Musings on Life and Medicine Podcast Andrew Reid

So much has happened since the last article I published. This will serve as a quick update on what's transpired and for things to come. I last shared how I want to publish the book I've been writing for free on Substack and record the audio version as part of this podcast. After much deliberation, I changed directions and will post the first few chapters for free inside the Medgeeks community. The community we are building allows me to create the structure and format I want. I wanted to publish this in a way that allowed me to go back and edit as I please; I want this to be a living, breathing document. Eventually, this will be a complete body of work with a start and finish. The original intentions behind Substack and this podcast were to share my thoughts on various things in medicine and life (hence the title). Publishing the book here doesn't fit the format (even if the topics are related).So, if you want to access the first draft, please head to community.medgeeks.co. It's free to join if you don't have an account. You'll notice a new space in the left-hand menu titled "[Free Access] Upcoming Book."It's been exactly one month since I last published an episode, and a lot has transpired, preventing me from hopping on: * Chloe got sick, followed by my wife and later myself. I then lost my voice for a few days, making it hard to record a podcast.* Our Medgeeks office lease ended, so we had to pack furniture, paint walls, and clean up. We'll be doing a final walkthrough this coming week. We've been there five years, so it's sad to say goodbye. But, the team has been working from home, which makes it hard to justify the monthly rent.* We moved all our Medgeeks clinical courses and community onto a new platform, Circle. It has been an enormous undertaking, and we are still in the midst of the migration as we ensure our members can log in and access all prior course material. But, this new platform will allow our members to interact with our clinical staff and support seamlessly. It also allows me to host free material easily, like my book chapters. * If you go to community.medgeeks.co, you'll also notice I've copied over all the Substack posts into that community. If you're already reading my posts on Substack, don't worry; I'll still publish articles and podcasts on Substack, should you like that platform best. But, for those of you already inside the community, this will allow you to read and listen to any updates from the website/app you're already a member of. * Last but not least, my wife and I received the results of Chloe's whole genome test. The results have rocked our world, and the diagnosis was something no one saw coming. Chloe has been diagnosed with a mitochondrial mutation located on the MT-TL1 gene with the variant m.3243A>g. This is more commonly known as the MELAS gene, which stands for mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes. It's a misnomer, as MELAS is a clinical syndrome, not a genetic diagnosis, and doesn't occur in everyone with this mutation.Because this is a mitochondrial mutation, this can only be inherited from the mom and happens 100% of the time. Unfortunately, this also means my wife is affected, and her sisters, mother, maternal aunts, etc., all have the mutated gene. Although it's not characteristic for this mutation to lead to thrombocytopenia and various other antibodies, it's not impossible as it can affect any part of the body, and the phenotype can vary dramatically among family members. Because the problem is happening at the cellular level during embryonic development, any organ can be affected. I just finished a lecture from an immunologist with a special interest in mitochondrial disease, and he shared how the immune system is involved. Some patients may present with a primary immune deficiency or some form of immune dysfunction. Although it's not a typical presentation, thrombocytopenia has been reported. Side note: propofol affects mit

Today, we’ll be getting into the first sections of the book I’m in the midst of writing. Last week I announced that I’d publish the chapters for free on Substack as I write them.Please keep in mind that everything that is being written and recorded is a very rough draft; it’s semi-polished. But I want to get these thoughts out to the public quickly. This way, I can get feedback quickly so that I can continue to refine my thoughts. The entire premise of the book is my perspective on how to live a happy and fulfilled life as a clinician. I hope that my experiences help shed a new perspective and challenge your current beliefs to improve your life as a whole. Before we get into that, I’d like to share a quick update regarding my daughter Chloe…Thanks for reading Musings on Life and Medicine! Subscribe for free to receive new posts and podcasts as they’re published.Immune Thrombocytopenia & Lupus Antibodies.I’ve written extensively about the journey my wife, and I have been going through to figure out what is driving the abnormalities in our daughter’s lab work. The idea behind sharing is to:* Help educate you on a clinical presentation that isn’t all too common* Share the perspective of the father as his daughter goes through an extensive medical workup* Improve your communication with patients Ultimately, my goal is to give you information so that you can take what serves you and then discard the rest. For those who have been following along, I’d like to share a quick update as to where we are. We weighed the pros and cons of whole-exome vs. whole-genome sequencing but ultimately decided to move forward with whole-genome sequencing. Whole-genome sequencing is not covered at 100% by insurance, and it’s a significant difference when compared with whole-exome sequencing. The whole-exome is a couple of hundred dollars out of pocket, while the whole-genome is $4,000 out of pocket. But, it will give us the most information, even if the gap between the two tests in terms of usefulness is very small.It will take about three months to get the results from that test. From a rheumatology standpoint, we’ll repeat labs next month to see if her results, related to lupus, continue to resolve. Hopefully, this was drug-induced lupus superimposed with immune thrombocytopenia.All other labs that would categorize this as an active disease are currently normal; this buys us time to gather more information before having to proceed with a new medication. Lastly, we’re still waiting for all the labs to return from immunology.Aside from that, Chloe is stable and doing well. She has just recovered from a cold, where the virus led to an increase in nosebleeds due to bone marrow suppression (further driving down her platelet count). These nose bleeds would wake Chloe up a couple of times per night as the blood would clog her nose, making it difficult to breathe. Because of this, we used tranexamic acid for the first time. We crushed the tablet, mixed it with her milk, and Chloe drank it easily without any adverse reactions. I’m definitely grateful this was prescribed.We have an appointment with rheumatology next week and a follow-up with immunology in one month. So, I’ll keep everyone updated as we gather more information. Now, I’d like to shift focus and get into the very first section of the book…You can't just "mail it in"I started Medgeeks in 2013 to help students and clinicians advance their core medical knowledge. When I started PA school at UC Davis in 2010, there weren't any quality resources I could turn to. Everything was either oversimplified or overly complicated. As soon as I graduated in 2012, I made it my mission to create the best high-yield review on the market to help students master medicine. I created the resources I wish I had in school. Simultaneously, I worked full-time in primary care and OBGYN as a solo provider (talk about learning at an accelerated pace). The more I practiced, the more I

For the last five years, I've been working to answer a question most of us have struggled with at some point in time: how do we live a life we love that fulfills us? In the last six months, I've been working to put all these thoughts into one cohesive document that will one day become a book. Although many of the concepts I'm writing about apply to any human in any profession, there are distinct nuances I'll highlight that can only be understood by those working in medicine. My perspective behind these thoughts is a by-product of three major life events:* Practicing medicine as a physician assistant* Starting, growing, and managing Medgeeks (medical education) for the last decade of my life* Experiencing the health care system through the lens of a patient as we look for answers to help my daughterThen, on March 16, 2022, our daughter Chloe was admitted for thrombocytopenia with a platelet count of 17,000. As a father, much of my worry for her health came before she was born. During the pregnancy, I often wondered if she would be born with an illness or defect we missed during our routine prenatal workup. Even though I know that disease can strike at any age, I believed we were clear once Chloe was born. Then, seemingly out of nowhere, we were hit with a hematological problem. At the moment, I believed this was nothing more than an acute problem that would be diagnosed and treated during our hospital stay; we would be well on our way to living life as usual once discharged. I remember going to get breakfast for Liz and me after waking up from our first overnight stay. As I walked towards the elevator, I noticed a room with glass walls that was a dedicated playroom. This room had video games, board games, and all types of various entertainment.Instantly I realized this playroom was for children undergoing chemotherapy. As I saw the children playing, I felt an immense feeling of gratitude fall over me. It was a reminder that things could always be worse; things are worse for many others. It's been 11 months, and I still think about that room and how we were only a few doors away. This memory helps to put things into perspective.After our initial dose of IVIG, we all celebrated as her count increased to 41,000 after just a few short hours. Our physician reassured us that this was nothing more than Immune Thrombocytopenia (ITP) and that we should be good to go.  It has been 11 months since that day, and Chloe has been refractory to four medications. Her platelet count continues to be under 10,000, although she's stable with minimal bleeding symptoms. It wasn't until eight months into her diagnosis that I truly understood what it meant to be a patient in our current healthcare system. On November 7, 2022, I experienced the inefficiencies that often result in subpar care and burnout.Thanks for reading Musings on Life and Medicine! Subscribe for free to receive new posts and podcasts as they’re published.For five years, I've been looking to solve this problem of patient care and burnout.But it was when I had my own experience as a patient that I've come to see how narrow my focus truly was. Don't get me wrong; I always knew bedside manner, communication, and patient rapport were crucial to every visit. But, I never had to experience what that looked like from the other side of the looking glass.For those in practice, always remember patients are people, not just a set of labs. I know it's hard, but you have to remember their lives continue even after they leave your office. Clinicians are so focused on morbidity and mortality that they often forget what patients go through between visits. In all fairness, it's not something focused on during their training, and it would be impossible (at least on an emotional level) to truly empathize with every patient. But there must be something in between because typical concerns can turn into worst-case scenarios for many patients. Every patient wants to know that their clinicia

Relationships are hard. I don't mean to insinuate that hard is good or bad. It just is. These last two weeks have been met with sadness, followed by renewed hope. I last left off by discussing my experience with Mayo Clinic. A couple of days after, we met with rheumatology and immunogenetics at UCLA.The immunogenetics appointment went great. We met with Dr. Kuo (one of the two physicians in charge of the department), her resident, fellow, and fresh new medical student. It was interesting to see the hierarchy as the fellow took charge, the resident smiled a lot at Chloe and made a couple of remarks, and the medical student stayed tucked away in the corner without uttering a word. All in all, it was a thorough and pleasant visit. We officially began the immunological workup; we'll hold off on initiating another medication until we can gather as much data as possible. The rheumatology appointment, on the other hand, wasn't so pleasant. Don't get me wrong, Dr. Whelan is very educated and spent much time explaining his thought process. The problem came about when he told us that our daughter had lupus. He said it confidently but was very optimistic about her prognosis. Everything was in line with what I mentioned earlier, so the mention of lupus didn't come as a shock. For those who haven't read or listened, I discuss this extensively in the article/podcast titled "Patients are more than a set of labs." Even so, it was the first time someone with a white coat said it with certainty. It was the first time Liz ever considered this a real possibility. The two weeks that followed were tough for us.Baseline, Chloe's appointments take up 15-20 hours a week, not including the reading and research I put in every week to become as informed as possible so that when it's time for a decision regarding her care, I can make it knowing I've done my homework. It's interesting how events drastically change one's perspective. Before having a kid, I thought I was swamped. Then, Chloe was born, and I laughed at my past self for thinking I was anywhere as efficient and productive as I was at that moment. Now, I think about who I was just one year back, and I feel the same again. Not too long ago, I was watching a talk by Seth Godin. He asked the audience to raise their right hands as high as possible. Then, he asked them to raise them higher. Everyone visibly raised their hand higher. He says, "everyone holds back every time because that's what you've been taught to do. You've been taught to do that by your third-grade teacher, your coach, and your boss. Because if you put everything into it, they're just going to ask for more anyway."It's an interesting thought experiment. Was I willingly holding back for some reason unbeknownst to me? Was it something I automatically did because it's easier to do more when you hold back from the start? If true, how much of this bleeds into relationships?As we go through this journey as a family, I can't help but reflect. I've come to appreciate how complicated relationships can be when nothing is involved other than life's everyday obstacles. Most people work through this scenario. But what happens when the obstacles become bigger? Do things get more difficult? Yes, but not in the way you might be thinking. It's not that it gets complicated because people fail to rise to the occasion (many do, albeit separately). Tough times ultimately make it difficult to rise to the occasion with your partner. Maintaining the proper communication necessary to stay grounded and on good terms is tricky. But what is the point of a relationship if this doesn't happen? Survival is the inherent purpose behind a community or tribe. Anyone can survive when times are good, but we should be able to lean on our tribe (family) without breaking the system when times are tough.Ideally, you and your partner have a unifying goal that you both want to reach. If this end goal differs for both parties, you've failed before you star

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit andrewreid.substack.com

You can also listen to the podcast on Apple and Spotify:* Click here to listen on Apple Podcasts* Click here to listen on SpotifyI'm very excited about today's podcast for a few reasons. I've finally caught up documenting the journey my wife, daughter, and I have been going through as we try to figure out this mystery diagnosis.The process of writing and recording this podcast is both therapeutic and helpful in terms of critical thinking, as it forces me to think deeply about how I can best help my daughter. Today’s episode is a recap of everything that happened between December 18, 2022, and January 6, 2023; it's filled with medical pearls as I detail several diseases we've been investigating, including our daughters' clinical course.I hope you can learn from our experience if you're a clinician. There are lessons baked inside the good and the bad, which I hope you implement in your practice.I'll discuss the importance of looking for second opinions and why you will always your biggest advocate as a patient.I'll also call out the rheumatology department in this episode. They have done things I find unacceptable, so I've thought about how to handle this best. I want to be respectful, but I also want to caution whoever is listening.What an emotional roller coaster it has been my friends. Thanks for listening to Musings on Life and Medicine! Subscribe for free to receive new posts and podcasts as they’re released. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit andrewreid.substack.com