The Preventive Medicine Podcast

There’s no guest this episode. Just gratitude! We’re turned 1 year old on August 1st, 2021 and could not be more thankful for your support in this endeavor. In this episode, Ragav talks about the podcast from its beginnings until now, significant events and milestones along the way, and it’s future path. Ragav also talks about some of the behind the scenes in recording episodes as well as giving an overview of each of the episodes for those that might not have had a chance to go through all of our 30 episodes thus far.

We are incredible fortunate to have received the support we have and will continue making high-quality content on preventive medicine! Thank you for listening!

Dr. Eubanks’ thoughts and statements on this episode do not reflect those of his employer, The University of Pittsburgh Medical Center Department of Physical Medicine and Rehab. They are solely his opinions.

Dr. Eubanks is the first medical resident we have had on the show and for good reason. He has a tremendous amount of experience within the world of musculoskeletal and spine care given his masters degree in exercise science and rehabilitation as well as his doctor of chiropractic. Jim worked closely with a physiatrist during his time as a chiropractor and decided to take the step to become one himself. 

Since then, he has become a rising star in the world of back pain and spinal care and was recently given a chair on the clinical practice guideline committee for the North American Spine Society. Beyond his expertise in spinal care and back pain, Dr. Eubanks also loves giving back to the PM&R community by providing mentorship and guidance to medical students and residents through PMR Scholars.

This episode goes over EVERYTHING you need to know on back pain in a 1 hour distilled episode. We talk about why the care for back pain is so broken in the United States, what the current thoughts on back pain are, and what we can do moving forward. This episode is a masterclass in back pain so make sure to listen till the end!

Episode Outline:

Question 1: Tell us a little bit about yourself and what you hope to accomplish in the future?

Question 2: Given your unique experiences and background, what does preventive medicine mean to you?

Question 3: How did you get into spinal care and back pain?

Question 4: Why did you decide to go from being a chiropractor to attending medical school and becoming a physiatrist?

Question 5: What is the current situation with how we deal with back pain and how did it get to be this way?

Question 6: Given that lower back pain is extremely prevalent and often self-resolving, when should the average person know to get it checked out? What should the know?

Question 7: How does posture relate with back pain? Are the related?

Question 8: How do we move towards better care for spinal and back pain?

Question 9: When it comes to patients that actually require surgery for their pain, is there any sort of prehabilitation that can be done to improve outcomes?

Question 10: What is the role of a physiatrist when it comes to spinal care? What can a physiatrist offer that’s different from a surgeon?

Question 11: How do we improve medical education at the medical school and resident levels to improve spinal care? What about from a policy standpoint?

Question 12: If you’re in a coffee shop and someone asks you how to get healthy, what do you tell them in 2 minutes?

Other:

Statement by Dr. McGill on his views on spinal flexion can be found here 

Sports medicine is often a misnomer for what physicians in this field of medicine do. They don’t always take care of athletes and don’t always work for a sports team but they are the people to go to when it comes to musculoskeletal care.

Dr. Bowers is board certified in both Physical Medicine and Rehabilitation and Sports Medicine as well as a PhD in exercise physiology. In our episode, we discuss his unique path to medicine and his experience dealing with evidence-based musculoskeletal care. Furthermore, we also discuss the gaps in both medical care and in medical education that could help promote prevention for more patients.

Link to study mentioned in episode: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0096745

Topics Addressed in the Episode: 1. Tell us about yourself and your path to medicine, why did you go the PhD, DO route?2. What does preventive medicine mean to you as a sports medicine physician?3. What is sports medicine as a general field and what is the patient population? Can you practice preventive medicine from this position?

There are some people who just have a lot of experience and wisdom to share from those experiences. Leah Lutz is one of those people. From her incredible journey of losing over 100 pounds to transitioning here career from a teacher to a powerlifting coach, to her experience with cooking, Leah is a treasure trove of information.

In this episode, we discuss Leah’s journey through weight loss, the struggles and barriers she faced a long the way. We also discuss Leah’s invovlement with Barbell Medicine along the way and how she decided to transition her career from being a teacher to a powerlifting coach. From there we discuss the challenges facing women in the weight room along with the barriers encountered by her clients (male and female) with training and how she coaches through them. To finish the episode, we dive into a topic never before discussed on the podcast – cooking! Make sure to stay till the end of the episode for high-yield tips on how to make cooking more accessible and better serve your health goals.

(1:00 – 7:15) – Introductions

Question 1 : Tell us a little bit about yourself and what you do?

Question 2: How was the transition from teaching in school to coaching for you?

(7:15 – 21:20) – Experiences with Preventive Medicine

Question 2: What does preventive medicine mean to you?

Question 3: Can you tell us about your weight loss journey and how it coincided with powerlifting?

(21:20 – 45:00) – Barriers for Women and in Resistance Training

Question 4: Along your journey with weight loss, what barriers did you see or face with regards to resistance training as a woman?

Question 5: How do you find the positive rewards or reinforcements that help you keep going towards a goal?

Question 6: Does someone’s experience level with training impact your coaching of them through various barriers in training?

(45:00 – 57:00) – Cooking for Health

Question 6: Is cooking your own food better for you in terms of your health? Is it inherently healthier?

Question 7: How do you make cooking at home more convenient for those that want to cook at home but are on a time crunch?

Question 8: What are some of your basic food principles?

(57:00 – 59:00) – Wrapping it up

Question 8: If you’re at a coffee shop waiting for your coffee and someone asks you “how do I get healthy,” what do you tell them in 2 minutes?

We are told by everyone to value our health and get ourselves checked out once a year. The annual “well-visit” typically includes getting your blood pressure and other vitals taken, blood drawn about a week before or so, and recommendations to have screenings such as colonoscopies done. These have become a staple and are what most primary care doctors are known for. However, are they really necessary? Dr. Jeffrey Linder is a professor and physician at Northwestern Feinberg School of Medicine who has data saying they might not be.

In this episode, we dive into the annual “well-visit” with Dr. Linder and discuss whether or not individuals should be going to them. Originally discussed on a JAMA clinical review podcast, we discuss the useful parts, the not so useful parts, and the real utility of the annual check up. Furthermore, we discuss the role of primary care within healthcare as a whole and how the pandemic affected medicine. For details on the research conducted by Dr. Linder, check out the following links below!

(1:00 – 4:30) – Introductions

Question 1: Tell us a little bit about yourself, your journey through medicine, and why you do what you do?

(4:30 – 15:30) – Prevention and Primary Care

Question 2: What does preventive medicine mean to you?

Question 3: What are the key items that help prevent bad outcomes down the road?

Question 4: Are well-checkups necessary, how did they come to be, and are we going to do away with them in the future?

Question 5: What groups of people should be coming in to see their primary care physician?

(15:30 – 25:00) – Advances in Primary Care

Question 6: Do you think the use for tele-health and health monitoring via apps can be useful for providing healthcare?

Question 7: Do you think tele-health and new technology could assist with the primary care physician shortage and reduce overdiagnosis/overtreatment?

Question 8: What is a standardized physical exam and what are your thoughts on it? What are the potential harms of the less useful parts of the physical exam? Should students be conducting parts of the physical exam that are not as useful?

(25:30 – 33:10) – The Harms in Healthcare

Question 9: What are some of the biggest harms to patient health within healthcare and what do we do about it?

Question 10: What are some of the harms of over-prescribing antibiotics?

(33:10 – 41:40) – A Primary Care Rundown

Question 11: Take us through a primary care visit that you might have with a patient, how much time are you focusing on prevention vs. other factors?

Question 12: How do you address the social determinants of health within the patient visit? What resources can you provide?

Question 13: What are you recommending to patients when it comes to exercise and nutrition?

(41:40 – 50:30) – The Pandemic

Question 14: How did the COVID-19 pandemic effect your practice and how did tele-health impact care?

Question 15: Does tele-health actually make life easier for physicians?

Question 16: How do we address the shortage in primary care physicians?

(50:30 – 51:45) – Wrapping up

Question 11: What do you tell someone who asks you “how do I get healthy” in 2 minutes?

CEO – Sutter Health | Aetna

No matter what type of discussion we have regarding healthcare on this podcast, there is always one constant – Insurance. Insurance is the middle man between the provider and the patient and determines much of the transaction. In this episode we dive into the business of healthcare with the youngest CEO of an insurance/healthcare company ever – Jeb Dunkelberger. Not only is he the youngest CEO, but also the author of Rich and Dying, An Insider Calls Bullsh*t on America’s Healthcare Economy.

Have you ever wondered what preventive medicine means to a healthcare executive? That question and many more you didn’t even know you had are answered by Jeb in this episode. Jeb brings unique perspectives to the table as we discuss the incentives of insurance companies, the cost of healthcare in the USA, the relationship between insurance companies and physicians, and so much more! However, the most important question we discuss is the one of making our system better. This is one you don’t want to miss!

(1:00 – 4:00) – Introductions

Question 1 : Tell us a little bit about yourself and why you decided to go into medicine

(4:00 – 7:30) – Setting the Scene

Question 2: Where did you come up with the idea for this book and why did you decide to write it?

Question 3: What does preventive medicine mean to you from the insurance or administrator side?

(7:20 – 17:20) – Incentives

Question 4: How do we align the incentives of insurance companies and the general populace?

Question 5: There are many physicians who have recently been talking about how bad insurance companies are. Are physicians and insurance companies aligned?

Question 6: What are you thoughts on insurance coverage in instances such as the emergency room where neither the patient, physician, or insurance company may be linked?

(17:20 – 24:30) – Footing the Bill

Question 7: Why do we spend so much on healthcare and what can we do about it?

Question 8: Do you have any thoughts on the skyrocketing amount of administrators within healthcare compared to physicians?

(24:30 – 31:00) – Healthcare and Insurance Models

Question 9: What are the differences between different healthcare plans and why are there so many of them?

Question 10: From the consumer perspective, why do people pay different amounts for insurance and what are they paying for?

(32:00 – 44:10) – Trends in Insurance and Healthcare

Question 11: Do you think the trend of employer tied insurance should continue? What is value-based reimbursement?

Question 12: Value-based reimbursement is an ideal but may not be the most practical based on your book. How do we bridge the gap between what we have with fee-for-service and value based reimbursement?

(44:10 – 54:00) Funding Prevention and Medicare for All

Question 13: Why aren’t preventive measures incentivized more by insurance companies when it comes to reimbursement?

Question 14: What are your thoughts on medicare for all? What does the middle ground between the free market and government sponsored healthcare look like?

(54:00 – 1:04:15) – The Solution

Question 15: How do we fix healthcare, where is the middle ground?

Question 16: What are some of the key points you want listeners to take home from this episode?

Females have always had an uphill battle when it comes to sports and exercise opportunities. They have been told for decades to get “smaller” and to primarily do cardio as their form of exercise. This societal pressure was best visualized during the NCAA tournament with the massive discrepancy between the male and female exercise areas. Well, Claire Zai is an incredibly strong female helping other females get stronger themselves. Getting a masters degree in physiology, specifically biomechanics, Claire has worked in the scientific world but now works primarily as a coach with Barbell Medicine helping others reach their strength goals. Claire is a scientist, state-record holding powerlifter, and women’s advocate and brings all of that to the table talking with us.

In this episode, we talk with Claire about why empowering women is so important, how men and women differ when it comes to training, and also how differing biology affects exercise and recovery. Let us know what you think of the episode!

(1:00 – 4:50) – Introductions

Question 1: Tell us a little bit about yourself and what you do?

(4:50 – 18:00) – Preventive Medicine and Women’s Empowerment

Question 2: Given your background and perspective, what does preventive medicine mean to you?

Question 3: Do you think that your background in coaching will give you a unique perspective in patient care compared to other doctors?

Question 4: Can you tell us a little bit about the load women fundraiser and why you decided to start it?

Question 5: What does it mean to be chronically under-loaded, why are women under-loaded, and what experiences have you had where someone has told you “you’re lifting too much?”

(18:00 – 38:00) – Gender differences in training

Question 6: What gender differences are there between men and women when it comes to training?

Question 7: Are there any changes that females need to make around their training due to the menstrual cycle?

Question 8: How do we go about changing the narrative around women strength training and being chronically under-loaded?

(38:00 – 54:30) – Rehabbing and Training with Injuries

Question 8: You recently suffered a back injury and have been rehabbing it, can you tell us a little bit about that and what you’ve been doing to rehab it?

Question 9: Is there anything you wish people knew about pain and rehab?

(54:30 – 56:40 ) – Wrapping it Up

Question 10: If someone were to ask you how to get healthy while you were waiting for your coffee, what do you tell them in 2 minutes?

The human metabolism is incredibly complex and the backbone of every activity we do. Whether it’s laying on the couch or running an ultra-marathon, our metabolism supports whatever activities we engage in. In this episode, we talk with Alyssa Olenick who is finishing up her PhD in metabolism and exercise about just that! Alyssa is our second repeat guest and the perfect person to talk about this topic given her background! Alyssa not only studies metabolism and exercise but puts her knowledge to the test everyday as an avid runner, lifter, and overall badass. Alyssa has competed in poewrlifting, weightlifting, marathons, and even ultramarathons making her the perfect person to understand the potency of the human metabolism.

In this episode we talk about what the metabolism is, what it means in the context of weight loss or weight gain, how people can properly support their metabolism, and the role of exercise in supporting the metabolism. We also dive into gender differences within the context of both exercise and metabolism which brings out some fantastic segments. This episode is full of energy and we hope you all enjoy it!

(1:00 – 4:30) – Introductions

Question 1: Has anything changed in our outlook on preventive medicine since the last time we spoke?

(4:30 – 30:10) – The Human Metabolism

Question 2: What is the metabolism, how does the metabolism relate to calories, and what do people mean when they say “I have a fast [or slow] metabolism?”

Question 3: What determines someone’s metabolic rate, what is the metabolic rate, and how does it relate to energy balance?

Question 4: Can you increase your metabolism? How do you do it?

(30:10 – 1:05:30) – How the Metabolism Differs Between People

Question 5: is there a relationship between the metabolism and being obese or being fit? Do obese people just have a slower metabolism than fit people?

Question 6: Are there any gender differences between males and females in how the metabolic rate is determined and are there controllable factors such as diet or exercise that should be approached differently due to these differences?

Question 7: Why are carbohydrates important for exercise and how do you know how many to eat?

(1:05:30 – 1:09:15) – Wrapping it Up

Question 8: What do you tell people that ask you “How do you get healthy” if you have 2 minutes to answer while you’re waiting for your coffee?

Nutrition is a huge aspect of preventive medicine but there is so much more to nutrition than just the food we eat – the relationship we have with food also matters heavily. Astrid Naranjo is an accredited dietitian in Australia who is extremely passionate about helping people develop a healthy relationship with food. Born in Venezuela, she received her training there before moving all the way across the world to Australia, getting re-certified, and practicing there within the hospital setting. Astrid also has a significant following on social media and owns her own nutrition consulting company where she coaches clients and has had many interviews with industry experts.

In this episode, we focus on how to develop a healthy relationship with food as well as what disordered eating and specifically defined eating disorders look like. We also discuss Astrid’s motivations behind what she does, her story, and her presence on social media.

(1:00 – 15:00) – Introductions

Question 1: Tell us a little bit about yourself and what you do?

Question 2: How did you get into social media and how did it become such a big part of what you do?

Question 3: Why did you move from Venezuela all the way across the world to Australia?

(15:00 – 26:15) – A Healthy Relationship with Food

Question 4: How does a person’s relationship with food affect their choices and what they eat?

Question 5: Is there a difference between a poor relationship with food and eating disorders?

(26:15 – 34:40) – Prevention of Disordered Eating

Question 6: Do you think that eating disorders or disordered eating is preventable?

Question 7: What does preventive medicine mean to someone in dietetics?

(34:40 – 48:15) – Building a Healthful Diet

Question 8: How do you create a healthful diet that works in preventing both disease and disordered eating?

Question 9: Where do you find information to help build a healthful diet? What sources should they use?

(48:15 – 53:00) Closing Remarks

Question 10: If someone asks you how to get healthy at a coffee shop, what do you tell them in 2 minutes while you are waiting for your coffee?

The brain is one of, if not the, most important organs in the human body as it is responsible for coordinating nearly everything we do. The human brain is what makes us human and allows us to complete complex tasks and much much more. Well, what happens if the brain gets injured? In this episode, Dr. Tommy Wood, BM BCh (MD)/PhD talks to us about the brain, brain injuries, and neurocognitive diseases. Dr. Wood originally completed his medical training from Oxford before beginning his PhD in physiology and neuroscience at the University of Oslo. He now works in the department of pediatrics at the University of Washington researching brain injury making him the perfect person to talk to us about the topic!

We talk about what brain injuries are, how they effect us, and what we can do to reduce our risk of these injuries. This episode is packed with information throughout so get ready to take notes!

(1:00 – 7:50) – Introductions

Question 1: I told the listeners a little bit about you but is there anything else you want to highlight?

Question 2: What does preventive medicine mean to you?

(7:50 – 42:00) – Brain Health and Preventive Medicine

Question 3: How did you become interested in the brain, brain injury, and make neonatal brain injury your topic of research?

Question 4:  What is brain injury and what are the different types?

Question 5: Are there any ways to prevent brain injuries, traumatic or the other types you described?

Question 6: What are the neurodegenerative diseases such as Parkinson’s, Alzheimer’s, etc. and how do they differ from traumatic brain injuries?

Question 7: How do you prevent the neurodegenerative diseases, can you? What can people do on a daily basis to reduce their risk of neurodegenerative diseases?

Question 8: Is there any evidence behind genetic testing such as for the apoE4 gene? Should people go out and get genetically tested?

(42:00 – 46:00) – The Future of Brain Injury

Question 9: What do you think about emerging technologies such as Neuralink in their ability to restore cognitive function and help patient’s with brain injury?

(58:30 – 1:01:34) – Wrapping it Up

Question 10: If you’re waiting in line for your coffee and someone asks you, “how do I get healthy,” what do you tell them?