2 Episode results for "Michelle Kitson"
NEJM This Week November 7, 2019
"Welcome this is the New England Journal of Medicine. I'm Dr Lisa Johnson this week November seventh twenty nineteen we feature articles a neuro degenerative disease. He's informer soccer players triple treatment for cystic fibrosis. HETERO ZYGOTE S- PCI or cabbage for left main coronary disease ventilator later associated pneumonia after cardiac arrest mediators of insulin resistance and health social reform and medical schools a review article on acute severe hypertension a clinical problem solving that describes double trouble and perspective articles on the US insulin crisis on weather other emergency Holt would reduce opioid overdose deaths and on a good physician neuro degenerative disease mortality talapity among former professional soccer players by Daniel McKay from the Hamden Sports Clinic Glasgow the United Kingdom in this study death certificates were used to compare the causes of death among seven thousand six hundred seventy six former professional Scottish Soccer players and twenty three thousand twenty eight matched controls over a median of eighteen years. Fifteen point four percent end of the former soccer players and sixteen point. Five percent of the controls died. All cause mortality was lower among former players then among controls up to the age of seventy years and was higher thereafter mortality from ischemic heart disease was lower are among former players than among controls hazard ratio zero point eight as was mortality from Lung Cancer Hazard Ratio Zero Point Point five three mortality with neuro degenerative disease listed as the primary cause was one point seven percent among former soccer players wires and zero point five percent among controls among former players mortality with neurodegenerative disease listed as the primary or for a contributory cause on the death certificate varied according to disease subtype and was highest among those with Alzheimer's Disease Hazard Ratio uh-huh former players versus controls. Five point zero seven and lowest among those with Parkinson's disease hazard ratio two point one five dementia related medications were prescribed more frequently to former players then to controls odds ratio four point nine mortality with neurodegenerative disease listed as the primary or contributory cause did not differ significantly between goalkeepers and outfield players but dementia denture related. Medications were prescribed less. Frequently two goalkeepers in this retrospective epidemiologic analysis mortality from neuro degenerative generative disease was higher and mortality from other common diseases lower among former Scottish professional soccer players then among matched controls Robert Stern from Boston University. School of Medicine writes in an editorial that this study provides good news and bad news regarding the potential long-term consequences of playing soccer at the professional level. The results are similar to those from a study involving former the national football league players conducted by the Centers for Disease Control and prevention in which all cause mortality was lower among former NFL players then then in the general population but neurodegenerative mortality was higher professional. Soccer players. Do not share the body habits of American football players. There's but they do share the exposure to repetitive head impacts through routine heading of the ball and average player heads the ball six to twelve times per game in addition to heading drills at practice and thousands of times during a career in small case series studies heading has been associated with altered cerebral neuro chemistry diminished white matter integrity and quarter cle thinning in professional soccer players without obvious concussion. The new findings findings by McKay and colleagues should not engender undue fear and panic among soccer players. Parents and coaches as the authors of the current study indicate it is not possible to generalize their findings among male former professional soccer players to participants in recreational amateur or collegiate collegiate level soccer parents of children. Who headed the ball in youth or high school? Soccer should not fear that their children are destined to have cognitive decline and dementia later in life rather they should focus on the substantial health benefits from exercise and participation in a sport that their children enjoy however it is also important that the findings from the current study lead to research and increased awareness of the potential short term and long term consequences. NSA quences of heading the ball in amateur soccer perhaps however there is already adequate evidence that repeated blows to the brain from heading in professional professional. Soccer is an occupational risk that needs to be addressed Alexa Catheter. Teza Catheter Iva Catheter. After for cystic fibrosis with a single P. H. E. Five Zero Eight D. E. L. A.. Lille by Peter Middleton from the University of Sydney Westmead Need New South Wales Australia ineffective to trial involving patients who are heterosexual for the P. H. E. Five Zero Ad L. Cystic Fibrosis Trans Membrane conductors regulator cf tr mutation and minimal function mutation the next generation see FDR corrector Alexa Alexa calf door in combination with Teza Catheter and Ivankov after improved. PHP five zero ad L. C. F. T. R. Function and clinical clinical outcomes. This randomized phase. Three trial was conducted to confirm the efficacy and safety of Alexa. Catheter has occurred after Ivankov. After in four hundred three patients twelve years of age or older with cystic fibrosis with P. H. E. Five Zero Eight D. E. L. minimal function. Gino Gino Types Alexa after Teza. Catheter Ivankov after relative to placebo resulted in a percentage of predicted Efi v one. That was thirteen eighteen. Point eight points higher at four weeks and fourteen point three points. Higher through twenty four weeks a rate of pulmonary exacerbations that that was sixty three percent lower respiratory domain score on the cystic fibrosis questionnaire. Revised that was twenty point. Two points higher and sweat sweat chloride concentration. That was forty one point eight million moles per liter lower Alexa Teza Catheter. Ivankov after was generally safe and had an acceptable side effect profile. Most patients had adverse events that were mild or moderate Alexa after Teza Catheter. Ivankov after was efficacious in patients with cystic fibrosis with P. H. E. Five Zero Eight D. E. L. minimal function Gino types in whom previous previous cf tr modulator regiments were ineffective in an editorial Francis Collins from the National Institutes of Health Bethesda. Maryland writes that the results of a pair of phase three clinical trials in the journal and in a simultaneous publication. In the Lancet document and impressive benefits from triple drug therapy for persons with cystic fibrosis. And at least one copy of the P. H. E. Five Zero Away D. E. L. CF tr mutation who represent approximately ninety percent of persons affected by this life-shortening autosomal recessive disease. The these findings indicate that it may soon be possible to offer safe and effective molecular targeted therapies. To ninety percent of persons with cystic fibrosis. This should be a cause for major celebration yet. We must not abandon the patients with cystic fibrosis. Who have known mutations -tations and will not have a response to these drugs even beyond that the best day ever for all of us traveling down? This long road together will be the day. When the more than seventy thousand persons with cystic fibrosis worldwide? Do not need to take drug therapy at all. And they're finally is a permanent cure for cystic fibrosis. That works for everyone. Although the challenges are substantial one can imagine such an ultimate approach approach involving in Vivo Somatic cell gene editing of Airway epithelial cells shortly after their identification of cf tr. Thirty a years ago Dr Collins wrote a song entitled Dare to Dream. The lyrics expressed hope that the gene discovery would lead to effective treatments for cystic fibrosis. That someday we would see all our brothers and sisters breathing free. Dr Collins writes that it is profoundly. Gratifying edifying to see that this dream is coming. True Five Year outcomes after PCI or cabbage for for left main coronary disease by Greg Stone from the ICAHN School of Medicine at Mount Sinai New York long term outcomes after perky cutaneous coronary intervention. PCI with contemporary drug alluding stance as compared with coronary artery bypass grafting cabbage in patients nations. With left main coronary artery. Disease are not clearly established in this. Study one thousand nine hundred five patients with left main coronary artery disease of low or intermediate anatomical complexity were randomly assigned to undergo either. PCI with ever Alma saluting stents or cabbage at five years a primary outcome event of death stroke or myocardial. Infarction had occurred in twenty eighty two percent of the patients in the P. C. I. Group and in Nineteen Point two percent of those in the cabbage group death from any cause occurred more frequently in the P. C. I. Group then in the cabbage group in thirteen percent versus nine point nine percent in the p. c. i. and cabbage groups the incidences of definite cardiovascular death five percent and four point five percent respectively and myocardial infarction ten point six percent and nine point one percent were not significantly different. All cerebrovascular events were less frequent after p. c. i. than after cabbage. Three point three three percent versus five point two percent although the incidence of stroke was not significantly different between the two groups two point nine percent and three point seven percent send ischemia driven re vascular. Ization was more frequent after PCI sixteen point nine percent versus ten percent in patients with with left main coronary artery disease. There was no significant difference between PC. I and cabbage with respect to the rate of the composite outcome of death. Stroke or myocardial infarction at five years prevention of early ventilator associated pneumonia after cardiac arrest by blue no hosoi from Johnny Mass Young polyvalent Limaj France patients treated with targeted temperature management thirty to thirty four degrees Celsius after cardiac arrest are at increased risk for early ventilator associated. Pneumonia this is trial involved. One hundred ninety four adult patients in intensive care units who were being mechanically ventilated after out of hospital. Cardiac arrest related the two initial shock. -able rhythm and treated with targeted temperature management at thirty two to thirty four degrees Celsius. Either Intravenous Amoxicillin Ceiling Clavier Linate or Placebo was administered three times a day for two days starting less than six hours after the cardiac arrest the incidents it inside of early ventilator associated. Pneumonia was lower with antibiotic prophylaxis than with Placebo. Nineteen percent of patients versus thirty. Thirty four percent no significant between group differences were observed for other key clinical variables such as ventilator free days and mortality at day. Twenty eight at day seven. No increase in resistant. Bacteria was identified serious adverse events did not differ significantly between the two groups. A two day course of antibiotic therapy with Amoxicillin Clavier Linate in patients receiving a thirty two to thirty four degrees Celsius Targeted temperature management strategy. After out of hospital cardiac arrest with initial shock -able rhythm resulted in a lower incidence of early aleve ventilator associated pneumonia than placebo acute severe hypertension a clinical practice article by Aldo Aldo. Push Oto from Yale School of Medicine New Haven Connecticut. Blood pressure elevations. Above one hundred eighty over one hundred ten to one one hundred twenty millimeters mercury can result in acute injury to the heart brain and the micro vascular if acute hypertension mediated target. Arket organ damage is present. The condition is labeled hypertensive emergency and demands immediate and aggressive treatment to limit progressive injury. A hypertensive emergency is associated with substantial morbidity and in hospital mortality acute severe hypertension without acute target target organ damage. Hypertensive urgency is not associated with adverse short term outcomes and can be managed in the ambulatory setting non adherence to previously prescribed. Anti hypertensive. Medications is the most common factor leading to acute severe hypertension chronic hypertension engine shifts the cerebral blood flow auto regulation curve to the right. That is to hire blood pressure levels which confers a predisposition to cerebral cerebral hypo perfusion at relatively high normal blood pressure levels. This principle guides the pace of blood pressure reduction in acute severe severe hypertension hypertensive emergencies are managed with intravenous medications guided by the type of target organ damage. Hypertensive emergencies should be managed with oral medications and arrangements for prompted. Follow up listen to the full text of this article at any. AM DOT ORG double trouble. A clinical problem solving article by Christopher Smith from the Veterans Affairs. Ann Arbor medical all center Michigan a fifty one year old man presented with a four week history of cough associated with fever chills fatigue and aching living in the joints. The cough was initially productive of blood tinged flim but later became dry an x ray of the chest showed a no passively at the right cardio frantic angle but no plural of fusion. His condition did not improve after. Two courses of macrolide antibiotic therapy one month later. His wife brought him to the emergency department where he reported severe weakness Fatigue and frequent muscle spasms his wife noted that he seemed confused. His examination was unchanged from his previous outpatient visit except that he appeared lethargic had mild tenderness over the right anterior anterior chest wall and had asterix's C. T. of the chest revealed small right pleural of fusion. The patient produced no urine despite fight placement of an end. Welling you re throw catheter. And Maria is caused by severe intra-regional injury or complete urinary obstruction obstruction. The most direct test to elucidate the cause of the patient's pulmonary and renal disease would be renal biopsy a biopsy specimen of the kidney showed severe Calamari lightest on light microscopy ancillary testing showed markedly positive anti-proteinase three and anti GBM am antibody levels that indicated a dual positive auto immune phenotype Gla Mario nephritis with coexistent Anka's and anti GBM. Antibodies double antibody positive. Disease was diagnosed non Alcoholic Fatty Liver Disease Insulin resistance and Serra minds a clinical implications of basic research article by Varman Samuel from Yale School of Medicine newhaven insulin resistance is present in most but not all obese and elderly patients and even some young and lean persons it is a precursor cursor to and accelerate of coexisting conditions such as type two diabetes. atherosclerosis non alcoholic fatty liver disease and probably obesity obesity associated cancers. There is broad consensus. That insulin resistance is associated with ectopic lipid deposition in skeletal muscle and liver. However multiple lipid species are implicated and the molecular mechanisms? Impairing the action of insulin are debated in one model an the increase in. SSN One to dice glycerin all impairs insulin signaling. In addition a substantial body of work supports a role for ceremonies in promoting insulin resistance serum needs. Like the dyson Glycerin calls are bioactive lipid intermediates a recent study established. The importance of absurd reminds through the genetic manipulation of Di Hydro Serum I D- saturates. One does one in mice. The recent study implicates locates elevated levels of serum. I'd and their effect. I might owe conrail function in the mediation of cellular insulin resistance the health social reform and medical schools the training of American physicians and the dissenting tradition a medicine society article by Merlin Chow Kwanyan from Columbia University. New York medical schools. Continue to admit low numbers of black and Hispanic students groups that accounted for only five point seven percent in four point six percent respectively of twenty fifteen graduating classes and many medical schools continue to score low on standardized indexes gauging commitment to a broader social mission measured by percentages of graduates. It's who pursue primary care or work in medically underserved geographic areas. What can be done to address these deficits medical schools schools throughout the country? Have hosted white coat Diane's in solidarity with National Movements Against Racism and police brutality medical students the public defended the affordable care act as it faced new political threats most recently an ad hoc group called scrubs addressing. The firearm epidemic convened campus actions. That framed gun violence as an urgent health problem but this activist revival can also be the understood from a longer term perspective in the context of a dissenting tradition in. US medical training. Though never in the mainstream trainee the activists have repeatedly reimagined what the profession could be at. Its best these authors focus on curricular reform expanded did community outreach and the fight against racial exclusion as lead by two little known but influential organizations. The Association of of interns and medical students aims and the Student Health Organizations S. H. O. The US insulin crisis rationing a life saving medication discovered in the nineteen twenties. A Perspective article by Michael Froehlich from Mount Sinai Hospital Toronto on January Twenty Third Nineteen twenty. Two Insulin was successfully injected into a fourteen year. Old Boy with with severe type. One diabetes melodies type one diabetes had been considered a universally fatal disease for their discovery of insulin. Insulin Frederick Banting. And John Macleod were awarded the Nineteen twenty-three Nobel Prize in physiology or medicine. The members of their team sold the patent for insulin to the University of Toronto for one dollar each banting famously stated insulin does not belong to me. It belongs to the world immediately. After Insulin's discovery patients flocked to Toronto for what was being referred to as a Miracle Substance Indi- demand was strong but the supply was limited which led to the initial rationing of insulin in one thousand. Nine hundred twenty three before it was successfully mass produced by. Eli Eli Lilly. And the company that later became Novo Nordisk the price of one hundred units of regular short acting. Insulin was about one dollar in. US US dollars during this period and fell to less than twenty cents in the nineteen forties as manufacturing processes improved over the past two decades cades however the price of insulin in the United States has risen substantially and is now inaccessible to thousands of Americans because of its high cost. The rising costs can be attributed primarily to two phenomena first. US law allows pharmaceutical manufacturers factual errors to price their products at whatever level. They believe the market will bear and to raise prices over time without limit. Second Direct direct competition in the insulin market is lacking will emergency holds reduce OPIOID overdose deaths perspective article by Elizabeth Samuels from Warren Alpert Medical School at Brown University. Providence Rhode Island as part of efforts to reduce deuce overdose deaths and increase enrollment in treatment. Lawmakers in some states are contemplating an acting or expanding emergency hold laws that that permits some patients with severe substance use disorder to be involuntarily detained for short-term observation and in some cases treatment a bill introduced in Rhode Island during the past two legislative sessions. For example would allow physicians to request that a court order a seventy two hour hold for inpatient nation treatment for a person with substance use disorder who presents a danger or threat of danger to self family or others if not treated similar statutes have already been enacted in other states including Minnesota and Washington. Emergency hold laws are modeled. After and often extensions of existing testing measures that permit short term evaluation and treatment of people in mental health crisis using short-term emergency holds in the context of opioid use use disorder presumes that a person's risk of overdose will be mitigated by a brief involuntary hospitalization but the efficacy of emergency holds for substance use. Disorders hasn't been evaluated their use in this context raises ethical legal medical and practical questions that merit careful consideration consideration given the profound effects that holds would have an individual liberty relationships between patients and physicians and the healthcare delivery system them a good physician on complacency and communication a perspective article by Michelle Kitson from the cedars-sinai Medical Center Los Angeles Dr Kitson recently cared for a forty five year old man for over a month and never spoke to him. The patient patient was admitted with Cardio. GENYK shock stabilized and listed for heart transplantation every morning Dr Kilson rounded with her heart failure team. The patient pulmonary artery catheter secured to his neck usually looked up when they entered but then returned his attention immediately to his phone as Dr Kilson spoke to his father. She glanced at her patient. She never knew how much he understood or what he was thinking. After a few months the patient received the magic call aw he sailed through. Transplantation was home within ten days. Dr Kitson should have been proud but an adage from William Ostler nagged at her. The the good physician treats the disease. The great physician treats the patient. WHO has the disease? She knew she had missed the mark. When presented did with the unique challenge of caring for a deaf patient? She took the convenient way out every day for a month half the problem was logistics scheduling a daily real-life asl. Interpreters seemed impossible. The other half was the absurdity of video interpreter. In retrospect she should have used the patient's father as interpreter instead of Messenger but on her first day neither the patient nor his father requested that she speak directly with the patient and after the Second Linden third days past with the same calm acceptance they fell into an easy for Dr kitson inertia. She had failed to comfort a patient in need and she'd missed out on the joy of that relationship are images in clinical medicine features a fifty two year old man who presented to the outpatient clinic with with a bleeding mass on his right great toe. Two months earlier the patient had noticed a pink nargile that was approximately five millimeters in diameter on the door. Some of the to- one month later. His Toe was stepped on after which the Najran grew rapidly and bled intermittently on examination. The lesion was read head and also rated with surrounding hyper pigmentation. He was referred for surgical reception during Surgery Brown. Black Patches were found on the bottom of the mass his logic analysis of both the respected mass and the patch underneath. It showed nests of melanoma cells a diagnosis of acro link. Melanoma with invasion of the reticulation Durmus was made extended section of the lesion and skin grafting were performed the result of sentinel lymph node. Biopsy was negative. The patient received treatment with Interferon Alpha Two B. After surgery at the eighteen month the follow up there was no evidence of recurrence or metastases. A forty year old man presented to the emergency department with fatigue that it had progressively worsened over a period of three months. He had recently emigrated from Mexico where he had worked on a farm and eaten raw watercress laboratory. Laboratory studies showed severe anemia. An alkyl phosphates level of three hundred forty two units per leader and an absolute. Es Nfl Count of one. One thousand four hundred cells per cubic millimetre ultrasonography of the abdomen. Revealed Intra hypnotic Bill Eerie. Ductile Dila tation and Mr Colangelo NGO pancreatitis graffiti revealed a Hyler stricture endoscopic retrograde. Colegio pancreatitis. Griffey was then performed and large flat. Worms arms were visualized emerging from the major Waddell. Pilla see the video at any J. M. Dot org worms were extracted and identified as has the Common Liver Fluke. Fascia Sola have Hadaka Fanciulla eggs. In the feces of host animals commonly sheep contaminate fresh water the larvae mature in snails and attached to vegetation after the parasites are ingested by humans. They penetrate the intestine and invade the hip pat obituary tree after treatment with blood transfusion and try Klabin dissolved.
Getting the Facts Right with Dr. Danielle Belardo, MD
"Welcome back to the Wolfman. My World Changers today I'm speaking with Dr Danielle Bilardo cardiologists proudly using her platform for education. Dr Bilardo and I have an honest conversation around being advocates how to talk to our aging parents about heart, health and her mad love for nurses just to name a few. I love how honest and unbiased Dr? BILARDO DELIVERY IS I hope you're excited. Let's go. All right guys. I gotta be honest I have been struggling a bit lately with nursing energy. I thing most of you get the play on words, but if you don't men have their big Dick, energy but I'm all about reclaiming that for women, so that's where nursey energy came from. I want Whoa met listeners to make the space their own in share, their stories and moments that make them feel empowered and showered and strength especially now. Maybe it's all the Queer I've been doing but I wanNA. Know what you're doing to lift and empower the women around you. I want to know what your doing to be an ally in your community. Do it right now. Stop this podcast. Send me a DM of how you're showing up. Quarantine is lonely. I like message is. Okay, press play again. What practice are you joining? Is that the I? O. P. B. M. Yes I. Finish fellowship this week. Actually hooking on congratulations you. I was working on my credentialing now with like all the procedures I've done in all this stuff, but graduation Thursday and so that's been six years of post. Medical Training has to be a odyssey two three years of internal medicine and then three years of Crowley Fellowship, so by Don, and then my husband and I are moving out to so cow. WE'RE GONNA be in Newport Beach California I'm joining a practice. They're called IOP. EMC is to plant based medicine and essentially all. Physicians and registered Dietitians that are embarrassed sub specialties, gastroenterology rheumatology neurology I'm cardiology. We have internal medicine pediatrics, all different specialties, and we are all either Vegan or very plant predominant plant focused and so we combine essentially nutrition wits. General guideline directed medical procedural therapy to help patients that are really looking for disease, prevention, disease, reversal, and things like that, so I've known the doctors I'm going to practice with for quite some time, and so I'm excited to be able to do this raw kind of on the same page Lake minded in in the area prevention. We work in, so it's exciting. Oh. That is so fascinating I have been one Goo-. I've tried so hard to be more plant-based I even tried to go a month in January and not eat anything meet. I tried to be vegetarian I. still ate eggs. I, don't know. Yet, that's okay it was. It was really difficult for me I. Know Yeah, my body was like raving. Meet like it was craving, protein and I I don't know if that was just that I. Wasn't aware of the right proteins I should be eating in consuming by did a lot of temp and. Good, you put that little frank. Bread So true. Absolutely you do not need to go. One hundred percent plant based to see many many many health benefits so aplenty Susan like a lot of things. Is Dose Dependent? There's so many variables nutrition science that make. A lot of things controversial etc, but one thing that are dietary guidelines across the board. Especially cardiovascular disease guidelines do you recommend is latch predominant diets and a force plant based full plant based I follow him hundred percent Vegan balls into that you don't need to go. One hundred percent begin to see the health benefits and to reduce your risk for certain diseases, and there's also a big difference between healthy plant based diets and unhealthy plenty sites, and there's a lot of nutrition science and literature published on this. You know for example Orioles Vegan. VEGAN IT! They're definitely not helpful for you so. you know it's having a well-planned it can you beneficial or plant predominant diet, but no one has to feel the pressure to go one hundred percent base I have patients that have gone hundred percent in their incredibly happy patient that got eighty percent in the incredibly happy, but the general consensus of science does tell us that This is what systematic reviews. Reviews and randomized control trials really tells us that the more plants you eat better doesn't have to be one hundred percent, but you know plant suits definitely have many benefits from everything from cancer prevention, actually the American, cancer, society just came out with new dietary guidelines that recommends eliminating red meat, processed foods, processed meats, or any sort of one meet at upping fruits vegetables. Whole grains lagoons things like that for cancer prevention similar to our cardiovascular. Disease Guidelines and prevention guidelines so doesn't have to be all or nothing so don't feel bad about it if it was. You know tricky for you. It's it's just Everyone's got their own level of plants in their journey and so I just I. Always say just you know more plants is better than lesson yet. Don't don't stress out too much better. Good. 'cause I feel like I'm a lot better about eating vegetables, which is weird for me than I am about eating fruits, but I'm so picky and I've always been a picky. Yeah like I love pears and apples, an pineapple and everything else. If I'M GONNA eat, it's gotta be blended up in a smoothie so I can't tell the texture of. Yeah I'm not I'm not create among like A. Fruit or Alex some fruit, but I'm not a crazy, crazy fruit percent either I I tend to like more vegetables as well I know I like I can't eat enough like carrots and celery sticks. At our, I will say this wrong, but it's that spy. I think it's like Teijin or to Heen or something that they put on the rim of like Spicy Margaritas you you some like carrot or like celery sticks, and that and you crunch on that. It's like the perfect little. Bisi salty little kick to kick. I loved that. Yeah, so tasty so tasty. What's kind of been your pathway to medicine? How'd you decide in cardiology being doctor? Yes, so I do not come from a family of physicians, a No one in my family's a doctor, but I just kind of gravitated towards science, then decided to kind of go to medical school and to Brooklyn and applied, and then I'm when I was in medical school. I really liked to A. A lot of my rotations, but it was kind of like I. knew which ones I didn't WanNa do I wasn't really that interested in cycle, though is fascinating, I love my rotation. I just didn't think about you for career and seem with surgery, but I really liked my cardiology rotation and actually being med school. My Dad, who's currently healthy and knock on wood is doing great. Great but during my Third Year Med School, my dad, who's like super healthy runner, he's like been like the top ten for like new. York triathlons like his fifties. He's crazy on his like eighth mile of running was starting to have these weird shortness of breath kind of symptoms as a third year medicine I didn't really understand what that meant yet, and so I was like. Like, well, he's like maybe I'm getting asthma. I was like you're not just suddenly developing, I know that much in your sixties or early sixties or whatever, and so I sent him to his primary care providers, stress test, and his justice was positive, so we ended up having a cardiac catheterization procedure we do nowadays. We go through the rest back. Then that was like. Seven or eight years ago, they were still going through. Some places are still going through the groin, but we go through your arrest with A. Catheter and we're able to. Go Up to your corner arteries to the arteries that feed the heart and take a look and see if there's something causing heart attack, and so my dad had this procedure done He had a ninety nine percent blockage of his right coronary artery, which is like the most important while one of three of the most important arteries we have have three main ones of and so he had a stent, which is just a little device that we deploy in the artery to up, and he's been doing great ever since he's back to running, he runs like. Five seven miles a day. He's seventeen out and fly. Mama crazy healthy, but it was interesting. What was interesting to me? Is that you know with so? That was actually one of the things that me WANNA, go into cardiology and then what I started to, it was very surprising to me because I've been VN for a long time time team with my sisters, but my parents weren't being at the time, but I always now, but I considered. My parents super healthy, like even though they're omnivores. You're really healthy. I'm like I. Mean they're athletes like they're always eating like fruits, vegetables like ton of Greens, but also. You know red meat chicken whatever, but never fried processed foods, and so I was so surprised because I was thinking ahead. Like wow like using a diabetes does not hypo are barely had high cholesterol. And how did he had a ninety percent? Ninety nine, and so I know you know. Of course there's components that are genetic, but you know this is when I convinced my dad and my mom to go vegan because you know, he needs of course genetic component especially with how hopeful he is, but at the end of the day he doesn't eat anymore. ADDED COSTS DRAWL END I won't get into the biochemistry of it. There's a lot that goes into the reason. My plants with cholesterol and cardiac disease general, but you know I wanted. Wanted him to switches diet night. Just I advocate for it and he did and of course I, you know he's stayed on the correct medications. I am very very agdam believer of evidence based medicine in addition to nutrition I never liked when people I co-signed from recently about how you know, some patients get told we can stop their medications from like these random is rim influencers because there you know eating healthy again. ETC, so yeah. I do not like that so he's on his. Medications forever just for his thinning and his staten, but he's now begin. My Mom's begin their super healthy. They love it, and so it kind of a not only made my. In cardiology, and so when I started my internal medicine residency, a new won't cardiology, but it also made me. Really, think about how important nutrition is and disease prevention, but also at even just preventing disease and helping patients who have disease to help them from having another cardiac event, eighty percent of cardiovascular disease in general overall is preventable with nutrition and lifestyle modification so That's really wild priorities and apply there. That's amazing. It just feels like now is as. You know a woman in her thirties. Watching my parents like start to get older. I feel I feel like of added stress, but it's so difficult to get them to listen to me on things that they need to do for. Me Lifestyle Change. And even as a nurse I mean. I got my grandma who has also nursed a late start wearing Ted hosein and stuff. But I can't get my parents to like. To not eat a massive cheeseburger, each or you know followed with like a big potato and it's stay. Trying to trying to talk to my parents about like a healthy eating lifestyles has been. A challenge like my dad hates vegetables. I mean like I feel like. I feel like such a mom when I go home, and I'm like all right Dan I see everything that you just. At least eat a spoonful of Broccoli. It's a tough dynamic. I've had quite a few patients because I started. Pennsylvania's first plant based preventive. Chronology Clinic which I did that was thankfully. My crouch fellowship was incredibly. Supportive allowed me to start this clinic where people came from everywhere to see me that we want to go Vegan, and modify the risk for cardiovascular whether or not they had or. Before they had an event or had one already, so when I did this patients a lot of times more times than I can count. That were I. WanNa say dragged there by their daughter who is either a nurse or a doctor? Follows social media was like you need to convince my dad to eat something great. I get it I. Totally get it I mean even my dad I used to give him a hard time even about state, because Mr seven beginning of for so long I used to give hard stay hard time at stake even before his. like before he had the stent place, and he's just kind of brush it off once. He actually had a credit event being a runner and being so healthy already, he realized okay well. This is some lifestyle modification that I can already make and I and I think an important thing is like for parents especially is that you weren't thing isn't like I would never? Advise. Anyone tried to change any one hundred percent or you know It's just not sustainable life change. People have to change because they want WanNa change but I think the hen due to help people, change is give them a little actionable changes. They can make like little swaps. It doesn't have to be like you give up completely starting tomorrow. It can be like you know just once a week. Can you just tried this recipe? And it's made from Tempur some vegetables. Narrow, whatever could you just give up? Cheese switched to. A plan based cheeses, bur example, said regular dairy just like twice a week and just give it a try, because some of them are really amazing and she just small changes. Add Up, and then he will start to notice when they start to make, and this is I've seen this over three years consistently without bell, so when people start to make small changes and they start feel better from small changes, actually want to make more of those changes, and then there's no one that has to convince them. It's all of a sudden they are like. You know driving that train and they want to go in a more helpful direction, and so yeah I I always say you know. No one needs to give up animal bronx forever, although that's what I've done. I've tons of patients that have done that, but. Really just make small amounts of changes that can add up and I think those are more manageable for for parents who are kind of you know a little stuck in their ways. Well, that's really good advice because I haven't been home in a minute because of Covid Ryan and I'm planning a trip in the while. Unlike the next month I'm going to go home for a little over week and I plan on, you know. I'm going to be the one that's cooking and showing them like okay, these are. These are great recipes that we can do. This woman. They don't know what they're in for the sign. Okay I have never been much for video games and I have had a lot of fun doing research as like to call it on best scenes. It's like friends without the our best means is casual, and anyone can play, but it's made for adults. The Puzzles are super challenging and fun, and I like to plan my lunch breaks, and no along around like level three hundred not to Brag I love it. It helps me use my brain on a whole other level. Best fiends the game monthly with new levels and events, so it never gets old. It also doesn't require the Internet to play, so you don't need to worry about. Wi Fi access or using data. With best fiends, you can engage your brain with fun puzzles and collect tons of cute characters. Trust me. With over one hundred million downloads, this five star rated puzzle game is a must play. Download. Best fiends free on the apple, APP store or Google play. That's friends without the our best fiends. So. Have you been working Cova I was not able to. If I was still working in the hospital I would have you know been, but I left a nick you year ago, but I've been working in and set clinic doing. All are like Oh. My God it's so cool it. There's there's so many so many things that you can do so cool. Yeah, and I'm just I'm learning a ton and it's great to be an environment that I feel supported. Yeah and you're like when you get into that space. I always tell like all my friends in plastic surgery space dermatologists Beasley New Internet speech. You become like heart, science part artists, and it's like yeah I really like a skill. Old Balance I love it I'm learning all the things cool, but obviously our clinic had to shut down during while we were shut down for I. Think about a month and a half. So that was strange right, but if it felt good to be able to get back to work, but it also just feels weird like there's. A the whole concept of like the new normal with with Covid, and you know. influencers wanting to get back to posting a regular stuff in. It's like come on people. There's so much going on right now that. You have to create this new normal because like this old normal saw. You know people just living, and not truly caring and empathizing with. What was happening in the black communities and huge medical disparities? It's like how can we have to create this new normal? We have to create this new normal in relations to cove it, and in relations to how especially in the medical community, people of color are treated. Yes, so true so to start healthcare are real and. Everything. We've seen with George. Floyd, being murdered and everything that's happened over. I mean I hate to say over the last few months 'cause for people in the black community been living this for years and years and years and years. And so I. Don't want to minimize it by saying Oh. It's just been the last few months. People in the black community have been suffering with racial injustice. Stomach racism forever and. I feel for me personally, although I've always considered myself. An ally to people in the community I realized that like wow. I haven't until everything happened with George. Way. I don't feel like I have been vocal enough about how cornices? Trained at Temple North Philly work all might be. She's Reebok and I love them so much and I think that this is really important that healthcare providers every specialty, no matter what they work in and no matter where they work. Vocalized that. It is a health issue just like Cova, because you even ever cardiovascular society. We have the American society. BECO- America Chronology. The American Heart Association the American to block cardiologists all came out with statements, saying that this that racial injustice systemic racism this is a health issue, and in really leads choose so many disparities in healthcare in our patients from everything from what their access to food with their access. Access to jobs with their is even to medical care. It's all really complex dynamic system and a lot of overhaul and change, so I have been happy to see a lot of physicians on social. Media nurses on social media and different healthcare providers social media kind of speaking out about how this is important, and I do feel like our generation. is a few protests here in Philly and I feel like. Felt so much energy from them. Positive Energy I felt like everyone really is. Our generation is really ready for change and so two I agree with you that going back to business as usual feels strange I. Don't think we'll ever have just a single. I think for me personally and sounds like for you to that. This will always be part of advocacy from. From now on for me, heart of what our clinic is sides knees seen patients in our office and being a cardiologists. We're doing KISHAN programs online. We have courses that were submitting for CME So you know help different healthcare providers can get see me credit for them Cetera. A I think he's just so you post on that? Oh? Yeah, yeah, other part of. Of Our our course design is that we actually are going to have a an entire program about I have one of my greatest friends name is a demo, Tarshis at an amazing foot and ankle surgeon. She's black. She's Vegan and she is very passionate about using levies magician in the black community, so we're GONNA have entire horses designed for advocacy for plant based nutrition. Nutrition in the black community misconceptions about nutrition on all sorts of different information, culturally appropriate sensitive, and we have a scholarship program that if anyone's listening, that's a healthcare provider, and you have a patient that is black that you think would not be able to afford our online courses. We are happy to give them the courses free. Just send us an email. At mind if I give the MELTZER, no, please. Write it down just put in the episode of these zinc? You can send us an email at scholarships at. MD DOT COM. Through this program we're having physicians, order or Any healthcare provider. You nominate a patient of yours. That is black that you do not think we'll be able to afford. Our online courses were went to give them access to them for free up and then anyone else. That's just interested in our courses were at learn dot, Iot am dot org, so we for me. It's going to be a huge part of mission. No matter what I do, I think if anything this happening has made me. Wake up and realize. Wow! Maybe I wasn't as vocal about us. For long enough, you know this should have been a part of my discussion in healthcare. Always even though I consider myself someone some cares a lot about disparities in healthcare. I think that this kind of woke up a lot of us to WANNA, be better allies, better advocates during this important time. I could not agree with that statement more like I've again like I've I've been one who's. Always tried to to be a voice for. The voiceless and you know, go on these like medical mission trips and stuff which I've. Had to do a lot of soul-searching onto with the whole white savior complex, but I was also just listening to the six hundred nineteen podcast this morning. And I tagged it in the Wool Med, and it was the episode on like how like the whole concept of bad blood got started, and they talk about how you know. People think all this stuff is in the past, but I mean. Medicare only just came into effect in the nineteen sixties, and that is one of the major things that desegregated a lot of hospitals. Wow! Like just think about that I. Crazy. It's so crazy i. mean it's just so crazy. Nineteen sixty seven was that when interracial marriages were finally allowed I. Don't WanNa. Get the date wrong, but I thought I know what you're talking about with like loving day yeah! I'm not sure the year on that, but that again. It's like this is all within the last six years, so it's so recent like our parents. Lifetime's crazy. Like that, that's how recent this is and I don't think a lot of people fully comprehend that that you know this is. This has been going on for. For so long and continues to so I. I think that's so important I love that you're doing that. You're making those resources more available because. The podcast is talking about this other study that had been done showing that even a black patient, being treated with diabetes and a white patient, being treated for diabetes by the same doctor. The black patients still had a poor outcome. Oh, Gosh, that might just just breaks my heart it just like. Like their shit, so much inherent racism like we all. Face like we just need to. We need to acknowledge that as absolutely as weight people, and and especially as as white healthcare providers. And I think it's also super important to like with regards to. Diversifying our instagram feeds but also professional lives and for me it's like I'm not going to sit there and teach a course to block people about how to go plant-based when I cannot understand what it's like to grow black with regards to the different cultural. McIntyre's that go into food, etc. That's why I feel like your time at the White Savior. Complex, etc, I want to bring in an uplift black. People in medicine who are passionate about this and that's why we have doctor Tar who's going to be? She's a black female surgeon. Who is such a bad us. She's amazing and she's Vegan and she is passionate at the. She can speak to it. because for me I'll never understand what it's like growing on. Black in America and with different access to food issues and the cultural exit surrounded, and so I'd be uplifting. Black people in medicine they're nurses doctors. Arm Assists our tease just uplifting are black colleagues. Medicine is Super Inborn, not only do we learn so much from them, but it they also just need to be elevated uplifted, and their voices amplified, so everyone can learn more from them and it's yes really important. Yeah, and they can be seen more as figureheads and stuff in their community so they can you know empower the next generations after them for sure absolutely? Love it. I knew we get along. WHO showed Mir's? I think Tammy nurse Tammy and I didn't interview with her. She was talking about how vocal you were with everything related to cove it and I was like okay. I need another like like minded person than I started falling you because of her, and I was like yes. This is. Like, it's just as a nurse WHO's trying to you know has tried to to talk about it and have these discussions on Improvised Lake, some knowledge on her platform to have like another woman doing the same thing, and then finding more and more people in the medical community like. debunking everything that you know our. Current. Personnel Charge is zero certainly. Has Been Leg. Excruciating I think for people in medicine for the that there is just so I've never felt like I've Al- I've always felt like misinformation is out there and seniors. especially in the medical space. It's so hard to be a non medical person, and like and be consumer of this information because you don't know who to trust. You don't know who to believe. and. It's really confusing. I really empathized with everyone out there. That's kind of like well. I mean this person says this is person says that we believe, but this pandemic took scientific communication misinformation to the next level, and I was cringing I was cringing from people in the Vegan community. who were what immune booster food post I mean? Listen. I've been Vegan for like twelve years. Eleven years and it's like I literally used plant based nutrition might be fairly here's Cova, but these. Other. Yes. Me Insane medical media. Who is now blocked me? But he puts out such a PSEUDOSCIENCE and I. It drives me crazy because you should not be selling also attrition information on social, because it's dangerous, and people think who's going to protect them and I'm personally. I've been on the front lines. Kobe seen patients die Ovid, and it is because there's such a huge cardiac component with it well. There's a lot we still don't know about it. you know there's so much? We don't know there's like a lot of its this underlying cytokine storm on. There's a lot of blood clotting that happens. It exacerbates things with people's chronic medical conditions. Although we see patients with without medical conditions, it really causes lung injury Respiratory Distress Syndrome and so there's this whole host of things that you know. It's a novel virus with a been seen humans before it's spreading rapidly and then you have people on Social Media Sherry misinformation. Mean you've been worse than the celery juices? People were saying it's not real. It's five G. S.. I mean I couldn't. Owada with it. Oh my God! It was painful like yeah. Those one hundred eighteen thousand people so far that have died in America alone are. We just made them up right now. There's anti mask people and. Off People. Who say like Oh like you can't? Oh, my Gosh I just saw. Some followers has sent me like someone saying. Oh, if you wear a mask all day. You carbon monoxide poisoning. It's so crazy I literally spent two years of my training, wearing a mask cab in procedures like wearing a mask like twelve hours of the day and I like it's just Misinformation out there is is wild, and during a pandemic sesame, the most because you know to see people who get sick as a result of of mulling misinformation, it just drives me crazy. I am actually happy to see that. Some of the social media networks like youtube started to censor videos on facebook and did a good job with I. Think they try effort. Get rid of misinformation and all about first. Amendment rights I am a white liberal Gal and I am not about taking I meant rights, but scientific and medical misinformation kills patients. The first hand and is not okay. The other issue that happened with the pandemic to is that even scientific research was at an accelerated rate because we're in this pandemic. That's new novel virus. You were all like us on the front. Lines were just trying. XYZ See this work. See if anything sticks so our research that we normally everything we do on randomized controlled trials from systematic reviews from you know really just diligent work wasn't able to do that. So a lot of the reprints. That came out before pure review or based on. You know things like co small cohort samples. Small case studies seems like that and so You know things like I not to get political, but things that our president would sometimes miss inform would be based on small cohort studies, every doctor sitting there cringing when he would say, take X. Y. or Z.. And one of the biggest flops of this helmick that drove most physicians crazy because the hydroxy corporate thing. With Lupus who could not build their medication you because people were starting to word it. My God and it wasn't even based on randomized controlled trial or any good data, and and just you know at set it, so it was. It was a really really tough time in scientific communication, it still is, but I think this highlighted a big need for increased scientific literacy across. the country and. Increase Literacy in Medical Education, I actually think I never to be honest with you. Some that ever watched the news, but obviously during the pandemic kind of all did and I thought Sanjay Gupta, did I. don't know if anyone or if you watched him a great job of really like just keeping the public informed really easy to understand way. I honestly hadn't watched. I, I don't have cable. Of kept up too much with like actual news. Sources I've read like a lot of articles and stuff. Like the televised things. I haven't seen too much of unless you know. Those outlets posted there quick. Segments on instagram and stuff like that which speaks to a whole new bike way of people consuming their news like bad, but some true, but again that can all be misled because of you know biopsies? Indifferent, News Corp.'s yes. Absolutely I never. I've never been someone that really watches the news ever just been so busy in my medical training, and this is the first time I've kind of me and my husband had been like well. We like watched a lot of the news. The way we consume information whether it's social media, etc. Everything has a bias, but it's. It's one thing. 'cause you know medical. Twitter is one is a great place for medical information with regards to you know in historically physicians and sure nurse twitter I think nurse, twitter's huge and amazing Um physicians. We have you know cardio. Twitter Med. Twitter where everyone conferences medical information and the rate of information that was released on twitter was actually incredibly helpful during the pandemic. Sharing C. T. Scans but the Radovan formation so fast that you know it can get really confusing for someone not in medicine doesn't understand what robust researches or clinical trials. So that's where I think. It got really messy, and plus you add the conspiracies to that. It was it was rough. Food. It's just been like a moment where you just have to just have to take a breath and be like. Okay and next thing I. Need to debunk air. Exactly. The whole concept of. Now wearing a mask. Even it's just. I don't know and there's different things like I feel like. I mean everything if if you're GONNA be looking for anything online like just. Look at where it's coming from. You have to at least research that Google. The names of the people who have written it or who are quoted in it and you know find out their educational background so that like you can make. A concise in lake educated determination on. and. You know what's really hard about right now and not to lake. Disheartened your listeners, but was really hard right now. Is that even people? We'd really previously. We've not inside viewings, information, five G., whatever and then even people that we had previously all really respected in science for example John I notice. Who is this Stanford researcher that? I mean I always thought his research takes a didn't love it nutritional epidemiology, but he was quite a respected researcher, and even he has totally like he the hill he was going to die on. was that Kobe wasn't that dangerous? And he wrote he it started out with him writing like an OP. Ed In the Wall Street Journal or something like that. And then about how Kobe not that dangerous. And then he stopped the hypothesis, he did a bunch of research that was botched his the assay he used for the sampling at Stanford was like the the immunologists worked with them was like I'm not even GonNa put my name on this paper because it's so bad, then he surges making the rounds on the Fox News and he. He just started to ease respected site. He was a respected scientist who just started to fit the narrative of Kobe's not dangerous, objectively looking at the data more out without good data, and so even trust scientists all of sudden I mean new in the Journal of medicine just had a massive retraction, so it's like. Even regular science that we can usually. Trust mostly even has started to be shaky during the skin DEMOC, so it's like I need. If you are a consumer out there of information, it is tough. It's tough to know. Jehuda. Listen to so I mean and even. Even and I think every physician nurse listening can agree that even during this pandemic, sometimes, the WHO and the CDC like you Wanna be able to rely on them i. they said doctors need just surgical masks. Then it was Mindy Basques than it was back to search I mean it's because the pandemic was happening so fast, and it's so new. That I think everyone is. You know it gets. It gets tough to sort through all of it I think that the good news is that now. We. have amassed a good amount of data to help us figure out what does help us. Prevent the spread of Kobe and I think at this juncture we really do know. There's so much robust data for the fact that wearing a mask helps to reduce the transmission it reduces the are not of the transmission of the virus not necessarily to you from getting up and reduce the spread of it so wearing a mask distancing yourself school distancing six feats to even I have been a very loud and public speaking about how going to has into three protests for black lives matter. Perfectly safe as a physician advocate for if you want to. Advocate for you know black lives and human rights which I think is so important. You can do so if you stay succeed away, which is fully able to deal we see to. Everyone. Wore masks and we were. There are people handing out masks? You're handing out. Mass. People were handing out water hand sanitizer like ass. You know people care, and and like I got I got bit of flack for that, too. Like how can you is a medical professional who has spoken so passionately about the dangers of covid be going to these protests and I'm like. At a certain point, it's like racism is a pandemic. That also needs to be fought, but there are ways you can protest safely exactly. I got the same kind of flack from people on it, and no, it's just. It's the idea that you know I try to keep saying people that were protesting. They're going out. Protesting for a haircut is not the. The same as has seen for black men being murdered for over eight minutes on national television. We all were able to watch. Be Murder I. Mean that is just to imagine black people in America have gone through for years and years and years and years and years, and the fact that it's reached this boiling point I think the protests have been. have been more than needed and. It is a human rights issue and You can do it like you said you can do it safely. Every protest I went to everyone was wearing masks I everyone. It was so amazing to see so. I totally agree with you I think it's an important distinction to be made that you can support the protests and be a healthcare provider WHO's worried about covert and actually a New York City. Easy job. They opened itchy. New testing centers just for people that were protesting La has reopened all their testing centers. They have free testing for everyone There's just a lot of resources for testing to and you know force. Not everyone can go out and protest which I understand. If you have a live with someone, that's compromise yourself Murray. Of Chronic illness, or if you just don't want to, you can still make a change from home from your computer with your money. Where you put your money, you know supporting companies that are. Black individuals supporting uplifting black professionals like businesses, there are many ways to support but I do think that, too. Many people jumped on the Oh, well now doctors are saying you can go outside and it's. It's it's not. It's obviously. Carefully still have to use commonsense. They're in and that's what I feel like is is lacking. A lot is common sense. Yeah and. Man There's there's so many things like I wish I could say about some stuff. Alliot, so many people I know well listen. We're not alienating like. Incredibly, you know, listen I have friends of all over the political spectrum. I have friends who love you know I. Have Some friends who trump ben you know, even though as you can probably tell from my tone I. I'm not a huge fan, but I have friends that that the like him and I'm in cardiology, which generally tons of cardiologists are are very conservative. Listen. This isn't even a political issue. Issue I think for every healthcare provider for every nurse doctor for offices like a human rights issue as healthcare provider go into scientifically proven human rights. Yes, yes, and you go into medicine because you want to help you seek people live and I feel that way about anyone. I feel that way about everyone, and so it's not even a political issue. It's just no just care about people's lives. Yes. I love that. How. Many women were in your cardiology program. Oh, that's a great question, so my fellowship program there was. Let's see the here I. my program is one of the most I think. Women heavy programs that I can think of the area amazing when I I know is amazing. When I started in my class, two of the four of us are female, and then the class above US had one female in the class above that won't be. Like a forty percent email, which is huge because nationwide, only ten percent of cardiologists are women so. And Yeah. So do you think we can change that like? Yeah, it's what's good. Is that now? I think the last few years has seen like a turn with MED school admissions. I think that now over fifty percent of medical students are now, which is amazing I think it's just making. Women in medical school understand that that cardiology is a great option for women I think sometimes women feel like either Detracted from going to chronology because they're worried about the lifestyle or because It's like a very male, dominated field, and so I can understand why people gravitate towards I. Am like very much girls girl so I like I loved my own. Rotation I just didn't love Obgyn as a specialty but I loved. All I loved working with women all day. It was like had in for me, but I really liked. Basketball disease so. that. It's You can still do a lot of women focused in Korea Jamie. Women the number cause of death for women is heart disease, so I mean you know all of our patients are women and I can't end of course, but you can have tons of female beaches and so I think that. That's interesting. Is that so many female patients who come see me are like Oh. Thank goodness finally you know email cardiologists, and so I think it's just kind of getting the information out there about the career and making less less of a male oriented male dominated career. Because it's really amazing and you can have, you can have a crazy busy lifestyle in any specialty, you can have a chill lifestyle and any specialty you can really once you're done training. Really make it. What you want it. I've I've heard that from a few doctors that I have interviewed in. Is that like? They're still kind of that. Stigma misconception that you're. Like you might not be able to be a mom who's like poem with her kids all the time like lifestyle like you have to be, you know more married one. One of my fellows is She is the year Bolom Age. She's going into interventional cardiology, which is like the most demanding of the cardiologists specialties, and she is. She just had her second baby so in one of our CAF, attending one of our interventional cardiology, attending who I is like my. Idol she's named Mara Caroline. She's just such a boss cheese. This great interventional cardiologists, just four children so. It is fully fully possible. Anything has yes. Yes? And I. Think I think a lot of I've also heard that you know. A lot of women have to work. Ten Times. Harder to prove their worth to like that also kind of yeah. Can detract A lot of women from joining the specialties and it just it's so frustrating because it still feels like it's such. A man's world. In Medicine and I mean you can feel like it. You can feel it. You can see it changing. I'm that's what I'm here in like I want to. Do you know like empower nursing? Voices empower Dr Voices. You know because I. WanNa see that change. I WanNa see that equality. I WANT! You know women to be taken. For their skills, not because they've had to work. Ten Thousand Times is hard for you know. A A significant pay cut for. Like there's. there. There's so much to fix and change but I. Feel like we're finally like on the cusp of like really. Changing in Lake, making like a movement happen. I agree well shadow to your nurse listeners because I. There is no way on this earth. Any of US would get through our medical training without nurses and to me like Oh my gosh shadow to the seventh floor heart failure nurses at. The ICU nurses like they just were so amazing throughout my residency training, and I think my biggest frustration. Is that adding? They're still so much sexism. The medicine I mean like. I grew up with parents that have told me my whole life. You could do anything you WANNA. Do like the I. Never even had a second thought. It was grover or anything like my parents have always been supportive in like you can do whatever you want to even be cardiologist, sure and then you get into medicine and you're like Oh my goodness if there is still some sexism and even the way there was nothing though Piss me off more than like if a medical intern that was a male. And this happened often like sometimes the surgery and center would back talk a nurse, a nurse who lake work so hard and knows exactly what's going on the patient and they're concerned about the patient I used to lose my temper and Osmin. Out On these surgery, endurance or the medicine in terms if they back talked nurse, because there is a respect issue there, and they wouldn't always do the male nurses, and so this evening with us as fellow so now we might six year of training I am about to be an attending position in like a week, and like even just the last time I was on call I had a surgery intern was like a first year out of MED school or send call me for salt. I was on call and You know, give me an attitude about my recommendations and I'm like you know what. Dr, for thirty minutes like you called occurred algae cops halt. It's just the every single female medicine, weather, nursing, or or your physician. We all feel that still exists, and all we all. We got to keep pushing through and changing and. I just appreciate nurses so much because their patients level for new interns in July must be. I just can't even like crazy. I appreciate that so much and I know the nurses listening are like Oh, yeah. I just feel they're paying all. July you know Joe schmos finish in. Med School and then tries to tell a nurse who's been on the floor for five years knows exactly what she's doing like. They're like okay now. My my rule number one for every intern always was listened. Choose nurses and I'm not saying that doctors don't know a lot they do, but the nurses are the ones that are with the patients nonstop. They are the ones who seeing clinical changes. Just go listen to the nurse. Reevaluate the patient and do not give them attitude the there's nothing that drives me more crazy, and that's where I see sexism all the way up and down the the line from even men are AJC behaving this way. I'm like, can you? Not I mean I just call someone out on twitter about this yesterday? Like I, so frustrated like Michelle Kitson is like. The most amazing heart failure cardiologists at Cedar Sinai anyone who's listening unique to follow her. Her name's Michelle Kettles in. She's a hardware failure transplant. At cedars-sinai she's on twitter, she tweets the most useful clinical pearls she calls them. KITSON rules and they're super. Awesome are brilliant. Super Helpful, so she posts this kid Olsen rule yesterday that was about how and nurses will love. This is about how hey listen. We need to change the way we structure around. When you pre round, you should be checking labs. Checking the vitals checking any of the nursing notes check the over nursing notes talk to the nurse You don't physically see the patient and wake them up for pre rounds. We you as you're telling leg odd. Q Oh my God and let me tell you what the stream of comments on there were of men. This is a Cedar Sinai heart failure transplant cardiologist, who so accomplished. It's ridiculous and MVP men interns. In this thread, saying Oh, my God, you can't wait till rounds to see the patient workers. Clinical Satis Change Bubba volley making points that really just carried no weight I lost. It was like the amount of men trying to to manslaughter a atop world accomplished our failure transplant. Just right now is absurd like please just check yourself and they're like interns and there's like an intern dermatology. I'm like what the Hell It's like iron to the you get this level of confidence, and then so it doesn't even end it doesn't she's attending? Was So -CCOMPLISH famous? She's phenomenal physician and they're still. Madman's flaming her in the twitter comments like. That our interns, so for the nurses that are listening. It's we all feel your pain. We're on the same page. We're all MRS sexism fight together because it is frustrating. Because I, yeah! I can and can't imagine that but I mean what she's talking about with rounds like that's one of my big frustrations especially in the Nikki where you're dealing with. These these little sensitive alive set. You. The whole purpose of developmentally appropriate care is bundling cares like not disturbing them some money. It's like yes, listen I know that like you need to come in and put your hands on this patient, but these are the care times. This is the time that I will there with them? I will. I will wait for you, but like in at that time like this, kids can eat it. Eight kids can eat at nine. You know right one of those other. Income see then, but your Cisco on them. Listen to him. I can tell you everything you need to know, but I swear to God. If you put your hands on the Child on, wake him up. He is going to Brady and his oxygen requirements. Backup, you're gonNA break up all the progress. I've made on him only. Ray and it's it's called patient centered care I had some guy some guy was like I'm hot guy so I. RE posted on Instagram I'd hospitalised. Who was like I'm a hospital soon to be cardiology fellow and I think that this is wrong. Because what if you walk in on rounds? And the patient is dead and I was like you know it, Sir have. Code Blue Button. Like, have a little more he's. What about these heart? Failure patients have a little more than than nurses who are taking care of these patients while you are home solely bang and like have more even the nurses like I, not even it just and guess what I do, not see one message like that from a female and listen I'm not a man hater, my husband, my dad I just think that in medicine the sexism is still there and nurses and female doctors all our get. We also get the effects of it, and so it's frustrating especially when goal is patient centered care like you said yes. I actually I've been I've been talking to this one guy. He's in the medical field and I will I will say that, but he. He told me he's like Wilson's meeting. You and Listening to the PODCAST and hearing your perspective on medicine from like as a nurse. It's really changed how I interact with nurses that I with and like I made an active changes in. Actually, building a better relationship with my nursing staff. And I'm like good for year. That is good man. That is a good man that is amazing. I mean I can't even like Oh my God I can, because I am literally a cardiologist in like three days and let me tell you. The first time I was in the CCU by myself and a patient goes into this. Crazy S in the middle of the night and I was like a second year. Medicine resident and I will never forget this nursing Brianna I. Look at her, and she's like okay identity now Mike Okay identity, and she literally was telling me. What's your dentist twelve like Okay Desi twelve. Nervous yeah. I didn't know how to run the rapid and then the first time I ever ran a Co. there's a nurse next meeting like I'm okay. Happy and like Dear God nurses have no joke gun. Every single doctor through training and they have been a huge part of our medical education they. are like a massive component of what is made us doctors, and so for anyone to ever you little or put down the people that contribute so much education. They're just out of their minds. Because literally I I can think of a million incidents where I've had nurses literally be the ones who've taught me how to do X. Y. or Z. You know? I can't I can't thank you enough for that. Because I've always looked at nursing as as a, it's a team sport. You know like yeah, you can't have one thing without the other like it's it's. That's how you save a patient. Every system. Every player has to work together. And I mean you might get some stunning nurses sometimes, but that's because they've been believable there. You know what I to be honest. I think that you get what you put out there like I. Have Never I can honestly say this you know. Knock on when six years of my training I never had a nurse Sassy, but I have had so many. Male turn SAS name. Because I think that Lake I. Respect, they showed me respect him. We know where they're the team. There is so much I've never had I've never had negative experience for nurses because I think we really do every nurse. With is like I just have so many. I can think of so many. Events in my head of where nurses taught me something. How the EGO people just Graduate Medical School? They know anything. It's like when you an intern literally just via sponge and just know that you are just there to learn and listen to me. Listen to your your upper level residents. You're respectful and just have an open mind and get into that like you said team sport mentality yet were all there to help the patient. Yes. That is what it's all about. Your team and you saving that patient's life. Truth. while. Dr Bilardo I can't thank you enough for coming on. Will you tell fun so much having you're? You're welcome on any time. For having me please tell our listeners where they can find you. Plug your platforms plug. IOP b. m. like everything you're working. Feel free to plug it all again, so I am on Social Instagram at denial alert Ob audio so Deniau Blerta D. and then I'm on twitter at Deibel Arto MD because my name's long and then our organizations called. And we well, that's our practice. We've nonprofit arm of it and we are a headquartered in Newport Beach California where multidisciplinary practice with we all sorts of Physicians Gi director of Cardiology. We have rheumatology and chronology everything you can imagine. We have Obgyn I'm Natalie. Crawford amusing obgyn fertility. Love her I love her. She's joined US doing telehealth arm. That's only thing we asked. We've a good group of people that we all evidence based medicine we advocate for Evans is nutrition. We have courses that people can take it. I am literally in the process of gangs, CME and C credit for nurses, nurse practitioners, everyone and that's at learn with I. O P M is instrumental for that and. That's it, so thank you so much for having me. Thank you for coming on and I will link all of that in the show notes and. Follow everything because you by also need to keep my cme's up. Exactly, and now that none of us can go to conferences anywhere I. GotTa do it all virtual anyway, yes. Well, thanks Junio, thank you. I want to thank Dr Bilodeau again for taking the time to speak with me today. I hope you enjoyed this episode, and if you have someone that would benefit from the online courses, doctoral lardo offers had them submit to scholarships at Danielle. BILARDO DOT COM. Follow Dr Bilardo on Instagram at Danielle Bilardo. MD and on twitter at D. Bilardo that's B., e., l., A. R. DO MD.. and. If you aren't already be at the Wool Med or personally at the MLB, I love y'all catch next week. WARHEAD OUT!