The Art of Medicine with Dr. Andrew Wilner

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Show Notes
Recorded February 4, 2021

Many thanks to Kenneth Tyler, MD, for sharing his expertise as a specialist in neurologic infections. Dr. Tyler is Professor and Chair of Neurology at the University of Colorado School of Medicine, Aurora, CO.

Dr. Tyler recently co-authored a paper on the neurologic complications of COVID-19, “COVID-19: A global threat to the nervous system,” published in the Annals of Neurology, July 2020. You can download this paper for free at this link.

Both Dr. Tyler and I come from the same generation of medical training. We are both board-certified in internal medicine and neurology. Dr. Tyler’s interest in infectious disease led to his research on brain infections. 

The high infectivity rate of the SARS-CoV-2 virus has created worldwide havoc. While many infected individuals suffer only mild symptoms, others are not so lucky. Dr. Tyler explained that the virus can cause systemic illness that results in neurologic complications. Rarely, the virus even invades the nervous system.

Dr. Tyler emphasized that vaccination is the most powerful tool we have to fight the SARS-CoV-2 virus. I agree. Please do not hesitate to get vaccinated! Dr. Tyler also advised that people should not stress over the specific type of vaccine. All of the FDA-approved vaccines are much better than no vaccine at all! 

Even though both of us have received the Pfizer vaccine, we continue to wear masks and practice social distancing and hand hygiene. If these measures prevent even one COVID-19-related death, they are well worth the inconvenience.

To learn more about the neurologic complications of COVID-19, please listen to our 20-minute discussion.

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Show Notes

Interview January 8, 2021

Many thanks to Armin Feldman, MD, for sharing his secrets of the new medical subspecialty, “forensic medicine.” A psychiatrist and psychoanalyst by training, Dr. Feldman initially focused his energies on traumatic brain injury patients. However, for the last 13 years, he has assisted attorneys in pre-trial and pre-litigation medical-legal case preparation. Rather than function as an expert witness, Dr. Feldman delves into the medical literature to define each case’s merits, interviews every client, and prepares a report. His work helps attorneys negotiate and arrive at prompt and favorable settlements. These are not medical malpractice cases but involve disability, personal injury, or workmen’s compensation. To date, Dr. Feldman has accumulated a vast experience, assisting in over 3,000 cases. 

Dr. Feldman has already shared his experience with this type of medical-legal consulting with over 1,600 physicians. If you would like to learn more about this meaningful nonclinical work that helps people, increases your medical knowledge, and pays well, you can join Dr. Feldman at his next online seminar, April 24 and 25, 2021. 

To register: www.medlegal2021.com

For more information: www.andrewwilner.com

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If you enjoy an episode, please share with friends and colleagues. "The Art of Medicine with Dr. Andrew Wilner" is now available on Alexa! Just say, "Play podcast The Art of Medicine with Dr. Andrew Wilner!" 

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Show Notes

November 17, 2020

Many thanks to David Weinstock, MD, Professor of Medicine at Harvard Medical School and oncologist at Dana-Farber Cancer Institute in Cambridge, MA, for commenting on his recent article published in the New England Journal of Medicine (NEJM 2020;383 (19):1809-1811). Dr. Weinstock’s impeccable credentials make his article all the more persuasive.

Dr. Weinstock reluctantly concluded that it was humanly impossible, at least for him, to maintain optimal clinical skills while running an oncology laboratory searching for a cure for cancer. He admits to “feeling like a failure” at being unable to continue as a “triple threat” (clinician, researcher, and teacher). Finally, he realized, “Medicine is an art. Great artists obsess over their work, they practice to the exclusion of all else.” We agreed that primary care clinicians and other generalists face an explosion of knowledge to master that tasks even the most talented and dedicated practitioners.

Dr. Weinstock’s realization took courage to put into print for colleagues and students to see. Nonetheless, he felt obligated to share this new reality with current students who hope to become physician-scientists. He still encourages trainees to pursue a career as a physician-scientist if that is their passion. A physician-scientist is still “the best job that there is, but it’s a very long training process, and you’ve got to be in it for the journey, and you’ve got to get goosebumps every once in a while when you discover something….” To put his advice in perspective, note that Dr. Weinstock trained for 18 years before getting his first job!

Please join us for this 20-minute interview as we discuss how the practice of medicine and medical research has evolved since the days of Sir William Osler, Wilder Penfield, and James Parkinson--when physicians really could do it all.

For more fascinating interviews, please subscribe to “The Art of Medicine with Dr. Andrew Wilner” at www.youtube.com/c/andrewwilnermdauthor. Also available as a download on your favorite podcast player.

More info at www.andrewwilner.com.

Please click "Fanmail" and share your feedback!

If you enjoy an episode, please share with friends and colleagues. "The Art of Medicine with Dr. Andrew Wilner" is now available on Alexa! Just say, "Play podcast The Art of Medicine with Dr. Andrew Wilner!" 

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Show Notes

November 6, 2020

Many thanks to Maureen Czick, MD, a locum tenens anesthesiologist and author of an intriguing publication that explores the role of the renin-angiotensin system (RAS) in the pathophysiology of COVID-19 (Czick et al. 2020).

Dr. Czick shared how locum tenens returned “agency” to her life, which allowed her to spend more time with her family and pursue other interests, such as writing. We also discussed her recent paper, which illustrates how RAS dysfunction might be the key to understanding the pathophysiology of COVID-19. 

The RAS hypothesis is provocative because we already have medications, such as the antihypertensive losartan (Cozaar), that act on RAS and could potentially improve the disease’s morbidity and mortality.

Please join me during this fascinating 25-minute interview with Dr. Maureen Czick.

Reference
Czick et al. COVID’s Razor: RAS imbalance, the common denominator across disparate, unexpected aspects of COVID-19. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2020;13:3169-3192.

For more links to interesting video interviews and other resources, please visit: www.andrewwilner.com

Please click "Fanmail" and share your feedback!

If you enjoy an episode, please share with friends and colleagues. "The Art of Medicine with Dr. Andrew Wilner" is now available on Alexa! Just say, "Play podcast The Art of Medicine with Dr. Andrew Wilner!" 

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Show Notes

November 6, 2020

Jeff Anzalone, DDS

Many thanks to Jeff Anzalone, DDS, for sharing his hard-earned wisdom about passive real estate investing during this 20-minute interview. Just two months before starting his first job, his new employer canceled the contract without explanation. Jeff found himself $300,000 in debt, saddled with a mortgage, and faced with supporting a young family. Jeff had to resort to one of his previous professions to pay the bills, mowing the neighbors’ lawns. That experience was his wake-up call regarding the need for more than one income stream 

Since then, Jeff has created a successful periodontal practice and thoroughly enjoys his work. He also has learned about the benefits of a passive income stream from real estate. This second income stream has provided him with more family time and peace of mind. When his practice shut down for two months because of COVID-19, he successfully weathered the economic fallout thanks to passive income from his real estate investments.

Jeff freely shares his expertise with others. You can receive his free guide on his website, www.debtfreedr.com/freeguide.

For more information: www.andrewwilner.com

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If you enjoy an episode, please share with friends and colleagues. "The Art of Medicine with Dr. Andrew Wilner" is now available on Alexa! Just say, "Play podcast The Art of Medicine with Dr. Andrew Wilner!" 

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Many thanks to Gene Sung, MD, Director of Critical Care at LAC-USC Medical Center, Los Angeles, CA, for discussing his recent paper "Determination of Brain Death"—The World Brain Death Project. This monumental work took five years to complete and includes input from experts in 45 countries (JAMA 2020;324(11):1078-1097). 

The paper proposes uniformity of the clinical definition of brain death. Dr. Sung related that his academic interest in brain death began many years ago as a medical student when a mentor's work inspired him to learn more about this vital topic.

About ten years ago, as incoming President of the Neurocritical Care Society, he hoped to standardize brain death determination. Since a current World Health Organization (WHO) project had the same goal, he deferred to them. However, when the WHO project failed to deliver, Dr. Sung started the current project. The World Federations of Intensive Care, Pediatric Intensive Care, and Neurology and Neurosurgery became the project's backbone.

Dr. Sung explained why conformity is crucial in brain death determination. He discussed the difference between the 1968 Harvard Brain Death Criteria and the current World Brain Death Project Guidelines. For example, one brain death examination is now sufficient, rather than two separate assessments 24 hours apart. The paper also provides a foundation of knowledge regarding brain death.

Clinicians should note that the new brain death guidelines will not substantially change the current practice of brain death determination in the US and many other Western countries, which have similar protocols. It also provides a model for countries that do not yet have clinical brain death determination standards.

Dr. Sung emphasized the importance of excluding confounders, such as hypothermia and medications, which could confound brain death determination. The new guidelines have been well-received by the American Academy of Neurology and many other professional societies. Dr. Sung deserves congratulations for obtaining participation and consensus from so many different organizations and countries and completing such an ambitious and important project.

For More Information: www.andrewwilner.com

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Show Notes

In this 20-minute episode, Memphis real estate agents Dianne and Bruce Milner offer tips for physicians looking to buy their first home. With 40 years of experience between them, Dianne and Bruce discuss the importance of finding an agent with whom you can comfortably communicate. Other topics include how to establish a realistic budget for your new home, work within a realistic timeline, avoid PMI (private mortgage insurance), the criteria lenders use to determine loan eligibility, the benefits of a “Physician’s Mortgage,” and more.

In this era of COVID-19, Dianne and Bruce explain that virtual home showings have become standard operating procedure for real estate agents.  Virtual home tours can help busy physicians and others searching for a home in a new city.

As we are currently in a “seller’s market,” the right agent is essential for a prospective home buyer to successfully acquire the home of their dreams at a fair price. For more information about purchasing a home, contact Dianne and Bruce through their website: DianneMilner.com.

For links to more interesting programs, please visit www.andrewwilner.com.

Please click "Fanmail" and share your feedback!

If you enjoy an episode, please share with friends and colleagues. "The Art of Medicine with Dr. Andrew Wilner" is now available on Alexa! Just say, "Play podcast The Art of Medicine with Dr. Andrew Wilner!" 

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Episode #20, November 15, 2020

Uma Naidoo, MD

Many thanks to Uma Naidoo, MD, for joining me on this 20-minute episode of “The Art of Medicine with Dr. Andrew Wilner.” Dr. Naidoo is Director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital, Cambridge, MA, nutritionist, chef, and author of “This Is Your Brain on Food.”

Dr. Naidoo explained that while growing up, she was surrounded by adults who cooked and enjoyed food. While still a child, she learned to bake. With allopathic physicians and Ayurvedic practitioners in the family, she was also exposed to medicine at an early age.

When Dr. Naidoo became a practicing psychiatrist, she realized both the power and adverse events of psychotropic medications. To help her patients discover a more integrative approach, she began her investigation into food and lifestyle modification. Along the way, her journey included formal training as a nutritionist and a chef. Rather than a chore, cooking meals become a welcome, mindful, and creative activity.

Although she still prescribes traditional psychotropic medications, she takes a careful history from her patients, searching for lifestyle factors that may be out of balance. Dr. Naidoo stressed that not only must we take care of ourselves, but our gut microbiome as well. 

Dr. Naidoo shared healthy food tips for those who frequently eat away from home. Given that we live during the COVID-19 pandemic, she also offered some nutritional advice to improve immunity, such as Vitamin C from citrus fruits and red bell peppers. She recommended spices such as ginger, garlic, and turmeric for their healing properties.

I thoroughly enjoyed my interview with Dr. Naidoo and learning more about how the proper food and spices can make us healthier and happier.  Her book, “This Is Your Brain on Food,” is available on Amazon and other booksellers.

For more exciting programs, please visit www.andrewwilner.com 

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Show Notes

Today is September 29, 2020, and we are still in the midst of the SARS-CoV-2 pandemic. As of today, more than 1 million people have died from COVID-19, 200,000 of them in the USA. I felt compelled to speak with Alfred Alcorn, a well-known author from Massachusetts. Mr. Alcorn wrote a prescient novel, Sugar Mountain, about a devastating pandemic, published in 2013, long before anyone had heard of SARS-CoV-2.

Before devoting himself to writing full-time, Alfred Alcorn graduated from Harvard University and worked as a journalist, teacher, and travel director of the Harvard Museum of Natural History in Cambridge, MA. He has authored approximately a dozen novels, including Sugar Mountain, Murder in the Museum of Man, Time is the Fire, and his latest book, The Evil That White Men Do, published September 21, 2020.

During our 20-minute interview, Alfred and I discussed his motivation for composing a novel about a pandemic, how he approached accomplishing the necessary medical research, and his passion for writing. More than a simple adventure story, Sugar Mountain explores what happens to ordinary human beings when facing the threat of death. When I asked him why he chose this topic, he responded, “The oldest story in human history is survival.”

Mr. Alcorn writes full-time from his home, located near a mountain quite similar to the one in the book. His novels are available on Amazon.com. Alfred can be contacted at his Facebook page: https://www.facebook.com/alfred.alcorn.

Many thanks to Alfred Alcorn for this fascinating interview!

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Show Notes

Dennis Leber

Recorded September 17, 2020

Introduction

Dennis Leber, Chief Information Security Officer (CISIO) at the University of Tennessee Health Science Center (UTHSC), Memphis, TN, joined me for this interview about cybersecurity. Dennis developed his cybersecurity expertise with a stint in the Marines, followed by 14 years in law enforcement. Looking to develop his career, Dennis discovered that cybersecurity addressed his desire to "serve and protect" and his interest in computers. He obtained a master's degree and is soon to complete his Ph.D. When the Army Reserve called him up to active duty in the 2nd Gulf War, Dennis applied his skills to military communications. Back in civilian life, Dennis worked IT in auto manufacturing and built cybersecurity systems from the ground up. 

Scope of Responsibility

At UTHSC, Dennis is responsible for the security of tens of thousands of computers and systems, as well as several thousand users. During our 25-minute chat, Dennis explained the two schools of thought regarding changing passwords (or not), the value of password managers, and highlighted threats from "Brute Force Attacks" and "Rainbow Tables." 

Cost

Although I couldn't pin him down on the dollar cost of UTHSC's cybersecurity, Dennis shared that the industry-standard for cybersecurity is 20% of the IT budget. Because security breaches can cost millions of dollars, cybersecurity has become necessary for every business and institution.

Self-Defense

Dennis offered some tips on how individuals can protect themselves and their institutions from cyber-attacks. UTHSC requires students and faculty to participate in annual cybersecurity training based on the prior year's threats. He emphasized that cybersecurity is everyone's responsibility.

Email

I learned that my UTHSC.edu email is NOT private--the institution owns it!  Cybersecurity concerns, Freedom of Information Act Requests, and HIPAA audits can all trigger an email audit. Something to keep in mind…

Conclusion

Many thanks to Dennis Leber, Chief Information Security Officer at UTHSC, for sharing his cybersecurity expertise on "The Art of Medicine with Dr. Andrew Wilner." New programs appear every two weeks on YouTube and your favorite podcast player. If you enjoyed this program, please subscribe!

Disclaimer: The opinions expressed by Dr. Wilner during this program are his and his alone and do not necessarily represent those of UTHSC. 

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