Critically Speaking

With our rapidly aging society, there is a growing question around what it means to be geriatric and what will happen to each of us when we reach that stage in our lives. Dr. Michael Harper has had a long and satisfying career in the field of geriatric medicine and, in this episode, brings his expertise and knowledge to the discussion. Unlike a lot of other specialities, in many medical schools, there is no specific geriatric training, other than end of life care,  It is also a field of medicine that has many fellowship training spots unfulfilled each year. Therese Markow and Dr. Harper discuss why this may be, as well as the growing needs of geratric patients. 

 Key Takeaways:

• There are a lot of variations in how we age and every person is different. As we get older, those differences become more stark than when a person was younger.
• Those in the geriatric speciality, have one of the highest career satisfaction ratings in medicine. 
• Geriatricians know how to keep people out of the hospital, how to prevent unnecessary care, and more, if we give them the chance to share. 

"We need to increase our exposure of young people, before medical school, to older adults." —  Dr. Michael Harper

Connect with Dr. G. Michael Harper:

UCSF Profile: Michael Harper, MD  

Book: Geriatrics Review Syllabus (10th Edition)

Connect with Therese:

Website:   www.criticallyspeaking.net

Twitter: @CritiSpeak

Email: [email protected]

Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.  

Dr. Christie Wilcox has had a lifelong love of animals and creatures, and not just those of the cute and cuddly variety. Her love of these creatures evolved into her academic and now professional career as an award-winning science writer, including the popular book Venomous. In this episode, Therese Markow and Dr. Christie Wilcox discuss the types of species that make venoms, how the venoms are delivered, and their modes of action on their victims.   We are aware of some venomous species, such as rattlesnakes or cobras.  But others are less well known, such as the platypus, and others exist, such as the mongoose, that are immune to venoms. 

 Key Takeaways:

• All animal lineages, with the exception of mammals and birds, contain venomous species.  
• All venoms are a cocktail of some kind, but the ingredients in the cocktail can range from a handful to thousands of different molecules. The ones that we care about can range from 1 to dozens, or even hundreds.
• Venomous animals are not out to get humans. A lot of times, they are trying to stay away from us.

"Not every bite or sting from a deadly species is going to be deadly. Some of that depends on the animal and what it delivers, where it delivers it, and how much it delivers." —  Dr. Christie Wilcox

Connect with Dr. Christie Wilcox:

Twitter: @NerdyChristie

Facebook: Christie Wilcox, Ph.D. 

Website: ChristieWilcox.com

Book: Venomous: How Earth’s Deadliest Creatures Mastered Biochemistry

Connect with Therese:

Website:   www.criticallyspeaking.net

Twitter: @CritiSpeak

Email: [email protected]

Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.  

In this episode, Therese Markow and Dr. Ed Vargo discuss all things cockroach, from the number of species, their lifespan and reproduction, as well as the relationship between cockroaches and humans.  Cockroaches don’t bite, but they can still transmit disease.  Because they spend time in sewers, many microorganisms, some pathogenic, are on their legs and bodies and can be transferred to food in the kitchen.   Dr. Vargo also discusses the ways in which cockroach traps and repellents do (or don’t) work and what we can do to minimize the risk of the allergens of cockroaches (especially harmful for those with asthma) in our daily lives. 

 Key Takeaways:

• The Antarctic research station may be the only place without roaches. Where people go, we tend to bring cockroaches with us. 
• Cockroaches can infest any house. If your house is tidy, you’re more likely to notice them and be able to stop them earlier.
• Boric acid is a non-toxic, effective insecticide. As long as it stays dry, cockroaches will walk on it, groom themselves, and ingest it where it acts as a poison. 

"Studies show that if you can control the cockroaches effectively, then you can eliminate the detectable levels of allergens fairly quickly, even without cleaning." —  Dr. Ed Vargo

Connect with Dr. Ed Vargo:

Texas A&M University: Urban and Structural Entomology Program at Texas A&M University

Connect with Therese:

Website:   www.criticallyspeaking.net

Twitter: @CritiSpeak

Email: [email protected]

Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.  

In this episode, Therese Markow and Dr. Gabriel Danovitch discuss the history of solid organ transplantation, how the organ donation list works, and the standards for donation, from both living and deceased donors. Kidneys are the most transplanted of solid organs.  In some countries, poor people are exploited to sell a kidney which is then used in a transplant tourist. With the Declaration of Istanbul in 2008, stronger standards were put into place to protect both the recipient and the donor involved in a transplant.  While this has helped reduce organ trafficking, certain countries are still exploiting underprivileged groups to sell their kidneys. Because genetic matching can be overcome by modern medicine, almost any healthy person can serve as a donor.  Dr. Danovitch continually reinforces the importance organ donation as a society value, and a value completely separated from any financial incentives.

 Key Takeaways:

• You do not need to be related to the recipient to be an organ donor, which simplifies this aspect of transplantation.
• At the same time, the incidence of end-stage renal disease is increasing owing to the obesity and diabetes epidemic, and thus the need for donors also has increased.
• Willing organ donors have better mental and physical outcomes than individuals that sold an organ.

"A donor needs to be healthy and motivated, and then we can find a way to make that transplant happen, whether they’re matched or not." —  Dr. Gabriel Danovitch

Connect with Dr. Gabriel Danovitch:

David Geffen School of Medicine

University of California at Los Angeles

[email protected]

United Network for Organ Sharing: UNOS.org

Connect with Therese:

Website:   www.criticallyspeaking.net

Twitter: @CritiSpeak

Email: [email protected]

Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.  

In this episode, Therese Markow and Dr. Ben Albensi discuss the different types of dementia (now officially known as neurocognitive disorders) as we currently know them. With almost 50 million cases worldwide, and a new diagnosis every 3 seconds, it is important that we know what we can do to identify, treat, and potentially even slow down dementia – all of which are discussed in this episode. It has only been in the last couple of years that the amount of funding for dementia and Alzheimer’s research has increased, though it is still lower than the research funding for cancer and heart disease related research. It is vital that we all do what we can to create a dementia-friendly community and support the research being done to help us learn more about the differences of the types of dementia, the differences between the sexes and races, and other information currently being studied that we are still learning about.

 Key Takeaways:

• Aging is the greatest risk of dementia; however, it is not always associated with aging.
• There is no cure for dementia. There are some drugs out there, but they are not effective for all patients.
• If you follow the advice of four or five good health choices, you can lower your risk of dementia by up to 60%. The one thing that may be the most important is lowering your blood pressure.

"Like we learned in cancer therapy, we need to treat different types of Alzheimer's disease or dementia differently. I think that we're going to have an improvement in the effectiveness of these drugs once you're able to discriminate the type of dementia people have more accurately and also earlier." —  Dr. Ben Albensi

Connect with Dr. Ben Albensi: 

Hôpital St-Boniface Hospital Profile: Dr. Benedict C. Albensi  

Email: [email protected]

Cell Phone: 973-668-0206

LinkedIn: Benedict C. Albensi, PhD, BCMAS, CRQM

Twitter: @balbensi & @albensiconsult

Connect with Therese:

Website:   www.criticallyspeaking.net

Twitter: @CritiSpeak

Email: [email protected]

Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it. 

In this episode, Therese Markow and Paul Irving, Chairman of Milken Institute Center for the Future of Aging, discuss the changing landscape of aging and retirement. How has aging changed throughout recent history and what are the challenges that we, as a society, face looking towards the future with the changing family, economic, and society dynamics? We can’t ignore the realities of aging, but we also need to acknowledge the thought patterns and attitudes and how they negatively affect the workforce and society. They continue on to discuss the need for a national conversation on health and what we, as a society, owe to one another.

Key Takeaways:

• Most of us will, at some point in our lives, be caregivers, need care, or both, and most services are not covered by Medicare.
• Ageing is the one characteristic we all have in common. While we live in a society today that protects against racism, sexism, or other discrimination, the same is not true for people 50 and over. False assumptions regarding the capacity and ability to engage and contribute is something that needs tackled by all of us.
• A majority of older adults are fully able to engage, provide value, and offer wisdom, judgment, and experience that adds meaningfully to workplaces, academic institutions, communities, and families. 
• The question about the composition of workforces and how you enable, support, celebrate, and capitalize on the assets of older workers will be the differentiating factor between success and failure for the 21st century.

"Ageism is just as insidious and just as destructive and just as hurtful as racism, sexism, and other forms of bias and discrimination." —  Paul Irving

Connect with Paul Irving:

Milken Institute: Paul Irving   

Book Recommendation: Man’s Search for Meaning by Viktor E. Frankl

Connect with Therese:

Website:   www.criticallyspeaking.net

Twitter: @CritiSpeak

Email: [email protected]

Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it. 

Dr. Adam Schiavi is an assistant professor of anesthesiology and critical care medicine and neurology at the Johns Hopkins University School of Medicine. His areas of clinical expertise include anesthesiology, neurological critical care, disorders of consciousness and brain death diagnosis, clinical ethics, critical care medicine, and traumatic brain injury.

In this episode, Therese Markow and Dr. Adam Schiavi discuss how the definition of death has changed throughout history, what the current definition is, and how that is determined by the medical technology of the time. Brain death is the current definition of death, medically, but what happens to a body after brain death is determined can vary depending on the state you live in. This can be a trying time for families and for the providers involved with the now-deceased patient as the definition of death is not understood by everyone. They also discuss how brain death differs from other states of consciousness and how people often confuse the terminology of those different states, as well as the ability to hope for healing from all but brain death.

 Key Takeaways:

• The total cessation of all functions of the brain is the current definition of brain death in the United States. This definition is based on a clinical exam testing all parts of the brain, typically done by somebody certified in doing brain death determinations.
• You have to have a reason for the neurologic exam to be declining. Without a reason, you can't call somebody brain dead.
• You can replace every organ in the body, but you cannot replace the brain and when the brain dies, the body dies all the time 100% unless those organ systems are artificially supportive. 

"Our culture changes with technology and the way we define death is a part of culture. As that culture has shifted, the way we define death has also shifted with our new technologies of how we can actually determine whether people are dead." —  Dr. Adam Schiavi

Connect with Dr. Adam Schiavi:

Johns Hopkins Bio: Adam Schiavi, MD, PhD, MS

Email: [email protected]  

Connect with Therese:

Website:   www.criticallyspeaking.net

Twitter: @CritiSpeak

Email: [email protected]

Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it. 

In this episode, Therese Markow speaks with Dr. Michael Fratkin, a board certified palliative care physician in California. Throughout the episode, Dr. Fratkin discusses what palliative care is by the standard definition and what it means to him, his team, and their patients. They explore the use of technology in medicine, which is growing by leaps and bounds, including in palliative care, to enhance the care received by those in need, whether for a short-term or a long-term illness.

 Key Takeaways:

• Dr. Fratkin’s definition of palliative care is composed of 3 things: 1. People, not patients. 2. Symptom control and support for quality of life. 3. Navigation and coordination to integrate our work with everything else you might be receiving in health care.
• Palliative care is more than just end of life care. It can be for people anytime they’re confronted with an illness.
• Modern technology allows those in palliative care to connect with their team members without leaving their homes, to complete a high value engagement. Leaving home for medical visits expends more energy, with the risks of falls and exposure to sick people in a waiting room.

"We're all professionals focused on quality of life and the lived experience of human beings while they’re facing serious illness and we're all incredibly, impeccably trained." —  Dr. Michael Fratkin

Connect with Dr. Michael Fratkin:

Twitter: @MichaelDFratkin

Facebook: ResolutionCare

Website: ResolutionCare.com

Connect with Therese:

Website:   www.criticallyspeaking.net

Twitter: @CritiSpeak

Email: [email protected]

Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.

In this age of smartphones and social media, people of all ages spend lots of time staring at screens, both for practical and social purposes. With this increased use in screen time, comes the question of how this use affects and influences the user’s brains. Therese and Dr. Turel discuss some of his ongoing research into how excessive social media use and social media addiction affects the brain, particularly the reward system in the brain, and what we are now beginning to understand as the interaction between social media, and technology in general, on the brain and brain development.

 Key Takeaways:

• There is  a fine line between social media addiction and excessive social media use that is not an addiction.
• Excessive media use, at least in the college students sampled, is associated with significant changes in the brain
• The brain,  especially the reward system in the brain, is very flexible – it can shrink, be pruned, and grow back based on behavior.
• Using your phone, such as for social media, in bed before sleep affects sleep quality and reduces sleep time, which has further implications on health such as excessive eating, increased appetite, and obesity.

"We do not know if social media use has led to these brain changes, or rather, existing brain changes or differences have led to different social media use patterns. So, it's a chicken and egg type of question that is very difficult to address in research." —  Dr. Ofir Turel

Connect with Dr. Ofir Turel:

Dr. Turel’s Bio: Ofir Turel, PhD   

Connect with Therese:

Website:   www.criticallyspeaking.net

Twitter: @CritiSpeak

Email: [email protected]

Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it. 

Today's guest is Dr. Dennis Orgill, award-winning Professor of Surgery at Harvard University and Director of the Wound Care Center at Brigham and Women's Hospital in Boston.  Dr. Orgill recently reported an increase in the number of patients coming to the hospital with complications from cosmetic surgeries performed abroad. Medical tourism may seem like an inexpensive way to have certain procedures, but the complications can be very serious as well as costly.  Therese and Dr. Orgill discuss the problems observed in returning medical tourism patients.

 Key Takeaways:

• Common procedures sought abroad include breast augmentation and abdominoplasty. 
• While foreign countries have many excellent cosmetic surgeons, some have no regulations and clinics are substandard in a number of ways.
• Medical tourism websites present very positive before and after images and the average patient is unaware of what safety standards govern a particular clinic.
• Infections, many highly resistant to antibiotics, and failure of wounds to heal, are the most common medical issues seen in returning patients in the Boston area. 

"If you go outside the US, in many countries, they do not have the same infrastructure, the same quality control mechanisms that we have to assure safety." —  Dr. Dennis Orgill

Connect with Dr. Dennis Orgill:

Brigham & Women’s Hospital Bio: Dennis Paul Orgill, MD, PhD   

Connect with Therese:

Website:   www.criticallyspeaking.net

Twitter: @CritiSpeak

Email: [email protected]

Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.