeners, but also our more experienced subscribers as well. Dr Berkowitz: Thank you so much. Like I said, it was a big honor to be invited to guest edit this issue. I've read it every three years since I started residency. It's always one of my favorite issues. As you said, a manual for consultative neurology, and I learned a ton from our authors and really appreciate the opportunity to work with you and the amazing Continuum team to bring this from an idea, as you said, probably over a year ago to a printed issue. So, thanks again, Lyell. Dr Jones: Thank you. And again, we've been speaking with Dr Aaron Berkowitz, guest editor of Continuum's most recent issue on the neurology of systemic disease. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.
Health Affairs' Rob Lott interviews Dr. Robert Wachter, Professor and Chair of the Department of Medicine at UCSF, about his new book A Giant Leap: How AI Is Transforming Healthcare and What That Means for Our Future. Wachter reflects on his own daily use of AI as a clinician, the reasons he has grown optimistic about its potential, and the challenges of regulating fast‑evolving technologies. Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast
Send us a textIn this episode, Dr. Amy Gelfand, a child neurologist specializing in pediatric headaches, discusses the complexities and treatment of migraines in children. Gelfand explains the genetic nature of migraines and their commonality among kids, noting triggers like menstrual cycles and changes in sleep patterns. She elaborates on distinguishing features of migraines and provides insight into preventive and acute treatments, including NSAIDs, triptans, neuromodulation devices, and supplements. The discussion also covers the importance of a regular schedule, the benefits of cognitive behavioral therapy (CBT), and recent advancements in migraine-specific medications. Dr. Gelfand emphasizes the significant progress in migraine treatment and encourages families to consult specialists for personalized care.About Dr Gelfand:Dr. Amy Gelfand is a pediatric neurologist who specializes in diagnosing and treating children with a variety of headache disorders, as well as those with childhood periodic syndromes (such as abdominal migraine), which may be precursors to migraine headache later in life. Her research focuses on the epidemiology of pediatric migraine and childhood periodic syndromes.Gelfand received her medical degree from Harvard Medical School. She completed residencies in pediatrics and child neurology at UCSF.Gelfand has received a teaching award from the UCSF pediatric residency program and writing awards from the medical journal Neurology. She is a member of the American Academy of Neurology, Child Neurology Society and American Headache Society.Your Child is Normal is the trusted podcast for parents, pediatricians, and child health experts who want smart, nuanced conversations about raising healthy, resilient kids. Hosted by Dr. Jessica Hochman — a board-certified practicing pediatrician — the show combines evidence-based medicine, expert interviews, and real-world parenting advice to help listeners navigate everything from sleep struggles to mental health, nutrition, screen time, and more. Follow Dr Jessica Hochman:Instagram: @AskDrJessica and Tiktok @askdrjessicaYouTube channel: Ask Dr Jessica If you are interested in placing an ad on Your Child Is Normal click here or fill out our interest form.-For a plant-based, USDA Organic certified vitamin supplement, check out : Llama Naturals Vitamin and use discount code: DRJESSICA20-To test your child's microbiome and get recommendations, check out: Tiny Health using code: DRJESSICA The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditi...
Corey Dion Lewis sits down with Dr. Margot Kushel, a practicing general internist with over 30 years of experience at San Francisco General Hospital and Director of the UCSF Benioff Homelessness and Housing Initiative, to explore why homelessness is fundamentally a housing problem—not a healthcare problem—and what this means for medical professionals and communities.Dr. Kushel shares compelling insights from her three decades of clinical practice and research, revealing how the lack of affordable housing creates impossible situations for healthcare providers trying to treat patients experiencing homelessness. From managing diabetes in a tent to storing insulin without refrigeration, she illustrates why "there is no medicine as powerful as housing."What You'll Learn:Why regions with high homelessness rates are defined by housing affordability, not mental health prevalenceHow structural racism and redlining created the current crisis, with Black Americans 4-5 times overrepresented in homeless populationsThe stark reality: only 36 affordable housing units exist for every 100 extremely low-income households in AmericaWhy Housing First policies work better than Treatment First approaches, backed by evidence from veteran homelessness reductionThe hidden homeless population: workers living in cars, college students couch-surfing, and older adults losing housing for the first timeHow the politicization of Housing First policies threatens progress and patient outcomesPractical ways healthcare providers can advocate for housing as a health interventionKey Clinical Insights:Dr. Kushel explains why treating chronic conditions like diabetes, hypertension, and mental health disorders becomes nearly impossible when patients lack stable housing. She shares real stories from her practice, including a 63-year-old patient who hadn't eaten in four days while fighting eviction, and discusses how readmission penalties unfairly penalize hospitals serving homeless populations.The Evidence for Housing First:Learn about the dramatic 85% housing retention rate of Housing First approaches compared to 5-10% success rates of traditional Treatment First models, and why the George W. Bush administration adopted this evidence-based policy. Dr. Kushel also shares findings from California's comprehensive statewide homelessness study, debunking myths about people traveling from other states.For Medical Professionals:This episode is essential listening for physicians, nurses, nurse practitioners, physician assistants, medical students, residents, community health workers, social workers, case managers, and anyone in healthcare who treats patients experiencing housing instability. Dr. Kushel provides a framework for understanding how to advocate beyond the clinic walls.About Dr. Margot Kushel:Dr. Kushel is a physician and researcher who has dedicated her career to understanding and ending homelessness. She directs the UCSF Benioff Homelessness and Housing Initiative and the Action Research Center for Health at the University of California, San Francisco. Her research informs policy at local, state, and federal levels.Resources Mentioned:UCSF Benioff Homelessness Initiative: homelessness.ucsf.eduCalifornia Statewide Study of People Experiencing Homelessness"There Is No Place" by Brian GoldstoneEpisode Takeaway: "There is no medicine as powerful as housing. Homelessness is a housing problem."Whether you're a healthcare provider frustrated by social determinants of health, a medical student learning about population health, or a community advocate, this conversation will change how you think about the intersection of housing and health.SHOW NOTESEpisode: Housing as Medicine: Why Homelessness is a Housing Crisis Guest: Dr. Margot Kushel, MD Host: Corey Dion Lewis Category: Medicine Duration: ~49 minutesABOUT THIS EPISODEDr. Margot Kushel, Director of the UCSF Benioff Homelessness and Housing Initiative, explains why homelessness is fundamentally a housing crisis and how this understanding transforms medical practice and healthcare advocacy.GUEST BIODr. Margot Kushel, MDPracticing General Internist, San Francisco General Hospital (30+ years)Director, UCSF Benioff Homelessness and Housing InitiativeDirector, Action Research Center for Health, UCSFLeading researcher on homelessness and health outcomesPolicy advisor at local, state, and federal levelsKEY TOPICS & TIMESTAMPS[00:00] Introduction: The Housing-Health Connection[02:00] Homelessness is a Housing ProblemWhy mental health and substance use don't explain geographic variationsThe role of affordable housing shortagesComparing high vs. low homelessness regions[05:00] The Clinical Reality: Hands Tied Behind Our BacksTreating diabetes in patients living in tentsWhy standard medical care fails without stable housingThe frustration of healthcare providers[08:17] The Numbers: America's Affordable Housing Crisis36 units per 100 extremely low-income households nationallySan Francisco: 24 units per 100 householdsOne million units short[09:15] "There is No Medicine as Powerful as Housing"Using physician voices in policy advocacyThe limitations of healthcare aloneAddressing root causes[13:55] Hospital Readmissions and Housing InstabilityHow readmission penalties penalize safety-net hospitalsPatients discharged to sidewalksThe need for systemic change[17:08] Structural Racism and the Homelessness CrisisBlack Americans: 4-5 times overrepresentedThe legacy of redlining and housing discriminationHow wealth gaps perpetuate housing instabilitySan Francisco example: 5% population, 37% of homeless[19:28] Historical Context: How Housing Policy Weaponized RacePost-WWII home ownership boomRedlining and mortgage discriminationIntergenerational wealth transfer blockedOngoing discrimination in rental housing[23:49] The Hidden Homeless PopulationWorkers living in cars (Uber drivers, janitors, fast food workers)College students experiencing housing insecurityThe invisible crisis in CSU, UC, and community collegesPeople with addresses who aren't truly housed[27:17] Older Adults: The Growing CrisisHalf of single homeless adults are 50+40% experiencing homelessness for first time after age 50Bodies breaking down from physical laborThe eviction-to-homelessness pipeline[28:14] Clinical Case: The Amoxicillin StoryPatient in garage without refrigerationAntibiotic treatment failure due to housingWhy "having an address" doesn't mean housed[29:11] Debunking the Migration MythCalifornia study: 90% lost housing in-state75% in the same county
It was reported in the media that Stephen Curry is dealing with patellofemoral syndrome (aka runner's knee). What exactly is this condition? Why does it effect elite athletes and weekend warriors? What are the various treatment options? Listen to our latest podcast to find out!
Hello everyone! In this episode of Dean's Chat Drs. Jensen and Richey have an in-depth conversation with Dr. Lawrence Oloff, a highly influential podiatric surgeon, educator, and sports medicine specialist. The interview spans Dr. Oloff's career, the evolution of podiatry, and his experiences at the highest levels of academic medicine and professional sports.Join us as we discuss “All things podiatric medicine and surgery” including Dr. Oloff's Career Path & Leadership. Dr. Oloff trained at Pennsylvania College of Podiatric Medicine, he served as faculty at multiple podiatric institutions, including the California College of Podiatric Medicine and was Dr. Jensen's Dean when he graduated from Podiatric Medial School. Most recently, Dr. Oloff became full-time faculty at UCSF and remains the program director for St. Mary's Hospital - podiatric residency program as part of the Department of Orthopedics. He now practices alongside orthopedic foot-and-ankle surgeons, operating equally within a top-tier academic medical center—an example of podiatry's integration into mainstream medicine.He has chaired national academic boards and played a major role in advancing multi-year residency training and residency placement for graduates. A leader in the advancement of Podiatric Surgical Sports medicine, Dr. Oloff has served as team podiatrist for elite organizations including the San Francisco Giants (over 25 years), 49ers, Warriors, Stanford University, and others. He emphasizes: the importance of being a team player over asserting ego; Judicious decision-making, especially around return-to-play; Learning directly from trainers and real-world experience; The pressure, risk, and legal exposure involved in treating professional athletes.Throughout the interview, Dr. Oloff reflects on earlier decades when podiatrists had to “break down doors” to gain hospital privileges and professional respect. Compared to that era, today's podiatry offers far greater opportunity, visibility, and integration, though challenges remain. He stresses that good surgery is not about technical skill alone, but about knowing when not to operate, understanding biomechanics, planning several steps ahead, and remaining humble.He credits mentors like Dr. Alan Jacobs and underscores the importance of rigorous academics, interdisciplinary collaboration, and lifelong learning. Overall, this episode is a rich oral history of modern podiatry—highlighting its struggles, growth, and future potential—through the lens of one of its most accomplished leaders.
In this episode of The Healers Café, Manon Bolliger, speaks to Cedric Bertelli, founder of the Emotional Health Institute, discusses his methodology, Emotional Resolution (EMRS), which addresses emotional imprints through somatic neuroscience. Inspired by his grandfather's resilience post-WWII, Cedric developed EMRS to help individuals resolve emotional patterns by feeling physical sensations without control. He explains that the brain predicts emotions based on past experiences, often rooted in trauma, and EMRS allows these predictions to play out naturally, updating the brain's response. For the transcript and full story go to: https://www.drmanonbolliger.com/cedric-bertelli Highlights from today's episode include: Emotions are outdated predictions: Debilitating emotions are often outdated predictions from the brain, triggered when current stimuli resemble elements from past traumatic moments. The body then recreates old physical sensations (interoception), even when they're no longer relevant. Resolution by fully feeling sensations (90 seconds) : If a person can safely stay with the raw physical sensations of an emotion—without trying to regulate, fix, or control them—the interoceptive wave naturally completes within about 30–90 seconds, and the brain updates its prediction, so the same stimulus no longer triggers that reaction. Stop building stories; stay with the body: Manon emphasizes the importance of not creating or feeding mental stories about what we feel. By witnessing the emotion innocently and staying with the body's sensations rather than the narrative, we allow real resolution instead of reinforcing the pattern. ABOUT CEDRIC BERTELLI: Cedric Bertelli is the founder of the Emotional Health Institute and co-developer of Emotional Resolution® & EmRes®, a somatic, neuroscience-based approach for resolving emotional imprints. Before dedicating himself to emotional health, Cedric spent more than a decade in the hospitality industry, including leadership roles with The Ritz-Carlton Hotel Company, where he developed a deep understanding of human behavior and service. Over the past 15 years, he has trained practitioners across the world, guided thousands of clients, and partnered with researchers at UCLA and UCSF to advance the scientific foundations of EmRes. His work focuses on making emotional healing simple, effective, and accessible so people can live with greater clarity, ease, and resilience. Core purpose/passion: My core purpose is to help people reconnect with their natural capacity to resolve emotional pain. Not to manage it, not to suppress it, and not to build workarounds around it — but to truly resolve it at the physiological level so they can live with more freedom, presence, and ease. – Facebook | Instagram | Website | LinkedIn | YouTube | ABOUT MANON BOLLIGER, RBHT, FCAH: As a retired Naturopath 1992-2021, I saw an average of 150 patients per week and have helped people ranging from rural farmers in Nova Scotia to stressed out CEOs in Toronto to tri-athletes here in Vancouver. My resolve to educate, empower and engage people to take charge of their own health is evident in my best-selling books: 'What Patients Don't Say if Doctors Don't Ask: The Mindful Patient-Doctor Relationship' and 'A Healer in Every Household: Simple Solutions for Stress'. and What if Your Body is Smarter than You Think? I am the Founder & CEO of The Bowen College Inc. which teaches BowenFirst™ Therapy and holds transformational workshops to achieve these goals. So, when I share with you that LISTENing to Your body is a game changer in the healing process, I am speaking from expertise and direct experience". Mission: A Healer in Every Household! For more great information to go to her weekly blog: http://bowencollege.com/blog. For tips on health & healing go to: https://www.drmanonbolliger.com/tips Follow: Manon Bolliger website | Linktr.ee | Rumble | Gettr | Facebook | Instagram | YouTube | Twitter | LinkedIn | Follow: Bowen College Inc. | Facebook | Instagram | LinkedIn | YouTube | Twitter | Rumble | Locals ABOUT THE HEALERS CAFE: Manon's show is the #1 show for medical practitioners and holistic healers to have heart to heart conversations about their day to day lives. Subscribe and review on your favourite platform: iTunes | Google Play | Spotify | Libsyn | iHeartRadio | Gaana | The Healers Cafe | Radio.com | Medioq | Audacy | Follow The Healers Café on FB: https://www.facebook.com/thehealerscafe Remember to subscribe if you like our videos. Click the bell if you want to be one of the first people notified of a new release. * De-Registered, revoked & retired naturopathic physician after 30 years of practice in healthcare. Now resourceful & resolved to share with you all the tools to take care of your health & vitality!
Brain Talk | Being Patient for Alzheimer's & dementia patients & caregivers
Older adults often turn to prescription and over-the-counter sleep aids — but what do we really know about their long-term effects on brain health? A large, long-running UCSF study, published in the Journal of Alzheimer's Disease, examined the association between sleep medication use and risk of dementia in older adults. Researchers found that frequent use of sleep medications was linked to a higher likelihood of developing dementia among white participants, while the same pattern was not seen among Black participants. Dr. Yue Leng, PhD, an epidemiologist at UC San Francisco whose work explores how sleep, circadian rhythms, and napping relate to neurodegeneration and cognitive decline in older adults, was one of the researchers on the study.If you loved listening this Live Talk, visit our website to find more of our Alzheimer's coverage and subscribe to our newsletter: https://www.beingpatient.com/Follow Being Patient: Twitter: https://twitter.com/Being_Patient_Instagram: https://www.instagram.com/beingpatientvoices/Facebook: https://www.facebook.com/beingpatientalzheimersLinkedIn: https://www.linkedin.com/company/being-patientBeing Patient is an editorially independent journalism outlet for news and reporting about brain health, cognitive science, and neurodegenerative diseases. In our Live Talk series on Facebook, former Wall Street Journal Editor and founder of Being Patient, Deborah Kan, interviews brain health experts and people living with dementia. Check out our latest Live Talks: https://beingpatient.com/live-talks/
Podcast: Carlsbad: People, Purpose and Impact Host: Bret Schanzenbach, President & CEO, Carlsbad Chamber of Commerce Guest: Dr. Gene Ma, President & CEO, Tri-City Medical CenterIn this episode, Bret welcomes Dr. Gene Ma, a long-time emergency physician and now President & CEO of Tri-City Medical Center, for a candid and hopeful conversation about the future of healthcare in North County San Diego.Dr. Ma traces his journey from a globally mobile childhood (Hawaii, Burma, Japan, Hong Kong) to growing up in Arcadia, then on to UC Irvine, UCSF, Stanford, and UCSD, where he trained in emergency medicine. He shares what it's really like behind the scenes in the ER, the importance of humility in medicine, and what 27 years on the front lines taught him about people, teams, and community.Listeners will hear how Dr. Ma:Discovered his passion for community-based medicine at Tri-CityServed as Chief of Staff and later Chief Medical OfficerLed and helped grow a democratic emergency medicine group and an occupational health businessWas honored 10 times as one of San Diego's Top Doctors in Emergency MedicineThe conversation dives into the financial and regulatory pressures facing hospitals today, including:How DRG-based payments and long COVID hospital stays pushed hospitals to the brinkThe impact of underfunded Medicare and growing staffing costsThe staggering costs of new construction and seismic compliance, with per-bed costs in the millionsCalifornia's 2030 (and 2033) seismic standards, and what they actually requireFrom there, Dr. Ma shares the transformational plan for Tri-City:Tri-City is entering a long-term lease and operating agreement with Sharp HealthCareThe hospital will become Sharp Tri-City, pending voter approval in JuneThe agreement brings the scale, resources, and experience of San Diego's largest not-for-profit health system to North CountyThe board's decision, he explains, reflects a commitment to put community before titles and secure a sustainable future for the districtDr. Ma paints an inspiring vision that includes:Reopening Labor & Delivery at Tri-City in partnership with Sharp Mary BirchReturning and expanding NICU and high-risk maternal-fetal medicine services to North CountyDeveloping a comprehensive cancer center on the Tri-City campus so patients can receive radiation and chemotherapy locallyA revitalized, state-of-the-art flagship medical center that drives both better health outcomes and economic growth along the Highway 78 corridorBret and Dr. Ma also discuss the upcoming public vote, clarify that no new taxes are being requested, and encourage district residents to vote YES to allow Sharp to manage and invest in the hospital.The episode closes on a personal and heartwarming note, as Dr. Ma talks about his five daughters, their life paths across California and New York, and what it's like to transition from sideline sports dad to a new season of life.If you care about the future of local healthcare, economic vitality, and quality of life in Carlsbad and North County San Diego, this episode of “Carlsbad: People, Purpose and Impact” is a must-listen.Key Topics:Dr. Gene Ma's global upbringing and medical training27 years in emergency medicine and leadership at Tri-CityFinancial and regulatory realities of running a hospitalCOVID's impact on hospital operations and financesCalifornia seismic standards and hospital infrastructureThe long-term partnership between Tri-City and Sharp HealthCareReopening Labor & Delivery and bringing high-risk maternity care back to North CountyPlans for a comprehensive cancer center on the Tri-City campusThe importance of the upcoming community voteDr. Ma's family and life in North CountyCall to Action: Be sure to follow “Carlsbad: People, Purpose and Impact” and share this episode with friends, colleagues, and neighbors who want to understand what's at stake for healthcare in our community.Quotes (for Reels / Audiograms)“The moment you think you know everything in medicine is the moment you become dangerous. You have to be humble—or medicine will humble you.”“People think hospitals made money during COVID. The truth is, it was devastating. Patients stayed for weeks or months while we were paid for just a few days of care.”“If the 2030 seismic standards were enforced today, more than half the hospitals in California would have to close. That's how expensive this is.”“There's no realistic path for Tri-City to reopen labor and delivery on its own—but with Sharp, not only can we reopen, we can expand and bring high-risk maternity care back to North County.”“One day, people won't be able to imagine a North County without Sharp Tri-City—they'll just assume world-class care has always been here.” Did this episode have a special impact on you? Share how it impacted youCarlsbad Podcast Social Links:LinkedInInstagramFacebookXYouTubeSponsor: This show is sponsored and produced by DifMix Productions. To learn more about starting your own podcast, visit www.DifMix.com/podcasting
The only certainty in medicine is uncertainty. It touches every aspect of clinical practice, from diagnosis to treatment to prognosis. Despite this, many clinicians view uncertainty as something to tolerate at best or eliminate at worst. But what if we need to rethink and reframe our relationship with uncertainty in medicine? In this episode, we sit down with Jonathan Ilgen and Gurpreet Dhaliwal, co-authors of the New England Journal of Medicine article, "Educational Strategies to Prepare Trainees for Clinical Uncertainty." Together, we explore the nature of uncertainty in clinical practice, its effects on trainees and seasoned clinicians, and strategies to embrace it as a fundamental part of medical reasoning rather than a regrettable byproduct. Jonathan and Gurpreet share insights from research and clinical experience, offering practical methods to help trainees and clinicians recognize, manage, and even embrace uncertainty. Key topics we discuss include: The paradoxical nature of uncertainty: When perceived as a threat, it can provoke anxiety or fear; yet when framed as an opportunity, it can inspire hope and optimism. Why uncertainty is inevitable in medical practice and its impact on clinicians. Is uncertainty a state or a trait? The distinction between epistemic uncertainty (knowledge gaps) and aleatoric uncertainty (randomness in outcomes). How experienced clinicians utilize strategies such as forward planning and monitoring to navigate uncertainty. Communicating uncertainty with patients: how to do it effectively without eroding trust. How to integrate uncertainty into medical education. During the conversation, we explore the emotional responses to uncertainty and how these reactions can influence clinical practice and decision-making. Importantly, Jonathan and Gurpreet emphasize the importance of openly communicating uncertainty with colleagues, supervisors, and patients—a practice that, contrary to common belief, actually strengthens trust, fosters transparency, and encourages collaboration. By normalizing and embracing uncertainty, clinicians can better manage the complexities of medicine and build confidence in their ability to care for patients in the face of the unknown.
Dr. David Avrin, MD, PhD, is a pioneering leader in medical imaging informatics with decades in digital biomedical imaging, twice serving as Chair of RISC/SCAR/SIIM during pivotal eras in PACS development and Imaging Informatics conception. A Professor Emeritus at UCSF, he helped integrate PACS and EMR systems, advanced clinical and educational workflows, and authored foundational work including numerous peer-reviewed papers. He created the first human dual-energy CT images, led major informatics initiatives as UCSF Vice Chair, founded UCSF's ACGME Clinical Informatics Fellowship, and served as Editor-in-Chief of the Journal of Digital Imaging. A Fellow of both ACR and SIIM and recipient of SIIM's inaugural Gold Medal, he remains one of the field's most influential innovators. Note: The is the second of two episodes. You can find our podcast on Spotify, Apple Podcast, or anywhere else you subscribe to podcasts. Please help us out by leaving a review! Visit us at https://siim.org/page/siimcast Special Thanks to @RandalSilvey of http://podedit.com for editing and post processing support.
In this episode, I'm thrilled to welcome Dr. Anna Glezer, a renowned reproductive psychiatrist and founder of Women's Wellness Psychiatry to the Egg Whisperer Show. Dr. Glezer has dedicated her career to supporting fertility patients, many of whom I've had the privilege to care for, through some of the most emotionally challenging moments of their reproductive journeys. With training from Harvard Medical School and UCSF, she brings a compassionate, integrative approach to helping people manage stress, anxiety, and depression during fertility treatment, pregnancy, and beyond. Get the full show notes on my website. Our conversation dives deep into the unique emotional landscape of fertility and pregnancy. Together, we explore how hormonal changes, societal pressures, and the ups and downs of the fertility journey can impact mental health. Dr. Glezer shares her expertise on building a strong foundation for emotional wellbeing, the importance of individualized care, and practical strategies for navigating grief, loss, and the rollercoaster of hope and disappointment. In this episode, we cover: The unique ways stress, anxiety, and depression manifest during fertility treatment and pregnancy How to build a strong support system and foundation for mental health The role of lifestyle medicine, nutrition, and supplements in emotional wellbeing Coping with grief and loss after unsuccessful fertility treatments or pregnancy loss Strategies for managing anxiety and "what if" thinking during subsequent pregnancies How Dr. Glezer tailors her integrative approach to each patient's needs Advice for loved ones and fertility teams on providing meaningful support Resources: Women's Wellness Psychiatry: https://annaglezermd.com/ Resolve: The National Infertility Association: resolve.org Do you have questions about IVF, and what to expect? Click here to join Dr. Aimee for The IVF Class. The next live class call is on Monday, February 9th, 2026 at 4pm PST, where Dr. Aimee will explain IVF and there will be time to ask her your questions live on Zoom. Dr. Aimee Eyvazzadeh is one of America's most well known fertility doctors. Her success rate at baby-making is what gives future parents hope when all hope is lost. She pioneered the TUSHY Method and BALLS Method to decrease your time to pregnancy. Learn more about the TUSHY Method and find a wealth of fertility resources at www.draimee.org where you can schedule a consultation. Other ways to connect: Subscribe to my YouTube channel for more fertility tips Join Egg Whisperer School Subscribe to the newsletter to get updates
In this episode, we explore the science of brain fitness and how targeted brain training exercises can strengthen key brain systems with Dr. Henry Mahncke, Ph.D.. Dr. Mahncke shares his journey from studying neuroscience at UCSF to leading brain plasticity-based training at BrainHQ. Learn how BrainHQ's specific brain training program can improve memory, attention, decision-making, and overall brain resilience across 300+ published research studies. Discover the profound impact of brain plasticity, the significance of the groundbreaking INHANCE study, and practical tips on incorporating brain training into your daily life. Dr. Mahncke emphasizes that brain training is not just a trend but a scientific approach to maintaining and boosting brain health. Tune in to find out how you can intentionally train your brain at any age and better understand the notion of cognitive fitness. 00:00 Introduction to Brain Fitness00:24 Meet Dr. Henry Mahncke, Ph.D.01:46 Personal Motivation and Early Career03:13 Graduate School and Discovering Brain Plasticity05:40 The Concept of Brain Fitness09:19 Brain HQ: The Science Behind Brain Training11:02 Understanding Brain Fitness and Training20:50 The Enhanced Study and Neuromodulatory Systems24:46 Exciting Beginnings: Launching the Study25:11 Study Design: Brain HQ vs. Ordinary Games26:18 Training Regimen and Compliance26:35 Breakthrough Results: Acetylcholine Levels27:43 Beyond Brain HQ: Broader Brain Health29:56 The Importance of Intensity in Brain Training32:58 Holistic Approach to Brain Health39:45 Practical Tips for Brain Training42:45 Final Thoughts and EncouragementResourcesTry BrainHQ's brain training exercises for free on their website.Explore the science behind BrainHQ in over 300+ research studies.Learn more about the INHANCE study's media coverage and results in the research article.Learn more about brain health in BrainHQ's “Better Brain Health” blog.Connect with Henry on LinkedIn.Stay in touch with BrainHQ on Instagram and Facebook.
This time of year we saw a tremendous increase in people embarking on a new exercise regime as one of their New Year's Resolutions. But there are several pitfalls that you need to avoid. Listen to our latest podcast to learn more!
What is the future of social media and medicine? How can it be utilized? What are some of the benefits. Listen to our latest podcast as we talk with Dr Adrian Huang.
After a year of political, economic and societal turmoil, we sit down with KQED's Arts team to talk about their annual series, One Beautiful Thing. The series gathers reflections on singular experiences and practices from the past year that served as a balm, nourishment or enlightenment. This year's picks include handwriting letters, supporting a struggling artist and taking a solo trip to follow a band on tour. And, we want to hear from you, what was the One Beautiful Thing in your life that punctuated 2025? Guests: Gabe Meline, senior editor, KQED Arts and Culture Pendarvis "Pen" Harshaw, columnist, KQED Arts Luke Tsai, food editor, KQED Arts and Culture Elissa Epel, professor and vice chair, UCSF's Department of Psychiatry; she is the author of "The Stress Prescription" Learn more about your ad choices. Visit megaphone.fm/adchoices
Traumatic brain injuries (TBI) like concussions are not uncommon, especially in children and older adults. These injuries can have both short-term and lasting effects on the brain, but what about their impact on cognitive function? Dr. Deling He of UW–Madison's Cognitive-Communication in Aging and Neurogenic Disorders Laboratory (CCANDL) lab joins the podcast to discuss her research on the connections between TBI, speech pathology and cognition and what her study findings mean for people with a history of TBI. Guest: Deling He, PhD, postdoctoral research associate, Cognitive-Communication in Aging and Neurogenic Disorders Laboratory, Department of Communication Sciences and Disorders, UW–Madison Show Notes Read the study from the University of California, San Francisco (UCSF), “Traumatic Brain Injury Strikes 1 in 8 Older Americans,” mentioned by Dr. Chin at 0:30 on the UCSF website. Learn more about Dr. He's study in the article, “TBI linked to long-term cognitive decline in preclinical Alzheimer's disease,” published on Healio's website. Learn more about the Cognitive-Communication in Aging and Neurogenic Disorders Laboratory (CCANDL) on their lab website. Learn more about Dr. He on the CCANDL website. Connect with us Find transcripts and more at our website. Email Dementia Matters: dementiamatters@medicine.wisc.edu Follow us on Facebook and Twitter. Subscribe to the Wisconsin Alzheimer's Disease Research Center's e-newsletter. Enjoy Dementia Matters? Consider making a gift to the Dementia Matters fund through the UW Initiative to End Alzheimer's. All donations go toward outreach and production.
In this insightful episode of Parenting Great Kids, Dr. Meg Meeker welcomes Larissa May and Dr. Raghu Appasani, co-founders of Ginko—an AI-powered parenting tool designed by clinicians to help families manage screen time and support their children's mental health. As screens increasingly dominate our kids' lives, this episode offers a powerful look at how Ginko promotes digital wellness through early intervention, behavioral insight, and personalized parenting support.Ginko is not just another screen-limiting app—it's a clinically informed platform that helps parents understand their children's emotional state through their digital activity. Larissa and Dr. Appasani share how Ginko personalizes digital guidance, supports healthier habits, and equips families to foster stronger, emotionally connected relationships in the digital age.Whether you're a parent feeling overwhelmed by tech, or a professional navigating the intersection of mental health and technology, this episode provides compassionate and data-driven solutions for raising healthy, tech-savvy kids.Our Guests:Larissa May: Globally recognized as the face of digital wellness, Larz has shaped policy and youth-centered advocacy.Dr. Raghu Appasani: An Integrative & Addiction Psychiatrist and Clinical Professor at UCSF and Mount Sinai. Check out Ginko here.
Today's episode is a must-listen for every woman who has ever felt responsible for everyone else's happiness but her own. I'm joined by the incredible Beatriz Victoria Albina — a UCSF-trained Family Nurse Practitioner, Somatic Experiencing Practitioner, Master Certified Somatic Life Coach, Breathwork Guide, and bestselling author of End Emotional Outsourcing: A Guide to Overcoming Codependent, Perfectionist and People Pleasing Habits (Hachette Balance, 2025). Béa has spent over 20 years helping women reconnect with their bodies, regulate their nervous systems, and step out of old patterns that keep them stuck. Her work is powerful, deeply compassionate, and incredibly freeing. This conversation goes there — childhood patterns, emotional outsourcing, nervous system regulation, codependency, and the lies perfectionism tells us. But we also talk about reclaiming joy, taking up space, and how women can finally come home to themselves. Grab your journal, because this one is filled with moments you'll want to pause, reflect, and come back to. ✨ What We Talk About in This Episode What emotional outsourcing really is — and why so many women do it without realizing How childhood conditioning shapes our adult behaviors and relationship patterns Why our nervous system often runs the show and how to finally regulate it The connection between people-pleasing and feeling unsafe in your body How somatic work helps you heal at the root instead of endlessly "managing" symptoms Rewriting the perfectionist narrative and choosing good enough Finding your joy again when you've spent years prioritizing everyone else Breaking out of codependent patterns in friendships, relationships, and work How women can become their own safe place Why being surrounded by the right people changes everything
The killing of Alberto Rangel, a 51-year-old social worker at San Francisco General Hospital, has left colleagues grieving and questioning whether his death could have been prevented. Rangel was stabbed by a patient who authorities say had made multiple threats for weeks. Incidents of workplace violence in healthcare facilities have been on the rise for more than a decade nationwide, prompting hospitals and medical offices to adopt stricter safety protocols. But are they working? We'll talk about workplace violence against health care workers and what employers are doing – and failing to do – to protect them. Guests: Annie Vainshtein, reporter, San Francisco Chronicle Dani Golomb, psychiatrist; Golomb was attacked by a patient in 2020 during her medical residency at California Pacific Medical Center in San Francisco Dan Russell, president, University Professional and Technical Employees Al'ai Alvarez, clinical professor of emergency medicine, Stanford University Cammie Chaumont Menendez, research epidemiologist, Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health Learn more about your ad choices. Visit megaphone.fm/adchoices
Overeating isn't about willpower; it's about your brain.In this episode, Dr. Laurel Mellin explains how Emotional Brain Training (EBT) can help you rewire the circuits that drive cravings and emotional eating.You'll learn what's really happening in your brain when you reach for food in moments of stress and simple strategies you can start using today to take control of your circuits, and create lasting freedom from overeating.Dr. Laurel Mellin is a health psychologist and nutritionist who during her more than 40 years as a professor at UCSF developed skills that address the root cause of why we overeat -- emotional brain training. She is a researcher, New York Times bestselling author and trains health professionals in the EBT methods. Her website is EBT.ORG.Tune in each week for practical, relatable advice that helps you feel your best and unlock your full potential. If you're ready to prioritize your health and level up every area of your life, you'll find the tools, insights, and inspiration right here. Check out Esther's website for more about her speaking, coaching, book, and more: http://estheravant.com/Buy Esther's Book: To Your Health: https://a.co/d/iDG68qUEsther's Instagram: https://www.instagram.com/esther.avantEsther's LinkedIn: https://www.linkedin.com/in/estheravant/Learn more about 1:1 health & weight loss coaching: https://madebymecoaching.com/coaching
New research links chronic stress, brain energy, and psychiatric conditions, including PTSD, depression, and bipolar disorder.Stress doesn't just impact your mood; it affects how your brain allocates energy. In this interview, Dr. Bret Scher sits down with Dr. Parker Kelly, a postdoctoral fellow at UCSF and the San Francisco VA, to unpack the Allostatic Triage Model of Psychopathology, a new framework proposing that psychiatric symptoms may emerge when the brain is forced to triage limited metabolic resources under chronic stress. Co-authored with mitochondrial researcher Dr. Martin Picard, this model could shift how we understand and treat mental illness.In this conversation, you'll learn:How stress drives brain energy dysfunctionWhy mitochondria and metabolism may be central to mental illnessWhich brain networks are impacted by energy deficitsThe role of predictability and routine in stress resilienceHow metabolic therapies like nutrition, sleep, and even psychedelics, may support brain energy regulationThis conversation bridges neuroscience, metabolism, and mental health, offering a unique and unifying lens on complex psychiatric conditions.
Dr. Ben opens a new chapter for tinnitus care in San Francisco. With Dr. Priscilla Giller, Treble Health now offers in-person support. Hope is possible—even if you've been told otherwise.Get started with Treble Health:Schedule a complimentary telehealth consultation: treble.health/free-telehealth-consultation Take the tinnitus quiz: https://treble.health/tinnitus-quiz-1Download the Ultimate Tinnitus Guide: 2024 Edition: https://treble.health/tinnitus-guide-2024
In this episode of Healthy Mind, Healthy Life, host Avik Chakraborty sits down with scientist, biotech leader and debut novelist Shivani Malik to unpack how grief can quietly reroute a life that looks “perfect” on paper. Shivani shares how losing her mother. the person who championed her move from India to the US for a PhD and a career in cancer research. forced her to ask a hard question. Am I building the life I truly choose. or the one that was handed to me as the immigrant gold standard Her debut novel “The Sky Is Different Here” becomes the container for that inquiry. blending STEM and storytelling to explore grief, ambition, belonging, identity, women in STEM and the emotional cost of chasing the immigrant dream. If you have ever hit your goals and still felt strangely empty. this conversation will land close to home and give you pragmatic language and tools to actually sit with your emotions instead of outrunning them. About The Guest: Shivani Malik is a scientist, immigrant, biotech leader and debut novelist. She moved from India to the United States for her PhD. trained at Stanford and UCSF and built a high impact career in cancer research and drug development. After the sudden death of her mother. Shivani began writing as a way to process unresolved grief and question the version of success she had been running toward. That process eventually became her debut novel “The Sky Is Different Here.” a work of fiction rooted in real emotional truths about loss, belonging and the complexity of being a woman, immigrant and dream chaser. Today she continues her work in biotech while using story as a way to build community around shared struggle, invisible expectations and the cost of never slowing down. Key Takeaways: Grief will not stay in the background forever. Shivani reached a point in her postdoctoral training where the “unopened package of grief” for her mother made it impossible to keep functioning on autopilot. The immigrant dream can silently become an emotional contract. She names how passion for science and external expectations blend. making it hard to tell where genuine desire ends and cultural pressure begins. Fiction gave her psychological safety. By fictionalizing roughly shaped versions of her lived experience. she could tell the emotional truth without exposing specific people, institutions or workplaces. Science and storytelling share the same backbone. In the lab you still “tell a story” about how a cancer drug works and who it can help. That pattern of connecting dots translated directly into shaping a novel. Healing required both solitude and community. Writing helped her sit with grief. but reading other grief stories and later sharing her own created a sense of community that science culture had not given her. Everyone carries loss and dislocation. whether it is a person, a home or a sense of belonging. Shivani urges listeners to find some way to express it. through writing, conversation, walking, meditation or sitting with feelings instead of numbing them. Expression is step one. sharing is step two. Naming your experience with someone who truly “gets it” becomes a powerful way to move forward rather than just cope. How To Connect With Shivani Malik : Shivani mentioned three primary ways to reach her. Book Personal Website : You can leave her a direct message and learn more about “The Sky Is Different Here.” Want to be a guest on Healthy Mind, Healthy Life?DM on PM . Send me a message on PodMatch DM Me Here: https://www.podmatch.com/hostdetailpreview/avik Disclaimer: This video is for educational and informational purposes only. The views expressed are the personal opinions of the guest and do not reflect the views of the host or Healthy Mind By Avik™️. We do not intend to harm, defame or discredit any person, organization, brand, product, country or profession mentioned. All third party media used remain the property of their respective owners and are used under fair use for informational purposes. By watching, you acknowledge and accept this disclaimer. Healthy Mind By Avik™️ is a global platform redefining mental health as a necessity, not a luxury. Born during the pandemic. it has become a sanctuary for healing, growth and mindful living. Hosted by Avik Chakraborty. a storyteller, survivor and wellness advocate. this channel shares powerful podcasts and soul nurturing conversations on • Mental Health and Emotional Well being• Mindfulness and Spiritual Growth• Holistic Healing and Conscious Living• Trauma Recovery and Self Empowerment With over 4,400 plus episodes and 168.4K plus global listeners. we unite voices, break stigma and build a world where every story matters. Subscribe and be part of this healing journey. Contact Brand: Healthy Mind By Avik™Email: join@healthymindbyavik.com | podcast@healthymindbyavik.comWebsite: www.healthymindbyavik.comBased in: India and USA Open to collaborations, guest appearances, coaching and strategic partnerships. Let us connect to create a ripple effect of positivity. 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Alice Wong, a disability rights activist, writer, and MacArthur Genius award winner based in San Francisco, died last Friday at UCSF at the age of 51. Wong was best known as the founder of the Disability Visibility Project (DVP), a group that highlights disabled people and disability culture through storytelling projects, social media and other channels. Alice's friend and fellow activist, Sandy Ho, wrote, “Alice Wong was a hysterical friend, writer, activist and disability justice luminary whose influence was outsized.” Today, we remember Wong by sharing a radio essay she recorded for The California Report Magazine in December 2022. Alice's GoFundMe Disability Rights Activist and Author Alice Wong Dies at 51 | KQED Bay Area Legends: Activist Alice Wong and The Power of Bringing Visibility to Disability Learn more about your ad choices. Visit megaphone.fm/adchoices