Podcasts about ut houston

Send us a textIn this episode, I had the pleasure of speaking with Dr Kelsey Kirkman who is now a third year Neonatology fellow at Texas Children's Hospital. Kelsey shared with us her primary fellow project on creating a debrief tool for residents following critical events in the NICU. She describes in depth about how she came up with this idea and how she found her mentor to help support and navigate her medical education interest.  We talked about medical education theories and how to perform a thematic analysis. We talk about her challenges in implementing her project and how she tackled them. We also discussed how she took her medical education research to the next level by pursuing a Masters in Medical education through UT Houston. She shared insights on how she balanced fellowship training with her masters. Kelsey also shared her lessons learnt from her experience and provided some of the resources that helped her understand medical education better. Kelsey hopes to have a medical career in a leadership role, leading a training program, and applying her knowledge in medical education in improving neonatology subspeciality training.  As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

On May 22, 2024, we summarized a then soon-to-be-released ACOG CPU on Screening for GDM in Pregnancy and Postpartum. That CPU was officially released July 2024. That update endorsed the possibility of immediate postpartum GTT testing with a 75-gram OGTT. Now, on September 19, 2024, authors from UT Houston have published a systematic review/meta-analysis on this subject. In this episode, we will review what this data is and what it isn't. Listen in for details.

Send us a Text Message.In this episode of "The Incubator" at NeoHeart 2024, hosts Ben and Daphna interview Dr. Brittany Graham, a cardiologist-neonatologist currently specializing in fetal imaging from Houston.Dr. Graham discusses her unique training path, which includes pediatric cardiology at Mayo Clinic, neonatology at UT Houston, and a current year in fetal imaging. She explains her motivation for pursuing this comprehensive training, emphasizing her desire to provide continuous care for families from fetal diagnosis through NICU care.The conversation touches on the challenges and rewards of such an extensive training journey. Dr. Graham expresses hope that her experience might pave the way for more integrated and efficient training programs in the future. She highlights the value of conferences like NeoHeart in connecting professionals with diverse training backgrounds.Dr. Graham shares her vision for an ideal career combining critical care and fetal outpatient settings, allowing her to support families throughout their entire journey. She also discusses her poster presentation at the conference, which focuses on a complex case of pulmonary hypertension and hypertrophic cardiomyopathy in an infant of a diabetic mother, highlighting the use of vasopressin in management.The episode underscores the growing need for specialists with comprehensive training in fetal and neonatal cardiac care, especially in light of evolving healthcare landscapes. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Discover the journey of Dr. Peter Cashio, a dedicated emergency medicine physician, and advocate for veterans' health. Born in Louisiana and raised in Houston, Texas, Dr. Cashio's path to medicine was shaped by his early years as a U.S. Marine Corps intelligence analyst, stationed in diverse locations such as Virginia Beach, Virginia, Okinawa, Japan, and Camp Pendleton, California.After his honorable service in the Marine Corps, Dr. Cashio pursued a passion for biology, earning his undergraduate degree from the University of Texas at Austin in 2000. He continued his academic journey, achieving a Master of Science in Developmental Biology at MD Anderson Cancer Center, UT Houston, in 2005. Driven by a desire to make a difference in patient care, he embarked on his medical education at UT Health Science Center, San Antonio, ultimately becoming a licensed physician.Dr. Cashio's commitment to excellence in emergency medicine led him to complete his residency training at the prestigious University of Virginia Hospital in Charlottesville, Virginia, in 2012. He is proud to be recognized as board-certified by the American Board of Emergency Medicine.In his medical practice, Dr. Cashio firmly believes in the importance of listening to his patients. He follows the age-old adage that "listen long enough, and the patient will describe their diagnosis." This patient-centric approach forms the cornerstone of his care philosophy, allowing him to provide personalized and compassionate healthcare.Dr. Cashio's professional interests encompass a wide range of medical fields, including preventative care, men's health, pain management, and critical care. However, he holds a special place in his heart for veterans' healthcare needs and is dedicated to serving those who have served our country.Outside the office, Dr. Cashio balances his life with a passion for powerlifting, a pursuit of aviation knowledge, and a flair for writing. With his family residing in Dripping Springs, he finds inspiration in the beauty of his surroundings.Experience healthcare from a physician who understands the value of time and the importance of each patient's unique story. Dr. Peter Cashio is here to support your health journey, combining expertise, compassion, and a commitment to your well-being.---------------------Check out the My DPC Story RESOURCE PAGE HERE!Find a DPC checklist on how to start your own DPC, DPC conference recordings, and more!---------------------LISTENER'S GUIDE!NEW TO THE POD? Get started by downloading our FREE LISTENER's GUIDE with 10 Episodes that will give you a great introduClick the link below to learn more about the Hint's website builder and Elation Health:Hint's Website Builder link: HEREElation Health: HERE Learn more about Med Mastery: HERESupport the showVisit the DPC SWAG store HERE!Let's get SOCIAL! Follow My DPC Story! FACEBOOK * INSTAGRAM * LinkedIn * TWITTER * TIKTOK * YouTube

Today's guest is Dr. James Grotta, who after joining UT Houston faculty in 1979, he established the UT Houston Stroke Program and developed its NIH funded fellowship training program. He has been continuously funded to carry out translational research in acute stroke treatment, and played a leading role in many clinical research studies, including the NINDS TPA Stroke Study. In 2013, Dr. Grotta stepped down as department chair and moved his practice to Memorial Hermann Hospital to lead the Mobile Stroke Unit Consortium, the nation's first Mobile Stroke Unit to deliver TPA and other stroke therapies wherever the stroke occurs Dr. Grotta joined us for a Vascular Neurology Grand Rounds and stuck around to record this episode with one of our Vascular Neurology Fellows, Mohammad Rauf  to answer some more questions, so that we can share more of his insight and research.  ____________________________________ Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke LinkedIn: linkedin.com/company/uthealth-stroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at ⁠info.uthiscd@gma⁠il.com

In this episode, host Dr. Ally Baheti interviews vascular surgeon Dr. Anahita Dua on the importance of political advocacy in healthcare, including why she created a PAC, the importance of healthcare workers in Congress, and how you can get involved. --- CHECK OUT OUR SPONSORS Boston Scientific Eluvia Drug-Eluting Stent https://www.bostonscientific.com/en-US/medical-specialties/vascular-surgery/drug-eluting-therapies/eluvia.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-de_portfolio-hci&utm_content=n-backtable-n-backtable_site_eluvia_1_2023&cid=n10012337 Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES Dr. Dua is a vascular surgeon at Massachusetts General Hospital, associate professor of surgery at Harvard Medical School, co-director of the Peripheral Arterial Disease Center, Clinical Director of Research, the Director of the Vascular Lab and the Associate Director of the Wound Care Center. Her passion is limb salvage, and she performs open and endovascular techniques. She was born in Scotland, grew up in Wisconsin, completed medical school in the UK followed by general surgery residency at the Medical College of Wisconsin, vascular surgery fellowship at Stanford, a post-doctoral research fellowship at UT Houston, and finally an MBA and Masters in trauma sciences. She is also a wife, mom of two, and recently created a political action committee (PAC). Before creating a PAC, she initially considered running for Congress. She was tired of seeing injustices both on the healthcare side with her patients, as well as in her own family. She bought a bulletproof backpack for her daughter after a school shooting near where they live, and since that day, she has not stopped fighting for change. Instead of running for Congress herself, she decided to create a PAC with the goal of getting 10 people in Congress who shared her ideas about the change needed in this country. She raised money, surpassed her goal, and got two people in Congress in just one month. She knew she had to pick a side to get anywhere with the current state of politics in this country, so she decided to support someone only if they were a healthcare worker and a Democrat. She chose candidates based on their policies and their personality. She spoke with each one to get a sense of who they were, and she was looking for people who were intelligent, nimble, and who she would trust to babysit her kids. She then called a list of colleagues, informed them who she was supporting, and asked for their financial support. Dr. Dua hopes to have an impact on healthcare reform by creating advice specific to diseases such as diabetes. There is no standardization for limb problems, and this leads to disparities in care, with staggeringly unequal rates of amputations among different racial and socioeconomic groups. She aims to develop a standard of care that is implemented federally to improve limb care and reduce amputations. --- RESOURCES Healthcare for Action: www.healthcareforaction.com

On this episode of BackTable Urology, Dr. Mike Hsieh (UC San Diego) interviews Dr. Larry Lipshultz (Baylor College of Medicine) about his journey to becoming a renowned specialist in male infertility and reproductive medicine. --- CHECK OUT OUR SPONSOR Veracyte https://www.veracyte.com/decipher --- SHOW NOTES First, Dr. Lipshultz explains how he became interested in urology through working in a basic sciences surgery laboratory with a urologist. He became passionate about doing research in male infertility as an intern after hearing a Grand Rounds lecture. Before his residency ended, he was sent to El Paso, Texas by the military, where he was able to start his own semen analysis laboratory to treat male infertility patients. He then accepted an AUA fellowship and followed a mentor to UT Houston for training in male infertility. He eventually transitioned to Baylor College of mEDICINEand stayed after fellowship to join the faculty. Next, Dr. Lipshultz reflects on major events in his life, such as the opportunity to perform trailblazing surgeries, like gender-affirming surgeries and vasovasostomies, and graduating productive male infertility fellows. He gives advice on balancing clinical duties and research, the importance of goal setting, and mentoring junior faculty. Finally, the doctors discuss the future of men's health. Dr. Lipshultz disagrees with the concept of direct-to-consumer marketing and “low T clinics”, as he believes they do not exist to serve the patient's best interest. He is excited about new research implicating that testosterone may have other health benefits besides treating erectile dysfunction and that male infertility may be an indirect measure of men's health. He encourages urologists to explore running their own IVF clinics and incorporate biotechnology into their practices as well.

Barbara Orlando, MD, PhD, an associate professor of anesthesiology and the division chief of obstetric anesthesiology at McGovern Medical School at the University of Texas Health Science Center, in Houston, discusses several ways to reduce morbidity and mortality in pregnant patients. She also addresses high-risk pregnant patients with various comorbidities, such as obesity and those with a lack of prenatal care.“This podcast is about my personal journey as an anesthesiologist in gaining understanding and being more involved with societies and committees in charge of maternal mortality and morbidity. My interest was sparked by my passion for obstetric anesthesia, and my new role as a division chief of OB anesthesia at UT Houston. Reviewing bad outcomes and thinking of ways of reducing such events was very eye-opening to me, and I hope to inspire others as well.”

We sat down with Madisyn Cox, the 10x NCAA All-American and 5x World Champ medalist who recently announced her retirement from swimming. Cox takes us through the last year of her career, from her last meet at the Texas Swim Center, where she went 3 lifetime bests, to the Olympic Trials, where she was .02 off of making the 2020 Olympic team. She also discusses what her life looks like now that she is living in Houston and attending UTHealth Houston.

I have known Ashley Barber for over 10 years from my days of working out at Define Body & Mind. Her smile and energy has always been contagious. Ashley founded Simply Maven to help busy families and professionals simplify their homes and lives for better health and happiness. Through 1-on-1 sessions, virtual coaching, and public speaking, she and co-owner Jane McCullough guide their clients to do just that. As the first certified KonMari Consultant in Houston, and currently studying public health at UT Houston, she combines 1200+ hrs of organizing with a decade of fitness instruction, a philosophy degree, and an eye for design to bring a unique touch to each project. The KonMari Method™ was created by famous tidying consultant Marie Kondo, known for her best-selling book The Life-Changing Magic of Tidying Up and other books , as well as her unique folding methods. The method promotes keeping items that "spark joy" while discarding what does not. The results are less stress in clients' lives and more time and energy to pursue their passions, spend time with loved ones, or engage in whatever creates a joy-filled life. Ashley combines her organizing skills with her eye for design and a passion for physical, mental, and spiritual wellness. Ashley loves teaching others the best ways to edit + organize their spaces to make room for more joy. On the episode we talked about her career as a Marie Kondo consultant and being a Mom to her two adorable boys, Theo and Wes. Highlights- -Prioritizing your life and what you want in your home. -Taking ownership of your time and space. Simplifying. -keeping the house in order with kids.getting kids interested in keeping order and simplicity. Make it fun. “Structure with wiggle room.” -Creating a vision for your ideal lifestyle and go from there. -Editing before organizing. Storage isn't usually the issue. Most people have plenty of storage space for the things that are important. -Being more intentional with the things you have. -The definition of balance isn't one size fits all for every person Connect with Ashley- Website- https://www.simplymavenhtx.com IG- @simplymavenhtx

In this episode we sat down withDr. Nneka Ifejika, Associate Professor of Physical Medicine and Rehabilitation and Section Chief of Stroke Rehabilitation at UT Southwestern Medical Center, following her Grand Rounds presentation, Stroke Recovery Throughout The Continuum of Care at McGovern Medical School. She has secondary appointments in the departments of Neurology, and Population and Data Sciences, and has both clinical and research interests spanning each of these fields. Outside of her numerous research accolades, Dr. Ifejika has exceled as a clinician, earning Texas Monthly's title of “super doctor” in each year from 2018 to 2021, and “Top Doctor” in Physical Medicine & Rehabilitation; awarded each by H Texas Magazine, Texas Monthly Magazine and Houstonia Magazine in numerous years from 2014-2018. She is beloved by her patients, and strongly missed by her colleagues here at UT Houston. Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. The Institute for Stroke and Cerebrovascular Disease (UTHealth Stroke Institute) http://www.utstrokeinstitute.com/ UTHealth Stroke Institute Vascular Neurology Fellowship https://www.uth.edu/stroke-institute/training/vascular-neurology-fellowship Dr. Nneka Ifejika https://utswmed.org/doctors/nneka-ifejika/ Hosts: Amy Quinn, Pam Zelnik Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke

BG (Dr.) Shan Bagby discusses how at an early age a role model dentist inspired him to pursue a career in dentistry.  After earning his Doctor of Dental Medicine degree, he then went on to train in Oral and Maxillofacial Surgery in Los Angeles and advance trauma fellowship training at UT Houston.  He describes complex cases that helped care for and his role as Commander of the 561st Medical Company (Dental Services) in Iraq.  He describes the importance of dental care in ensuring readiness in the military fight force. In this episode you will also hear about his multiple leadership roles including the Commanding General of Brooke Army Medical Center.  He describes his mentorship methodology and how military medicine professionals need to understand the profession of arms and their medical specialty profession.  Hear about how advanced military schooling helps shape the leaders of military medicine.  This episode also discusses the importance of role models and how by virtue of rank and education, military professionals must understand that they are role models to others.  Hear about a wonderful military career and how the military opened door after door of opportunity that BG Bagby walked through in his distinguished career.     Find out more about Dr. Bagby at wardocspodcast.com/guest-bios and visit our webpage and become part of Team WarDocs at wardocspodcast.com.   WarDocs- The Military Medicine Podcast is a Veteran Run, Non-Profit, Tax-exempt-501(c)(3) Organization.  Donations are tax deductible.     Please take a moment to follow/subscribe, rate and review WarDocs on your preferred Podcast venue.   Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast

Dr. Cristin A. Dickerson is the founding partner of Green Imaging. Dr. Dickerson was born and raised in Texas. She is a graduate of Baylor University and University of Texas Medical School at Houston where she was elected to Alpha Omega Alpha Honor Medical Society. Dr. Dickerson did a clinical internship at St. Joseph Hospital in Houston and her radiology residency at UT Houston where she was a chief resident, with extensive training in cancer imaging at MD Anderson Cancer Center. Dr. Dickerson practiced 13 years at Diagnostic Clinic of Houston where she served as two-term president of the 50 physician clinic. Her clinical interests include oncologic (cancer) MRI and CT and PET/CT, breast imaging and cardiac screening. She founded Green Imaging to provide affordable, high-quality medical imaging for uninsured and high deductible patients in Houston and rapidly expanded the company to provide services throughout most of the US and to employer-sponsored health plans. She loves being able to provide quality services to patients who otherwise couldn't afford it and providing significant imaging cost savings to patients with healthcare coverage and their employers without compromising quality. Dr. Dickerson is passionate about spreading the word that patients and employers do have great new nontraditional health care coverage options in the emerging alternative health care market. Unlock Bonus content and get the shows early on our Patreon Follow us or Subscribe: Apple Podcasts | Google Podcasts | Stitcher | Amazon  | Spotify --- Show notes at https://rxforsuccesspodcast.com/86 Report-out with comments or feedback at https://rxforsuccesspodcast.com/report Music by Ryan Jones. Find Ryan on Instagram at _ryjones_, Contact Ryan at ryjonesofficial@gmail.com  

This Wednesday I have the pleasure of continuing my interview with brother Dr. Ben Edwards. Dr. Edwards M.D is a practicing physician at Veritas Medical with locations on the west side of Texas. He is the proprietor of the "You're the Cure" podcast/radio program and graduated from UT-Houston medical school. He started off as a conventional doctor but changed his mind after a life experience that left him clueless as to the current medical system. Our conversation was enlightening and fascinating on so many levels. It was amazing to have this podcast and have the opportunity to interact with him personally as the interviewer. I hope you enjoy the episode and the truth conveyed there within. The clinic: https://medical.veritashealthycommunity.com/ The podcast archives: https://medical.veritashealthycommunity.com/resources/radio-talk-shows/ I could not find the telegram for the life of me. They have a telegram page though! Website: forthekingpodcast.com Facebook page: https://www.facebook.com/For-The-King-105492691873696/ Contact: forthekingpodcast@gmail.com Donate Crypto: https://commerce.coinbase.com/checkout/f63fd7db-919e-44f6-9c58-8ec2891f3eb5 --- Support this podcast: https://anchor.fm/rocky-ramsey/support

This Wednesday I have the pleasure of interviewing brother Dr. Ben Edwards. Dr. Edwards M.D is a practicing physician at Veritas Medical with locations on the west side of Texas. He is the proprietor of the "You're the Cure" podcast/radio program and graduated from UT-Houston medical school. He started off as a conventional doctor but changed his mind after a life experience that left him clueless as to the current medical system. Our conversation was enlightening and fascinating on so many levels. It was amazing to have this podcast and have the opportunity to interact with him personally as the interviewer. I hope you enjoy the episode and the truth conveyed there within. The clinic: https://medical.veritashealthycommunity.com/ The podcast archives: https://medical.veritashealthycommunity.com/resources/radio-talk-shows/ I could not find the telegram for the life of me. They have a telegram page though! Website: forthekingpodcast.com Facebook page: https://www.facebook.com/For-The-King-105492691873696/ Contact: forthekingpodcast@gmail.com Donate Crypto: https://commerce.coinbase.com/checkout/f63fd7db-919e-44f6-9c58-8ec2891f3eb5 --- Support this podcast: https://anchor.fm/rocky-ramsey/support

Conversations with Drs. Art Day, Matthew Adamo, and Charlie Sansur

In this episode of the AOCPMR Podcast, Student Doctor Shahana Momin chats with Dr. Nikola Dragojlovic, DO about a variety of topics including his eureka moment in PM&R and path to physiatry, his insights as program director for UT Houston's PM&R program, his advice for current students applying for residencies, and so much more! The views, opinions, and factual statements presented in this video are those of the presenter alone and do not reflect the views, beliefs, and/or policy statements of the American Osteopathic College of Physical Medicine and Rehabilitation, its affiliate organizations, members, or governing council. Medical statements made in this or other AOCPMR videos should not be treated as individual medical advice: consult your physician and/or other medical care providers before undertaking or discontinuing any course of medical treatment.   FACEBOOK: https://www.facebook.com/AOCPMR INSTAGRAM: https://instagram.com/AOCPMR TWITTER: https://www.twitter.com/AOCPMR Visit our website to learn more: https://www.aocpmr.org

September 10, 2021. Stephen Daiger, PhD, Director of the Laboratory for Molecular Diagnosis of Inherited Eye Diseases at UT Houston, discusses the challenges and advancements in identifying the genetic mutations that cause retinal degenerative diseases.

Dr. Jose Silva interviews Dr. Jonathan Clavell, a high-volume prosthetic urology surgeon and assistant professor of urology at UT Health Science Center Houston, about erectile dysfunction counseling and penile implants. Dr. Clavell goes into detail about his journey as a men's health specialist, ED workup and medical counseling, advantages and limitations of different penile implants, implants for complex ED patients (diabetics, cancer patients, etc.), and post-operative care for penile implant patients --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/GC1TnY --- SHOW NOTES In this episode of BackTable Urology, Dr. Jonathan Clavell, a high-volume prosthetic urology surgeon and assistant professor of urology at UT Houston, joins Dr. Jose Silva to discuss his journey to becoming a men's health specialist. He also shares advice on erectile dysfunction counseling and penile implant procedures and complications. First, Dr. Clavell shares his approach to starting a successful urology private practice. Early on, he invested in marketing himself and his prosthetic services through a professional website, a Spanish radio show, an informational Youtube channel, and social media. His diverse marketing strategy succeeded in Houston, a large urban city with a sizable Hispanic population. Next, Dr. Clavell and Dr. Silva talk about penile implants for patients with erectile dysfunction. Dr. Clavell emphasizes the importance of asking patients about their personal goals and having a partner in the room, if possible. Dr. Clavell then discusses the advantages and limitations of the two main penile implants, the AMS 700 and the Coloplast Titan. Special considerations may be given to patient age and penis size. Then, Dr. Clavell summarizes different approaches of complex ED patients needing penile implants, such as those with urinary incontinence, pump incompatibility, prostate obstructions, and diabetes. Finally, Dr. Clavell shares his postoperative care regimen for penile implant patients. He always prescribes a week of antibiotics to prevent infections and, if needed, pain medication. He also instructs his patients on how to cycle their implants properly after 4-5 weeks if the incision site has healed. --- RESOURCES Dr. Clavell's Youtube Video on Cycling the Coloplast: https://www.youtube.com/watch?v=o1t3YuJ_zz4&t=106s Dr. Clavell's Youtube Video on Cycling the AMS 700: https://www.youtube.com/watch?v=07gyeibMieU Dr. Clavell's Youtube Video on the Mini-Sling: https://www.youtube.com/watch?v=HpjJZuhA2uo Dr. Clavell's Radio Show, Sí Se Puede: https://houstonmenshealth.com/posts/events/new-radio-show/

This episode continues Season 3, In Depth Review, where we cover key topics with esteemed faculty in the field of Plastic & Reconstructive Surgery.Your Host for this episode, Dr. Morgan Martin @morganmartinmd, leads off the first introductory episode of our eyelid sub-series with Dr. Berry Fairchild @berryfairchild, an independent plastic surgery resident at UT Houston.  Listen in as they discuss relevant anatomy and pathology of the eyelid!Production, design, and editing by our Co-Founder Greta Davis @greta_davis Music was produced by Alec Fisher, MD @alechfishermdThe accompanying visual supplement for this episode can be viewed on our Instagram page:https://linktr.ee/Theloupepodcast

Get to know our favorite orthopedic hijabis, Dr. Aziz. After completing a 6-year combined undergraduate and medical school program, she completed her residency at Baylor College of Medicine in Houston, and her Foot and Ankle fellowship across the street at UT Houston. We discuss resiliency, Islamophobia, having children during residency, and much more! Articles we reference: (1) Poon S, Nellans K, Rothman A, et al. Underrepresented minority applicants are competitive for orthopaedic surgery residency programs, but enter residency at lower rates. JAAOS-Journal of the American Academy of Orthopaedic Surgeons 2019;27(21):e957-e68. (2) Siljander, B. R., Van Nortwick, S. S., Flakne, J. C., Van Heest, A. E., & Bohn, D. C. (2020). What Proportion of Orthopaedic Surgery Residency Programs Have Accessible Parental Leave Policies, and How Generous are They?. Clinical Orthopaedics and Related Research®, 478(7), 1506-1511.(3) A Guide to Hijab in the Operating Room

Get to know our favorite orthopedic hijabis, Dr. Aziz. After completing a 6-year combined undergraduate and medical school program, she completed her residency at Baylor College of Medicine in Houston, and her Foot and Ankle fellowship across the street at UT Houston. We discuss resiliency, Islamophobia, having children during residency, and much more! Articles we reference: (1) Poon S, Nellans K, Rothman A, et al. Underrepresented minority applicants are competitive for orthopaedic surgery residency programs, but enter residency at lower rates. JAAOS-Journal of the American Academy of Orthopaedic Surgeons 2019;27(21):e957-e68. (2) Siljander, B. R., Van Nortwick, S. S., Flakne, J. C., Van Heest, A. E., & Bohn, D. C. (2020). What Proportion of Orthopaedic Surgery Residency Programs Have Accessible Parental Leave Policies, and How Generous are They?. Clinical Orthopaedics and Related Research®, 478(7), 1506-1511.(3) A Guide to Hijab in the Operating Room

Jennifer Swails, MD, is an Associate Professor in the Department of Medicine, the Co-Director of Interprofessional Education, and Program Director of the internal medicine residency program at McGovern Medical School at the University of Texas Health Science Center at Houston. Dr. Swails received her bachelor's degree in biology from Davidson College, and her M.D. from Weill Cornell. She then completed residency training in internal medicine and primary care at Brigham and Women's Hospital and joined the faculty at UT Houston in 2012. Dr. Swails has received numerous awards for teaching and patient care, including the Leonard Tow Humanism in Medicine Award, the Dupont Master Clinical Teaching Award, and the John P. McGovern Outstanding Teaching Award. Often in Dr. Jennifer Swails' career, she struggled with feeling like she had to choose between being smart or likeable. Today, we learn that it's okay to be both. It works to our benefit to express when we're facing difficulty, and we need to be honest when life gets complicated. Dr. Swails' best advice for students and residents is to be honest when we need help. She advises us to look for the mentors who will provide a safe space for us to express our concerns and struggles. And in the end, it's that honesty and vulnerability that will lead to a greater reward. Pearls of Wisdom: 1. As Glennon Doyle stated: Disappoint everyone in the world, but not yourself. When we're honest with ourselves, we may take the risk of disappointing a few other people—but it's important not to let ourselves down. 2. Lower the stakes when it comes to mentorships: It's not always so formal. Ask a mentor if you can simply shadow them for a few hours, or talk to them about what they do. It will go a long way and make a big impact on you. 3. Have an attitude of resiliency throughout your career. The key qualities of a great residence are having a deep sense of purpose.

Olakunle Idowu – Anesthesiologist, MD Anderson David: I know you said it’s a long story, but I’d love to hear the short version of the long story.  I’m Nigerian, I was actually born in Nigeria.  I’m the last of four children.  My siblings were born in Boston, but my father, who is a math professor took a position at the university of Dos.  We were living there when I was born.  I came to the United States when I was 3 years old.   I grew up in Maryland, went to University of Maryland, I’m a Terrapin.  I went to the Virginia Commonwealth University for medical school, SUNY Downstate in Brooklyn, NY for Anesthesia Residency, and Critical Care here in Houston, which is what brought me to Houston.   Since then I’ve spent time in private practice and in academics.   Initially I left private practice and came MD Anderson for 3 years, then my wife was recruited to Yale in New Haven CT, we went there for a year, decided to come back, and here I am!  (Laughter) There’s been some moving and shifting, but I think along the way that God has revealed things to us.  We feel Houston is home even though our families are in the northeast.   My wife is a pediatric anesthesiologist, she works at MD Anderson as well.   David: When you say critical care, is that anesthesia or normal medicine.   Kunle: The track is critical care through anesthesia, it’s a one-year internship after training, I spent a year at UT Houston, and during part of that time I was at MD Anderson, which is how I connected to the institution.   David: What do you love about your work?  Why anesthesia?  Aside from talking to me, what gets you out of bed in the morning? Kunle: (audio drops briefly) Learning includes lessons about life, about vulnerability, about faith, about spirituality, about strength, perseverance, about conflict.  I think working both in the operating room and also having experiences in critical care. . .they’re very different environments.   In the operating room, most people walk into the hospital, most procedures tend to be elective, the intent is that things end well.  That is always the expected outcome, or what people perceive as a good outcome – to get through surgery or whatever procedure they are having.   In the ICU the dynamic is very different.  Expectations and goals change daily, hourly, by the minute depending on the patient situation.  Sometimes you find yourself healing not through intervention but through support and prayer and walking side-by-side with patients.  That is where my energy comes from, that’s what wakes me up.   You know, I drink coffee like most people, to get me going.  But somehow when I get in front of a patient I’m up, I’m there, I’m present.  David: Have you done any overseas work lately?  What you describe sounds like the role of somewhere like Kijabe.  When an anesthesiologist comes, they are everywhere, they’re in the operating room, they’re in the ICU, they’re in the emergency department if something goes strange. . .they’re everywhere.   Kunle: Compared to some of the other people involved in this project, I’m fairly new.  I’ll tell you that story.   In coming back to MD Anderson, I pivoted in terms of focus.  There’s something in me, and there’s something that’s always been in me.  I have relatives or people who are Nigerian, who came here as immigrants who for training with the intent of going back.  My father came to the States for post-graduate training, but never returned to Nigeria permanently.  So, I’ve understood that there has always been this void, not only in Nigeria, but across the continent, in terms of people who receive opportunities who receive opportunities overseas whether in the States or across the world, and never return.  It’s almost like there’s a resource that’s been taken away. . .people don’t go back to even plant seeds to grow.  I think people are realizing this, and that itch. . .I’ve always had that itch to be involved in this work.   I was initially looking to do things in Nigeria and I was looking to start projects I was looking to start a symposium and looking for schools/teaching hospitals in Nigeria to connect with.  I connected with HBO.  They have a site at Kat Karmasi, Ghana.  My wife and I were set up to go this April for a two-week trip.  She was going to help with Pediatric Anesthesia education and I was going to teach a fundamentals critical-care support course, because critical care mortality is extremely high across the continent.  That is one thing that is very clear.  The contact I have there is very concerned about obstetric mortality, the availability of resources and ventilators is limited.  I work with Louis Pisters, a urologist at MD Anderson, and he’s connected with PAACS.  He said, “you know, I work with a great organization.”  He’s a person of strong faith and conviction.  I attended a meeting with PAACS and learned that there was an Anesthesia task force.  Everything about the project aligns with my personal goals and how I see myself.  It brings my faith, it aligns my faith, my practice, and this internal feeling – this urge – to start doing more global outreach.  The timing couldn’t be better, and I have support from my institution to do this.   That’s how I got involved.  Long story, but I’m extremely excited because at the center of it is God, and my love for Christ.   Through medicine, I’ve affirmed the idea that only God can perform miracles.  We are tools that he has put here to carry out his will and to be blessings upon others.  You know, blessed to be a blessing in a sense.  That’s how I practice and that’s how I see this project.  Everything that I’ve come to understand about Kijabe, that’s my understanding of the center, of the people there, of you and your work.  I’m just excited and so very thankful and grateful.   David: That’s awesome Have you ever heard of Howard Thurman?  He was an African American pastor.  He was Martin Luther King’s spiritual mentor.  I went down the rabbit trail this weekend and I ended up with a book of his sermons that I got on Amazon for a dollar – that’s the best dollar I’ll ever spend – he’s got this amazing passage about medicine as ministry.  It’s so, so good and reminds me of what you just said. He goes through the entire passage and ends up with the statement that “every hospital, every clinic, every consultation room should be an altar for the burning heart of God.”   Kunle: Absolutely.  You can almost draw a parallel to the pandemic.  You see how limited our understanding of the human body and where is this virus coming from?  All these resources focused on one thing. Right? Its human will that we are going to control this, yet every day we are reminded that we are not in control. There is only one person in control of all of this.    These are the same interactions that happen on a daily basis in the hospital.  When it comes to cancer care you realize it.  People often want to treat the numbers, or they see a CT scan. “I have to fix this.”  That’s the human instinct.   You learn how limited you are, in the sense that you could do everything and not change the outcome.  You could do nothing, and the outcome can be favorable for the patient.  It’s because God is in the center of it.  He has a masterplan.  You have to step back, realize your place, that you are just a tool.  You cannot fix the situation. You just have to trust God.   That’s why I bring spirituality and I bring faith.  MD Anderson is obviously not known per se as a Christian institution.  I always ask people, are you a person of faith?  Regardless of their background, most other religions or people who consider themselves as being spiritual, they are open to prayer.  Prayer is universal, for everyone.  I pray for them.  I know my father, but I pray for them.  I love that aspect of medicine.   David: If we get you over here, you’ll meet Jack Barasa, our head of surgery.  Whenever you talk to him, he says a similar thing about Kijabe “this is God’s hospital.”  He says, “We do these things, and somehow a patient gets better.  We do the exact right thing and they don’t get better.  Or we make a mistake and somehow, they walk out the door three days later.  It’s very clear that we are not the ones in control of the situation.”  My wife had this awesome mentor in Alabama.  When she was in residency, she had a really low moment.  Her program director called her into her office, and she said, “Arianna, you need to trust God. You do not hold the keys to life and death.  A patient could walk in the door, and they could walk out even if you do everything wrong.  This is ultimately not about you.” That’s the big challenge of what you do in medicine, how to work with all your skill and all your power yet know your limitations and to be at peace with that at the end of the day.  Kunle: I think about these things every day.  I reflect on the day and the lessons learned.   Even for me, as I’m caring for patients in stressful situations, that He is my quiet in the middle of the storm.  I can only trust Him to give me the thoughts, wisdom, understanding, compassion.  It has made me a better person, ultimately.  David: What do you say to a family member, say you’re in ICU and you have a patient who is not doing well. How does it go?  What is running through your head and what are you trying to convey to them?  Kunle: It’s tricky, a lot of it depends on their background.  It depends on their knowledge of medicine.  It depends on the conversations they have had prior to the moment.  In critical care, you tend to have limited access to the patient’s perspective.  Either because people are too ill to communicate, or because they are on mechanical ventilation and have a breathing tube and they just can’t talk.  So, you have to rely on surrogates.   I take a few days, when a patient isn’t doing how I would expect.  I take a few days and really try to understand the situation, before I jump in and try to give a perspective.  I want the family or the caregivers to know I am taking my time to reflect, to comb through things, and make sure we have explored all options.  I ensure through communication and bedside manner that I am there to support them in any way that I can, whether that is moving around hospital resources and so forth.  I remain objective about the data points.   “This is what this shows, this is where we are, this is where we were yesterday.  Your loved one (the patient) doesn’t have control of the situation, I don’t have control of that situation, and you don’t have control of the situation.  So, we must take it one day at a time, using God-given tools every single day to apply.  He will show and reveal to us how your loved-one responds.  In the meantime, the tool that we have, the most powerful one, is prayer.”   I remind them, I pray with them, and I offer the hospital chaplains for support.  Sometimes in situations when there is no family around, we still bring chaplains in to pray, or I will pray.  That’s typically how it goes.   I’ve seen a difference from when I first started practicing, because people trust you more, they understand you can’t fix the situation, and they know that you’re on their side.  It also reminds them that in the middle of all storms, you must stand firm and rest in your faith. . .in God, in Christ, and he will see you through.   I don’t have to go too far to know how blessed I am in a cancer hospital. I’m reminded every day.  It’s a topic that really hits home, and I spend a lot of time in this area because of how important it is to me.   David: That was an amazing answer actually.  Always when I’m doing these things, I’m thinking what is a universal concept?  Beyond we are trying to put this (anesthesiology) program together.  When someone is going to connect with on a personal level, whether they do medical work, but I think it applies to any area of our lives.   Anything you would like to add in closing?   Kunle:  I would like to say I think it’s exciting to be involved in something like this.  My hope for this project is that it expands – on God’s time – to different parts of Africa, because the need is there.  Not just in anesthesia, but in emergency medicine, in surgery.  There are so many specialties and there is so much expertise needed.  You have people there who want the knowledge, who want the help, who need the resources.  And you also have people who are unfortunately dying from very preventable illnesses, diseases.  We want to use God’s given tools to help.  Those tools are knowledge.  Those tools are prayer, that’s the best one in the box.  Community support.  The resources that we can pull together from our institutions in the United States.  The great resource in having the Christian community at the soul of all this, that unites us, and I’m very excited about the future.   David: Kunle, this is fantastic.  I would talk to you all day if you were not going to work.   Kunle:  Thank you so much.  

An informal but enlightening conversation with 3 UT Houston Orthopedic Surgery residents of differing years. In this podcast, we discuss topics such as choosing a residency program, positives and negatives of the residency, and how to manage balancing a strenuous residency with the demands of everyday life.

On today’s show I welcome Dr. Jackie Parchem, an OB/Gyn who specializes in Maternal Fetal Medicine, and an Assistant Professor at the McGovern Medical School, (UT Houston). We discuss what life is like for a practicing OBGyn in this time and her very interesting research, especially as it relates to health care disparities. Disclaimer: This podcast does not constitute medical advice. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.

Dr. Jarvis had an opportunity to sit with Dr. Ben Bobrow at the Texas EMS Conference. Dr. Bobrow is the chair of Emergency Medicine at UT Houston. During his time in Arizona, Dr. Bobrow was instrumental in the studies of Traumatic Brain Injury and approaches to improved outcomes in cardiac arrest. If you know about the dangers of hypoxia and hypotension in TBI or the importance of minimally interrupted chest compressions and passive oxygenation in cardiac arrest, you should hear this interview. If you like what you hear, please give us a 5-star rating on Apple Podcasts and other premier podcast purveyors and tell your friends to subscribe (or download each episode several times… we've gotta beat Second Shift after all).

Session 47 Dr. Westley Ohman is an academic Vascular Surgeon in the St. Louis area. We discuss why he chose academics, what makes a good vascular surgeon and more. Good news to all premeds out there! We have a new podcast called Ask Dr. Gray Premed Q&A. Or if you know someone who's a premed, point them to the podcast as well as all our shows on MedEd Media. [01:54] Interest in Vascular Surgery Westley had exposure to vascular surgery from an engineering standpoint as an undergrad. But it wasn't until late in his third year and going into his fourth year with his sub-I's that he had world-class mentors from the cardiac and vascular side of things. He was fortunate enough to be guided in his decision making. They supported him going into vascular seeing that's where his interest and his skill set lie more than on the cardiac side. He likes the interventional approach where you can treat aneurysm in one room with two small needle pokes in the femoral arteries and then patients go home the next day. Then in the next room, you can be doing an open aneurysm and the patients can stay for a week. You're deciding which patient benefits from which and really try to master both open and endovascular surgery. Westley is fortunate enough to where his mentors would let him manipulate the wires when it was safe to do so even as a medical student. So his appetite only went from there. Other specialties in the running as he was going through his sub-I's were cardiac surgery and cardiac interventions which he found interesting. But he can't explain but the technical aspects of doing a fenestrated aneurysm appealed more to how he approaches problems and think about things. He also thought about neurosurgery more on the endometrial neurosurgery as opposed to true neurosurgery. [04:50] Traits that Lead to Becoming a Great Vascular Surgeon Westley sees spatial reasoning more so than any other surgical discipline. They do open surgery anywhere in the body. So you have to understand not just where the blood vessel runs but where's the nearest muscle insertion or origin. Understand how you're going to be able to tunnel your bypass graft or how you're going to get exposure to that artery. And in the belly, understand where the important organs live as well as be able to manipulate the space in terms of where you're going to run your bypass. "I really demand for technical precision. Vascular surgery has a way of humbling you." In short, you have to know every inch of the body to be able to successfully operate on somebody. He even jokes in medical school that he's a practical radiologist. They know the anatomy from looking at pictures, but this is his practice on a daily basis. [07:00] Types of Patients and His Decision to Stay in the Academic Setting A big portion of the patients they're treating are the end stage renal patients. They do access creation or maintaining functional access through dialysis or revisions. They also treat peripheral arterial disease that comes along with the disease brought about by end stage renal disease. Your average VA patient encapsulates a lot of vascular surgery from a general standpoint. They're the smokers, the diabetics, the ones that don't necessarily take the best care of their body. So they get peripheral arterial disease or aneurysm. But from an academic standpoint, he also gets a lot of the referrals for infected endografts, aneurysms, in and of themselves. As to his thought process behind choosing academic versus community setting, he looked at jobs for both academic and community settings. One of the things that made him stay in the academics was a job available for him. When you're going through looking for a job, the academic jobs are always posted about 4-5 months after the private practice jobs. "No one truly knows when an academic job is going to pop up because of the difference in funding cycles." The complex endo interventions entail pushing the limits of what they can do from an interventional approach or minimally invasive approach while still doing right to a patient. It's very easy to do something to a patient but determining if it's the right way to do it. They also have to consider limiting the physiologic stress on aortic surgery patients. And this is what kept him in the academics. Moreover, he has always wanted to be a big aortic surgeon having found the disease processes in terms of aneurysm and dissections fascinating. And a lot of the smaller hospitals and mid-sized hospitals just don't have the resources to support the very sick and very challenging patient population. Westley clarifies it's not the fault of the hospital. It's just not their mission or their buildup. And it takes a very specific type of place to do it which he always saw himself doing as a surgeon. [11:10] Percentage of Patients, Typical Day, and Taking Calls Westley says two-thirds of his patients come in already diagnosed with a caveat. If he'd do thoracic outlet syndrome, they have one of the biggest, if not the biggest, thoracic outlet syndrome referrals in the country. Nearly 100% of those patients come in with a diagnosis in the ballpark. But for the remainder of his patients, he will get referrals from the hematologists or the rheumatologists. Once you get outside of the pure simple cases, you see patients in end stage renal disease and they need access or they've been smoking and they have peripheral arterial disease. So there are a lot of esoteric diagnoses they made in an interdisciplinary process. "There are days in my clinic where the diagnosis is made for the patient before they get there." This said, 25%-33% of his patients are usually an interplay between himself and another consulting physician where they bounce ideas off each other. But a lot of his diagnosis are not made from subtle physical exam findings. They're important but they're a more imaging-driven specialty. Westley can't say there is a typical day for him, which has been a selling point for him. But if he's on call at a major center, he could get a ruptured and aortic aneurysm and go do that. While he could also deal with a gunshot wound to an extreme median having to figure out how to reconstruct or what conduit to use. But it's very easy to start your day with one procedure and then going to a different procedure. And then you bounce back upstairs to either do bypass or belly revascularization. Outside of clinic days, he doesn't really know what comes his way. Because even if he's not on call, if they happen to get swamped and being pulled into other cases. So being able to be flexible and offer the full toolkit really allows his day to be as variable as the hospital needs him to be or as he wants it to be. He takes one and a half days of clinic per week so he basically spends more time in the OR or the cath lab or the interventional suite. Westley describes being one of those rare groups with ten partners, nine of which will take call. So it ends up being a one in eight or so calls. He'd be on call a weekday, usually every other week. Then he'd have a weekend call every other month. For him, this is better than it was when he was in training. Outside of those large groups, it's easy to be in a Q3, Q4 call. That said, he's in a major referral center so although it's an infrequent call, it's still a very busy call. Half of his calls, he's operating most of the night, if not all of it, and still running the full day the next day. And the other half, he's interacting with the referral line or fielding inpatient consults that don't necessarily need to go to the operating room. But students should expect that there are going to be emergencies going into vascular surgery. Not a lot of their cases is that when something goes wrong can be sit on until the next morning. "Going into vascular surgery, there should be the expectation that there are going to be emergencies." [16:52] Work-Life Balance Westley still finds having life outside of the hospital. He's married to a fourth year general surgery resident. They have a toddler and two dogs. It's tough. But since he's finished training, their life has gotten significantly better. Regardless of what his wife is doing, he has time for what he wants to do in terms of family and career. It's about finding that right balance and for them, that right balance is a wonderful nanny who helps them out. This allows them to stay in the hospital late on a rare night that you need to. [18:03] The Training Path to Vascular Surgery Westley explains that there are two routes. One is the traditional two-year fellowship after a five-year general surgery program, known as the 5+2. There's also the 0+5, which is 5 years of some amount of general surgery and a lot more vascular surgery. His program did it half and half for the first three years and the last two were only vascular, This allows you board certification only in vascular surgery. From this, you can go on to do fellowships in cardiology or critical care to augment what you can offer. Westley comes from a 0+5 program where he could whatever he wanted anywhere in the body that he needed to be. I don't think either pathway is the right way. I don't think there's a wrong way to go. He noticed that his co-fellow who came from general surgery training when he started his fourth year, was more comfortable in the belly. But by the end of it, they were roughly equivalent. And he felt he had stronger interventional or endovascular skills. That because he didn't learn laparoscopy whereas he did. "It really takes some soul searching from the student as to which pathway they think is best for them." According to Westley, all of his friends who have done general surgery and the vascular don't touch a laparoscope. And in fact, he's more likely to touch one than they are just by accident. Regardless of the setting, Westley stresses the importance of the quality of the training program. There are 5+2 programs that will prepare you for a very successful private practice. And there are some 0+5 that will prepare you for a very successful academic, doing the big cases and vice versa. He thinks that each program has its own individual strengths. When he sat down six years ago to make his rank list, his first three were integrated programs and his fourth was general surgery. He would recommend students to figure out what you want from there and what you want your life to look like. They may not know that and think 5+2 is the way to go since they have their general surgery to fall back on. It's not a bad decision. But it's a mindset that a lot of vascular surgery is moving more towards 95%-100% vascular surgery. This is because of what they can do and how they can do it expanding every year. In terms of competitiveness, Westley describes it as fairly competitive. He thinks there are slightly more applicants than there are spots. And in terms of the 0+5, when he applied, it was more competitive than dermatology. They still have 80 programs per one spot per year and they interview about 20-25 of them. And for the fellowship, the numbers are a little smaller. A big debate going on is that a lot of the 0+5 programs were born out of the big academic centers. Michigan was the first to have it as well as Pitt and Dartmouth, which are big names in vascular surgery. At WashU, they keep both pathways open. They're committed to matching one for each pathway per year. Part of that is having complementary learning that makes for a better learning environment. Then there's always the big academic centers that don't have the 0+5. And the biggest leaders in vascular surgery right now say they will hopefully never have a 0+5 at their program. So even though it's been out for almost a decade now, it's still a very polarizing topic for some of the very senior people in the discipline. [23:50] Advice to Students to Become Competitive Just like for everything else, Westley says it comes down to having a reasonable Step 1 score. It's going to be a very easy, quick, and dirty screening outlet. Another thing is that vascular surgery being a small field, doing a sub-I is absolutely critical. This allows you to get your name in the door in different places. And if you can, you get letters and phone calls fro not only your home institution, but other institutions as well. So this goes a long way towards building a competitive application. Especially at 0+5 level, it shows exploration and an interest. There are also people falling out of the pathway and having an empty spot for the next x number of years where you're supposed to be training. Being able to show you know what you're getting into goes a long way. This is something they look for when they're interviewing applicants. "Vascular surgery is a very small field and I think more so than general surgery...doing a sub-I is absolutely critical." [25:30] Bias Against DOs and Subspecialty Opportunities Westley doesn't see any overt bias against DOs. They've interviewed some DOs in the last couple of years. It's just that a lot of the big programs for vascular surgery aren't associated with an osteopathic school. This is an extra hurdle the student has to go through. They have to show they're investigated and they have the commitment. And if they can show that, then they could go further than the allopathic student who comes from a program that might have a great reputation for vascular surgery but didn't necessarily show as much interest or build a competitive application packet. In term subspecialty opportunities within vascular surgery, there are several ways to make your niche. There isn't any formal ACGME fellowships. But as he said, what comes into anyone's mind is there is advance aortic endografting fellowships. Cleveland Clinic has one as the Mayo Clinic, which they've rolled out as a complex aortic reconstruction fellowship. UT Houston also has it, which is where he went to medical school. These are big aortic referral centers so they attract the aortic "super" fellows to learn those techniques. Moreover, Westley says it's very easy to build a very heavy thoracic outlet syndrome practice if that's where you want to make your mark. Because if you can do it well and show consistent outcomes, those are patients that will come to you. And the referrals will come to you as well fairly easily. A lot of people in the community end up either specializing or treatments for venous reflux. Those are disease process that he thinks they've undersold as a society or medical profession. There's always one guy in town who's that carotid surgeon just like the thyroid surgeon that get good outcomes with your carotid procedures. Referrals will also continue to come as well. But in terms of established training pathways, there aren't any besides the aortic surgery. "Beyond the general training, it's just kind of how you want to market yourself." [28:50] Working with Primary Care and Other Specialties Westley wishes to thank primary care physicians which he considers as his very best friends.A lot of the medical management of vascular patients is driven by the primary care physician. Whether in terms of following the JNC guidelines and the AHA guidelines in terms of the best medical management. About a third of his clinic patients, he ends up getting or giving a phone call to the primary care physician to pick their brain about it. He thinks it's underrecognized. In a large portion of society, everyone thinks about carotid disease and stroke but lower extremity and peripheral arterial disease and critical limb ischemia are fairly quick to pick up in terms of simple questions. These are quick and easy things that can prompt a referral to him and really impact the patient’s overall lifespan. "A lot more medical management happens in vascular surgery than a lot of the other specialties." Other specialties he works the closest with include the cardiac surgeons, nephrologists, hematologists, trauma team, radiology, and primary care. He is fortunate where the turf war was fought by a generation before him so he no longer has to fight them. But they do interact a lot with the interventional radiology colleagues in a congenial relationship and not antagonistically. The same think with interventional neuroradiologists that have made a name for themselves in the intracranial work. They do most of the extra cranial carotid disease. If those issues had not been settled, Westley admits it would have been different. As far as limiting their scope of practice in the future, Westley doesn't really see this coming. He thinks a lot of the blame for the vascular being open for other specialties is they've done a poor job defining what's the best treatment option for this disease process. And the interventional cardiologist or interventional radiologist has the skill set to treat those patients as equivalently as he does in terms of cutting a wire across the lesion. Or whether it could be putting a balloon or a stent. Westley believes a way for vascular surgeons to really sell themselves is that mindset of having multiple skill sets. But also think whether they're burning any bridges. If they can define who benefits from what procedure, and also market themselves as being the one-stop shop for lower extremity work. Either they protect their patient population or start to grow it. He won't sit and tell that there aren't interventional radiologists that can do phenomenal work in the peripherals. Or that the cardiologist can't do a good work in the renal segment for instance. So he thinks it as not only someone who can put a hole in an artery or fix a remote artery, he can also make an incision and provide a definitive fix to that problem. [35:49] Opportunities Outside of Clinical Medicine The first thing that always comes to mind is a lot of early advances in the industry. The first stent was developed by a physician (not a vascular surgeon). And a lot of the newer stent grafting was pushed by a vascular surgeon or helped developed by a vascular surgeon. Where he's at, they have a very large industry presence and they’re very active on clinical trials. The IP world for vascular surgery or devices in general has changed. Before, they'll just run with it and sit back and collect royalties. But those easy-picking days are gone because they really want to see an idea almost brought to the market. This could be in terms of the background studies, safety and efficacy studies. Some of his partners are working on small drug molecules and working with industry from that standpoint. One of his former partners who moved on from the University of Michigan was big in "nanotherapeutics." They're pushing the envelope of how they can augment devices with small drug molecules to bridge the device industry and the pharmaceutical aspect of it. "From the policy standpoint, vascular surgery hits on a lot of different disease processes that unify different body areas." Moreover, he knows other vascular surgeons who have tried to move into more of a healthcare policy standpoint. They don't only look at the cardiovascular system but also the cardiology or nephrology world. Westley believes there has to be a healthy relationship with industry right now in terms of devices, balloons, grafts, and stents. [39:15] What He Wished He Knew and What He Likes the Most and Least When he was in training, he would curse the middle of the night and thought he should have gone to a place that's not a major level 1 trauma center. He really doesn't like operating that much in the middle of the night. "Looking back on it, I really see that the trauma situations were really the ones where I grew the most as a surgeon." And in that moment, he was tempted to curse and throw an instrument. And as he looks back, he thought that was actually an opportunity to learn how to approach new problems. He thinks it really made him a better surgeon. Would he pick vascular surgery all over again? Westley is absolutely sure, but just with a caveat that there are going to be a lot of nights and late days if you're going to do the big cases. If you want to design your practice to where you are treating venous reflux all day, then you're not going to have any inpatients. And you're going to live a very comfortable life. So it depends on what you want. What he likes the most about being a vascular surgeon is being able to treat any disease process outside of the head and the heart. Because it always keeps his days different. And he really enjoys interacting with not only other surgical disciplines but also other medical disciplines. And in terms of approaching and managing those problems. Not every patient that comes across him needs an operation. But almost uniformly, he'll be interacting with either the primary care physician or some sort of medicine subspecialist to help provide some input on the disease process. He would still be treating patients even without a scalpel or without a needle. What he likes the least is not operating at night. He often jokes with his trainees but there really is nothing more humbling than vascular surgery. He finds it very demanding from a technical aspect. Sometimes, he finds himself losing more sleep now as an attending than he did as a trainee. He's worried about whether it's okay enough to where he can leave the operating room or does he need to work on the problem. He likes the challenge but it's starting to wear on him. So he's starting to explore with his senior problems as to how to deal with it. Not to wear him down but to motivate him to either do better in that moment or do better for the next patient. [43:05] Major Changes in Vascular Surgery in the Future Westley explains that there's always going to be turf wars and he thinks that should be a call to better ourselves and better define ourselves. There's always going to be pushing the envelope. Fifteen to twenty ears ago, the only way to treat aneurysm was a big belly incision. Then they got to a groin cut downs and rudimentary endovascular devices. Today, he can do a complex paravisceral aneurysm through a procedure that at the one month follow up, you can't even tell they had an operation from the outside. That said, the explosion of minimally invasive techniques is going to allow more and more people who say they have the skills with wires and catheters to come into their "turf." It's going to be up to the next generation to show that they can do it a lot better and here's how. Eventually, all hardware fails. It's just a matter of whether or not the patient lives long enough for the device to get fatigued. Westley adds that as all hardware fails, it's only a matter of time until the device can get fatigued. In which case, they'll require an open conversion and you do want them to be at a major aortic referral center. It's not just about putting in the equipment but being able to manage all the complications that come from it. This is where vascular surgeons are going to help be able to define themselves. "It's not just putting in the equipment, it's also being able to manage all of the complications that come from it." [45:30] Final Words of Wisdom Westley says vascular surgery is one of the more dynamic and rapidly changing surgical disciplines not only in terms of who they can treat and how. But also, pushing the envelope of what may be inoperable now. Ten years from now, you may already have a very simple device or very simple fix that you may very well be a part of developing. It's not for everyone. But people who will love this are those who welcome the technically demanding challenge or the opportunities of the spatial challenges that come along with vascular surgery. If you're good at it and you have inclination towards it, you're going to love it. Especially for the general surgery resident who may only do it as an intern or a second year, not to see as a full breath and just be taking care of the patients. It's so much more than that once you get into the operating room. If you have the opportunity to rotate as a senior, by all means you should. It is night and day from just managing them post-operatively or sewing a simple fistula. And he was quick to discover there's no such thing as simple fistula, which he thought it was as a second year resident. When you're doing the more challenging cases either technically or intellectually, it's incredibly rewarding even though the patients may be challenging at times. "When you're doing the more challenging cases either technically or intellectually, it's incredibly rewarding." Links: Ask Dr. Gray Premed Q&A MedEd Media

Join Dr. Samir Desai as he discusses how to develop a compelling and powerful answer to the interview question, "What discovery do you think has had the greatest impact on medicine?" This was a question some applicants were asked at UT Houston Medical School last year but has also been asked at other schools across the country.

The lead paper presented at the AAST, is authored by Dr. Laura Moore from UT Houston along with colleagues from the Cowley Shock Trauma Center in Baltimore. In a related paper, presented at EAST, Dr. Sundeep Guliani et al from Virginia Commonwealth University demonstrated the reliability of ultrasound guided central aortic wire placement, thus, theoretically avoiding, the need for fluoroscopy for REBOA placement. Dr. David Notrica and colleagues from ATOMAC (which apparently is an abbreviation for Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium), a group of ACS verified Level I pediatric trauma centers, reviewed the relevant literature with respective grading their recommendations for organ injuries ATOMAC proposed practice management guideline based on hemodynamic status rather than organ injury score formally employed in the American Pediatric Surgery Association guidelines that have been considered the standard for over two decades. Dr. Carl Wahlgren and Dr. Bjorn Kagsterman from the Karolinski Institute in Stockholm provide a review of pediatric vascular injuries managed in Sweden over the past 25 years. Transcript

Episode 7 Dr. John Holcomb former Army surgeon, now  Professor of Surgery at UT Houston where he also serves as Chief of Acute Care Surgery, and Director of  Center for Translational Injury Research.   On the Podcast he discusses (All Things Trauma) -Taking care of soldier in Mogadishu, during the Blackhawk down incident -Being lead author of PROPPR trial, and what we can really take away from this  -Massive resuscitation with blood products   -Using thromboelastography to guide resuscitation

This is an interview that I did on www.medtalknetwork.com with Dr. Brian Cotton. Dr. Cotton recently left Vanderbilt to take a new position at UT Houston. He is an excellent teacher and his opinions on fluids resuscitation are cutting edge.