Lunch and Learn with Dr. Berry

This episode on the Lunch and Learn with Dr. Berry is a follow up to episode 138 where we learned about the origin of the motto & why I have dedicated my life to saving the lives of others by instilling in them the confidence to take control of their health care.

On today's episode I explain exactly what it means to level up your health care and how those in the Lunch and Learn community can soon become masters of their own health.

Also get an exclusive download with today's episode so you can get keep a cheat sheet on the different levels of success.

Text LUNCHLEARNPOD to 44222 to join the mailing list.

Remember to subscribe to the podcast and share the episode with a friend or family member.

Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify

Sponsors:

• Lunch and Learn Community Online Store (code Empower10)
• Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you)
• Dr. Pierre's Resources – These are some of the tools I use to become successful using social media
• My Amazon Store – Check out all of the book recommendations you heard in the episode

Social Links:

• Join the lunch and learn community – https://www.drberrypierre.com/joinlunchlearnpod
• Follow the podcast on Facebook – http://www.facebook.com/lunchlearnpod
• Follow the podcast on twitter – http://www.twitter.com/lunchlearnpod – use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast
• For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drberrypierre.com/lunchlearnpodcast/

If you are looking to help the show out

• Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better
• Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod

Download the MP3 Audio file, listen to the episode however you like.

Download Episode 139

Here we go, you ready for Season 4?

Welcome back Lunch and Learn Community!!!

I am so happy to be bringing you along for another season of great content, amazing guests and opportunities to help you Empower Yourself For Better Health. This is the first episode of the new season and we are back to bring you more amazing educational content to help you learn, educate and empower.

This episode will serve as an introduction to many as I discuss just why I do all the things you see here before you. Its a powerful story but one that will remind you that you have to push through the tough times to get to the better ones.

Text LUNCHLEARNPOD to 44222 to join the mailing list.

Remember to subscribe to the podcast and share the episode with a friend or family member.

Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify

Sponsors:

• Lunch and Learn Community Online Store (code Empower10)
• Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you)
• Dr. Pierre's Resources – These are some of the tools I use to become successful using social media
• My Amazon Store – Check out all of the book recommendations you heard in the episode

Social Links:

• Join the lunch and learn community – https://www.drberrypierre.com/joinlunchlearnpod
• Follow the podcast on Facebook – http://www.facebook.com/lunchlearnpod
• Follow the podcast on twitter – http://www.twitter.com/lunchlearnpod – use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast
• For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drberrypierre.com/lunchlearnpodcast/

If you are looking to help the show out

• Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better
• Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod

Download Episode 138

Download the MP3 Audio file, listen to the episode however you like.

On this week's episode of the Lunch and Learn with Dr. Berry I am back with a final solo episode to end season 3 on such an amazing note. Learn what spurred on some of the changes we made from season 2 to season 3. Want to hear about the ups and downs of the year then this episode is the one to listen to.

Most importantly listen to the episode to know what is in store for the Podcast for season 4. I would like to take the time out and say that the support you have continued to show has been amazing and I hope that I can continue to earn your support over the next year.

Text LUNCHLEARNPOD to 44222 to join the mailing list.

Remember to subscribe to the podcast and share the episode with a friend or family member.

Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify

Sponsors:

• Lunch and Learn Community Online Store (code Empower10)
• Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you)
• Dr. Pierre's Resources – These are some of the tools I use to become successful using social media
• My Amazon Store – Check out all of the book recommendations you heard in the episode

Social Links:

• Join the lunch and learn community – https://www.drberrypierre.com/joinlunchlearnpod
• Follow the podcast on Facebook – http://www.facebook.com/lunchlearnpod
• Follow the podcast on twitter – http://www.twitter.com/lunchlearnpod – use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast
• For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drberrypierre.com/lunchlearnpodcast/

If you are looking to help the show out

• Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better
• Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod

Download the MP3 Audio file, listen to the episode however you like.

On this week's episode of the Lunch and Learn with Dr. Berry we have Maria Davis-Pierre, LMHC, CEO of Autism in Black. She returns to give us the latest update on what has been happening with her company Autism in Black since the last time she was on the show as well as give us an update on our daughter and her progress through the school system.

As one of our favorite guests of the show (no bias of course) she also drops some amazing news on us so please stick around till the end to find out what she has in store for those in the Autism community.

Text LUNCHLEARNPOD to 44222 to join the mailing list.

Remember to subscribe to the podcast and share the episode with a friend or family member.

Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify

Sponsors:

• Lunch and Learn Community Online Store (code Empower10)
• Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you)
• Dr. Pierre's Resources – These are some of the tools I use to become successful using social media
• My Amazon Store – Check out all of the book recommendations you heard in the episode

Links/Resources:

• Self Care book - www.autisminblack.org/selfcarebook
• Pay Hip Store - www.autisminblack.org/payhip
• Instagram - www.autisminblack.org/instagram
• Facebook- www.autisminblack.org/facebook
• Teespring - www.autisminblack.org/teespring
• Facebook Group- www.autisminblack.org/fbgroup

Social Links:

• Join the lunch and learn community – https://www.drberrypierre.com/joinlunchlearnpod
• Follow the podcast on Facebook – http://www.facebook.com/lunchlearnpod
• Follow the podcast on twitter – http://www.twitter.com/lunchlearnpod – use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast
• For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drberrypierre.com/lunchlearnpodcast/

If you are looking to help the show out

• Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better
• Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod

Download Episode 136

On this week's episode of the Lunch and Learn with Dr. Berry we have Dr. Sylvia Gonsahn-Bollie, is a dual Board Certified Internal Medicine physician and Obesity Medicine Specialist with a passion for promoting helping busy people especially working women obtain their happy, healthy weight through honesty and hope. Personally Dr. Bollie has lost 40lbs twice and maintained her weight journey for over 5 years through overcoming emotional eating by maintaining a holistic, healthy lifestyle that includes prioritizing her Faith, family time, fitness (especially running), friendships and delicious healthy food.

She is one of the favorite guests of the show and joins us to help save us from ourselves for the holidays. On today's show she talks about the importance of understanding that temptation is natural and WILL occur but as long as you remember why you made the lifestyle changes you did then everything will be ok.

Text LUNCHLEARNPOD to 44222 to join the mailing list.

Remember to subscribe to the podcast and share the episode with a friend or family member.

Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify

Sponsors:

• Lunch and Learn Community Online Store (code Empower10)
• Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you)
• Dr. Pierre's Resources – These are some of the tools I use to become successful using social media
• My Amazon Store – Check out all of the book recommendations you heard in the episode

Links/Resources:

• Official Website
• Facebook
• Twitter
• Instagram

Social Links:

• Join the lunch and learn community – https://www.drberrypierre.com/joinlunchlearnpod
• Follow the podcast on Facebook – http://www.facebook.com/lunchlearnpod
• Follow the podcast on twitter – http://www.twitter.com/lunchlearnpod – use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast
• For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drberrypierre.com/lunchlearnpodcast/

If you are looking to help the show out

• Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better
• Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod

Download the MP3 Audio file, listen to the episode however you like.

On this week's episode of the Lunch and Learn with Dr. Berry I am back with a solo episode and this time I want to talk to you all about my experience over the past 3+ plus as a patient instead of the physician. For those who may already follow me on my instagram patient this is more of a refresher but as I know that there are many who do not, I talk about what it was like suffering a broken leg and having to deal with the health care system on the other side of the coin.

Its always great to start with a backstory so you are going to hear how I ended up in this predicament in the first place, some of the best purchases I made during all my free time and what I learned from the experience.

Text LUNCHLEARNPOD to 44222 to join the mailing list.

Remember to subscribe to the podcast and share the episode with a friend or family member.

Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify

Sponsors:

• Lunch and Learn Community Online Store (code Empower10)
• Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you)
• Dr. Pierre's Resources – These are some of the tools I use to become successful using social media
• My Amazon Store – Check out all of the book recommendations you heard in the episode

Links/Resources:

• Instagram

Social Links:

• Join the lunch and learn community – https://www.drberrypierre.com/joinlunchlearnpod
• Follow the podcast on Facebook – http://www.facebook.com/lunchlearnpod
• Follow the podcast on twitter – http://www.twitter.com/lunchlearnpod – use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast
• For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drberrypierre.com/lunchlearnpodcast/

If you are looking to help the show out

• Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better
• Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod

Download Episode 134

On this week's episode of the Lunch and Learn with Dr. Berry we have Dr. Nina Lum, is a board-certified Family Medicine Physician who currently works as a Hospitalist and the Chief Quality Officer at CHI St. Joseph Hospital. Dr. Lum is a co-author of the best selling medical anthology "The Chronicles of Women in White Coats" and recently the visionary, co-creator and co-author of the Amazon bestseller "Beyond Challenges: Survival Stories of African Immigrant Physicians". On this week's episode, we talk about her work on theencouragingdoc.com and how her work as the IMG Coach came about.

We also will be taking a deep dive on what motivates her to help so many find success on the path to medicine as an international medical graduate.

Text LUNCHLEARNPOD to 44222 to join the mailing list.

Remember to subscribe to the podcast and share the episode with a friend or family member.

Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify

Sponsors:

• Lunch and Learn Community Online Store (code Empower10)
• Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you)
• Dr. Pierre's Resources – These are some of the tools I use to become successful using social media
• My Amazon Store – Check out all of the book recommendations you heard in the episode

Links/Resources:

• www.theencouragingdoc.com
• Beyond Challenges Book
• Instagram

Social Links:

• Join the lunch and learn community – https://www.drberrypierre.com/joinlunchlearnpod
• Follow the podcast on Facebook – http://www.facebook.com/lunchlearnpod
• Follow the podcast on twitter – http://www.twitter.com/lunchlearnpod – use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast
• For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drberrypierre.com/lunchlearnpodcast/

If you are looking to help the show out

• Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better
• Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod

Download Episode 133

Episode 133 Transcript...

Introduction

Dr. Berry: Hello and welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com, as well the CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, education and affirmation. This week we bring you another amazing guests on the podcast. We have Dr. Nina Lum who is a hospitalist and Chief Quality Officer at chai CHI Saint Joseph Hospital in London, Kentucky. Board Certified Family Medicine Physician. She's also co-author of the bestselling medical anthology, The Chronicles of Women in White Coats as well as the co-creator and co-author of the Amazon bestselling book Beyond Challenges: Survival Stories of African Immigrant Physicians. She blogs on theencouragingdoc.com. She writes, she coaches for international medical students and graduates on how to have successful blueprints for their unique pathway into this field, crazy field we call medicine.

She is a credo. Also an online course coaching platform for IMGs, notice IMG roadmap, at imgroadmap.com and she's a featured health and wellness speaker. And guys, this is an amazing episode with a person I've been following along. Actually had the chance to jump on her IMG roadmap series to talk to them with IMGs and other medical graduates and people who are getting ready for a residency about successful tips on the ERS application as well as interviews. And I have her on the show today really to give us an interesting perspective on international medical graduates, their path, their struggles, and why, especially in this day and age where we're seeing just the shortage of physicians out there and of people who want to become physicians. Why that, there may be a solution on our horizon, but unfortunately it is a lot of roadblocks in the weight.

We're going to talk about some of those roadblocks. She gonna talk about her experience with creating her second Amazon bestselling book Beyond Challenges: Survival Stories of African Immigrant Physicians. What motivated her to drop a second book and what to expect from her from the rest of the year. So guys, get ready of course for another amazing episode. If you have not done so, already make sure you hit that subscribe button wherever you're listening to. If it's on YouTube, if it's on Apple podcast, Google play, Stitcher radio, Spotify, wherever you listen to remember to hit the spot. Remember hit the subscribe button so you'll always be in tune with what's going on here on the Lunch and Learn with Dr. Berry and leave us a five star review, especially from Apple podcasts users and make sure you tell 10 friends about this amazing episode. Let's get ready for another one here with Dr. Berry

Episode

Dr. Berry: Alright Lunch and Learn community, I want to thank you for joining us for another amazing podcast and I have an amazing guests who have definitely been excited and earmarked to get a chance to talk to you guys for many different fronts. For those who know Lunch and Learn community, especially on my listeners. I actually had the honor of being a guest on her video show that sponsored and talked about just the tips and tricks of getting into residency. Definitely was excited about that. So again, Dr. Lum, thank you for joining today's podcast on Lunch and Learn with Dr. Berry.

Dr. Nina Lum: Thank you so much for having me. It's an honor actually to be on your podcast. I enjoy it.

Dr. Berry: So I have an introduction, but I have people who already know, they like to skip and get to the meat of the episode. I think they'd like to skip a commercial. I'd do a little mini commercials. Tell us a little bit about yourself that I may have missed in a bio or they would have known outside of what we've got in your bio.

Dr. Nina Lum: I'm Nina Lum. I am originally from Cameroon. I currently practice hospital medicine in Kentucky. My background is in family medicine. I'm also in hospital administration as a chief quality officer at a community hospital here in Kentucky. More recently, I guess what's more exciting is that I have my second book out, the book collaboration, titled Beyond Challenges. And so that makes me a second time bestselling author, which is pretty surreal. And I also spent some time blogging. I'm at theencouragingdoc.com. A lot of my content is focused on for medical graduates like myself because not only being an international student when I moved to the States, but I also most of the Caribbean for medical school. So that makes me as sort of a foreign and international graduate. And it's a soft spot in my heart and I want to share with other people just tips and tricks that I learned along the way. I do enjoy traveling, shopping. I do enjoy learning about personal finance and applying that in my life and seeing where that takes me. So that's me in a nutshell.

Dr. Berry: I love it. And we're definitely going to deep dive in all of your business. I just want to put out there right now because I want to know and for those especially Lunch and Learn community, I always get excited talking to them. Sometimes I think I'm more excited than my Lunch and Learn community, just talking to some of the amazing guests who are doing just still amazing things and things that, yes, you're a physician, but just outside of being a physician, Docs Outside the Box. Shout out to Dr. Darko, a good friend of mine as well too. I just love highlighting everything that you do and I want to tell Lunch and Learn community full disclosure, I've been following you for a while. And I knew you as I seen people were sharing it, people commenting and people are like, oh, this IMG coach. That's how you were dubbed when someone said I should follow you, the IMG coach. If you are an IMG and you're trying to get to where you're at. That's the person you need to follow.

And as a program director of an internal medicine residency program and understanding, and I'm pretty sure we probably get a similar, the same types of questions over and over again. I was definitely enamored, not only by what you do as far as coaching, interview and consulting and everything else. But really I could, as a physician, it's very easy to spot compassion. And that was something that I realized right off the bat, this was something that you love doing. It wasn't something that I'm just going to do it because I got the ability to do it and people gonna pay me to do it. I'd do it because I actually love doing it. So let's talk a little bit about just where that compassion came from and what made you want to start even doing it? Because again, you could have been a physician hospitalist quality because you gotta just did that and been perfectly fine. Right? (Yeah). But you're stepping outside of yourself and say, you know what, I'm going to do extra work because not only did I get through the door, but I want to hold it open for others behind me.

Dr. Nina Lum: Yeah. A strong point. And I just want to let the Lunch and Learn community know that the interview that you did with me, I am pretty confident has it got the most hits on my blog for several months.

Dr. Berry: Wow. Ok. I loved it. Lunch and Learn community I didn't even pay her to do it.

Dr. Nina Lum: No tips involved. But seriously just being able to give them that perspective from your position of authority as someone that's on the other side and in more ways the target audience for these IMG. That was invaluable information. The comments, the reviews I got, the feedback. A lot of people came out and said that was the best interview in a long time. Because it was so packed with good information and I know people that actually went back and worked in ERS applications a little bit differently after interview. So just want to put that out there. (Thank you very much). You indirectly impacted my community as well. So we appreciate you for that.

Dr. Berry: Thank you very much for that. Like I say again, it was something that I almost, its crazy Lunch and Learn community I felt obligated. I had to do it because just because I saw just how much she loved doing it and I felt like, you know what, let me try to give it my all because I want to put as much energy and effort that she's doing to help her community. And also again, really, really thank you for the kind words.

Dr. Nina Lum: Yeah, you're welcome. So back to your question was about the passion. I think, the shoe hurts where, oh they say, you feel the pain where it fits or whatever, do you know that adage. So that's sort of my story. It's like I know where it hurt when I was a student and right before applying into residency. And so I never, at that point in time, I didn't even think about ever doing this because I never told anybody anything. I just kept it to myself. I kept my struggles with myself. I'm one of those weird people who never had a true mentor, which is something that right now I'm like, what was I thinking? And that's why I extend myself so much to other people. But I just did not know that there was so many other people out there except for those that were in my school who we were all struggling together, that we're dealing with the same challenges that I was facing. And I feel like mine was a little bit different again to most IMGs. Most IMGs are actually US citizens that moved to the Caribbean for school temporarily and then then moved back home.

Well, I was a little bit different from that because I was, I'm not a US citizen. I'm a citizen of Cameroon, lived there my whole entire life. Studies there out of my undergrad. Moved to the Caribbean really for medical education and then from there transition state. So it was like being in the States was new for me for one. And then second, I didn't understand the immigration system at all. So I didn't understand that that came with its own challenges. And then you put me again in the US system trying to compete to get into residency and not really understanding the process. I don't know how I did it all, but I didn't have any delays in getting into residency specifically for me, but it very well could have been the case.

Dr. Berry: And that's all confident Lunch and Learn community because I don't know if you guys understand just the level of barriers. I hate to call them barriers, but really they are, that are placed in front of many who are trying to get into this profession and have the passion and love, but it's so many steps that they forced them to take just to get here. So I really want you guys to really take a deep dive and understand she had to do all of that to get to where she's at. And while you're doing, it's almost like a blurry, like, oh my God, I can't believe I have to do all of that when look back at it.

Dr. Nina Lum: And I think also, it's important to point out that for a lot of my colleagues who, like yourself and people that are from here and maybe trained here and didn't have to deal with the other side of those things, it's like, it's almost oblivious. You don't believe that it happens until you know somebody personally that's been through it. So it's one of those things where I just want to point that out that sometimes a lot of times I talk to my coworkers, they don't really understand the process, but they've seen me walk through it over the last few years and they're like, oh my God, I can't believe you had to do X, Y and Z, just to practice medicine here. The rest of us it's usually just pass your boards, apply, and get in.

But then when you add the layers of visas and different things that come with that financial constraints, not being able to team any kind of financial aid for school and such, those things do add up and they have a lot of stress on the students, especially the IMGs. So anyhow, based on my personal struggles with primarily just the maneuvering to be sub-process and then various financial hurdles that I had to with that process. And even just the complexity of not understanding ERS when I went through it, my personal statement was whack.

Dr. Berry: You ever look back again.

Dr. Nina Lum: I always joke about that. I don't know who will read this thing. I thought it was good. I didn't have anybody proofread it. I just wrote it and submitted it. My ERS application, I didn't even think to include certain things that would actually work that I've done. When it comes to educational posters, publication, presentation, I didn't even count. I didn't count my own work as solid enough to go on that portion of the application. So lots of emissions, loss and mistakes. Gracefully got a few interviews, whether on the interview trail, learned on the interview trail too because my press interview was crazy. And then by the time I got to the second one, it got better and such. But that just being said, its lessons I learned the hard way.

I felt like once I became an attending actually, and had no intention of sharing this ever. But once I became an attending and I was working in rural Kentucky and I just had some more time on my hands doing the seven on, seven off. And I thought, I've always how to blog but never really opened up about the truth behind who I was on that blog. And I started to glow more about the struggle and that seemed to resonate with a lot more people. And I started getting emails or messages asking for more information or advice and tips. And I thought, everybody's on Instagram these days. I used that platform to speak a little bit more about the struggle side and the more I opened up the more I realize there were more people that identified with that pain point and that just really helped me get a message out to them.

Dr. Berry: And what I love is because your story, especially as a physician isn't unique in that we'll go through a struggle and just in our level of training, we're not necessarily taught to publicize it and we're taught to internalize that we're the only ones going through that struggle. When you started blogging, you were like, oh wow, people are actually like gravitating to it. Is because a lot of us are sitting in the back like, oh, well I'm going through the same thing, but like one, I don't want to be like, I'm the only one doing it. Or like, oh, it's just me and like I need to kind of fix myself. So I love just that aspect of understanding that yes, it's not unique to keep it to yourself because that's probably been one of our biggest issues. I guess I like to say as a physician that we don't tell the people behind this like, hey, this was hard, right? I tell people all the time, I've failed multiple levels. There's not a level that I didn't fail at. But I just kept going. But like me telling you, I felt hopefully gives you a glimmer of light. So if you do trip, you understand it isn't an end in the world.

Dr. Nina Lum: Correct. I think in a sense we're almost preaching a different kind of healing when we share these stories. It's not necessarily that bedside healing, but it's actually, I think maybe in carries some stronger value because if you're able to get one more physician who was well-meaning, intelligent, and able enough to practice, that person's going to touch a lot more lives than you alone could as a physician. I think teaching other people how to cope when we do these things. And by sharing our stories with teaching other people how to, in many ways deal with the diverse challenges that are bound to come. But then more importantly, we're sort of replicating ourselves in a sense of they'll still continue to spread the message.

Dr. Berry: So as you're blogging and you're realizing that you're picking up steam and now people are reaching out to you and say, hey you know, I have that question too. Or hey, I have a question could you answer. Was that something in your element were you used to being more and more public, more out there, or are you even as we speak more of the reserve type, like you'd rather just chill with your own but because of the platform that you've built, you're forced to be out there a little bit more?

Dr. Nina Lum: So I will definitely say, people that knew me when I was a younger person would say I was very reserved, initially. But I think part of the self-development that has occurred in the last few years, which I think some of it has to do with medical training, it just pushes you out of your comfort zone period. But beyond that I have sort of just really transformed into an extroverted human being, but I still believed that it was a great component to me that's introverted in the sense that, I'm actually right on when it comes to certain things like talking about this IMG struggle right now. I can talk about it all day. But certainly there are other parts of my life that I'm probably still very introverted in. So I think because of the need, I've learned to adapt to meeting the need. But it's been a great process for me, so it doesn't make me uncomfortable necessarily, but I can see where if this was another area of my life or probably would be uncomfortable with it. You see what I'm saying?

Dr. Berry: I totally, totally agree. I think I run in that similar ilk, especially when I tell people like, oh yeah, I got a blog and a podcast and do video, but I might try to keep to myself, they almost can't believe like, oh ok, I'm very sure.

Dr. Nina Lum: Yeah. Right. I think people expect it to just be Dr. Berry that we see on the internet and they don't realize that maybe Dr. Berry has several interests in and there's different parts of Dr. Berry that we don't see on. And so when we see one part, we tend to think that's the person all the time which isn't always true.

Dr. Berry: So as you're gaining the interest and gaining some of the fanfare, and I guess recognizing that you have something that people want. How was that transition like? Was it a simple one especially for these past couple of years especially when you say like, yeah, I have no problem coaching you or I have no problem, what was that transition?

Dr. Nina Lum: I think it started first within me, the transition I would say. So I had to figure out how to coach people. And these days you can go, there's so many courses you can take on coaching right from the comfort of your own room. For me, I decided to read up more about it. I realized the best way to do it is to first look within myself. And so I started reading a lot more personal self-development books and that really helped me resonate with sort of a gifts that I think I've always had which is I believe personally, and I think my family will probably attest to this, that I do have a gift in helping people identify their purpose and their goals. And so I just help people streamline things that they want and make it more attainable for them.

Maybe that's an actionable steps that they can take. And so that's something I've always done for my friends and my family, but I never thought of it as something that was a gift or something that I could use on a larger scale platform like what I'm doing now with coaching people that are international students or graduates from medical schools. And so I think it's just been more of that fine tuning process, which I'm still in a growth process anyhow. So I believe that it's just been more of a growth process. When you figured out, okay, maybe I have a gift here or a talent here, the best thing you can do is sharpen it. Make it better. Talk to people that are better than you what you're doing. Talk to other coaches, read material written by coaches that you admire.

Watch the videos that you can find. There's tons of videos on coaching, everyone in internet, this online courses you can take. And so those things just help develop, gives the other people have seen naturally in you. So that's been really my transformation has been taking what I've always heard compliments about. Like, hey, you're really good at helping people figure stuff out. Or hey, you're really good with creating new ideas. You're like an idea queen or something. So I've heard those kinds of comments from people that know me on a really personal basis. And so I just took that and sort of ran with it and said, hey, how can I make this better for the people? How can I become an expert at it or maybe more professional with my approach? And a lot of that has come with just more of what I would call a personal development plan.

Dr. Berry: Can you talk about maybe, especially during this transition, some of the highlights and even low lights as you've gained traction in what you've been doing?

Dr. Nina Lum: There are a few things as far as highlights. The highlights are really the people that I get to impact. So, right now I have people that have coached that are currently in training, some are looking into fellowship applications this year. So it makes me feel very fulfilled in that is when I see people that actually worked with, is actually few that have lived in my house with me. Maybe they came by to observership and I housed them and walk them through that process, viewed the application and it had a person's statement and walk them through the interview process and all that. And now they're looking into the third year of residency and applying for other things. And I'm like, oh my gosh, you're my first experiment so to speak. And so that's my highlight is, is those doctors, male, female, different countries and just like, wow.

This is actually something that you can do Nina. So it's been a good encouraging force we need to watch. Low lights, I would say have to deal with, sometimes it gets exhausting just honestly, because when you give a lot of yourself, it was about self-care and sometimes self-care is being still and just minding on business. But when you give a lot of yourself out to people, you actually spend a lot of emotional energy and that is something that you cannot, nobody can award that to you. You just have to recover from it. You recuperate and get back up and sort of fill your tank and so what I like to call it. And then you can help more people because if your glasses empty, you can't pour onto another person's cup.

So that's sort of been, maybe the little lights is those moments where I get low on fuel and I had to step back and recharge. And that may mean, I don't coach for a season or I only keep with the people that I have and not take any new people in. Or it may just mean that I call my folk fewer times and I usually would schedule coaching calls with them and said, well, sometimes they may just mean that I take a vacation for a week and unplug and come back. So it just varies, it just varies sometimes. But I would say that's the biggest, I would say the low light. Another thing can be maybe just comparing yourself with other people that are maybe doing different kinds of coaching programs and feeling like maybe you're not that far advance. And that's just something that comes with what I've realized every just every great thing you're going to feel a certain type of way that you just have to move beyond your feelings and look at the impact that you actually have on individualize.

Dr. Berry: Very true. And what I love about it is that be open because it's such an active process. It's active process when coaching right? When it's active process, when you're having to withdraw as well. And I'll be honest with you, Lunch and Learn community, I do send a lot of people towards their way, because if I get it so much and maybe I feel like they had imposter syndrome too. I'm like, well, you know what, as a former medical grant, I got this perfect person for you. I know this is the person, so I do send a lot of people. So I got asked, but that's me now.

I haven't ever remember, oh I have to be mindful. She is only one person. I gotta be mindful that we're not draining you too much because you have such a gift. Like I said, because when we did our interview, I saw the comments and I was like, wow, they are really like, one, how enamored they were and how intended they were. You could just tell like, oh, they were like thank you. They're not just like, just having a conversation that would just glad I was able to get.

Dr. Nina Lum: I had people taking notes and coming back and weeks after with notes saying, remember the interview you did with Dr. Pierre, you said such and such and such. And he said such and such and such. Do you think I should do X? And I was like, wait, I don't remember talking about that. So you have people taking notes. I mean, it's a serious deal, but I just want to put this out there. If anybody's listening and they feel like they wanted to reach out to me. I don't want it to sound like, they don't need to be worried about burdening me or anything like that. They can always just, I mean, I respond to emails usually in those periods where unplug. You get an email stating I'm taking a break for X five days and I'll get back with you whenever I get back. But that's usually how it works. So there's some close with communication there.

Dr. Berry: Nice. Okay. And remember Lunch and Learn community, we're going to make sure, and whoever's listening, we're gonna make sure that you have all of our kinds of information to bombard her, to follow her, to make sure you stay up with her because again, she is definitely want, like I said, I'm all over. I'm watching, I'm watching her stories. I'm watching her. I'm watching because I want to see not only how she doing it, but again, if there's something where I can improve on myself and just the position I am, I definitely will take nuggets as well. So you talked about just a time bestselling author but two-time bestselling author. Obviously I want to get into beyond talented, but talk about the first time when you decided like, hey, you know what, I'm going to write something. What was that like? Especially people write books. Was that something that was like, yeah, I'm gonna write a book one day and the opportunity came, or you would just with all of the life changes that were happening, it just felt right?

Dr. Nina Lum: So the first time was when I partnered with a group of other female physicians and we wrote The Chronicles of Women in White Coats, which is ever since moved into a great movement. And there's been a wellness retreat, a blog and so many things birth out of it that have continued to encourage women in medicine and across the country. But then more recently, this was something that I was a part of the organizing team of and sort of co-leader in the project. And that really was something that was near and dear to my heart because this one was really focused on the struggles that immigrants space and particularly immigrant physicians. I'm just detailing accounts of their lives from different facets of general life, love the practice of medicine and how that has maybe made us better, or the challenges that we encountered along the way have made us much better for or thankful for who we are today.

And so that is the project that was just recently released this. Oh wow this month we launched, this month, actually October 4 and within the first day of releasing when Amazon made the best seller list, and I actually almost passed out when I saw that we were right below the book written by the neurosurgeon, When Breath Becomes Air, we were breaking underneath of him and I was like, oh my God, I took a screenshot of it. Because I could not believe that. And for several days after we stayed on the number one new releases, medical biographies, so that was a pretty good win for us, just because our stories are different but they're the same as everybody else's. So, even though I may feel like, oh my gosh, this is the book about immigrant docs. I'm not an immigrant. I may not relate with them. You'll be surprised because even though it feels like the origin of a story is vary from yours, but the struggles are going to be underlying, very similar and really boils down to what virtue that this person gained from that experience that I can maybe reflect on. And that's really been a joyous experience I would say.

Dr. Berry: And it's been amazing and Lunch and Learn community obviously I want to give Dr. Lum community an opportunity to get a free book on us. We're definitely gonna make sure were saying out in the air we're going to sponsor so she can give a book away on us because I think you need to read this. But like I said again, I've been a secret spy on everything you do. And I think even I as a person who always wanted to do academic medicine. That was always my passion. I remember writing when I was a medical student. I was either a medical student, maybe a first year resident.

It talking about like, oh, I can't wait to be a Program Director because that was just something that I've always wanted to do. (Awesome). And still understanding and learning as I grow in in this role that I've been on three years now. Just a different side of it as osteopathic physician, we didn't typically deal with international medical graduates. So I'm learning all of these things. I'm like, wow, you guys have to deal with all of that. So that's why and when I say that, especially for the medical students who maybe are going to school here and they think like, no, we don't go through that same struggle. And you'd be surprised. The questions I get, the DMS I get, emails I get of going through that same like hurdles and trouble and how do I get over this?

Because I get those same questions for students who go here too. So I 100% agree that everyone should read this. One, because it definitely opens up your heart and your eyes. But especially your heart to say like, oh, okay. I definitely need to make sure I'm more mindful of there's the struggle that everyone has to go through and then it makes it. I'll say it online. I'll say it on live right here. I respected more because I know your hurdle was a little bit harder that in someone even like me who went to school here, who's from here, once osteopathic medical. So I understand that even my hurdle wasn't the type of hurdle or that you typically have to deal with. I'm definitely a fan of that book and really that premise, that you women got together and say like, let's write our story because, even though it's, you said 28 does that, how many, what that?

Dr. Nina Lum: We have 15.

Dr. Berry: So 15 different stories. But it was, it's still one collective theme. Like, hey, we struggled but we got to where we needed to be.

Dr. Nina Lum: Right. And that's the message you're trying to put across. As you know, I usually say this jokingly, but and a lot of times when you moved to America from another country, you don't have the same opportunity as a person where this is their homeland. And so when we choose to share our stories, it's also a way to say that despite the fact that we maybe did not have the opportunity to get some added advantage, we still were able to overcome X and Y challenges in our lives to get to a goal. Just like you said, you always wanting to be a program director, thinking, oh my God, here you are walking in goal today. So a lot of times we have all these goals we set for ourselves, but maybe along the way you get a detour or encounter some kind of roadblock remembering that even people that may be could have been statistically considered less fortunate than you are still able to get their goals.

If anything that you can certainly get yours and so that's really the message of encouragement or empowerment or putting out there is irrespective of what origins you have or irrespective of your disadvantages and if you have advantages to take advantage of them. And so that that way our stories are able to resonate with more than just immigrants. But even just people that are non-immigrants or people to whom this is home. To not only share that story for awareness, but also to remind them that, hey, yes, you could still also achieve a lot of the other things you want to do for yourself given that you have certain advantages.

Dr. Berry: So like I always asked, you come together and you write a phenomenal story, a collection of stories like this, what is next? When we talk about just getting the message out there and we already know what you're doing on the personal front, what's next for you?

Dr. Nina Lum: Oh my gosh, I have so many plans Dr. Pierre. I don't even know sometimes how I go to sleep at night with all these plans in my head. But I have a dream of creating some more structure around international medical graduates and their pre-residency process. The biggest thing that I've noticed, I guess if I could create a study, this would be my retrospective analysis of I've worked with. The foundation is lack of knowledge. It's just what it is and it's not a lack of medical knowledge. Because I should have these IMG sense of score way higher on some of their boards. And maybe even students that have taught as part of my job here in the States. I know in the past, the first three years on a residency, I was a community based preceptor for and osteopathic school out of tenancy.

So I do know that scores can vary, but these IMGs they tend to really knocked up all of the park when it comes to some, not all of course. So that being said, medical knowledge I've noticed maybe is not so much of an issue, even though when it is an issue, that's a usually more difficult hurdle to overcome because you need to have the competitive score. But that put aside, just understanding of the process has been an area where I've seen the biggest gap. And so one of the things I've done is creating an online course geared to with this, but I'm looking at a more structured and casual approach, if that makes any sense. So maybe something like what you're doing, I don't know yet. Maybe something like a podcast or an annual meeting or that could really equip people one time.

Here's all the information you need, beyond just maybe a static online course, which I do enjoy and I do have and people use it. But beyond just that course, I would like something more dynamic, where there's more interaction and more real time. So whatever that is, I'm yet to discover. I'm yet to find out. Who knows, maybe someday it would be it, my dream will be the educational commission for medical graduates if I can get to work with them in some capacity in the future. That's definitely would be a big, big thing for me that ever happened. So I think for now that's really what I'm looking at is a more standardized platform that would equip IMGs with necessary information, evidence-based information that would really help them be well-armed on the front and instead of reaching out to me when they fail to match one time. Then that just makes it, it's a snowball effect. But they can get that information earlier on. And really I like to emphasize this. My message is not for people to go to foreign medical schools. That's not my message. My message is for people who already found themselves enrolled in those schools to improve their options and their chances of making their dream of being a board certified physicians in States. So it's really not a message of telling people to go to foreign schools because I would not do it over again if I have the choice.

Dr. Berry: Is that just because of the hurdles that are placed?

Dr. Nina Lum: Yes. The challenges that I faced, which I did not anticipate because I didn't know any better, I'd never lived in America before to understand the medical systems that extent, hindsight is 20/20. I can't see that far ahead. And so when you're just ignorant to societal standards. That being said, it's never my intention to say or premed student listening to this should go the premed and that's not the message. The message really is this, that if you already are in that predicament, here's what you need to be focused on because maybe the school may not equip you, especially when you start your clinical year. But exactly that piece of information. But then there's people like myself, we're developing with resources to help meet that need.

Dr. Berry: I love it. And so interesting because that was the biggest driver for me. And I've said it before, when I talk about compassion, I don't use it loosely because when I see people who have such a drive, I just generally want to help them. I definitely want to see them succeed. I remember going to school at Nova Southeastern and I remember thinking like, okay, who's on the admissions committee? Because now that I'm at the door, I need to see what they saw in me and what do I need to do to tell someone behind me. And that's probably been secretly my drive to become a program director. Because I already know that my residency, alright, what are people on the other side looking at for potential resident applicants who to get into program.

And I remember when I did my webinar, right? Because I have a webinar as well too. The ERS interview webinar. The reason why I did it was because I saw so many people and you're so right. Making the same mistakes over and over again. That I knew it was just that they just didn't know. It wasn't they weren't trying. It was just that they just did not know this process. And I figured like, hey, if I just yell out and scream like, hey, by the way, put down your poster presentation. It was like, hey, by the way, I knew if I just yell at the screen that someone would take it and say, oh, you know what, I did do a lot of poster presentations or I did a lot of oral presentations.

Maybe I should put that in the scholarly activity so my ERS section doesn't look blank. I mean the amount of students who don't even know what goes in the ERS is still mind boggling to me. But like again, I was naive as well too. I didn't know until I got to the other side and I had actually put stuff into the ERS and realized that, oh wow, all this stuff I remember doing, I don't remember doing that. I didn't write it down. So I 100% agree, is never and especially because you're 100% right. It's not the scores are usually not the issue. I wish I could be like, oh yes, the scores that keep them out. It's no. There's so many systems in our medical society that again, and I've talked about this before ad nauseum that keep our foreign medical graduates, try to keep our foreign who graduates outside of the system.

I'm an internal medicine. So you already know, I think as if I had to pick a specialty that does an amazing job at trying to keep people out. It's internal medicine. So I understand that there are systems in place that purposely make it harder for you. And that's why I love everything that you do. And that's why, again, like I said, whatever your dream, whenever your dream comes to fruition, if you ever need some support, please let me know. Because I know that there's barriers that we have to artificially break down to make it easier for those who are in that predicament to get over here and learn and be able to take care of patients. That's really the end of the day we're trying to take care of patients.

They got these structures. They don't even let you do that. You have people here who do amazing, amazing work, clinical work, do amazing grades. But because of where they went to school, or maybe they had a hiccup. And like I said, full disclosure, there's not a level that I have not failed at all. So full disclosure and understand, I'm still a program director. I am 35 years, I always forget how old I am. I'm 35, 36, I think I'm 36, maybe 35, 36, but I'm still a program director. And I've had plenty of missteps and fails. So, and I've never believed that a misstep or fail anywhere during a medical school career should dictate whether you have a career at all.

I am 100% champion of what you do and really how you do it. And I think that's why I was such so excited just to have this discussion because one, I think we're opening up a lot of people's ears who probably don't realize, a lot of these outside forces that effect our international medical graduates, to the point where they hide for them. We're DOs and MDs. That's all they know. They don't know our struggle and they need more people like you, like saying like, hey, look, look, read this book. This is our collection of struggles. Just so you realize like, hey, yeah, it wasn't all straight A's and high, it wasn't all that.

So before I let you go, if you can, I know were about yourself care, right? But I do want people to make sure that they can follow you, you're always doing that. Again, Lunch and Learn community, let me brag on her a little bit. She is always doing a live. Now My ERS is an automated webinar. Reason why is because I'll be having a time to do that very often. You can go click it already. Press play. It's already prerecorded. It's done. My seat does it live multiple times. I know she just went through as a session where she was doing interviews. I'm not sure if you're still doing that. But I want people to follow. You just gonna just see how you're doing and see how they can stay within your community. Where are you at social wise, website wise, all of that stuff here? And remember Lunch and Learn community, whether you're driving, whatever you do, listen to it. We'll make sure it is all in the show notes as well.

Dr. Nina Lum: Thank you for that. I think Instagram, it's sort of my most active social platform and um, @drninalum. Previously I was known as the encouraging doc in Instagram and I'm still being encouraging doc. But my handle is @drninalum. And my blog is theencouragingdoc.com. So those are two places where people can find me on the internet. My online courses are on imgroadmap.com, which you can also find through my blog as well. Um, and I think those are the only places where I exist right now.

Dr. Berry: Sure. What about the book? What about the book?

Dr. Nina Lum: Oh yeah. I forgot. Okay. Yes. So you can get the book on my square site. It's also included on my Instagram bio page. But it's also available on Amazon and this title Beyond Challenges, survival stories from African immigrant physicians on love life and the practice of medicine.

Dr. Berry: Perfect. Remember Lunch and Learn community listeners and especially those in your community, we want to give away on behalf of us a 180 paperback books. So I don't know how, however best you feel, whether through your email list or your website. Whatever way you feel this, let us know. Because we want to sponsor one to give away because it is a message that I think people needs to be have in hand so you can understand like, okay, I really need to respect the grindness of some of these amazing physicians are doing down here.

Dr. Nina Lum: Absolutely. I would love to do that. So we can probably figure out the rules to give away and maybe use one of our social platforms to further announce that. But I'm down. I can mail a book to that person directly whoever wins that give away.

Dr. Berry: Let's give them paper back. I know people are digital but let's give hard copy book.

Dr. Nina Lum: Right. And that way it can get signed before you get it.

Dr. Berry: Even better. See? We got to give the paper back and we've got to get that signed.

Dr. Nina Lum: Absolutely. We'll love to do that.

Dr. Berry: So again, thank you for joining the Lunch and Learn community. This has been an absolutely amazing episode and we just want to support you and thank you and give you all the well wishes on such an amazing journey. Like I said, to me you are the IMG coach. I'm going to keep sending people to you especially when I can't. I'm too busy. Especially as Program Director, this is interview season, so it's very busy.

Dr. Nina Lum: Oh my God. I'm sure you're slammed. I can't imagine. That's one thing I can't imagine how you doing.

Dr. Berry: Oh yes. Crazy. It's crazy. You have a great day. Again, thank you for everything that you do.

Dr. Nina Lum: Alright. Thank you so much. Thanks for having me. And to all the Lunch and Learn community folk, it was great spending some time with you today.

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On this week's episode of the Lunch and Learn with Dr. Berry we have Dr. Anila Ricks-Cord, a wife, mother of 3 hilarious children and a board-certified obstetrician-gynecologist. She is a motivational speaker, a 2-time bestselling author of The New Laws of Mommyhood & Marriage: From A New School Mom With An Old School Hustle and the co-author of The Making of a Medical Mogul. She is a media personality whose passion is to encourage women to address their health care concerns and fears, giving them a voice and empowering their best lives, mind, body, and spirit.

This week she is on the show to talk about endometriosis, a disease that affects 11% of women, can responsible for painful menstrual cycles and even infertility. Listen to how Dr. Ricks-Cord has to deal with this problem in her current practice.

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Download Episode 132

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Episode 132 Transcript... Episode 132 Transcript...

Introduction

Dr. Berry:

Welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of DrBerrypierre.com as well as Pierre Medical Consulting. Helping you empower yourself with better health with the number one podcast, for patient advocacy. Today I get to bring you a special guest today Dr. Anila Ricks-Cord which is a good friend of mine and an expert in women's health and what she calls vagina land. She is hilarious, first of all. But she is really an expert because you guys know I'm not the biggest women's health discussion, right? Because there was a reason why I went into medicine but so I figured. Let's bring someone on who can kind of help me, kind of grasp what is knowledge and I really kind of avoid it when I was a medical student in medical resident. So today we're gonna be talking about endometriosis which depending on when you listen to gets its entire month of awareness March is Endometriosis Awareness Month. So I figured if a disease gets a whole entire month, it has to be important. And if it has to be important let's bring an important guest on. So I just want to talk. I'm just gonna give a little bit of a bio just so you can kind of understand exactly the person we gonna talking to. First of all she's hilariously funny. You definitely gonna enjoy today's episode. Dr. Anila Ricks-Cord is a wife, mother three hilarious children. She's a board certified obstetrician gynecologist. She's a motivational speaker. She's a two time bestselling author.

She's a media personality whose passion is to encourage women to address their health care concerns and fears giving them a voice in empowering their lives, mind, body and spirit. Can you know the theme: Empower yourself a Better Health. She currently resides in Texas where for loving spouse, three children and two lizards. She attended college at Indiana University. While there she performed research and published articles on rats in order to help curb alcohol behaviors in humans which is absolutely hilarious. She did move to Baltimore to perform research and publish articles at John Hopkins University. This time investigating acute respiratory distress random at the molecular level. She attended graduate school at Johns Hopkins and pursue a master's degree in biotechnology. She was accepted at the University of College Medicine. Experience significantly shaped how she practice medicine culminating her receipt of the Leroy Week's Award for Outstanding clinical skilled bedside manner and commitment to service.

Again, she is absolutely amazing and I get again especially from my fellows who are probably not sure this is a podcast. I listen to this is a disease process that could affect your mom, could affect your sister, it could affect your cousins. So this is something you may well listen to just be able to kind of pass it on, right? Especially if you have a female friend or spouse or a wife or a sister who has these very vague complaints and no one seems to know what's wrong with her. And then you start kind of attributing it to maybe in her head. This is a disease process that may make you think different right. So sit back for another great episode again if you have not had a chance, make sure you subscribe to the podcast. Leave a five star review for the podcast. So we are on the radar of everybody so everyone can be empowered for better health. So again thank you. Let's listen to another amazing episode this week with Dr. Dr. Anila Ricks-Cord.

Episode

Dr. Berry:

All right. Lunch and Learn community. So you heard that amazing intro with Dr. Anila and we're gonna, you know, really let her speak and introduce yourself to the community. And of course, you know guys, I've said this before, I am not no women's health expert. One of the reasons why I went and turned on medicine is because I kept getting kicked out of their rooms when I was a medical student, right? So I figured if we're going to be talking about women's health, especially disease course like endometriosis, right? I figure let's get the expert to talk and I'm just going to sit here and listen. So really, I'm actually going to be listening along with you guys and you know this, this expert kind of expand her knowledge on this and tell us what endometriosis in the show. But first and foremost, Dr. Anila, please again, thank you for coming to the Lunch and Learn with Dr. Berry.

Dr. Anila Ricks-Cord

Thank you Dr. Berry so much for allowing me to be able to be graced by your presence and share a little bit of knowledge.

Dr. Berry:

Just the feeling is, oh, a hundred percent mine. I've told Dr. Anila, a friend of mine and I told her, I said, I'm gonna get you on a podcast. Like you can't be given all that amazing information out to the community on Facebook and everywhere else and not give it to Lunch and Learn community. So I already, I had already pre-warn she would be on the show.

Dr. Anila Ricks-Cord

That's you did, that's you did. And I'm honored to be here. So.

Dr. Berry:

For those who may not know, you may not be following you, you give a little bit, you know, outside of the bio, little bit about yourself. Tell us why you do what you do and you know, kinda how you got to where you at now.

Dr. Anila Ricks-Cord

Sure. So I am a board certified obstetrician/gynecologist. I'm a wife of 22, going on 23 years. Praise God, Lord willing. I'm a mother of three awesome kids and I'm a two time best-selling author and a speaker. So through my books, my patient care, and my coaching programs, I encourage women to address their health care concerns and fears, giving them a voice and empowering them to live their best lives, mind, body, and spirit. So I'm originally east coast native. I'm the eldest of three children and a big science geek. I openly where their pin. I attended school in Indiana University, Purdue University at Indianapolis. And that was where I met my love and my biggest cheerleader perform research at Hopkins before having the privilege of attending Howard University College of Medicine and then completed my residency at WellSpan York, Pennsylvania. So I was inspired to practice medicine and led to become an obstetrician gynecologist secondary to the death of my mom. She was last 22 years old. She was misdiagnosed with the flu and subsequently died of Septicemia. For those who don't know what that is, it's essentially a bacterial infection in the blood, which basically causes massive organ failure and death. So this is why I do what it is I do. So.

Dr. Berry:

I love it. And you know, thank you for sharing that story with us because I think a lot of times people outside of in fact very, you know, full disclosure, we're actually recording this on like, you know, national doctor's Day, right? And I love this day. Because a lot of times physicians really aren't getting a lot of the fanfare and the good light that they should be getting. Right? You know, a lot of times there's a lot of misconceptions of why we became physicians. For some reason people think it's all about the money. I keep trying to tell you, trust me. (Most assuredly is not. Fannie Mae, Sallie Mae, she visits me on a regular). Can you chat and tell folks that, and it's really the love of wanting to see that next person get better. Right? And understanding that is, you know what, I wasn't there. I wasn't able to maybe make the steps I wanted to. It's like for my mom. Right? But maybe I can do for someone else. Right. And I, I'm, you know, I'm totally feeling that because I remember being a second year medical student and getting a phone call that my father was in the hospital and again, I'm a second year medical student. I didn't even know my dad had like medical problems. But you know, that's a whole another discussion. They don't, you know, patient guys don't like to talk about nothing. Right? And you know, subsequently from that he passed away and I said, you know what, there's no way that I'm not going to let people know, like, hey I only, I'm physician but I can't help you right from that day forth, I just kind of took that man once again, thank you for kind of taking your mantle and kind of really running with it.

Dr. Anila Ricks-Cord

It is what I was called to do. I feel like knowledge is power and my angelus says, when you know better, you do better. And my goal is to make it so that people know better so they can do better.

Dr. Berry:

I love it. So the topic at hand today is endometriosis. And I could tell you from a, I'll be honest, I'm an internist. I take care of patients than I used to take care of patients outpatient where I knew a little bit about it. But once I went inside the hospital, you know, my knowledge of it was very, very weak. Right? So I know that again in March where it's actually National Endometriosis Month, right? So any disease process that gets a whole month is one that I feel like the Lunch and Learn community needs to know.

Dr. Anila Ricks-Cord

So I happily, I will tell you about endometriosis. So before I can tell you what it is, allowing me to describe what's normal. First told you I'm a big fan of that Geek and women who become their menstrual cycles every month. The body attempts to get itself ready for the possibility of pregnancy. So I like to describe it as your brain calls her ovaries and says, hey girl, we're trying to get pregnant this month. Under the influence of your brain. Your ovaries make estrogen and progesterone, which causes the lining of your uterus to get nice and thick and fluffy, and it causes you to ovulate. The thickness of this lining. This thing happens every single month where every month we get nice and thick and fluffy, so we actually do get pregnant. There's a nice and nourishing space for a fertilized egg to implant and grow. If you don't get pregnant, that lining dies and peels off. And that peel, that lining is actually your menstrual blood, and so if you don't get pregnant, it starts all over again.

Better luck next month. Maybe it'll work out next month. Exactly. Just like we bleed out of our uteruses and out of our vaginas and owns or whatever, you know, products you used. There's also something called the theory of retrograde flow where we actually need backwards too. So if you imagine that this uterus has like this cavity on the inside, and whenever I talked about my lives, whenever I do them, I use my face as the uterus and I take my laps and I separate and pull them up to the side and said this is the fallopian tubes. You bleed backwards into the uterus are actually from the uterus into the fallopian tubes and into the pelvis. You know, this is where it's an issue and some of us, that tissue, that lining, endometrial lining, the supposed to regenerate itself every month. Some of that tissue takes residents actually in your pelvis and your abdomen and so come next cycle, the tissue does what it does and it sickens to try and make a lining where it is, but it's in the wrong place.

Yes, exactly right. Right. So you've got this out of bounds, bleeding going on, which triggers inflammation. Kind of like if you hit your elbow, you hit your knee and it swelled up. Right. Nice. And is sore. Your body responds to this perceived injury and your immune system kicks in and gets involved. And this is where scarring happens. So what is endometriosis is when you have your period in places other than in your uterus. And these endometrial cells, once they get access to your pelvis, they can then travel to other places and get access to your blood vessels and your root system and go outside your covas, to other places. So it is primarily a disease of your pelvis, but because they don't have any limitations and they don't know down, they can go other places too.

Dr. Berry:

So once that I retrograde bleeding happens. There's really like, oh all fair in love and war pretty much.

Dr. Anila Ricks-Cord

Yes. For some of us, we all do it. Not all of us, we all have this, this retrograde flow, but not all of us have tissue that are like boundaries. I don't know things like no boundaries. And so there's a, there's a thought that there's a genetic predisposition where there's a subset of people who have tissue that decides, Oh yeah, I'm going to be a topic, I'm going to grow wherever it is I wanted to go. Maybe, maybe it's like living in a large city, you need to get to some places not so highly populated. So you decide, a lot of people live like on the pelvic. The actual prevalence of endometriosis is not exactly known. So they say that you see it in between 25 to 38% of adolescents that have chronic pelvic pain and in 10 to 15% of women that are reproductive age. And so there's a substance and we talk about this theory of retrograde flow and then there's also a thought process to or told you big baggy claim. I apologize. I put disclaimer on it.

Dr. Berry:

We trust. We're just, we're all here for this. I'm sitting there, I'm listening. I'm like, okay. Okay. All right. All right.

Dr. Anila Ricks-Cord

Cool beans. So from an embryo logic perspective, I know you remember, you don't tucked it back in the rule that dig somewhere because it doesn't serve you anymore. But those of us who are women, when we actually go about being formed in our mother's womb, we have got a fallopian tube and a uterus and another fallopian tube and a uterus. And what happens is these two halves come together to make a hole. The center hollows out. And you've got, if you're lucky, you have one normal functional cavity. There's a subset of people who have what are called Mullerian anomalies where the two little pieces and uterus don't get together where they're supposed to. It doesn't hollow out the center and become one. And so these people are also a set up for endometriosis because they have topic endometrial tissue that ends up in other places. And so about 40% of these children that have these genital check defects will have issues with individuals. As they say, 50% of women that have infertility's had endometriosis and 70% of women and adolescents that have pelvic pain actually have endometriosis.

Dr. Berry:

And because we don't know the true figures, do you feel like the figures maybe higher than what we're even picking up?

Dr. Anila Ricks-Cord

I would say so because unfortunately it takes about nine years to diagnose endometriosis because it's a disease of exclusion. And so when people present, so you have a patient that will come and see you in and they've got these vague multitude of symptoms. So like in women in grownups, people who are not adolescents and adolescents have defined 10 to 19 years old. So reproductive age women, you can have a lady that comes to see you with a complaint of pelvic pain either with her periods or with sex.

And so if it's pelvic pain with her periods and call a dysmenorrhea, which is this dull crampy pelvic pain, that might start about two days before your cycle starts last. The entire length of cycle might occur a couple of days afterwards. Or if it's chronic, we're, it's been present for more than six months. It can be dull or throbbing or sharp or even in one of my patients, she has a burning sensation every month on her cycle shows up. She's got a spot in her left lower quadrant or her anterior abdominal wall where it's like a hot poker. That's how hers that she has pain all the time, but when her period's shows up, it just burns in this one little spot. So that's what cycle you're paying with your period. If you have pain with sex, you will have patients that have complaints of pain with penetration, particularly deep penetration, and so when you go see your Ob-Gyn, one of the ways that you can kind of mimic this is the thought is when you get these endometrial implants in such a personal space, you can get these.

It starts off as a microscopic disease and you can get nodules or uterus has got this support system inside our pelvis is kind of like the ladies who wear bras, kind of like a bra strap. So you've got the same call, uterine staples that supported on the inside of your pelvis. You can take your fingers in a lady who has endometriosis, put them in the back part of her vagina, separate them like a peace sign and stroke and practically make her leap off the table because she has nodular implants in the back. So you can simulate this, this pain with sex when you stroke on these easier to cycles on the back issues that nodules implanted inside. Ladies who present with infertility and so infertility technically is defined is a chick, is less than 35 years old, has been trying for a year to have, has been having regular sex for a year and trying to get pregnant and hasn't.

If you're over 35 is six months essentially, but they say the 30 to 50% of women who have infertility had endometriosis. If you have a lady that presents and she has an incidental finding on ultrasound which has got some pain and you do an ultrasound, she's got a mass on her ovaries, there's a particular. Endometriosis implants can actually implant anywhere inside your pelvis, on your bow, on your bladder, inside the wall of the uterus to, and I'll come back to that one. And inside the ovary you can get what it called Endometrioma where when you look at them on an ultrasound where essentially the equivalent of blood clots inside the ovary, a lady that's got an ovarian mass and is an Endometrioma, if you have a high index of suspicion that she has endometriosis, you know, also present in ladies and have bladder issues.

Like if you have a feeling like when you do not have a UTI but you feel like you go into the bathroom all the time or you feel like you've got to go right now or you have pain when you go to the bathroom. That could be a sign of endometrial implants in your bladder. If you have bowel issues where you have issues with diarrhea or waxing and waning diarrhea and constipation or pain when you desiccate or colicky bow, that can be a sign of endometrial implants in your bow. There is a version of endometriosis called adenomyosis. Which is what Actually Gabrielle Union had. Heavy menstrual bleeding is is a possible sign of endometriosis and by heavy menstrual bleeding. Allow me to clarify. A regular period is supposed to be no more than 80 cc's so in simple terms in an English

Dr. Berry:

Talk to the men. I hear.

Dr. Anila Ricks-Cord

Right. I'm about to say so. A normal period is for hotel bottles of lotion. That's 2.7 fluid ounces or it's about a third cup. That Mixing Cup that you have in the kitchen when you make us up on one third cup size, that's ATC seats. Anybody who has more than that and some of the patients that don't have had that have had heavy menstrual bleeding, they making crosses and ease and the underpants they've got multiple two, three second. I'm like mattresses. Or they're use tampons. If you can use a super plus tampon and that thing falls out in an hour or two you have heavy menstrual bleeding. For Gabrielle Union. When she was talking about her fertility struggles, what she suggested was that she was in it to her doctor with heavy menstrual bleeding. Traditionally put her on OCP is birth control pills in order to be able to regulate her flow.

She subsequently was found after having her struggles with fertility so she could, she had gone through some ivs cycles. She got pregnant a couple of, actually, she's pregnant more than a couple of times. I think she suggested maybe nine times. She got pregnant, something along those lines, seven to nine times. But with her, she has endometriosis in the walls of her uterus. And so you've got this glandular tissue that's supposed to do right and be nice and fluffy like a comfort in the winter time for this egg that's on fertilizer on the wall. But it has a place where it's supposed to be. It's only supposed to be on the lining of the inside of the shoe is not deep with them. A muscle for people who have the endometriosis inside the wall of the uterus or the Adenomyosis. They actually have bleeding that occurs within the muscle itself. And this leads to inflammation and issues with fertilization and implantation and being able to carry a pregnancy. So again, heavy menstrual bleeding was also a sign as well as irregular menstrual bleeding. Endometriosis can also make itself manifest in the form of low back pain or chronic fatigue. This is why it's so nondescript and it takes forever to diagnose.

Dr. Berry:

That's I think about. Nine years?

Dr. Anila Ricks-Cord

Nine years. Yeah. In adolescence, which is that group between ages 10 to 19 and there had been some documented cases of little girls who didn't have Mullerian anomalies I talked about what you just didn't come together. Right. They had the babies that have been documented to have endometriosis as young as eight and a half years old. Those little girls will have symptoms that are, that can be cyclic, like only a time with your pain and not having anything to do a period. But they can get pain that gives worsening and more severe when they actually start having periods and they can have rectal pain, they can have constipation, they can have pain with defecation when they go to the bathroom associated with their cycle. Rectal bleeding, pain with urination, and even blood in the urine or that need to go right now and so is so nondescript. You can see how a physician would run through a litany of tests before finally getting to the point where you even considered endometriosis at all.

Dr. Berry:

Nine year seems so long. (It is). Should it not be like more ahead of the line or do you really have to kind of rule out some big stuff first before you can say like, okay, let me let's think about endometriosis inside of them. No, cross my t's of everything else.

Dr. Anila Ricks-Cord

So I think that because it was a diagnosis of exclusion for the longest time to truly diagnose it, you need a tissue staff and so the thought process, (Tissue it's in the muscle. How do you get, wow, okay). Right and endometriosis, you only get, if you have a uterus of the path lab, that's how you diagnose that otherwise is I take you to the operating room. I do a diagnostic laparoscopy where I poke a hole inside your belly button, do you up the carbon dioxide, took another two holes inside your belly in order to be able to get camera inside there and some graspers to move around and look to see if I can see signs of disease. And it's not four stages to what you could have minimal disease, which is microscopic, and you don't see nothing to stage four disease where you have everything stuck like chuck on the inside.

But ideally if you get to the point where you have to do laparoscopy, then you go inside and you biopsy this different parts of the pelvic sidewall underneath the uterus cycles. If it's on the ovary where ever you see there'll be, sometimes it looks chocolate, sometimes it looks white, and so any abnormalities you see you're biopsying them in order to be able to confirm the presence of disease and that's part of it. A lot of us who are conservative would want to try. I think old school thought was if you had endometriosis, let me try all these other things to make sure it's not that before I'd used last resort and take you to the operating room. (Which is operating room. When I talked to some people and say operating room, what? ). Exactly and yes, just when you think about that, if at any time you poke a hole inside anybody, anytime you performed surgery, there's a risk of it. It's a disease thereafter and so it's a risk versus benefits kind of thing.

But I think that the thought process, I think more people are becoming more aware about how much of a big deal this is. Because you think about how often do when you were seeing patients that were women, you joked that you got put out of the room all the time, that it's a comfort level that's got to exist between you and your physician and I'm sure you've seen the commercials talking about the meds and the chick the study have had endometriosis. When people don't feel comfortable talking about what's going on with their period, how much they bleed. Like you'd be surprised the number of women that have gotten Menorrhagia or heavy menstrual bleeding where they practically write their name on the floor in blood and cursing every time their period shows up and they think it's normal and they ask anybody about anything.

Dr. Berry:

Wow. Have you have trouble in the past and tried to even pull that type of information out of your patients?

Dr. Anila Ricks-Cord

You know, I think for me I'm fortunate in that I laugh and joke with my patients and then because I have also had issues with Menorrhagia like so black people are real good at making fibroids. Sidebar, I have a fibroid. Uterus is about the size of a 12 week pregnancy. And as a consequence, I think God has got a funny sense of humor cause at the Ob-Gyn, if somebody thinks that I have experienced it, I can relate to with my patients. And having been one of those chicks that has been a Menorrhagia without, not that people want to know what my contraceptive option is, but I use a Mirena IUD in order to control my Menorrhagia. Without my Mirena IUD, I can use a super plus tampon and it falls out every two hours. And I could write my name on the floor of blood curse using a regular tampon. Using a regular tampon, about Mirena. I don't know what that was.

And so I use humor in what are the bridge the gap in order to be able to ask those kinds of questions. So tell me about your menstrual cycle. How long does it last? What products do you use, how often do you change them? Because a large number of these people who have, who should have hemoglobin hematocrit of six. They eyeball rolling because they believe, they think that's absolutely normal. They think that's absolutely normal. And then because it's, it's your period and you're not comfortable talking about that stuff anyway. It's a don't ask, don't tell, unless you have the kind of relationship with your physician where you feel like you can talk about.

Dr. Berry:

Can you talk about it and if you can't, if I want to say you can't take their relationship isn't there to talk to it with your OB, you definitely not talking to the hospitalist.

Dr. Anila Ricks-Cord

Of course not. If the person see it on the bottom, you can to the physician. Why talk to people that you are not close? Exactly.

Dr. Berry:

Okay. All right. All right. So let's see. So you mentioned liking me and I told you I was going to get some learning today. I already let her know, oh we're going to do some learning today. Cause again this is, I'm taking those right along, which I'll be going again. I've experienced in taking care of patients with this disorder. But of course you know me, I'm referring out to the OB clinic when I, well I think is what you got. Go ahead. See my OB friends, see if that's the case. So definitely. Wow. Okay. So what about, so we talked about it. I, I hear somebody, you know, some of the signs and symptoms kind of really associated with it. Now, is there anything that these patients are doing that may have attributed to getting any endometriosis? I mean because I guess they have to have a menstrual cycle, right? So it's not all about the retrograde bleeding, but is there…

Dr. Anila Ricks-Cord

Well in theory, remember there are some babies eight and a half and haven't had periods that have issues with the document in endometriosis. Wow. The vast majority of us have this menstrual, heavy menstrual cycle related signs and symptoms. We were, we're cycling and we've got this retrograde flow, but you don't necessarily have to have a period. You can have these, these girls. So when you're talking about risk factors for it in the materials, as we talked again about the, the developmental conditions that predispose you to basically having your belly tampered with endometrial tissue. We talked also about the fact that there are some people who are believed to have the genetic predisposition. So if you have a first degree relative that has endometriosis and by first degree relative is either your mom or your sister or your children, if you have a first degree relative that has endometriosis, you have an increased likelihood of having it too. And there's a thought process that, and these people who have a genetic predisposition for endometriosis, there's something about the way their cells signal that they don't respect boundaries and go from one place to another. Like tutors, I'm going to the pelvic. And then there's also a thought to that if you started your period early, like 10 or less that you're an increased risk for endometriosis. And then it has unfortunately has awful side effects too. Awful side effects.

Dr. Berry:

Now are, those are the, especially because we would kind of lean on, they're kind of starting to period early. So of course, you know, we're talking about like kids and then obviously this is an issue that a dose deal with as well. But I'm always kind of fascinated, especially as I'm an internist, I really only see 18 and up, you know, as an OB, you know, you're seeing all kinds of ranges. Do the complications associated with it? Like are they much worse off in the child than adult or is it still kind of tight? I gets bad either way. Like we know the rectal bleeding, we know the urinated, we know all this. But like if you, if you had to I guess choose, right? Like when would you rather start dealing with these problems? Would you rather deal with it as you know, in, in the younger age or more of that old, they're 35 40?

Dr. Anila Ricks-Cord

Well, oh, sorry. That's interesting. Thank you for reminding me. I forgot about that. One might tell you a little sidebar about that one. So in theory with children, the thought process is again, 40 days, 40% of adolescents with general tract anomalies, 50% of them have issues with infertility and 70% of women and adolescents with pelvic pain, it's got it. But the thought is that you've got longer in, would it be repetitive or your belly with these things? And so as a child, outside of the symptoms that we discussed beforehand, okay, the issue is think about all the years particularly undiagnosed, that you've got your belly, your abdomen, and your pelvis, your bowel, your bladder being peppered by these implants inside your personal space that then may not reflect or respect boundaries. Hop a ride on your vasculature or in your lymph system and go to other places. You can actually have endometriosis implants in your chest.

Dr. Berry:

The chest wall?

Dr. Anila Ricks-Cord

Yes, you can actually, it's this thing with, with so you know, cells and how they're supposed to respect boundaries and go to confluence and owning by protein signaling. Endometriosis implants can end up inside your lungs. You can actually get a collapsed lung as a consequence of endometrial implants. You can actually have Hemolysis when you cough blood for people don't know where that is. Yes. Or you can actually have, what is the other one is there's the collapsed lung, this coughing up of blood. And there's one other, I'm gonna circle back. When you talked about the difference between adults and children from the standpoint of what it is they have, you think about you have longer to be able to develop the side effects which are infertility. And if he's a disease which distorts the tubes and the ovaries, you have inflammation which is going to cause scarring and you've got pain and so you've got a longer time in order to be able to do this.

So yeah, it can give you chest pain, collapsed lung, a blood in the lungs and coughing up few months. And then also with endometriosis, which I'm a sidebar in people who don't have one, you talked about the difference between adult versus children. You can be a perfectly normal lady who went to go have a C section. And as a consequence of having a c section because the uterine lining was disrupted, you can get into endometriosis impulse anywhere along that incision line. So where when I do C section, so we, after the scan we cut that we cut through the Fascia, separate the muscles cut. So the organs are online with this peritoneum is what he's got his own thought casing. Your bladder sits on top of your uterus and there's this thing called the physical uterine peritoneum that you cut your, put some letter out of the way you cut inside the uterus, you deliver the humans, you close uterus one layer and then folded back on itself. You can get into the endometriosis implants from the opening of that uterus being out in the abdomen, in the Fascia, in the anterior abdominal wall, and in the incision site. In my residency program, we had a lady who had a complaints of pain every single time her periods showed up. And actually when we imaged her, you found what looked like a small little one meter hole and it was actually much larger when you got inside her and started dissecting out where it could be. Endometrial lining had implanted in her incision and every single time she had a period it would bleed in her anterior wall and that incision site.

I had a lady who when she was a child she had, I can't remember what her particular condition was. She had some kind of condition where she ended up having anomalies with her legs. One was rotated backwards, the other was rotated in a strange way and so she ended up having to have one of an amputated and was a compromise. Actually had that, she had booked a mandated bilateral amputees and there was something going on with her belly when she had some kind of surgery or maybe there was a challenge or something that was playing. She presented with complaints of belly button pain at one point in time and on further inquiry when you talked to her, she said that she could milk her belly button around the time of her period, showed up and get a round discharge to come out. And sure enough she had endometrial implants in her belly wall were when she started cycling because she had surgery when she was a child. It was enough to disrupt stuff and literally she blown through her interior wall where there was a defect of a wall with the implants would bleed right inside there. She'd get a little know what's inside.

Another chick who came to office, same kind of thing, complaints of just barely walk. She had an endometrial coma in her anterior wall as well. And so you, you go to the treatment modalities for endometriosis cause she's got endometriosis. And then outside of what it does from a standpoint of being a child and you having all this time to pepper your belly and being able to get it being a normal chick who just had a c section or a disruption in the lining of the uterus. Now you have it causes all kinds of pregnancy complications. We causes miscarriage, increased restricts topic pregnancy. You can get bleeding during pregnancy and hemorrhage afterwards sets you up for Preeclampsia. You can have a Placenta Previa where ideally placement of the placenta is hanging from the top of the readers like a chandelier. It increases your risk for a preview where it covers the opening of your cervic for a c section, such your upper preterm labor and delivery, a c section and low birth weight babies. So it's just all unpleasant. (Oh Wow. Okay).

And the thought is that because you have got these ectopic implants, this endometrial tissue inside your pelvis within triggers an inflammatory response. As women when we get pregnant. So we have relations, the sperm travels up of vagina for the rest of, it's through our uterus, Fallopian to define the egg, fertilizes the egg, and then the Fallopian tube pulls the egg, desperate lives towards itself. And then in the tube you got these hairs, these silly or that kind of push the egg through the tube and into the wall of the uterus. It is a thought process that with people who have endometriosis, that'd be inflammatory. Mediators are chemicals and their pelvis are so high that it's toxic to sperm. And that's part of the compromise with your fertility too, that this from getting sad then go.

Dr. Berry:

It's just not the place for me. Right?

Dr. Anila Ricks-Cord

No, I can't work on these conditions. I cannot be. So, no, it's crazy.

Dr. Berry:

That's and I guess the question is like, especially in your stance, like how, what's the likelihood that you're going to, you know, you see a young who is complaining of a lot of these issues and say, you know what, let me let, let's open you up and see. Right? Like let's do a laparotomy, right? Like is that, does that also ate into it as well that you know maybe the surgeons aren't likely to open them up to check because of like I don't want to put a surgeon. I don't want to put a kid through that.

Dr. Anila Ricks-Cord

And you think about the fact that if it's a child, some of us are comfortable with adolescents, some of us are not. There is a branch of gynecology that is specific to pediatrics and so you think about asking about whether or not people are even listening to what the complaints are. How many people with a child who complains of having constipation would ever think that has endometriosis and that you just eat too much junk or you need to drink some more water. I think that there's such a vague complaints that unless the child has been complaining about them the entire time and you've done a complete workup and I can't tell you the number of times where we'd endometriosis, it comes down to the gastroenterologist and the Ob-Gyn they've been sent and would it be able to get a colonoscopy in order to be able to be assessed to see what's going on with this presumed abdominal pain that once they ruled them not that is not GI in origin. Then it becomes, well the only other thing you got left down there is your reproductive organs. So it's either your guts or your uterus, which is where the attachments to it.

Dr. Berry:

I'm scared, scared for you. I don't have any of those issues with it being clearly, clearly this is why the disease process like this needs whole month. Right? Because it average nine years to like that, we got to move this out, right? We got to move this up quickly. That should not be the case. I'm sorry. I'm so sorry for you.

Dr. Anila Ricks-Cord

I think things are getting better. Again, we used to treat it like it was a zebra and you go through everything before you, and even from the same point of you ask about what's the like of somebody performing surgery. So ideally the founder to do laparoscopic surgery, but you think about people who manage conservatively, they would put you on everything first. Exactly. Birth control down to see what exactly you would. You would go through all the other conservative options before definitively going to surgery and, and the data suggests that even if you do surgery alone and that's it, there are people who have defended over get relief with surgery, particularly if you have adhesions where you imagine that you've got with a good example of an adhesions? Where you have an abnormal connection of one thing to another. Maybe like imagine a ribbon and not inside your uterus but still if you had a connection between your uterus and your bowel or your uterus was stuck to your anterior abdominal wall because this inflammation causes this scarring and this is music disease that take place. If you want surgery, you just…

Dr. Berry:

Almost like a fly trap where like it's like it's stuck to that.

Dr. Anila Ricks-Cord

Yes. That's a good analogy. Yes. Minus the dead flies. Exactly. Well you have things sticking from one point to another and it causes for the people who have chronic pelvic pain and have that disease, just going to the bathroom causes them problems. If they have issues with constipation and near bowel is stuck to the anterior abdominal wall or stuck to their uterus. A contorted in some way, shape or form. Can you think about how though the bow has got this motion where kind of squeezes fecal matter from one point to another? Just being constipated is enough to cause you wicked pain. And so people who have chronic pelvic pain secondary to disease, secondary to endometriosis, have to do things to alter their lifestyle to make it so the consistency of their stool is more like saucers. So the bowel doesn't get over distended and pissed off and cause pain.

Dr. Berry:

Wow. So we didn't scared Lunch and Learn community enough. They want to hear now. Like all right, you scared us. We believe you. We notice issue. Please tell me how to treat it or at least prevent it, right? Because I guess that's a two part question, right? Is this a way? Again, little kids is getting even before there, you know, they're menstruating, right? Is there an actual way that you could do anything about this? And if there is like how do I treat it? Like I, I know we've mentioned a little bit about the oral contraceptives, which again, I'm an internist. I don't know none of those things.

Dr. Anila Ricks-Cord

Oh that's hilarious. So I'm trying to be really, really good. But all I could hear you say…Nope, and I don't do that. So treatment options and prevention, unfortunately at this point, because we understand its mechanism of action, but we don't really understand what causes it. So because we don't really understand what causes it, we've seen the clusters of people that look like this and clusters of people that look like that, we don't know how to prevent it. And so the thought now is with treatment options, there are a couple. They thought ideally as you want to decrease your inflammation, and initially I didn't mean to scare anyone. Knowledge is power. I wouldn't scaring anybody at all.

Dr. Berry:

Lunch and Learn community knows that you know, we're going to talk about a lot of disease courses. That you know what, if you're not, if it's not taken care of, it can cause a lot of problems. Yes, yes. Yeah. Take care of the problem. If you don't know that the problem is out there.

Dr. Anila Ricks-Cord

This is true. You're absolutely correct. And so with treatment, so ideally, first line is nonsteroidal anti-inflammatories, Ibuprofen and Naproxen. Back in the day we used to give people for chronic pelvic pain narcotics. And unfortunately we turned them into crack heads. So ideally the goal is to stay away from opioids. You want to do what you can do to increase, decrease, I'm sorry, inflammation. That's first one. Second is you use hormones. So you either have a couple of choices. You can either use birth control for non-birth control reasons. If you're not sexually active and you just have wicked pain or you get a two for trying to decrease your pain and make it said that you don't get any unplanned babies. The thought as you can use birth control pills, you can use injectable, which would be depot, you can use the implant, which is the next one on the ring. Do you either use them continuously when you get on a method and you stay on a method or use it cyclically in order to be able to make them.

Dr. Berry:

And from a, you know, from a non OB, I'll even talk about the guy on the guy's perspective, right? When y'all take birth control pills, so that it bleed less? So, yeah.

Dr. Anila Ricks-Cord

So yes. Ok I got you. Thank you for asking. In my case, I can write my name on the floor in blood and curse if mine is definitely about, not having or bleeding less. And so earlier when we talked before about how the brain calls the ovaries and tells the ovaries, we tried to have a baby and the ovaries go about thickening of the lining of the uterus and making it so you ovulate. Your body doesn't care how the hormones are made. You can either make them or take them. Your body just wants them to be present. And so the thought with the use of birth control pills or contraception, depending on which condom use is to thin the lining of the uterus. So you don't have a nice fluffy learning for an egg to implant. And some of them that modalities actually shut your ovaries down so you don't ovulate. In this case, the goal is to be able to thin the lining of the uterus and if you're using it continuously to shut down those ovaries so that that you don't have that tissue, that's another places. It's getting nice and thick and then after it gets nice and thick, it dies and you've got all this inflammation. You're trying to stop that process. Just shut it down. Thank you very much. Where you, you're in these other locations. Yes. Where you're living, where you've traveled abroad with this issue…

Dr. Berry:

We trying to starve those areas off. (That is exactly right). All right. All right guys, trust me guys. I got, y'all are here. I know. This is a woman's cell phone. Trust me.

Dr. Anila Ricks-Cord

Yes. From the standpoint of endometriosis, the goal is to starve that estrogen sensitive tissue that sitting out in the periphery. So you can either use hormones in the form of birth control or they're another batch of medicines you can use called GNRH agonist. I'm not going to have moment over this cause this term too much. But old school, there was a medicine called Lupron, which was a shot that you could get. New school, is this the one that you've seen on TV called Orilissa. They're both GRNH agonist and what they do is they cause the equivalent of a medical menopause. They shut you down, allow the implants to starve and die. But they can only be used short term, like the Orilissa. Depending on what your symptoms off, you can only use a six months to 24 months. And the same with Lupron because there's some side effects that go with it because it puts you into a medical menopause.

It can actually decrease your bone mineral density and make it like a little old lady. The snap. Exactly. So those are treatments and if you do hormones that thought as if you do hormones, you do insets to so hormones and insets. And the goal was if you use the hormones when the same one of the contraception, the goal is to trick your body into this sort of false pregnancy state. Shut down your ovaries and make the implants die or go into a coma and decrease that inflammation. The next option would be surgery. Like we talked about laparoscopic. Laparoscopic surgery where you fill the belly up with carbon dioxide, drop the camera on the inside, put in some graspers in order to move things around. See if you can find some tissue to biopsy to confirm the diagnosis. If there adhesions, you disconnect those adhesions. And then if there are lesions that you can see, you do what's called ablation, you literally go and you burn these adhesions on the inside of the belly. Now, the lovely thing about surgery, but the bad thing about surgery is that anytime you have surgery, God makes all of our organs have their own organ case to them. Even your belly, it's got aligning cause like the inside of your mouth, anytime you pop inside somebody's belly, you risk the possibility of causing them adhesions as a consequence of the surgery. And if the surgery alone…

Dr. Berry:

With a c section?

Dr. Anila Ricks-Cord

Yes. Well, the endometriosis actually tracks. So all of these layers that you put together, it actually tracks into all of these. So imagine anywhere your nice touch, your skin fat Fascia, peritoneum, the endometrial cells can be in any of that line. From the inside of the uterus all the way out from the incision site in the uterus to the peritoneum, to the Fascia and the muscle wall in the back, all the way through in the skin itself, all the way through. And the lady I was talking about in residency, she had a tiny little lesion in her skin. But when you went to go dissect this thing out, it was huge. And it was in her Fascia. So it was like a mountain top. You just saw the top of the mountain. And when he got up on the news, right, you saw the rest of this mountain down inside, they were like icebergs. Now that…so.

Dr. Berry:

I'm not gonna lie, I might not wish endometriosis as my enemy. That's what I'm hearing.

Dr. Anila Ricks-Cord

It's not a pretty thing to have at all. And the problem with surgery is that if you just do surgery here within a year, you've got symptoms that returned. Yeah, definitive treatment for endometriosis once you have done having your baby. So ideally for ladies who are reproductive age, the goal is to shut you down so you're ready to get pregnant, you get pregnant, then we shut it back down again. And then when you're done, depending on the severity of your disease process, some people respond well to hormones, some people don't. And definitive treatment for endometriosis is removing your uterus, tubes and ovaries being without hormone for a period of time to allow the implants to die off. And then restarting the hormones afterwards because you really need to be on hormones. Still menopause up in this country and average age is 52 otherwise you look like a man about to blood vessels and you snap crackle, pop in, all kinds of stuff.

So outside of that, there's a thought process that there are some alternative medicine options that may or may not work. Now traditional data says it doesn't work. But you have to bear in mind that we are unique individuals. We have bio individuality. And so what works for one person may not work for somebody else but may work for the person that's using it. So this on is that acupuncture, herbal remedies and homeopathic May. I worked for some people outside of that. From the standpoint of you asked if there's anything you can do to prevent it. No. The thought process is to try and make yourself as healthy as you can be and to have coping mechanisms for the pain. So exercise.

Dr. Berry:

Health wise, you're talking about food or?

Dr. Anila Ricks-Cord

Right. We talking about food. We talking about balanced diet with very little processed food in it. We thought, I'm like getting enough sleep because you feel yourself when you sleep at night. We're talking about exercise and what it be able to decrease inflammation and meditation in order to be able to help cope with the pain. There's also in the DDA goes a suggestion to they're people who have endometriosis are deficient in vitamin D and so when we talk about how this tissue response and how we can say, Oh, you have to say the curb, but I'm going to go outside the boundaries and do other stuff. And these people who have endometriosis and are found to have vitamin D deficiencies. Folks believe this supplementation of vitamin D you might make a difference in any woman who is of reproductive age needs 800 international units of vitamin D a Day. Anyway, some of US Brown people don't spend a whole lot of time in the sun and don't generate the vitamin D and I'll give you an example.

A lot of people who drink milk, they get milk and eat cheese. Drink milk and eat cheese. They get all the calcium and vitamins they need, I don't drink milk because I'm lactose intolerant. The last time I had my labs on, I'll tell you my vitamin D level with 17. I'm the surprised Dr. Berry laughing at me. Normal is considered to be normal to be 30 and in Vagina land as the OB Gyn. We lasted to be around 6. And so vitamin comes supplement outside of of finding that people who have endometriosis are deficient in vitamin D. There's also a thought process that vitamin D and depression have a role with deficiencies in vitamin D and colon cancer. There are deficiencies in vitamin D, so just bone up on your vitamin D.

Dr. Berry:

Get your Vitamin D. Right. Like I say that again. I kind of scoffed at first. I was like, what is this little thing had his own month? This ain't heart disease. This ain't, you know, verbally like, okay, all right.

Dr. Anila Ricks-Cord

It affects quality of life. Talked about seriousness of disease. The reality is the endometriosis isn't going to kill anybody at all. There's a thought process that when I talked earlier about the ovarian masses that you can get the Endometriomas. The endometrial tissue that invades into the ovary and obviously takes residents can actually give you so with ladies who held a Sidebar, I'm making a correlation. I apologize, I coming back. For the Ovarian Syndrome who don't have regular menstrual cycles are at increased risk range and mutual cancer because at lining become can become atypical and find it. That same kind of thing can happen in the ovary where the endometrial tissue that is implanted in the ovary this now cause this chocolate fiscal of blood, which is the endometriomas. He can take on abnormal qualities just like the lining of the uterus when it is a typical he ladies are at PCOS.

They haven't found words actually become for lung cancer, but it has the capability to change cause it's inter-mutual tissue crazy stuff. Right. The bad thing about endometriosis is, like I said, if you, if you have it, it's everything. Unfortunately it can cause infertility. It can dictate whether or not you can move your house and function without pain. The patients that I have had that have had chronic pelvic pain secondary to endometriosis sometimes have to be selective about the kind of jobs that they take. Because if you have a pain syndrome that's present, say 21 days out of the month where you might have eight had a 10 pound most days. But maybe you get a break in on some other days, you've got five out of 10 pain interferes with your ability to be able to live. If you can't get up to bed and get functioning because your belly is his feels like his demonically possessed and it's telling you all kinds of things from a pain standpoint and you can't function. Pain was, and how can you hold a decent job?

There are people who, because they have issues with endometriosis and the pelvic pain is exacerbated when they have relations. If you are single and not all of you in an intimate relationship, you have a difficulty with engaging in relationships and if you're married, it can interfere with your ability to be able to have an intimate relationship with your spouse. And then that over time leads to depression because is a chronic pain syndrome. Intimacy is a huge part of having relations or we're having a relationship and imagine not being able to be intimately associated with the person that you've vowed to spend the rest of your life with because it hurts so bad you can't stand it, but it's like having a nails in the back of your personal space and so you'd much rather that than have an intimate relationship.

Dr. Berry:

Wow. Okay. All right. You and Endometriosis. Before we let you go. Right. I got a couple more questions are, you know, but more on a, on a lighter note, right. Because endometriosis is scary. Again, I might have to tell my residents like hey, that patient who comes in for this vague abdominal pain. We might've needed to move it up a couple notches on the differential. Now can you talk about how what you do can help women take just take better control? Not necessarily just for this show, but it's just in general. Right? And this is a question I like to ask. I just want to, and I want to kind of get my guesses thoughts on like what do they do to help people empower, especially in your world, women empower themselves for better health.

Dr. Anila Ricks-Cord

Sure. So what I like to do with all of my encounters be an individually as a patient, either in the hospital or in coaching or when I was in private practice in private practice is I encouraged them to be their own healthcare advocate. When you're looking for a physician, the purpose is to find somebody that you can partner with, with the ultimate goal of optimizing your health. Medicine is no different than customer service. It actually is like customer services for women. For those of us who like to drop some coins every now and then in places like say Nordstrom. Nordstrom is pricey as all get out, but the one thing that you can bank on with Nordstrom is they have customer service on luck. You know, they're rumored to have taken back a tire from somebody who said that they bought it there even though they don't feel tight.

Medicine is no different than that. If you don't have a relationship with someone who listens to you and is genuinely vested in you being successful, you being healthy and your money someplace else, this also puts the onus of your health care on you. So I think when I think about my patients and they come and they talk to me, they say that nobody has listened to them and I think that's crucial. I think that you have to bear in mind that however old you are, you have had that body and know how that body works for however many years God has allowed you to live on the face of the earth.

Dr. Berry:

No one gonna knows better than you.

Dr. Anila Ricks-Cord

Right. You are your own healthcare advocate. You got this on lock. If you go see somebody and you were trying to talk to them about what you're experiencing and then listen to what it is you say, go ahead and pick up and walk right on out the door and take you off your money and your insurance card with you. Because you wouldn't take bad customer service at a restaurant. You wouldn't take bad customer service in a product that you purchased. (Nope). So why would you take it with your health care, which is more important and lasting than product you going to buy, meal that you eat and pass on through it.

Dr. Berry:

Please tell Lunch and Learn how can they find you? Right? Because I know some people are probably energized right now. You know, and I kind of alluded to your Facebook, like give them all the ditails because I need people to be able to kind of track you.

Dr. Anila Ricks-Cord

Sure. On the sly, I'm a firm believer that food is medicine that tells the body what to do. And so I have invested in becoming a health coach. So in addition to being an Ob-Gyn, I'm a health coach. And with that said, I love answering questions that Dr. Berry's alluded to. So on Wednesday evening, 7:00 PM CST cause I'm in Texas, I do Facebook live on women's health topics and you can find me across all social media At D R A N I L A O B Gyn, that's Doctor Anila OB Gyn. You can also find more information on my website, which is also www.drnilaobgyn.com. That's D R A N I L A O B G Y N.com. And if you tune into any of my lodge will find that I love answering questions. I think that as I alluded to earlier, my mom died because there was nobody there to advocate for her. And at 22 years old I didn't know the questions to ask. My goal as a health provider is to make it so that you know what I know. So your arm to take better care of yourself.

Dr. Berry:

I love it. Absolutely love it. And of course Lunch and Learn community, like always, if you're running out, you're in the car, you're driving, wherever you doing, you don't have to worry. All the, all of her information will be in the show notes. So you we will make sure and, and you really just got to watch one of her Facebook lives because she gets very animated, right? Like she really make like, okay, yeah, this one was health really is, that's why I say that, you know, you're going to be on my show because I need someone animated to educate me. A women's health to really educate y'all. So again, she is always, which she seems to be when you listen to her and you could just tell the love that's there. I like that and have everything right. You could just tell the love that is there to educate, to help you. Right? Get to where you need to be. And that's what I love about her. Right. She's absolutely amazing. Again, we're going to make sure she will be a repeat regular on this show, especially again at ya'll. Y'all ask me a lot about women's health stuff and I'd be like, I'd be like, hey they, and this, I know what I know and I know that I don't know. Once I realized I know what I don't know. That's when I get the console.

Dr. Anila Ricks-Cord

It has been my privilege and it would most assuredly be my pleasure for wherever it is you'd like for me to talk about from vagina land cause I have it on low.

Dr. Berry:

All right. Again, I appreciate everything that you do for your community. Appreciate everything you do for just the world and allowing you to take your amazing talents outside of the clinic and outside of the one on one and being able to talk to the master. So again, thank you Dr. Anila for coming on the show this week.

Dr. Anila Ricks-Cord

Thank you so very much Dr. Berry. I appreciate it.

On this week's episode of the Lunch and Learn with Dr. Berry we have Dr. Sabine Elisee, a Board-Certified Family Medicine Physician, the CEO and co-founder of Cornerstone Medical Group Inc. Not only is she fellowship-trained in Hospice Palliative but one of her best attributes is that she is a former classmate of mines and close friend.

Today she joins the podcast to discuss one of the most important lifesaving skills that we are imploring that everyone learns ASAP. Dr. Elisee goes through two different scenarios where she was able to use these lifesaving skills to ensure that someone made it home to their loved ones.

Check out today's episode to find out exactly what these life-saving skills are.

Text LUNCHLEARNPOD to 44222 to join the mailing list.

Remember to subscribe to the podcast and share the episode with a friend or family member.

Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify

Sponsors:

• Lunch and Learn Community Online Store (code Empower10)
• Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you)
• Dr. Pierre's Resources – These are some of the tools I use to become successful using social media
• My Amazon Store – Check out all of the book recommendations you heard in the episode

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Download Episode 131 Transcript

Download the MP3 Audio file, listen to the episode however you like.

On this week's episode of the Lunch and Learn with Dr. Berry we have Dr. Andrew Berry, a Gastroenterology Fellow to discuss one of the most talked-about current public health crisis which is Vaping. As we have moved the public needle in regards to the harmful effects of cigarette smoking, e-cigarettes/vaping has become the alternative but unfortunately, that has come with consequences.

Dr. Berry gives some amazing facts about how this craze first began, just how many deaths are attributed to vaping and what to expect for the future of the industry.

Text LUNCHLEARNPOD to 44222 to join the mailing list.

Remember to subscribe to the podcast and share the episode with a friend or family member.

Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify

Sponsors:

• Lunch and Learn Community Online Store (code Empower10)
• Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you)
• Dr. Pierre's Resources - These are some of the tools I use to become successful using social media
• My Amazon Store - Check out all of the book recommendations you heard in the episode

Links/Resources:

• The E-Cig Vaping Health Crisis: Medical Overview
• Pathology of Vaping-Associated Lung Injury
• Twitter

Social Links:

• Join the lunch and learn community – https://www.drberrypierre.com/joinlunchlearnpod
• Follow the podcast on Facebook – http://www.facebook.com/lunchlearnpod
• Follow the podcast on twitter – http://www.twitter.com/lunchlearnpod – use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast
• For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drberrypierre.com/lunchlearnpodcast/

If you are looking to help the show out

• Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better
• Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod

Download Episode 130 Transcript

Download the MP3 Audio file, listen to the episode however you like.

Episode 130 Transcript...

Introduction

Dr. Berry: Welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com, as well the CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, education and affirmation. This week we are going to be talking with Dr. Andrew Berry who is a Board Certified Internist and also a second year GI fellow, gastroenterology fellow. But we are going to be talking about a topic of vaping because that's something that's right along his alley as known as the GI fellow. But he is very well versed in lots of different academic related topics. And we got together thinking, you know what, let's talk about a subject at hand that if you are a smoker, if you know a smoker and you've heard about this this new, this trend. I would say new, but this trend of e-cigarettes and vaping, let's talk about vaping.

Let's talk about what we're hearing in the news about vaping. Whether it's harmful, whether it's good for you. Who should be vaping? So we're gonna be talking about vaping on this episode today and I think it's a good one because it is something that, again, I listened to this episode and I was getting so much education from it and I know you will too. So again, Lunch and Learn community and like always, if you have not done so, please subscribe to this podcast. Leave us a five star review especially from my Apple podcasts users. Your help is greatly appreciated and like always, if you remember to share with not one but maybe 10 friends and let them know how much of an amazing episode this was today. So we're talking about vaping. Get ready to sit back for another amazing episode here on the Lunch and Learn with Dr. Berry.

Episode

Dr. Berry Pierre: Alright Lunch and Learn community, you just heard another amazing introduction for a topic that I think you are really in for a treat for. Again, when you turn on your TV, read the blogs. This is definitely something that has been really on front page news now. Especially, I work in a hospital setting and people keep asking me about it. People keep asking me vaping, vaping, vaping. What is vaping? How dangerous is vaping? Why are so many people dying from vaping? And I figured, hey, you know what, let's get someone who knows what they're talking about on the subject.

So again, I want to thank, I like to call the real Dr. Berry to talk about a topic. It's so funny because I call myself Dr. Berry but it's a funny thing. People like be able to call me by my first name some weird reason. I'm not sure why. But I like be able call my first name, but I still want it to attach the doctor to it. So alright, sure. I'll be Dr. Berry. But we have the real Dr. Berry - Dr. Andrew Berry who's going to be really educating us today Lunch and Learn community on just what vaping is and just why we should be really, really worried about it. So, Dr. Berry, thank you for joining the podcast today.

Dr. Andrew Berry: Thanks for having me. I appreciate it. This is definitely a topic that's hot and we want to hit the hot topics that are relevant to all markets. I appreciate you having me on.

Dr. Berry Pierre: So Dr. Berry before we get into this amazing topic, tell the Lunch and Learn listeners about yourself, who you are, why this topic is such a hot button topic for you and that way we can get into the meat of it.

Dr. Andrew Berry: Actually a GI fellow currently. So basically one more year of training and then I'm out in the practice, treating all your stomach problems. But right now I'm still in training. Internal Medicine Board Certified, so obviously something that you're familiar with. You deal with people all the time and training the next wave of internal medicine physicians, which is highly appreciated. Also did my training, medical school. Some of my rotations were actually in West Palm Beach where you were.

Dr. Berry Pierre: So funny because first of all Lunch and Learn community, Dr. Berry sent me a CV, I think 20 plus pages. So I'm already impressed at a CV and I'm seeing some of my former residents. Amongst some of the persons, I'm like, how does he know Dr. Kaplan? I tried to figure out. And then I'm trying to be like, hold on. Now it's called JMP North campus, then we'll see at the time when I was there? And then I was trying to go back and I was like, I couldn't remember. I couldn't remember if you were there at the same time I happened to be there. I definitely, because I heard name, just for some reason it was so crazy because I was seeing all of these publications. Her name just stood out. How she get there?

Dr. Andrew Berry: I think it's a small world. But I think you were there when I was there, just like vaguely. So I saw you in passing, I didn't have the privilege to work with you.

Dr. Berry Pierre: Yes. I saw some of the posters that are like 2014 so I wasn't sure if, because that would have been my last year, uh, as, as a residence. I wasn't sure where you were your student that year or wasn't sure we just hadn't crossed there or was just that in passing.

Dr. Andrew Berry: Yeah. I'm not sure, who knows? Probably both.

Dr. Berry Pierre: So definitely well-read. And like I said again Lunch and Learn community I'm not joking. The CV really is like 20 plus pages. Just amazing story. And especially for someone who, as a person who does academic medicine, I'm loving it. Oh wow, okay. This is a person who is really, really well-read. So definitely a person I want to make sure that we get to try to touch on a whole bunch of different topics as we can. And so today we're talking about vaping. Just for those maybe someone who does not know what would vaping is. What is vaping, just so for the general community?

Dr. Andrew Berry: Everybody knows smoking taking off big time in the last couple of decades, middle of 1950s, 1960s. The big social stigma. But ever since let's say 2012, there's been a trend for this new thing called vaping, which is electronic cigarettes. So instead the smoke you get the tobacco coming out, you just get to smell the vape. It is a little shot of a smoke in the air, disappears and dissipates. And it's not like tobacco, it's usually nicotine based and nowadays they're becoming more THC, cannabis based also. But now it's becoming a little bit more of an issue because there's more illnesses and patients having symptoms that are arriving from these vaping products.

Dr. Berry Pierre: What's interesting because I love how you touched on the fact that it is nicotine based because I think sometimes people think that if they do the vaping or is it, first of all, question, is e-cigarettes and vaping, is that similar from a reference standpoint?

Dr. Andrew Berry: It's interchangeable. So initially e-cigs you know, a way to ween known adult smokers off of tobacco products, cigarettes. But now it's becoming more cool slang term to call it vaping. And there's even more other terms for it. But that's what everybody thinks. E-cigs is what's called two years ago and an older crowd, but they think it's the trending way.

Dr. Berry Pierre: Okay, perfect. And I love the fact that you touched on that it's nicotine based because I think some people make a fuse the fact that if they're vaping that they're not getting the nicotine aspect that they would get like in a regular cigarette?

Dr. Andrew Berry: Yeah. In fact, they're actually getting more. Some of the studies have shown that they're actually more nicotine in these products. We're used to the patch and the gum to wean smokers off, which is FDA approved, as you probably use in your clinics and in a hospital setting. But the vaping is not FDA approved to wean smokers off. It is just a means to do so for adult known smokers. But the nicotine product content is actually in some of these products much higher than traditional cigarettes and/or patches or gum.

Dr. Berry Pierre: Wow. So, okay. Alright. Lunch and Learn community, I always tell you guys that sometimes, I have to learn from my guests as well. So it has definitely, some really strange, but very interesting thing to hear the fact that you're not really putting it away from the nicotine because if it's not more that you're going to get in this, the vaping aspect of it. When did it all start? How long has this been around? Why is this such a hot topic now? What would you say?

Dr. Andrew Berry: Yeah, exactly. So it's been really going relevant a little bit since 2012. But 2017 is when you noticed a huge rise up to the point that over the last three years, well currently this year is about 8 million adults using e-cigs or vape products and about 5 million children also vaping, which is crazy. Because of 2017, so it's two years ago, it's 11% of high school students admitted to vaping on a daily regular basis. However, 2019, so just in two years, it's up to 27%. So over two and a half times increase. One out of four high school students are actively vaping on a daily basis.

Dr. Berry Pierre: Wow, that's crazy. Okay. Alright. Especially because you said kids, so I'm thinking like, is he 16, 17? So that young they're starting to vape?

Dr. Andrew Berry: Yeah. Even in middle school. So in middle school were about 5% right now, which is one out of 20 middle school students admit to using vape products on a daily basis. And this is also people that admit to it. So as you and I both know, the numbers are actually higher.

Dr. Berry Pierre: Exactly. If our patient says they drink two drinks a day, it's probably closer to four. So that's definitely a point I agree with wholeheartedly. For sure. When we talk about just vaping, why do you think like this I guess boom? And I don't know if we should even be calling it. Why do you think this level of popularity just exploded in such a short timeframe?

Dr. Andrew Berry: Yeah, exactly. So it's not even much advertising was needed. Multiple hypothesis, event thrown out there. One is social media. This is something that can be spread easily in social media. The market uses social media in the last two, three, four years. It's skyrocketed. Instagram, Twitter, all the above. And they can do these tricks, these vape tricks. So there's all these YouTube videos, millions and millions of views regarding tricks with the vape, the smoke, they play it to music, EDM music to Friday night, vape night where they've smoke, vape and play music and just do stuff like that.

Dr. Berry Pierre: Wow. When you say vape tricks, what type of tricks are you doing?

Dr. Andrew Berry: You having some sort of fan product in the room or they huff and puff at the vape and then swirl smoke around with their hand. In addition to music and EDM and then they hold and they make music videos out of it. I mean from a third party viewer, not in my words, but it's cool.

Dr. Berry Pierre: So funny. I've seen those videos and really never paid it any mind that that's what they were actually doing in those videos. Okay, that's weird. I'll take it back. I used to say that's cool too. I used to be like, okay that's nice.

Dr. Andrew Berry: Exactly. And a couple of years ago when this first started and like 2017, there's principals and high school teachers even coming out now saying, they didn't even notice these people. They thought it was a USB drive. So one of the main companies, Juul, which is one of the hottest companies in the last couple of years, worth billions of dollars. You could stick their little vape into a USB drive on your laptop and looks like you're charging a USB drive. (Wow). So no one knows people are smoking in the classroom. They're actually, the goal, it's not like a cigarette where you, let's say in 1999 you'd go in the bathroom and hide, sit there, you're faking constipation, sitting there for 10 minutes trying to smoke a cigarette and hide it and spray cologne. Now people are vaping purposely. They want, they've tried today vape. Every time the teacher turns their head, someone, their friend takes a picture, they post it and it goes viral. So it's the opposite, which is kind of, that's why it's…

Dr. Berry Pierre: And do they even get like that smell that tends to linger? If you're smoking a cigarette, obviously there's like a cigarette type smell, but when they vaping is that just like not there?

Dr. Andrew Berry: Yeah, exactly. Very good point. So 80% of Juul's sales and which is the best surrogate for the market because it's the best company. Biggest company sells flavored e-cigs. So when you smoke these, they actually smell like fruits, female student high schools perfume. You literally can't tell the difference. And it goes away fairly quick. So that's why this whole, we'll get to that in a second, about this whole ban, to try to ban these flavored products first and foremost.

Dr. Berry Pierre: Interesting. Okay. Alright. Like I said Lunch and community, I am being educated along with you guys. Because again, this is a topic that again, because I'm internist so I take care of a lot of adults. And most of the time I take care a lot of older adults. So a lot of times the cigarettes and I'm trying to get out their hands. I'll never ever usually having to say like, hey, stop that vaping machine. I'm never having to say that. So this is definitely seems like a problem that's been pushed towards a younger crowd.

Dr. Andrew Berry: Correct. And the marketing, the Juul company has specifically said they've never marketed toward young crowd. They have been, they have had some small social media promoters, some actors and all that that they sort of pay as years ago. But right now they are currently not marketing to this crowd. And that is the whole litigation legality issues currently going on with this company and all the other electronic cig vaping companies. The government is warning and trying to prevent any sort of marketing for a younger crowd. That is the number one topic right now.

Dr. Berry Pierre: I'm naive to this topic. Are kids able to buy these things? Is there an age or how are so many of these young kids able to get this stuff?

Dr. Andrew Berry: Exactly. So up until recently, most States had age of 16 or 18. But nowadays about 18 or about 20 of the States have now enforced new regulations saying that you have to be 21 to buy these products. Also the company which has been forced upon the company by the government is coming forth with these age verification systems where they only sell certain amount of products, certain amount of refills over certain periods for checking IDs stronger. The government is making them do this. They've had to spend a hundred a million dollars to try to give incentives to retailers to install these new age verification systems.

Dr. Berry Pierre: So obviously with something that is so popular with a crowd that will only get older, which means there's going to be a long-term customer. Why has it been come such a problem? What has been the catalyst to say like, oh, we gotta do something about this vaping.

Dr. Andrew Berry: Exactly. So with success of companies, these first couple of companies comes, want from other companies in third parties to create more products so they can get a share of the market. So it is these, some of these new products mainly containing THC components. And usually black market, which means they label it as one certain product, but they actually just use the label. They print it illegally from other outside the United States and they put these third party products in it that you don't even know what's in the product. And a lot of them have some sort of THC components. But mainly that's part of the answer to your question. The other half is over about in July or August this year is a little long answer, but this is their important in this content.

I'm from Wisconsin, so go figure. It all started, in Wisconsin, in July of this year. There was about six patients over a two month period that they just were wondering, they couldn't figure out their diagnosis. They are these young patients presenting to the hospital. Let's give you an example. I have the perfect example for you. July 7th, 18 year old who ran track, just graduated high school, presented at urgent care with breathing issues. She had an x-ray with some infiltrates. She was sent home with antibiotics. She never got better. She came back in a few days, a chest pain. She couldn't breathe. She had shallow to keep breathing. Give her oxygen and she actually became worse. She had been to the ICU, she became oxygen mask dependent, almost intubated.

In the end there had 6 or 5 other cases like this, about six. And the doctors were confused, wondering what's going on. They frantically reviewed all the records and the only thing that the patients had in common was a history of vaping. They're all young. In Illinois, the neighboring state had similar issues also. And the first death ever reported from vaping ruling out all other causes with full vaping history and objective data was in August in Illinois. That's what triggered it all. Once you heard the word death in vaping, then every newspaper every day since August has had multiple stories as you probably are aware.

Dr. Berry Pierre: Well, to the point where even when I started to do a little research for this discussion. I just type in the letter V and it already knew that I wanted to talk about vaping. It was as like Google is like, oh you must want to talk about vaping real quick. Fun facts about vaping, what to worry about vaping things, everything was like, oh wow. You right almost everyone's like writing an article now about just this how has become such a problem. And I know you touched a little bit on the fact that this introduction of the THC related products. Was that always a goal in mind? Did it start out with, was it always just to be nicotine but the THC folks, hold on we can maybe get in here as well.

Dr. Andrew Berry: Exactly. So nicotine was the original goal. But you know, the culture of America in general over the last five years has been more open to the concept of THC for different recreational or medicinal uses. It's still not approved under federal law or I believe 21 States plus or minus okay it under state law for recreational or medicinal purposes. So obviously it's a free market. The United States is a free market. People jump on it. So they're thinking, wow, we've got these vapes going. Now what about introducing THC? And we know people will try to do it because it's another way to hide or kind of disclose their use of THC product.

Dr. Berry Pierre: Where these THC products, where they also in this flavor contraption so it didn't even smell like THC?

Dr. Andrew Berry: Yeah, that's a tough topic actually. The flavor ones are mainly the nicotine. But I think there's some of these third party companies, newer players in the market now that are trying to introduce some sort of flavor THC product to mass that traditional smell that you may smell as a third party viewer walking in public.

Dr. Berry Pierre: So we're now all of a sudden the microscope is on, right? And now we're like, really going in on vaping and everything else. So of course, I'm going to be the devil's advocate. Is this an overreaction? So I think we should start there because I already know that there's someone listening who vapes and are like, no, my vaping is great. No, I'm never letting the vape go. So there's going to be someone there who's like, no, no, no, they're just over-exaggerating. Is this an over exaggeration or is this something we really should be worried about?

Dr. Andrew Berry: Very good point. I think there is a small, small component of over exaggeration because you're so tuned into this now. So you see somebody in the hospital, you rule everything else and have easy scapegoat. Oh they vape a lot. They vape daily. It must be that causing their lung illness or maybe they got an infection. I had a patient who had a mycoplasma positive infection that told me quote, I vaped more than anyone else you'll ever know, end quote. So I'm like, okay, it must be that. But yeah, so there is actually, they actually made a formal definition of probable cases of vape or probable component or for sure objectively determined this diagnosis. And it confirmed case describes someone who has vaped in the past 90 days presenting with haziness or CDs in their chest scan and no signs of infection or other plausible diagnosis.

So that's their CDC official definition. But I agree with you, this definitely going to be over reporting now and we need to find, people are frantically finding, when you do your article search over the last 24 hours, there's institutions and academic centers trying to do all these tests to figure out some sort of objective way of what is actually causing this. Is it the vape? I have a feeling it's actually the traditional Juul product may not be the issue. It's just these THC laden third party products that are being intertwined or switched over with not really a marketed and monitored products. So I think there's just something, the component of like spice, the drug, sometimes people take. It's like a grab bag. You don't know what you're getting.

Dr. Berry Pierre: Now, question. Especially because I know we've talked a little bit, I know we're getting on the Juul and now is Juul the same phrase when I think about iPod? There's a lot of MP3 players but then the standard we always think about is iPod. Is jewel the main maker of those devices or is there different ones? But Juul just happens to be the big dog?

Dr. Andrew Berry: There's different ones. But Juul is the big dog. It's so big. In fact the two major tobacco companies, Altria and Philip Morris bought a huge stake in Juul last year. They paid like $12 billion for 35% stake. And Philip Morris did similar thing this year. However they were gonna merge. But because this whole new vaping issue, they called up their merger in last couple of weeks on Wall Street.

Dr. Berry Pierre: So this topic…

Dr. Andrew Berry: This is huge. This decision and this vaping, illnesses and deaths have actually changed stock market prices drastically to CEO, owes, have quit in the last two weeks. It's a very volatile market per se.

Dr. Berry Pierre: So right now we don't really even have a direct causation of why it causes a problem. We know it causes lung damage, but we're not necessarily sure how it even does that?

Dr. Andrew Berry: No, the best objective scientific as you know, something that you would be okay. You'd read in a journal, which I'm sure you do all the time, came out October 2nd in New England journal. So that's six days ago. It took 17 patients that have lung biopsies that have confirmed cases. So as of right now, today there's about 1,080 confirmed cases of vaping related illnesses or vaping related long illnesses and 19 confirmed deaths. So they took 17 patients. Most of them are men. Median average age is 35 and they all had a history of vaping and three quarters of them are with marijuana or cannabis oils and they actually got this stylogy from the lungs to see what's going on at a molecular level. And they just had a vague answer. There's no real one thing going on. There's edema, there's a possibly organizing pneumonia and there's sloughing off of the epithelial cells at the lung level. But there's no one finding and they couldn't trace it to one product. That's the problem. The people in the CDC think it just might be one or two bad apples in the group, but that is the best like objective study today just came out in last couple of days.

Dr. Berry Pierre: Lunch and Learn community, we'll definitely make sure we put a link to that journal article so that you can read that yourself and then you get educated. When you have something like that, when you have something that we don't even really know how it causes the problems, so of course again I'll be the patient, Dr. Berry, how do I avoid this if you can't even tell me how to avoid?

Dr. Andrew Berry: I mean the easiest answer, you know these answers, stop. The CDC actually, they're not telling you, what they are telling you to stop by the polite way they're saying it is just stop in the meantime until we know what's going on. So a lot of these electronic cigarette users AKA vapers now, because it's cooler term. Successfully, studies have shown that they, it's been somewhat success for smokers that have weaned off as you probably you don't recommend it maybe, but you're okay with it. That's how a lot of physicians feel.

Dr. Berry Pierre: Someone will say, well are they in totality? Are they better than regular cigarettes? Are you telling me Dr. Berry that I should go and smoke regular cigarettes again?

Dr. Andrew Berry: Patients have said that. I had a patient today that literally said, I asked the history and I wanted to get more vaping questions and he says he was 50 pack your smoker. He's like, at least I don't vape, that's the bad thing for me.

Dr. Berry Pierre: Unfortunately we know how we know how patients think. Because I already know I've got someone who's probably listening to this like, whoa, I think they're telling me that I should just go back to the regular cigarettes. (No). So are we saying that they should go back to your regular cigarettes until this vaping thing goes round? I wish this was a facetious question, but I'm 100% sure someone is thinking that.

Dr. Andrew Berry: Correct. And I think the best answer to suffice all parties would be, if you're relying on this to wean off cigarettes and keep you off cigarettes, I'm not gonna adhere to or support this decision. But I would be okay with continued vaping products. However, I would highly caution against anything THC or cannabis space, vaping products, especially sold online or at small retail stores, not regulated with licensed state. But a lot of people are getting these online because no one, a lot of States don't have it. And then the demographic is the younger person, they're all online people trying to do stuff without under the radar.

Dr. Berry Pierre: Right. Well we have their parents and guardians anyway, so what better place to a dude is than order it through the internet. So what tips would you give for now? I'm personally, I'm being educated, so what tips would you give a person in the health field that needs to understand the importance of this vaping topic and how to talk to their patients and I guess get them to quit or just getting them to stress to stay away from the THC related products, if anything?

Dr. Andrew Berry: Very valid discussion point right there. I think you just tell them the facts. So if you tell them the facts, it's such a dynamic thing and tell them that you're staying on top of it. I feel like every physician should at least stay on top of this subject since it's so popular. I mean, I'm a GI physician and I've had cases consult cases that I think related to their THC laden vape products, after ruling out everything else. I have one or two in the last couple of months I feel. But I think telling them the truth and let them know, be honest and tell them that we don't know. So why would you want to take something that's such sketchy that you don't know what's actually happening currently? I think the best thing would be tell them they should be stay up to date and we should all just work on this together. Figure out what's actually causing the issues. Obviously you want to caution to decrease their usage overall.

Dr. Berry Pierre: Especially the THC. I got question, is there any THC that I can do vaping? Is there any that have been federally stamped and given the okay or should I just be really staying away from all THC related products right now?

Dr. Andrew Berry: Personally I would say there is small of them. But I think there is some states that have traditionally been selling the THC, especially the medical aspect. Physical stores that have been doing it for a while. And it's a tricky, tricky subject because it's not really regulated. So I wouldn't do it. I know the numbers are small. So you look at all the people that vape across the country in the world, you're saying, okay, only 19 deaths.

Dr. Berry Pierre: Exactly and of course people always, well only have 19 people.

Dr. Andrew Berry: Exactly. There's 19 people that got in a car accident today. But these are young healthy people. That's the thing. Okay. I mean these are people that shouldn't be getting sick, shouldn't in the ICU. There's gruesome photos online if you Google them of kids on ventilators, even one kid holding a sign that once you got extubated, I want to start a no vaping campaign. It went viral.

Dr. Berry Pierre: This is definitely a topic. So I got to ask especially in your professional career, where you're at right now, where do you see vaping going from here? Because you're saying, you've got CEOs dropping out, you've got people losing a lot of money because of this, I don't want to call it a roadblock, but definitely there's bumps in the road. Where do you see vaping going?

Dr. Andrew Berry: Well, on September 11th this year, President Trump wanted to ban vaping. Everybody's talk on banning flavored vapes because that's targeting those younger people. That's the main target of their goal.

Dr. Berry Pierre: Younger people aren't doing the non-flavored ones or is it just most of the time if it's flavored?

Dr. Andrew Berry: I think they're getting a hook. I think a lot of them start on the flavor and then they advanced or progressed to the THC one. 80% of Juul sales are flavored, so the government is trying to hit the Juul market by stopping their flavored and they think if they can do that, they can stop the overall trend. My personal opinion from an economic standpoint is that this whole regulation, they'd probably will find some trace it to a couple companies, maybe a couple of chemicals, and that will wean out those companies and chemicals. And I think it actually may make Juul stronger because they don't have any THC products. It's all nicotine. So once they prove that their product is safe, I feel like a lot of kids will go back to it. (Wow). And it may get a little bit worse. That's my own opinion though.

Dr. Berry Pierre: And I know especially because I know you talked about the almost three quarters of it being THC related. So we still got like that 25% that the nicotine related issues that are kind of still happening as well too.

Dr. Andrew Berry: Correct or inhalational issues. I think some of these are having heat or caustic burns to the lung, sort of like a chemical pneumonitis. So that's on the differential. So the heat is, might be an effect also, but three quarters of them it is sure fire three quarters, I've checked all the numbers. Three quarters are usually men. Three quarters are usually younger under the age of 35 and three quarters. Usually THC is some sort of derivative. So those are the unhappy triad of things to avoid.

Dr. Berry Pierre: Dr. Berry I wanted to thank you for really educating us and educating, especially me on a topic that is, like I said, as popular as it has been. Again, I felt like it just popped up out of nowhere. And then all of a sudden I see this crisis and almost every article that I read, I'm like, okay, alright. Write down my favorite again. I typed the vape again, nope. I typed the vape again, Nope. Read article. Everything just pop that in over. Thank you for helping enlightening us for such an important topic at hand that really does not seem to be, I guess by your words, does not seem to be going away anytime soon.

Dr. Andrew Berry: No, I think it's just heating up literally.

Dr. Berry Pierre: So before I let you go, I always love to really spotlight a guess. And like I said, I, I talked about it a little bit, especially in the beginning the fact that you got CV that's 24 pages. But tell people about just about yourself and where can they find you and what's next for you. Because like I said, I know you've got about a year and some change before you're out here, but clearly you're doing some things that I would love for our Lunch and Learn community, be able to follow it along. Tell us about your social media, any other ventures you may have coming up.

Dr. Andrew Berry: I appreciate you letting me on. Basically, I'm not sure. Open mind. Just like the stock market, diversify your portfolio. You never know what opportunity you're going to get or were going to happen. Obviously, you never know. Obviously I'm set for medicine. I'd probably gonna do private practice, but academic twist to it. I like to publish on a lot of topics. A lot of my publications are not on the same topic.

Dr. Berry Pierre: Yeah, which I know. I was like, wow, you were very wide range with it too. I know my fellows typically hyper focused, GI stuff, and I'm like, oh no, no, that's not even the case.

Dr. Andrew Berry: Yeah. Some of the hot topics I like to hit because I think, well I talk about men to a syndrome when you're gonna see five this year. Might talk about vaping when you're gonna see five this hour. So I don't know, a social media, I like to follow a lot of things. An Instagram doctor pub med, and just something funny fitting. I guess Twitter I use sometimes mainly just to catch up on literature, but mainly Instagram. It's a great story. People want quick things as you do on your page. You've got a lot of links, a lot of quick things people are. It's an inpatient market out there.

Dr. Berry Pierre: Yeah. You right. Especially for attention. You gotta snatch their attention like, hey stop real quick.

Dr. Andrew Berry: You've got to mix out audio, video, you gotta mix links. I don't know. You just got to keep it hot. No one wants to read about the same stuff. So that's the fact that you do all these podcasts and different people, different subjects keep the viewers on their toes, you know.

Dr. Berry Pierre: Perfect. We would definitely appreciate your efforts. Remember Lunch and Learn community, all of his links will be in the show notes as well. Definitely follow him. I know you were talking about a YouTube page as well too. You have a YouTube as well?

Dr. Andrew Berry: I have a YouTube page. I have a lecture that I gave a similar topics. I put it on YouTube. It's got video, audio. I got a little bit everything. You gotta hit all the markets.

Dr. Berry Pierre: And remember Lunch and Learn community, if you want to watch videos, he's got stuff for you. If you want to just read, he's got a lot of stuff to read, I'm telling you. That's all I get. I'm not being facetious. There's a lot of stuff to read if you want to read. In fact, I was very interested and I have to get a read on the online symptom checker, I was like, oh, that's a topic.

Dr. Andrew Berry: That's one of the topics I really like too. I have done some TV stuff with that and some of the vaping, it's a hot topic.

Dr. Berry Pierre: What made you do that before I let you go? What made you like thinking, oh, you know what, we tackle there.

Dr. Andrew Berry: Everybody, just like you and I know. Everyone, every day you're going to see somebody that comes and says, well, I looked it up online web MD, this and this, and we all have the same reaction internally, a little different externally. It just made me want to do it and I just checked the accuracy of these symptom checkers and let's just say it's not good.

Dr. Berry Pierre: Not good. I love it. Here Lunch and learn community, please don't go to web MD and all these other places and click a couple of buttons and then come and tell me you have cancer. I don't want to hear it because web MD is always gonna sell high because they don't want to be the ones who say like, oh whoa, whoa we told them they had cancer and they didn't believe me. It was just a migraine. I guess that's all it was.

Dr. Andrew Berry: Exactly. And now I guess right now a new study we could do, hopefully one of your viewers maybe wants to do this. You can check these injectors now for vaping. See if that's in a differential.

Dr. Berry Pierre: It's so funny because as we've talked about it, I have not had one of my residents like throw it out in a different ritual.

Dr. Andrew Berry: We can tell who's listening your podcast now so hopefully whoever does it definitely a listener.

Dr. Berry Pierre: Exactly. So again Dr. Berry, thank you for really putting us on game. Putting the word out there. This is something that everyone needs to know and we'll make sure that happens. Such an important topic of vaping as it is.

Dr. Andrew Berry: Thanks for having me. I appreciate your time.