DDx podcast

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<div class="span index">1</div> <span><a class="" data-remote="true" data-type="html" href="/series/symptomatic-a-medical-mystery-podcast">Symptomatic: A Medical Mystery Podcast</a></span>

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Symptomatic: A Medical Mystery Podcast

إلغاء الاشتراك

منذ 4 أياممنذ 4d ago

إلغاء الاشتراك

شهريا

How terrifying would it be to fight an unknown enemy? One you don’t recognize and didn’t see coming? What if that enemy was coming from within; a disease that even doctors couldn’t identify? Nearly half of all Americans suffer from some chronic illness and many struggle for an accurate diagnosis. Every other week on Symptomatic, host Lauren Bright Pacheco unravels the medical mystery of a patient’s baffling symptoms and explores how their lives were turned upside down in search of answers. From the first signs of trouble, through a swirl of misdirection and failed treatment attempts, to the final relief at a confirmed diagnosis - these are their stories. This is Symptomatic. We want to hear from you! Tell us what you think of the show or share your own medical mystery by emailing us at Symptomatic@iHeartMedia.com .

DDx

منزل السلاسل•Feed

A podcast about how doctors think. Presented by Figure 1, the knowledge-sharing and collaboration app for physicians and healthcare professionals. Learn more at Figure1.com/ddx

85 حلقات

#Diagnosis #Fitness #Health Industry #Health and Well-Being #Health Care #Medicine #Science #Podcasting Education #Figure 1

DDx

65 subscribers

updated منذ 16 يومًا

منزل السلاسل•Feed

A podcast about how doctors think. Presented by Figure 1, the knowledge-sharing and collaboration app for physicians and healthcare professionals. Learn more at Figure1.com/ddx

85 حلقات

#Diagnosis #Fitness #Health Industry #Health and Well-Being #Health Care #Medicine #Science #Podcasting Education #Figure 1

كل الحلقات

1
DDx Deep Dive: Special Episode on Melanoma With Omid Hamid, MD 20:17

منذ 16 يومًا20:17

التشغيل لاحقا

قوائم

إعجاب

احب

20:17

“All clear” isn’t always the end. Melanoma’s ability to recur months or years after surgery is shifting how clinicians think about treatment timelines. DDx host Raj Bhardwaj, MD, and Omid Hamid, MD, chief of translational research and immunotherapy at The Angeles Clinic and Research Institute in Los Angeles, explore strategies for identifying patients at high risk for melanoma recurrence, new therapeutic approaches before and after surgery, and what these developments mean for the future of melanoma care.…

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More Than a Bleed: A Complex Care Plan for a Safe Delivery 12:26

منذ 5 weeks12:26

12:26

A woman walks into a clinic, she’s eight months pregnant: tired, pale, anemic. Her last pregnancy ended early—an emergency C-section at 32 weeks. This time, her obstetrician happens to flip through an old chart and finds a diagnosis so rare, most doctors will never encounter it. In this episode, follow a multidisciplinary team’s race to design a complex care plan that, despite many challenges, keeps mother and baby safe.…

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Hemophilia Treatment: When the Bleed Isn’t What Hurts the Most 9:49

منذ 6 weeks9:49

9:49

A young man walks into a hemophilia treatment center. He’s limping, certain his ankle is bleeding again—same as always. But this time, the team discovers the pain may be coming from something else, something that isn’t in the patient’s chart. In this story, we explore the many ways and forms pain can present, and the importance of treating the whole person.…

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The Hardest Shift: From Pediatric to Adult Hemophilia Care 22:16

منذ 7 weeks22:16

22:16

Transitioning hemophilia care from pediatric to adult care sounds simple enough. At home, though, it can be complicated—habits run deep, and for parents of children with hemophilia, the line between protection and independence isn’t always clear. In this episode, we’ll explore how hemophilia treatment centers put transition care into practice to help teens and young adults with bleeding disorders navigate taking ownership of their treatment and their first steps toward independence.…

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The Injury That Could Have Lasted a Lifetime 10:17

منذ 8 weeks10:17

10:17

A young boy goes to urgent care, he’s fallen and his knee is swollen – likely a soft tissue trauma or at worst a minor joint bleed. He’s given a brace, told to rest. At follow up, everything is as expected – until a nurse reviews his chart and sees the child has hemophilia. We’re no longer talking about a minor joint bleed, we’re talking about a joint bleed, that, if left untreated, could lead to permanent damage.…

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When It’s Not a Bleed 20:06

منذ 9 weeks20:06

20:06

A young man calls his doctor – he has hemophilia and joint pain – he knows what this is, he’s had it before: it’s a knee bleed. He’s given himself three doses of blood clotting factor, but it’s not working. When he arrives at the hemophilia treatment center, his care team takes a closer look – and what they find will change everything.…

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Season 12 Trailer 1:27

منذ 10 weeks1:27

1:27

If you work in healthcare, you’ve felt it—that moment when communication breaks down. This season on DDx, we’re going inside hemophilia treatment centers—places where teamwork isn’t optional. It’s what holds everything together. You’ll hear stories from the people who do this work every day—how collaboration really works, what it looks like in real time, and how filling gaps in communication helps ensure patients get the care they deserve. Coming soon, season 12 of DDx.…

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Special Episode: It Looked Like the Flu 25:09

منذ 26 weeks25:09

25:09

A man walks into his doctor’s office with flu-like symptoms—and walks out with a lung cancer diagnosis. What happens next opens up a broader conversation about early detection, access to screening, and the clinical nuances of treating non-small cell lung cancer. In this episode, Dr. Raj Bhardwaj brings you a candid discussion between oncologists Dr. Sanjay Juneja and Dr. Eric Singhi. They unpack a real patient case and explore the practical, diagnostic, and systemic challenges that shape lung cancer care today.…

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TRAILER: It Looked Like the Flu (Special Bonus Episode) 1:17

منذ 27 weeks1:17

1:17

This is a trailer for a special bonus episode of DDx—not part of Season 12. While we work on our next season, we’re bringing you a powerful standalone case: a patient arrives with flu-like symptoms—but the diagnosis is something far more serious. In this bonus episode, Dr. Raj Bhardwaj brings you a conversation between two leading oncologists, Dr. Sanjay Juneja and Dr. Eric Singhi, as they unpack a case that challenges assumptions and reveals how great clinicians think through the unexpected. Stay tuned—the full episode drops soon.…

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The Human Behind the AI in the Room Part II 15:19

منذ 37 weeks15:19

15:19

Last time, we spoke with the co-creator of DAX Copilot, Dr. Jared Pelo, about what DAX can actually do and the questions it raises about AI and the future of medicine. But today, we’re not just continuing that conversation—we have news. Dr. Pelo is back to share a major development, and talk about what this news means for physicians, patients and the future of clinical practice.…

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The Human Behind The AI In The Room Part I 22:26

منذ 38 weeks22:26

22:26

“Every physician has thought this idea. Every physician has thought, I should not have to write my own notes.” Dr. Raj Bhardwaj sits down with Dr. Jared Pelo, the co-creator of DAX Copilot, to delve into the origins and future of the AI-powered clinical documentation solution. Discover how DAX Copilot aims to revolutionize medical workflows, the challenges it faces, and the potential it holds for transforming patient care. Join us to hear insights from the creator himself on the evolving role of AI in healthcare and what lies ahead, as Dr. Pelo candidly addresses questions about AI accuracy, patient privacy, and the future integration of AI in healthcare. Episode guest: Dr. Jared Pelo LinkedIn: https://www.linkedin.com/in/jared-pelo-b849026/…

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From Clinic to Hospital 10:00

منذ 39 weeks10:00

10:00

Join us as we sit down with Colorado-based allergist and immunologist Dr. Robert McDermott, who has seen first-hand what an AI-powered solution can do for care providers at facilities of all scales. Dr. McDermott offers his unique perspective as someone who has integrated DAX Copilot as a documentation assistant at both a small clinic as well as a hospital. He delves into why and how, at each scale, he has seen the investment pay off for the providers, patients, and facility alike. For Dr. McDermott, the ability to give physicians on his staff hours of their day back, on top of the ease of integrating the new-age technology, swiftly quashed any early skepticism regarding his investment. Listen in to hear why! Episode guest: Dr. Robert McDermott…

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The Workflow Conveyor Belt 11:44

منذ 40 weeks11:44

11:44

“There's so many downstream effects of having people work in an inefficient environment.” Dr. Alfred Atanda, a pediatric orthopedic surgeon, shares his experiences dealing with inefficiencies in a clinical environment and the stress that results. Every day in his practice, he sees how broken workflows ripple out—straining providers and the patients who rely on them. Dr. Atanda highlights how DAX Copilot, an AI-powered solution, aims to simplify doctors' workflows by recording patient visits and automatically drafting medical notes, potentially improving efficiency and patient care. Dr. Atanda highlights the benefits and limitations of using DAX Copilot. Episode guest: Dr. Alfred Atanda…

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Burnout, Interrupted 9:33

منذ 41 weeks9:33

9:33

“If I’m running on empty, I can’t be the doctor my patients deserve,” said Dr. Theresa Nguyen. Dr. Nguyen, who is the Chair of Pediatrics at Greater Baltimore Medical Center and leads the Medical Staff Wellness Committee, joins us to discuss the culture of wellness at the workplace for physicians. She opens up about her own personal journey dealing with the stress of perpetual burnout, delving into the impact on her life not only as a physician, but also as a mother and human being. For Dr. Nguyen, utilizing the capabilities of an AI assistant like DAX Copilot is about much more than just being efficient in the workplace. Episode guest: Dr. Theresa Nguyen LinkedIn: https://www.linkedin.com/in/drtheresanguyen…

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The Human Connection 10:08

منذ 42 weeks10:08

10:08

We sit down with Dr. Patrick McGill, who shares his experiences and challenges as Chief Transformation Officer at Community Health Network and as a family doctor at South Indy Family Practice in Indianapolis, Indiana. Dr. McGill discusses the growing disconnect between doctors and patients due to administrative tasks and required documentation, which often take away valuable time and focus from patient care. Dr. McGill discusses his initial skepticism about integrating AI-powered solutions and his eventual relief, both personally and professionally, upon using the cutting-edge technology to help restore human connections in his practice. Episode guest: Dr. Patrick McGill LinkedIn: https://www.linkedin.com/in/patrick-mcgill-md X: @pmmcgill…

DDx

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Season 11 Trailer 1:11

منذ 43 weeks1:11

1:11

Imagine a world where doctors spend more time with patients—and less on paperwork. This season on DDx, we explore DAX Copilot, an AI assistant that listens to doctor-patient conversations and drafts notes for medical records. We’re asking doctors what it’s really like to use this technology. Does it help? Does it get in the way? And what does it mean for the doctor-patient relationship when AI is in the room too? Real stories from the frontlines of healthcare. Season 11 of DDx is coming soon.…

DDx

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Giving New Life Through X-linked Hypophosphatemia Research 10:44

منذ 2 years10:44

10:44

After a lifetime of treating her rare bone disease, X-linked hypophosphatemia, a patient is at the end of her rope. Due to a genetic variation of the X chromosome — specifically the PHEX gene — there’s an imbalance of phosphate levels in her body. Because of its domino effect on bone development and mineralization, the patient is in pain, she’s frustrated, and nothing seems to help. So when a clinical trial opportunity presents itself, Dr. Suzanne Jan de Beur, a professor of medicine and the Chief of Endocrinology and Metabolism at the University of Virginia, is unsure the patient will want to participate. While the decision to participate is surprising, the results of the clinical trial are astonishing.…

DDx

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The Bumpy Road to Hypoparathyroidism Diagnosis and Treatment 11:01

منذ 2 years11:01

11:01

It’s a summer day and a 45-year-old is out for a drive. As she accelerates her stick-shift car, she starts to experience familiar, and scary, symptoms: facial tingling, numbness around her mouth, and a sharp pain in her hands. Her hands cramp and lock onto the steering wheel. Fortunately, she makes it home safely, but it will take many wrong turns and the help of Dr. Google to determine a diagnosis of hypoparathyroidism, a rare bone disorder. Dr. Michael Mannstadt, the Chief of the Endocrine Unit at Massachusetts General Hospital and Associate Professor in Medicine at the Harvard Medical School in Boston, shares this patient’s story and how a clinical trial changed this patient’s life.…

DDx

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Unexpected Therapies for Fibrodysplasia Ossificans Progressiva Offer New Hope 10:32

منذ 2 years10:32

10:32

A local pool in the summer is teeming with kids. A 9-year-old does a cannonball into the shallow end. As she surfaces, a stab of pain shoots through her hip. As days pass, what seems like a straightforward bump takes a complicated turn. Dr. Edward Hsiao, an endocrinologist and Director of the UCSF Metabolic Bone Clinic at the University of California, describes how after discovering a new bone growth at the site of the pain and several rounds of major (and unsuccessful) interventions, the child is diagnosed with fibrodysplasia ossificans progressiva. This extremely rare bone disorder has a devastating impact on a patient’s life. But thanks to unexpected areas of research, patients have new reasons to hope.…

DDx

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Overcoming the Odds of Prenatal Hypophosphatasia 10:22

منذ 2 years10:22

10:22

In an examination room, an ultrasound technician moves a wand over a patient’s belly. The patient is 20 weeks pregnant. Usually, these appointments bring good news, but the news this day is devastating: the baby’s bones are broken and bowed. Despite this, the baby is born and does well. After testing, all signs point to hypophosphatasia for Dr. Eric Rush, a clinical geneticist at Children’s Mercy Hospital and the University of Kansas Medical Center, and an Associate Professor of Pediatrics at the University of Missouri-Kansas City, who shares this patient’s story. And thanks to the life-changing treatment of enzyme replacement therapy, today, this child and many others with this rare bone disease are living happy, healthy lives.…

DDx

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The Power and Potential of GACI Clinical Trials 9:49

منذ 2 years9:49

9:49

In a bustling maternity ward, an infant has a case of newborn hiccups. But this quickly transforms into labored breathing. A chest X-ray unravels an unexpected discovery – calcium deposits around her shoulder. Follow-up tests paint a complex picture, revealing narrowed blood vessels and widespread calcifications. Genetic testing confirms a grim diagnosis: generalized arterial calcification of infancy, or GACI, a rare genetic condition with a challenging prognosis. Nearly half of infants don't survive beyond six months. But as Dr. David Weber, a pediatric endocrinologist and the Medical Director for the Center for Bone Health at the Children's Hospital of Philadelphia, shares, a revolutionary clinical trial could potentially transform this child's life and the lives of others with this disease.…

DDx

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Biosimilars and the Quiet Revolution in Medicine 10:35

منذ 2 years10:35

10:35

On a December morning, a 62-year-old goes for a walk. There’s snow on the ground and she loses her balance. She falls and fractures her wrist. This simple fracture reveals underlying osteoporosis, requiring lifelong (and expensive) medication. But as you’ll learn from Dr. Richard Eastell, an endocrinologist and professor of Bone Metabolism at the University of Sheffield, this is where biosimilars come in. Biosimilars are extremely similar — hence the name — to the original biological drug they're designed to imitate. The excitement around biosimilars is that they’re cheaper, making them more accessible to more people, meaning fewer fractures … better health … a better economy … and ultimately, a better quality of life.…

DDx

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How One Child Overcame Hemophilia Complications Despite Incredible Barriers 10:40

منذ 2 years10:40

10:40

A 5-year-old child and his parents boarded a plane heading for a new life. They were Syrian refugees, who fled conflict in their country and then lived a difficult life in a refugee camp. Now they were heading to Canada. But soon after arriving, there’s a problem. The child has hemophilia and due to hemophilia complications, a minor injury while traveling became a major concern. Add to this a language barrier and trying to understand a new culture. Dr. Robert Klaassen, a pediatric hematologist and lead of the Comprehensive Hemophilia Care Clinic at Children's Hospital of Eastern Ontario in Ottawa, Canada, shares his experience working with a family who overcame incredible barriers and the lessons learned along the way.…

DDx

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Unraveling How a Hemophilia Diagnosis Went Undetected for 60 Years 9:15

منذ 2 years9:15

9:15

It was supposed to be a simple, low-risk procedure, but for this 61-year-old patient with undiagnosed hemophilia, undergoing a lithotripsy for kidney stones proved to be anything but. The patient was born in the 1950s in Taiwan, when many people in the country had never heard of the disease. So, despite signs throughout his life, the patient’s hemophilia diagnosis evaded him for decades. Dr. Yeu-Chin Chen, a hematologist at the Tri Service General Hospital's Hemophilia Care and Research Center in Taipei, Taiwan, shares this patient’s journey and how doctors should be on the lookout for signs of hemophilia, while understanding that symptoms can vary from patient to patient.…

DDx

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To Play or Not to Play, the Challenges of Managing Pediatric Hemophilia 11:09

منذ 2 years11:09

11:09

A young child living with severe hemophilia is adopted by a family in the United States. Prior to his adoption, due to a lack of resources and other challenges, his hemophilia was not properly managed. Dr. Meera Chitlur, a pediatric hematologist and the director of the Hemophilia Treatment Center at the Children's Hospital of Michigan in Detroit, has treated this patient since he first came to the U.S. As he grew older, like many children, he wanted to play sports. But for people with hemophilia, participating in sports brings great risk. Dr. Chitlur shares how together with the patient and his family, they navigated the challenges of growing up with hemophilia and how new treatment options for pediatric hemophilia have opened up a whole new world for kids living with the disease.…

DDx

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The History of Hemophilia and Its Evolution Toward Preventive Care 11:04

منذ 2 years11:04

11:04

About 40 years ago a mother brought her 6-month-old child into the hospital. He was covered in bruises. Dr. Victor Blanchette, a pediatric hematologist at the Hospital for Sick Children in Toronto, Canada, met the patient that day and, following a severe hemophilia diagnosis, has treated the patient ever since. Dr. Blanchette recounts how during the patient’s childhood in the 80s, the approach to treating hemophilia was reactive, not proactive. This meant that normal childhood activities could lead to devastating bleeds. During this episode, we walk through the history of hemophilia and how its evolution toward preventive care has had an incredible impact on this patient and so many others.…

DDx

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Undoing the Long-Held Misunderstandings of Hemophilia in Women 10:55

منذ 2 years10:55

10:55

A 30-year-old was in labor with her first child. Everything was going to plan … until it wasn’t. Dr. Azusa Nagao, a hematologist at Ogikubo Hospital in Tokyo, Japan, shares a case that illustrates how historically it was thought that women and people assigned female at birth could only be carriers of the disease, not have the disease themselves. This misunderstanding of hemophilia in women has led to women going undiagnosed and untreated with severe repercussions. For the patient in this story, it meant a frightening and dangerous birth experience that put her and her child at risk. Dr. Nagao also outlines efforts to educate patients and physicians about hemophilia, what to look for, and how to treat it.…

DDx

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The Ups and Downs of Hemophilia Treatment 13:09

منذ 2 years13:09

13:09

A patient was experiencing severe knee pain. Unfortunately, this wasn't anything new. For decades, he’d been suffering from joint disease, caused by severe bleeding in his knees from a rare blood disorder — hemophilia A. The patient was born in the 1960s, a time when the life expectancy for patients with hemophilia was only 10 years. But as Dr. Annette Von Drygalski, a board certified hematologist and the director of the Hemophilia and Thrombosis Treatment Centre at the University of California, San Diego, explains, advances in hemophilia treatment throughout this patient’s life allowed him — and many others like him — to live a longer, richer life.…

DDx

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Go Inside the Minds of Doctors Who Specialize in Hemophilia 1:20

منذ 2 years1:20

1:20

Go inside the minds of doctors who specialize in hemophilia — a rare, inherited bleeding disorder that once meant possibly not surviving past the age of 20. This season, we’ll explore the medical milestones that enable patients today to live longer, richer lives and examine the challenges yet to be tackled.…

DDx

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When the Doctor is the Bully 14:25

منذ 2 years14:25

14:25

What can you do when your attending physician is a bully? Hear from two nurses, Melissa and Laura, about their experiences being bullied by a physician. For Melissa, it was notifying an on-call physician that a baby was ready to be delivered, only to be scolded for calling too soon. For Laura, it was being reprimanded by a physician who questioned her abilities as a nurse in front of a patient. So how do you respond to a bully, especially when the bully is in a position of power? Connie spoke with Carolyn Smith, an associate professor and associate dean of research, and author of "Standing Up Against Workplace Bullying Behavior: Recommendations From Newly Licensed Nurses" for insight. Carolyn, Melissa, and Laura all weigh in on standing up for yourself, calling out bullying, and sticking to your boundaries.…

DDx

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Critical Learning on the Job 15:04

منذ 2 years15:04

15:04

When is it okay to admit that you don’t know how to do something? Hear the story of Tamara Kuhn, a bedside telemetry nurse, who in a moment of crisis, used her problem-solving skills to keep her patient (and herself) safe. Tamara was caring for a patient who suddenly became violent. After calling for help, Tamara was given what she thought would be a standard restraint system. But what she received was not equipment she was used to. So how do you set yourself up for success in these situations? Connie spoke with Jill Clemmons, an acute care nurse practitioner, for insight. Jill discusses how taking care of yourself, preparation, and finding your why are key to navigating difficult situations.…

DDx

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Trusting Your Gut 15:42

منذ 2 years15:42

15:42

What do you do when you know something is wrong with a patient, but don’t have the data to back it up? Hear the story of Diana Struthers Stanton, who, at the beginning of her 46 years in nursing, cared for a 10-year-old patient with Reye syndrome. The patient’s capillary refill had changed and was slowly getting worse and worse. Concerned, Diana spoke to her charge nurse and was told not to worry about it. She spoke with her colleagues who also told her not to worry. She paged the on-call resident in the middle of the night, but got the same response. Diana’s gut was telling her something was wrong, but she lacked the clinical data to back it up. So what do you do? For insight, Connie spoke with Dr. Sarah Kim, a specialist in emotion-focused mindful psychotherapy, about the importance of trusting your gut. We’ll also discuss being your patient’s advocate and learning to forgive yourself when things don’t end well despite all your efforts.…

DDx

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When Generic Symptoms Turn Serious 11:53

منذ 2 years11:53

11:53

How do you know when generic symptoms are masquerading as something serious? Hear the story of Molly Lalonde, a pediatric nurse practitioner, who met an 11-year-old patient with an unexpected concern. While surprised by the patient’s inquiry, Molly took the time to listen and ask questions. In response to the patient’s heightened level of concern, Molly investigated further. Following an assessment by a specialist, it turned out the patient’s concern was warranted. So how do you recognize the zebra in a herd of horses? To get another perspective, our host Connie Levie spoke with Dr. Raj Bhardwaj, an urgent care physician and host of the DDx podcast. Dr. Bhardwaj details how to zoom out and get the bigger picture, the importance of respecting the concerns of your patients (just as Molly did), and following your spidey sense.…

DDx

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Raj recommends our new show: They Don't Teach That In Nursing School 2:11

منذ 2 years2:11

2:11

While nursing school equips you with valuable knowledge and skills, it doesn't prepare you for the real-life challenges you’ll face on the floor. They Don't Teach That In Nursing School is your go-to guide, offering unique solutions to the unexpected problems you'll encounter as a nurse. Each week Connie Levie (RN) presents the story of a nurse facing a specific challenge and its possible solutions. Our episodes are snack-sized, designed for your commute, break time, or just when you need to decompress and connect to a larger community of nurses. This podcast is a must-listen for nursing students, recent graduates, and seasoned professionals alike, who want a deeper understanding of the profession. Whether you're mastering a new skill, managing difficult bosses, or thriving in your nursing career, we've got you covered with practical advice and eye-opening stories from the field. They Don't Teach That In Nursing School is a limited (four episode) series that launches on Nov 1st! Give it a listen!…

DDx

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RAJ WANTS YOUR VOTE 0:31

منذ 2 years0:31

0:31

DDx has been nominated for three Signal Awards. Click the links below and vote for us now! Documentary: https://vote.signalaward.com/PublicVoting#/2023/shows/general/documentary Health & Wellness: https://vote.signalaward.com/PublicVoting#/2023/shows/general/health-wellness Best Writing: https://vote.signalaward.com/PublicVoting#/2023/shows/craft/best-writing…

DDx

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SPECIAL ANNOUNCEMENT FROM RAJ 0:49

منذ 2 years0:49

0:49

Hi DDx listeners! We’ve got something special in the works, and we want you in on it. We're developing a new podcast by and for nurses - and we're searching for a host! It’s a show about innovative solutions to the most intense challenges - whether clinical or personal - that nurses face. In each episode, you, our host, will connect with fellow nurses who are grappling with specific challenges and unravel solutions that not only elevate their practice but also enhance their overall job satisfaction. Whether you're fresh to the nursing world or a seasoned pro, your voice matters. We're building a community of curious minds, a place where your insights and wisdom can light the way for others. This is a paid - not volunteer - opportunity. So, if you're ready to embark on a journey of camaraderie, inspiration, and learning, go to https://bit.ly/NursingPodcastHost Oh and keep in mind, our submissions will close on Sept 18 - so press that record button soon! Thanks!…

DDx

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Hypoplastic Left Heart Syndrome and a Trip Across State Lines 10:13

منذ 3 years10:13

10:13

Following a normal first trimester, a pregnant patient starts spotting. The patient’s care provider books an urgent ultrasound to see what is causing the bleeding. The main concerns are if the spotting is caused by a miscarriage or something else. Following the ultrasound, the technician calls in obstetrician Dr. Ashley Brant to review the results with the patient. There is a problem with the fetus’ heart — specifically, a condition called hypoplastic left heart syndrome. Essentially, the left side of the heart doesn’t develop normally and can’t pump blood in the way that it should. Hypoplastic left heart syndrome causes poor oxygenation, meaning the skin can be bluish or with dark discolorations. It also causes difficulty breathing, feeding, and lethargy. Treatment includes multiple surgeries after birth, and can even require a heart transplant. Without treatment, the condition is fatal. The patient is offered genetic testing to determine if the heart condition is a symptom of a larger genetic disease. Regardless, the prognosis is grim. The patient meets with Dr. Brant to discuss all of the options, including continuing or ending the pregnancy. “I think everybody who's in a situation where they're thinking about ending a pregnancy because of a major fetal anomaly, they are thinking about what is the kindest decision, the most loving decision that they can make for their baby,” shared Dr. Brant. “Nobody wants to be in this position. And they're thinking about what the experience is going to be like for this child.” The patient makes the decision to end the pregnancy through the dilation and evacuation method. However, the procedure cannot be performed in the state because of a heartbeat law in place at the time. And so Dr. Brant refers the patient to an out-of-state clinic where the initial procedure to stop the heartbeat can be performed. But, in order to be where the patient has the support of the medical team she knows and who has been by her side, the patient returns to her home state for the final procedure. “No one ever envisions themselves needing an abortion. No one ever thinks, ‘I want to have an abortion,’ before they're in a position of needing one. I would just encourage compassion and empathy and trying to understand the life that someone else might be walking in.”…

DDx

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Pregnancy Reduction in a Twin Pregnancy 12:20

منذ 3 years12:20

12:20

A 35-year-old with several children discovers she is having a twin pregnancy. This is happy news, until a potential abnormality in twin B is found. Twin B is measuring much smaller than twin A — almost a full 10 to 14 days behind — and there is fluid around the fetus. While it is too early to diagnose, it appears there is a brain abnormality. The patient, with a lot of apprehension and many questions, sees high-risk obstetrician Dr. Maeve Hopkins. Genetic testing is needed for decision-making — to help determine if twin B can survive or if the patient’s life and twin A are at risk, meaning a pregnancy reduction will need to be considered. Dr. Hopkins orders a biopsy of twin B’s placenta. The results from genetic testing reveal that twin B has three sets of chromosomes, instead of two. This results in a rare genetic condition that causes severe birth defects. Most pregnancies in this situation end in either miscarriage or stillbirth. While there are very rare cases of live births, survival is generally limited to an average of five to seven days. Carrying the fetus poses significant risk to both the patient and twin A. There could be a build up of amniotic fluid and difficulty swallowing for twin B, which could lead to preterm labor symptoms and birth, as well as stillbirth. Losing twin B in utero may increase the risk of losing twin A and put the patient at risk, too. In this case, there are two options. One is expectant management, which is essentially to wait and see. The other is a multi-fetal pregnancy reduction, where the cardiac activity of twin B is stopped, and the patient continues with a single twin pregnancy. While pregnancy reduction is considered a fairly safe procedure, there is a small risk that the patient could still lose twin A. “I think she was somewhat in shock,” Dr. Hopkins shared. “And I think she wanted some guidance, which is always difficult when patients want to know what to do … it's a very personal, very familial decision for the patient … I generally say these are the risks to you, these are the possible outcomes, and these are the risks of a procedure. And a procedure likely carries less risk than continuing a twin pregnancy. And ultimately, she was able to make the decision.” The patient decides to move forward with the reduction procedure. Reflecting back, Dr. Hopkins shared, “What I've learned practicing high-risk OB is when you face a situation like this with a patient, it is impossible to know what decision that you would make if you were in that clinical situation … So just taking a step back and not necessarily trying to put yourself in the patient's shoes, but just stepping back and giving the information and just listening to the patient. I think as high-risk obstetricians, we're often the ones who have these stories and who see these patients, whether we're political or not, that's a life-saving procedure for us many times.”…

DDx

1
The Complicated Decision-Making of a Molar Pregnancy and an Intrauterine Pregnancy 10:41

منذ 3 years10:41

10:41

A pregnant person is referred early in pregnancy to high-risk obstetrician Dr. Stacey Ehrenberg after an ultrasound detects an abnormally developing placenta. Dr. Ehrenberg diagnoses the patient with a molar pregnancy; a placenta that forms into a benign tumor with the potential to become cancerous. While the molar pregnancy will not survive, the patient also has a viable intrauterine pregnancy. Faced with this diagnosis, Dr. Ehrenberg counsels her patient about the risks of continuing or discontinuing the pregnancy. If the decision is made to continue, the patient risks developing mirror syndrome, a life-threatening condition marked by hypertension and edema. There is also significant risk of bleeding if any of the abnormal tissue is removed. If the decision is made to end the pregnancy, the patient faces the risks of any procedure done in a hospital; bleeding, infection, and damage to the surrounding organs, although this happens in less than 1% of cases. Regardless of the patient’s choice, Dr. Ehrenberg emphasizes that she and her team will support the patient, no matter what. The patient decides to continue the pregnancy. Dr. Ehrenberg and team develop a care plan to track both the molar pregnancy and the intrauterine pregnancy with weekly ultrasounds and blood pressure measurements. “I really watched her struggle throughout the pregnancy knowing that she knew that at some point the scale was going to tip and that this would no longer be safe for her to continue,” shared Dr. Ehrenberg. “Her hope, as was ours, was that she would be able to get far enough in pregnancy where the baby would be able to survive. She knew that this would probably be an extremely premature baby, but she was willing to take that risk to start her family.” But at 19 weeks, everything changes. “I didn't need vital signs. I didn't need to do a physical exam to know something wasn't right,” remembered Dr. Ehrenberg. “We got vital signs on her and I did a physical exam, and it was very clear to me that she had mirror syndrome and then we had to have the very difficult conversation that we knew that the baby was not yet viable, but it was no longer safe for her to remain pregnant.” The decision is clear: the only viable option is dilation and evacuation. But the procedure is not without serious complications and risks. “... These pregnancy complications are so complex,” shared Dr. Ehrenberg. “The physical aspects of it, the emotional aspects of it, the financial aspects of it … So I really just would love to see more kindness towards other people, more tolerance towards other people, more understanding that we don't understand all the time where other people are coming from and what they've been through.”…

DDx

1
Abortion as Healthcare (a Miniseries) 1:33

منذ 3 years1:33

1:33

Meet three obstetricians who perform an essential medical procedure: abortion. Learn about their patients and how abortion affects both physical and mental health. From a molar pregnancy to fetal chromosomal abnormalities, these stories illustrate the life-saving impact of abortion, and its necessity within healthcare.…

DDx

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Non-Specific Symptoms Lead to Complicated Diagnosis 11:42

منذ 3 years11:42

11:42

It starts small. A slight pain in the foot, followed by an achy shoulder. There's some fatigue. The type of non-specific symptoms that often go ignored … until they can’t be anymore. A 37-year-old visits the family doctor, complaining of foot, shoulder and chest pain that progresses over weeks. And she's really tired. Otherwise, there’s nothing notable. She's just a busy parent. Being tired is normal, right? Sometimes that’s true, but in this case, this would prove to be a dangerous assumption. She visits her primary care provider who decides to run X-rays. There’s nothing to note other than an expanded area of cartilage at the end of the sixth rib. The doctor doesn’t think much of it at the time, but this would prove pivotal to solving the case. The patient is prescribed physical therapy, but it doesn’t help. It actually makes things worse. “She's getting very fatigued to the point where she's having to lay down in the afternoons. She can't really do her full family activities,” shares Dr. Suzanne Jan De Beur, an endocrinologist with a specialty in metabolic bone disorders at Johns Hopkins University School of Medicine in Baltimore, Maryland. “She gets terrible pain … And then eventually she was found to have a left hip fracture and needed surgery to repair the hip fracture.” This incredible progression — a hip fracture with no trauma at 39 years old — leads to more tests. She’s diagnosed with celiac disease, a wheat allergy that can cause weak bones from not absorbing vitamin D and other nutrients into the bones. This explains the fractures, but not the muscle weakness. She’s compliant with her celiac therapy, but it keeps getting worse — to the point of needing a walker. This is when the patient sees Dr. Jan De Beur. It’s at this time that a very small discovery leads to a very big diagnosis. It also leads to many lessons — one being to not only zoom in on one specific symptom, but to zoom out on a case over time so you can put the puzzle pieces of non-specific symptoms together and find your diagnosis.…

DDx

1
A Lump on the Skull and the Misdiagnosis of a Rare Bone Disease 11:00

منذ 3 years11:00

11:00

In 1964, Nancy, a 5-year-old, is having her evening bath when her parents discover she has a lump on the skull the size of a grapefruit. This would mark the onset of a mysterious and debilitating disease that researchers are still struggling to understand. Over the next 40 days, medical professionals struggled to discover what was causing the lump on the skull. Each test seemed to exacerbate the swelling in Nancy's neck. In hindsight, that was a big clue, but it took doctors a while to recognize it. Instead, what happened next was a common mistake when it comes to patients with this disease. Nancy was diagnosed with terminal cancer. Doctors said she had less than a year. Yet, over the next few months, Nancy's condition didn't progress. She actually seemed to get better. Over the next few months, she was taken to a series of specialists. It was finally an oncologist who noticed something that was pivotal to her diagnosis ... her toes. Misshapen big toes — generally short and bending inward — are a hallmark of Nancy's disease. While Nancy had several telltale signs of the disease, diagnosing rare diseases is difficult in part because they’re exactly that: rare. “I can see how a practicing physician may feel a rare disease, ‘I'm never going to see it.’ But [this disease] is so striking that I think once you see someone with the disease … the image stays in your mind and even if someone, as a general internist or a pediatrician, never expects to see the case, you never know,” shares Dr. Eileen Shore, a medical researcher and geneticist specializing in musculoskeletal disorders at the University of Pennsylvania School of Medicine. And early diagnosis of this — and other rare diseases — is crucial, not only for treatment but to avoid diagnostic tests that can harm patients. While Nancy did finally receive a definitive diagnosis, many of the earlier diagnostic tests were actually causing more harm than good. “If you just have that in the back of your mind, that you have a vague image of what [it] is and see a patient who you think might have it,” says Dr. Shore, “to send a referral and get it confirmed, just think of the difference it would make in that family's life.”…

DDx

1
Metatarsal Bone Fractures and a Rare Bone Disease Hiding in Plain Site 12:00

منذ 3 years12:00

12:00

A patient in her mid-50s complains of foot and leg pain. She's post-menopausal with low bone density. A classic case of post-menopausal osteoporosis. Not exactly. And it won’t start to become clear until it gets to the point of her having repeated metatarsal bone fractures. Let’s go back a little. It’s 2005. Our patient visits her family doctor complaining of pain in her legs and feet. But the discomfort she's experiencing isn't your typical aches and pains associated with aging. “She develops a lot of [foot and leg] pain … So much so that she required pain management for this pain and her gate started to become affected,” shares Dr. Katherine Dahir, a professor of medicine at Vanderbilt University, who specializes in metabolic bone disease. Her gait becomes wobbly and she’s experiencing an acceleration of degenerative changes in her spine. An osteoporosis screening reveals she has low bone density. She’s diagnosed with post-menopausal osteoporosis and is treated with bisphosphonates, the standard of care for patients with osteoporosis. And this is when things get much more complicated. Although all signs show an improvement in bone density, she begins to experience metatarsal bone fractures, which is highly unusual with osteoporosis. And not only does she have these unusual fractures, the fractures will not heal. “And so that's when you need to put your thinking cap on and try and figure out, why is this patient a treatment failure?” says Dr. Dahir. To solve the case, the patient’s team studies her labs and finds a missing flag. “... It was called alkaline phosphatase, which is seen in a routine chemistry panel. Back at that time, it was only flagged if it was above the normal reference range because that usually indicates liver disease, but it wasn't flagged if it was below the normal reference range because that was considered to be non-significant.” But this finding would prove to be very significant. Combined with new research at the time, it helped identify a diagnosis for this patient — showing the importance of medical research that leads to more treatment options and more hope for patients.…

DDx

1
Hypophosphatemia and the Secret Locked in a Child’s DNA 12:21

منذ 3 years12:21

12:21

A toddler is taken to his pediatrician because his parents are concerned he might be small for his age. The pediatrician diagnoses him with knock knees, but there’s no cause for alarm. Although the child doesn't have any other known medical conditions, something is happening in secret, inside his DNA that won’t be discovered until a diagnosis of hypophosphatemia is discovered some time later. And if this disease is ignored, it can quickly become deadly. But back to that first appointment. “At that time, he had a rather normal diet, was taking [multivitamins] so his intake of vitamin D was at the recommended daily allowance,” shares Dr. Michael Levine, a pediatric endocrinologist at the Children's Hospital of Philadelphia. “And because he had no other medical disorders and no other conditions that were of concern, his pediatrician decided that they would just watch him to see whether he could outgrow his knock knees, and whether this might improve his overall growth.” At the age of 7, there is little to no progress. He visits an endocrinologist. Nothing significant is found. At 10, an orthopedic surgeon operates on the child’s knock knees. Two years later, he visits Dr. Levine for the first time. “When we first saw him, we were impressed by his prior history of knock knees, which had its onset in his toddler years, and we looked carefully at the evaluation that his pediatric endocrinologist had performed some years prior that disclosed normal levels of serum calcium, normal levels of PTH, normal alkaline phosphatase, and a normal serum 25-hydroxy vitamin D, which in the mind of the first pediatric endocrinologist had effectively ruled out rickets or osteomalacia.” But one test hadn’t been done — a test for serum phosphorus level, and when the results come back showing hypophosphatemia, this becomes a key to the child’s diagnosis. “When you have a child that doesn't respond as you might expect to calcium and vitamin D,” advises Dr. Levine, “you have to take that next step and begin to ask, could this be due to a genetic defect in the vitamin D system, or could it be a genetic defect in phosphate metabolism?” As it turned out, the child’s disease was genetic, and this unlocked the path to treatment. And while everything worked out in the end, it’s hard not to think about how this story could have been very different had one simple test been run, or if genetics had been considered sooner.…

DDx

1
Overlooked Diagnostic Test for Blood Calcium Levels Leads to Rare Diagnosis 10:29

منذ 3 years10:29

10:29

A 23-year-old presents to the emergency department with progressive symptoms. It starts with tingling in the fingertips that lead to leg cramps that turn into feeling like she’s turning into stone, frozen in one position with stabbing pain. And perhaps most troubling, she can't concentrate. In fact, the brain fog is so severe that she’s afraid to drive. Over the course of three days, her life has been turned upside down. She takes a taxi to the emergency department and is seen after waiting six hours. She provides a quick medical history, noting she recently had neck surgery for parathyroid overactivity — an important clue to her diagnosis. Parathyroid glands produce parathyroid hormone that regulates the blood calcium level, which maintains bone strength and helps muscles and nerves function. Calcium levels in the blood have to be kept at a very specific level. Just like in your physiology lectures: HYPERcalcemia and HYPOcalcemia. And calcium levels that are either too high or too low can be deadly. But in moving quickly in the emergency department, testing for serum calcium is overlooked. A patient with recent neck surgery has symptoms consistent with low blood calcium levels — why not check her calcium? It’s true that in a chaotic ER things can be overlooked. But a lot of time, calcium isn't ordered because it's not part of the regular "electrolyte” or “chemistry” panel — it has to be added specifically. With computer systems and the way test panels like these are built, they can shape the thinking of physicians, putting certain symptoms front of mind, while others might get neglected. Fortunately, a diagnosis was caught early enough for this patient that no long-term damage was done. But this case serves as a reminder that although rare diseases are rare, it doesn’t mean as a healthcare professional, you’ll never encounter them.…

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