This week we will discuss childhood trauma with author, speaker, and Licensed Clinical Social Worker Shari Botwin.  Shari has been practicing since 1996 and is a certified trauma expert treating those with eating disorders, anxiety, depression and trauma. She's here today to talk about her work helping individuals recover from childhood trauma. ​ Few of us will escape our lives without some sort of trauma—some more or less severe than our peers. Whereas previous discussions around trauma were conducted only on therapists' couches or in private diaries, they are now being more normalized. With this decrease in stigma, we are paving the way for more possible healing. ​ Family-of-origin trauma is a form of trauma that comes from our home—from the place where we are programmed to want to feel safe. If this environment feels unsafe during our developmental years, it affects everything from our personality and how we feel about ourselves, to our future relationships, and even our relationship with food and substance use (Mandavia, 2016). (Credits: Mandavia A, Robinson GG, Bradley B, Ressler KJ, Powers A. Exposure to Childhood Abuse and Later Substance Use: Indirect Effects of Emotion Dysregulation and Exposure to Trauma. J Trauma Stress. 2016 Oct;29(5):422-429. doi: 10.1002/jts.22131. Epub 2016 Sep 13. PMID: 27622844; PMCID: PMC5064859.

This week we will discuss a new rapid response test for Sepsis with one of the developers, Richard Brandon. ​Sepsis describes a syndrome that occurs when severe infection results in critical illness and affects 750,000 Americans annually. Sepsis occurs when a bacterial, viral, or fungal infection causes a significant response from the body's immune system, causing a high heart rate, fever, or fast breathing. Severe sepsis develops when the infection causes organ damage. Septic shock is the most severe form in which the infection causes low blood pressure, resulting in damage to multiple organs. About three in every 10 patients with severe sepsis, and half of those with septic shock, die in the hospital. ​ Consider asking the following questions: "Does my loved one have sepsis or septic shock?" "Do we know what organism is causing the infection in my loved one?" "Do we know where the infection came from?" "How well are my loved one's organs working?" ​ Antibiotics and intravenous (IV) fluids are two of the most important treatments for sepsis. Studies have shown that delays in receiving the right antibiotics can double the risk of death. Patients are usually started on antibiotics that treat many different types of bacteria—"broad-spectrum antibiotics"—until test results are available to help physicians select antibiotics that treat the specific bacteria causing the illness—"narrowing antibiotics". These tests are often referred to as "cultures", where bodily fluids such as blood, urine, and phlegm, are sent to the laboratory to identify disease-causing bacteria. Preliminary results from cultures may be available within 24 to 48 hours; final results from these tests often take several days. (credits: ATS)    Time is critical as you can see!  With Richard Brandon's new test, the results are rapid!!  ​   ​ Richard Brandon Chief Scientific Officer – BVSc (Hons), PhD, MBA 35 years' experience – veterinary immunologist, molecular biologist, pathologist, animal and human healthcare R&D executive: Cornell, Sloan Kettering Cancer Research, University of Queensland, various private pathology laboratories, Genetrax, Plasvacc, BioNiche. A listed inventor on most Immunexpress patents; architect of IP strategy.

On today's show, we are talking about the complex world of multiple chronic illnesses once again with Anna Cooper. Anna is a 35-year-old female who has an independent spirit inside of a body that holds an alphabet of health conditions. Anna worked as a case manager for individuals with intellectual and developmental disabilities, where she loved to advocate for her clients. When her health forced her to take a step back from working, things have been rough as she looks for a new way to advocate for herself and for others. The Difficult illness we will discuss today is Mast Cell Activation Syndrome or MCAS.  According to the National Institute of Health: Mast cell activation syndrome (MCAS) causes a person to have repeated severe allergy symptoms affecting several body systems. In MCAS, mast cells mistakenly release too many chemical agents, resulting in symptoms in the skin, gastrointestinal tract, heart, respiratory, and neurologic systems. Mast cells are present throughout most of our bodies and secrete different chemicals during allergic reactions. Symptoms include episodes of abdominal pain, cramping, diarrhea, flushing, itching, wheezing, coughing, lightheadedness and rapid pulse and low blood pressure. Symptoms can start at any age, but usually begin in adulthood. The cause of MCAS is unknown. Diagnosis is based on the symptoms, clinical exam, and specific laboratory testing. Other conditions may need to be excluded before MCAS can be diagnosed.    

This week we will discuss Palliative vs Hospice with Dr. Karl Steinberg.  Palliative Care, Hospice Care, End-of-Life Care, Serious Illness Care, and Advance Care Planning/POLST all represent important elements of care for individuals dealing with serious illness, particularly those facing end-of-life situations. These are related but distinct concepts within the healthcare system. Palliative Care: This is a type of care that is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve the quality of life for both the patient and the family. Palliative care is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment. It's not limited to end-of-life scenarios and can help patients manage symptoms and side effects of disease or its treatment. Hospice Care: This is a specific type of palliative care for patients who are in the final stages of an incurable disease and have chosen to focus on comfort and quality of life rather than treatments aimed at cure. Generally, hospice care is considered when patients have a life expectancy of 6 months or less. It is often provided in the patient's home but can also be provided in hospice centers, hospitals, long-term care facilities, and nursing homes. End-of-Life Care: This refers to the support and medical care given during the time surrounding death. End-of-life care can include a broad range of possible treatments and support, depending on the patient's needs. It might include treating pain and other uncomfortable symptoms, providing emotional and spiritual support, and helping the patient and their family make decisions about care. Both palliative and hospice care can be part of end-of-life care. Serious Illness Care: This is a broad term that includes all types of care that someone with a serious, potentially life-limiting illness may receive. This can include everything from aggressive treatments aimed at curing or controlling the disease to palliative and hospice care aimed at managing symptoms and improving quality of life. Advance Care Planning/POLST (Physician Orders for Life-Sustaining Treatment): Advance Care Planning involves making decisions about the care you would want to receive if you become unable to speak for yourself. These decisions are often documented in an advance directive. A POLST form is a type of advance directive that becomes an actionable medical order when signed by a healthcare provider. The POLST form helps ensure that a patient's wishes regarding life-sustaining treatments are honored by emergency medical personnel, nursing home staff, and healthcare providers. ​All of these concepts share a common goal: to ensure the best possible quality of life for patients facing serious illnesses, while respecting their values, preferences, and goals for care. About Our Guest Dr. Karl Steinberg has been a nursing home, hospice, and home health agency medical director and chief medical officer in the San Diego area since 1995.  He received his bachelor's in biochemistry from Harvard and studied medicine at The Ohio State University College of Medicine, then completed his family medicine residency at University of California San Diego (UCSD) in 1990.  He has board certifications in family medicine and in hospice and palliative medicine, and is certified as a nursing home and hospice medical director in addition to having a certification as a healthcare ethics consultant.   Dr. Steinberg also serves as president of the National POLST Collaborative, and is a past president of AMDA and CALTCM and past chair of the San Diego and California Coalitions for Compassionate Care.  He serves on the National Advisory Board for the CSU Shiley Haynes Institute for Palliative Care and is the recipient of the 2022 Doris Howell Award for Excellence in Palliative Care.  Dr. Steinberg is on the Board of Directors of the San Diego County Medical Society and serves as a delegate to the AMA and California Medical Association's House of Delegates.  He is also an appointee to the California Insurance Commissioner's Long-Term Care Insurance Task Force.    ​Dr. Steinberg enjoys presenting at educational conferences to professional audiences and the public, and also serves as a consultant and testifying expert witness in civil lawsuits and regulatory matters.   He hosts two podcasts for AMDA, called JAMDA-on-the-Go and Caring-on-the-Go.  Dr. Steinberg is perhaps best known for taking his poodles on nursing home rounds with him.   

This week we will discuss processed food addiction.  This is a rerun of an episode we posted awhile back.   Dr. Ifland has been creating breakthroughs in recovery from food addiction from 1999 with her first popular book to 2018 when her textbook, Processed Food Addiction: Foundations, Assessment, and Recovery was released by CRC Press.   She founded the online Addiction Reset Community (ARC) in 2016, www.foodaddictionreset.com. The Facebook group, 'Food Addiction Education' (2014) and www.foodaddictionresources.com (2014) provide free support.  Reset Week  is the first online live video program for withdrawal (2018).  ARC Manager Training is a program training future Addiction Reset Community leaders (2020). Dr. Ifland is the lead author of the first scholarly description of processed food addiction and definition of addictive foods. Dr. Ifland earned her PhD in addictive nutrition at Union Institute and University (2010); her MBA at Stanford Business School (1978) and her BA in Economics and Political Science at Oberlin College (1974). She currently resides in Seattle. Social Media links:  ​ https://www.facebook.com/groups/1806154526275515 ​https://twitter.com/JoanIfland ​https://www.instagram.com/foodaddictionreset/

This week we will discuss POTs once again with a new guest, Maddie Connell. Maddie is a 27 year old who works in Veterinary neurology and neurosurgery studying to become a Veterinary Neurologist herself.  She runs a popular TikTok to raise awareness and provide research based information on Ehlers Danlos, POTs, Mast Cell Activation Syndrome and Complex PTSD. ​ Postural orthostatic tachycardia syndrome (POTS): A disorder that causes problems with circulation (blood flow), POTS can cause your heart to beat too fast when you stand up. It can lead to fainting, chest pain and shortness of breath.  It is one of the 5 types of Dysautonomia.   Dysautonomia is a general term for a group of disorders that share a common problem – that is, an autonomic nervous system (ANS) that doesn't function as it should. The ANS is the part of the nervous system that controls involuntary body functions (functions you don't consciously control) like your heart rate, blood pressure, breathing, digestion, body and skin temperature, hormonal function, bladder function, sexual function and many other functions. When the ANS doesn't work the way it should, it can cause heart and blood pressure problems, breathing trouble, loss of bladder control and many other problems. ​ Dysautonomia happens when the nerves in your ANS don't communicate as they should. When your ANS doesn't send messages or receive messages as it should or the message isn't clear, you experience a variety of symptoms and medical conditions. Dysautonomia can affect ANS functions including: Blood pressure. Breathing. Digestion. Heart rate. Kidney function. Pupil dilation and constriction in the eyes. Sexual function. Body and skin temperature control. ​ ​  

This week we are repeating our episode on Crohns Disease and Trauma. Casey Hersch explains how childhood trauma could be the reason your gut is a mess!  We have heard of the brain/gut connection, Casey explains it in some detail on this episode.   Casey Hersch, MSW, LCSW, is a licensed clinical social worker, author, and founder of www.lightyoursparkle.life. She specializes in integrative treatment models for chronic illness. Inspired by her own struggles with autoimmune illnesses and trauma, she educates about empowerment and how to build individualized healing plans.

This week our Co-Host and producer is the guest once again!  The topic for this week is Pulmonary Embolism, which is a blood clot or thrombus in the lung.   A pulmonary embolism (PE) is a sudden blockage in a lung artery. It usually happens when a blood clot breaks loose and travels through the bloodstream to the lungs. PE is a serious condition that can cause: Permanent damage to the lungs Low oxygen levels in your blood Damage to other organs in your body from not getting enough oxygen PE can be life-threatening, especially if a clot is large, or if there are many clots. What causes a pulmonary embolism (PE)? The cause is usually a blood clot in the leg called a deep vein thrombosis that breaks loose and travels through the bloodstream to the lungs. Who is at risk for a pulmonary embolism (PE)? Anyone can get a pulmonary embolism (PE), but certain things can raise your risk of PE: Having surgery, especially joint replacement surgery Certain medical conditions, including Cancers Heart diseases Lung diseases A broken hip or leg bone or other trauma Hormone-based medicines, such as birth control pills or hormone replacement therapy Pregnancy and childbirth. The risk is highest for about six weeks after childbirth. Not moving for long periods, such as being on bed rest, having a cast, or taking a long plane flight Age. Your risk increases as you get older, especially after age 40. Family history and genetics. Certain genetic changes that can increase your risk of blood clots and PE. Obesity What are the symptoms of a pulmonary embolism (PE)? Half the people who have pulmonary embolism have no symptoms. If you do have symptoms, they can include shortness of breath, chest pain or coughing up blood. Symptoms of a blood clot include warmth, swelling, pain, tenderness and redness of the leg. How is a pulmonary embolism (PE) diagnosed? It can be difficult to diagnose PE. To make a diagnosis, your health care provider will: Take your medical history, including asking about your symptoms and risk factors for PE Do a physical exam Run some tests, including various imaging tests and possibly some blood tests What are the treatments for a pulmonary embolism (PE)? If you have PE, you need medical treatment right away. The goal of treatment is to break up clots and help keep other clots from forming. Treatment options include medicines and procedures. Medicines: Anticoagulants, or blood thinners, keep blood clots from getting larger and stop new clots from forming. You might get them as an injection, a pill, or through an I.V. (intravenous). They can cause bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin. Thrombolytics are medicines to dissolve blood clots. You may get them if you have large clots that cause severe symptoms or other serious complications. Thrombolytics can cause sudden bleeding, so they are used if your PE is serious and may be life-threatening. Procedures: Catheter-assisted thrombus removal uses a flexible tube to reach a blood clot in your lung. Your health care provider can insert a tool in the tube to break up the clot or to deliver medicine through the tube. Usually you will get medicine to put you to sleep for this procedure. A vena cava filter may be used in some people who cannot take blood thinners. Your health care provider inserts a filter inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. But the filter does not stop new blood clots from forming. Can pulmonary embolism (PE) be prevented? Preventing new blood clots can prevent PE. Prevention may include: Continuing to take blood thinners. It's also important to get regular checkups with your provider, to make sure that the dosage of your medicines is working to prevent blood clots but not causing bleeding. Heart-healthy lifestyle changes, such as heart-healthy eating, exercise, and, if you smoke, quitting smoking Using compression stockings to prevent deep vein thrombosis (DVT) Moving your legs when sitting for long periods of time (such as on long trips) Moving around as soon as possible after surgery or being confined to a bed   (Credits: NIH)

This week we will discuss the topic of Diagnostic Radiology.  The error rate of radiology is 4% world wide which comes out to be 40 million interpretive errors a year.  Errors in diagnostic radiology occur for a variety of reasons related to human error, technical factors and system faults. It is important to recognize that various cognitive biases contribute to these errors.    Cognitive biases have a complex and significant impact on the perception of examinations within diagnostic radiology, with the clear and present danger of diagnostic errors. The following are some of the more common cognitive biases that can affect day-to-day decision making Alliterative bias Alliterative bias (sometimes called satisfaction of report) is the tendency for your diagnostic impression to be unduly influenced by the prior interpretation made by another radiologist or clinician. It is a type of confirmation bias and it can result in the same incorrect impression being propagated from one radiologist to the next. Formulating your own interpretation before reviewing any prior imaging reports may help reduce alliterative bias. Anchoring bias Anchoring bias is the tendency for your initial impression to unduly influence your evaluation of subsequently collected information. Careful assessment of all imaging findings prior to formulating a diagnosis and consideration of alternate diagnoses may help minimize anchoring bias. Automation bias Automation bias is the tendency for reporters using computer-aided decision support to over rely on the software for the diagnosis, and to ignore their own opinions 2. Making your own assessment prior to reviewing the computer-aided findings, and knowing the limitations of the automated software, can help reduce this bias. Availability bias Availability bias refers to the tendency for your diagnostic judgements to be unduly influenced by information or experiences that are readily recalled in your mind. Use of information sources beyond your own personal experience, such as publications or an opinion from colleagues, may help to minimize availability bias. Bandwagon effect The bandwagon effect (sometimes termed diagnosis momentum) refers to the tendency for you to do or think as others do, simply because that's what others are doing. Applying your own judgment and not dismissing your own opinion can help avoid this bias. Confirmation bias Having a predetermined diagnosis in mind, then looking for evidence that supports this predetermined idea. Alliterative errors 3, sometimes referred to as satisfaction of report errors, are caused by the tendency to overvalue previous reports, and can be conceptualised as a type of confirmation bias. Framing bias Framing bias refers to the tendency to be unduly influenced by how a clinical question is asked or how the problem is presented. For example, a request form that presents a succinct history that perfectly matches a particular pathology, may influence your interpretation of the imaging. Reviewing the images prior to reading the clinical indication can help avoid any influence. Obtaining more detailed clinical information via the electronic medical record may help provide you with a more balanced assessment of the clinical situation. Hindsight bias Hindsight bias is the tendency to overestimate the prior predictability of an event (eg. a diagnosis) after the event is known. In other words, the difficulty of making the correct diagnostic decision initially is retrospectively de-emphasized, after the diagnosis has been proven. It is also informally termed as the "I knew it all along" or "retrospectoscope" bias 5. It is important to be conscious of this bias so that you are not overly critical of yourself or others when quite reasonable errors are made. Outcome bias A tendency to favor a less severe diagnosis based on empathy for a patient. Representativeness bias Making a judgment on an aspect of an image that is based on one's own perception of what that represents. Representativeness bias as the description suggest can also be heuristic in nature. Search satisfaction Search satisfaction is the tendency to prematurely stop searching after early findings satisfy the reader that the diagnosis or symptoms can be explained. Satisfaction of search (SOS) errors have been reported to account for 22% of diagnostic errors 4. A systematic approach to image interpretation and review of check areas and not-to-miss diagnoses can help to reduce this bias. Zebra retreat bias  A reader will not make a rare diagnosis, which is otherwise supported by the available evidence due to a lack of confidence.  There are businesses that do "second opinion" reads, here are links for two such companies for your use: www.ndximaging.com www.xmri.com ​ ​​​ ​ (Credits Radiopedia

This week we will discuss a debilitating neurological disorders of COVID-19 syndrome in survivors, the scope of SARS-CoV-2-induced dysautonomia (DNS) is yet to be understood, though the implications are enormous. Our guest today ended up with POTs (a form of dysautonomia) after receiving the first dose of the Pfizer vaccine.  Chelsea, a 21 yr old former nursing student was diagnosed after having so many symptoms she couldn't complete her studies.  Studies are just now surfacing that give credence to her claims it was the vaccine that made her ill.  Since the vaccine is very safe for the majority of individuals we would NEVER SUGGEST TO OPT OUT of the vaccine.  But knowledge is power, and researchers will find out more about this possible link thanks to stories like hers getting into the mainstream media.   Postural Orthostatic Tachycardia Syndrome or POTs is a debilitating condition  affecting the autonomic nervous system.    With neurocognitive impairments or "brain fog"; problems with body temperature regulation; gastroenterological symptoms like nausea, abdominal pain, diarrhea, or constipation; and dark red-blue discoloration of the legs being the most common symptoms. Some people with POTS also may have one or more associated conditions, including migraine, irritable bowel syndrome, and joint hypermobility syndrome.  Some people with POTs can have pre-syncope or syncope episodes where they feel like they might pass out or actually do pass out.  It's a serious condition that needs proper testing and follow up with a physician.