Dr. Rosh, can you help our audience understand this better?

sure so you know it's a big spectrum of disease pulmonary embolism and deep vein thrombosis so we have many deep veins throughout our body in the upper extremities and my abdomen but usually when you say the word deep vein thrombosis what organ do people think about the legs you know what i mean because we have deep veins in our legs.

And the reason why I'm bringing this up is that, you know, where does the pulmonary embolism, which is a clot in the pulmonary artery in the lung, where does it come from? From a DVT and most likely from the legs, you know? So when do I worry about it? So when we talk about a deep vein thrombosis, I'm only focusing on the legs for this quick talk, is that if you notice that one of your legs is swollen than the other, if you notice that one of the calf or your leg is a little tender than the other, hey, there's no harm in getting that evaluated.

And how do we work up a DVT in the legs? We order an ultrasound, which is a very simple non-invasive test to do.

Now, when you say pulmonary embolism, what are gonna be your symptoms? Well, you're probably gonna have some chest discomfort, some chest pain.

We'll use a medical word called pleuritic, which means that when you take a breath in, it kind of hurts the chest when you take a breath in, kind of like a pleuritic type chest pain.

And of course, you should get it evaluated.

So until next time, thanks so much.

Mm-hmm.

So when I want to diagnose type 1 narcolepsy, you know, it's nothing I just kind of wing and say, "I'm just gonna make it up." There are definitely guidelines that we use from the American Academy of Sleep Medicine, diagnostic testing, which is, which is not easy, you know.

And, you know, to over-summarize it, to not make it too boring, I mean, it, it could classically involve doing a sleep study at night from the hours of 10:00 PM to 6:00 AM just to make sure we don't have any sleep apnea, just to make sure that you're getting enough sleep.

And then during the day, you don't go home.

You s- plant your butt right there in the sleep lab, and you do these napping studies.

And the napping study is called an MSLT, a multiple sleep latency test, where I always kind of tell my patients if they ask, "What's an MSLT?" I say, "You know how you tell me that you could sleep anywhere at any time? Prove it to me."

Mm-hmm.

So after that nighttime study, you should be feel refreshed, but we actually see in 20-minute increments that can you fall asleep in 20 minutes? And if you fall asleep in 20 minutes, we actually wanna check if you could fall asleep in another 15 minutes into REM sleep.

What did you see that, that made you step away?

Yeah, that's a great, a great point there you had on, on the ma- large market's not necessarily the right market, and that's sort of reflected in our strategy as well.

So if you just look back, you know, fifteen years ago, Electrovaya was focused on electric vehicles, uh, foremost, and, uh, we were going the right direction there.

We had a partnership with Chrysler.

A little while later, Chrysler, uh, partnership with Mercedes.

That said, on, on the energy storage as well, we were one of the early players for a bat-- you know, lithium-ion battery-powered energy storage systems, which of course today are ubiquitous and, and a massive industry.

What ended up happening in the space though was scale came behind certain players, especially large Asian, Chinese, and Korean battery manufacturers.

Why can't a battery that costs more to store energy still be the better economic solution?

So Dr. Raj, tell us about this.

All right.

So when we talk about high cholesterol, I really put it into two categories, primary high cholesterol and secondary.

Primary high cholesterol means kind of like family history.

You know what I mean? And these individuals will end up having cholesterols in super high levels.

And definitely maybe they have heart disease at a younger age.

The one we really target is secondary causes of high cholesterol, being a diabetic, bad habits, obesity, alcohol, drugs, you name it.

And we'll look forward to seeing you next time.

And this is this is from like a few days ago, that article.

Yeah.

You know, it's funny.

I wish when we first met each other, I was doing so many things on the news about COVID.

And I want to find that hidden footage because many of us, including me, I'll raise my hand high.

The things that came out of my mouth back then, I was like, I remember when COVID first came out.

Hey, a couple of months and everything is all gone.

However, where are we at now with this post-exposure? technique or mindset?

Can you tell us more about that? 'Cause it does come into play, and we do hear it from time to time.

Yeah.

Well, you know, I'm gonna take a b- um, take your statement back.

I think most everyone is worried about sepsis with one of their loved ones, especially when you talk about the elderly.

Come on, urinary tract infections, when you get that urinary tract, are they becoming septic? So when we talk about, you know, sepsis, how do I define it? There are many different definitions out there, but something that'll be nice for this conversation is, you know, sepsis is kind of meeting what we call SIRS criteria.

Now, SIRS is not a name of a department store.

It stands for S-I-R-S, systemic inflammatory response syndrome, plus in a presumed source of infection.

This is really helpful for me, and, uh, definitely for the audience out here, so thanks so much again, Dr. Raj, and we look forward to seeing you next time.

And now, here's today's episode.

Hi, Dr. Raj here.

And let's finish off calcium metabolism.

So the two things I want to talk about today is one, Paget's disease of the bone.

Not a very common thing, but you know, one of my dark horses for the board is they might sneak in one question right there.

And of course, vitamin D, you know, and you're going to combine this knowledge with osteoporosis.

We're going to combine this knowledge with the basics of calcium metabolism.

And

Dr. Raj, talk to us about ILD and including IPF, which I'm not quite sure I know what that is.

Sure, and so I'm gonna try my hardest to make it super simple.

So on the top level, when I think about lung disease, I put them into two broad categories, obstructive lung disease and restrictive lung disease.

Obstruction is usually a disease of the airways itself, meaning that it's COPD or asthma.

When we talk about restrictive lung disease, most of the time we're talking about the restriction being in the body of the lung called the lung parenchyma, called the interstitium.

So many people will have what's called a restrictive lung disease and interstitial lung disease.

And I can think about it.

So Dr. Raj, thanks again, and we'll look forward to seeing you next time.

And now, here's today's episode.

Hi, Dr. Raj here, and we're gonna continue talking about calcium.

And right now, let's talk about something that's triple star high yield for the board exam, which is osteoporosis.

So when we talk about osteoporosis, um, we always should start off talking about screening.

Preventive medicine is always gonna be high yield for the board exams.

So let me start off by saying who do we focus on the most? It's gonna be women.

So we screen for osteoporosis in women sixty-five years of age or older.

And now, here's today's episode.

So of course I said earlier, treat the underlying cause.

So what are gonna be those causes of hypercalcemia? So notice like my coloring of this here on the pink side is PTH mediated and on the dark blue side is non PTH mediated.

So what are going to be things under PTH mediated? Number one has to be primary hyperparathyroidism.

And we're going to talk about that in the next slide.

So this is going to be someone who has a very high level of PTH.

They're going to have hypercalcemia.

And

It's a term that I'm sure folks have heard here and there, but what is it, Dr. Raj?

Yeah, I mean, I already got a little tingle in my chest because, you know, when I do ICU medicine, I don't think my job, let me take it back, I know my job isn't to put people on the ventilator.

I really feel is to have that conversation to prevent them from getting on the ventilator.

Don't get me wrong, there are some individuals you're fighting for really bad pneumonia, and I'm getting flashbacks from during COVID times, they needed to be on that ventilator.

But you know, sometimes you don't realize until you look at your loved one what it means to have a tube, but that's what mechanical ventilation is, is taking a tube, putting it through your vocal cords, and it goes into your lungs, and literally a machine is taking over your breathing.

And when you are in a mechanical ventilator, just like it sounds, I mean, it's not pleasant.

It's very claustrophobic to be there.

Is that the case?

And now, here's today's episode.

Hi, Dr. Raj here, and today we're gonna be talking about calcium metabolism, and I have fully enjoyed being part of your endocrinology journey, as well as just kind of leading the, the bus in regards to internal medicine board review and to get you the best score on your exams.

But today, let's focus on calcium.

Let's talk about hypercalcemia.

Let's talk about hypocalcemia.

Then we'll make some stops in Paget's disease of the bone.

We'll talk about osteoporosis.

It's the

best.

It has to be, dude.

So yeah, so I would always say lifestyle modifications first before grabbing anything.

When we talk about what are going to be some of the medications, sure, over the counter, you could take things like these Tums medications.

But the two broad categories that we use medically to treat reflux after lifestyle would be antihistamines.

They're called H2 blockers.

it.

you immediately looking for stroke or what are other things that are maybe lesser on the scale of severity that could also cause this?

Oh, yeah.

Well, you know what? I think that answer is going to be best suited.

Once we talk about what are those symptoms, then people like kind of pair it up together, pair it up together.

So I'm going to throw out what are going to be the symptoms of dysphagia.

Let's start with number one.

You know, I mean, if you were just having increased work to just swallow, like if you have all this effort to swallow food to the point where you're like, you know what? I'm chewing my food extra super long just to swallow it.

you from her.

Rush, can you share more about asthma? Sure.

Sure.

So it is sad when we talk about the United States, I mean, I think I'm underestimating this, 25 million people have asthma.

And of course, anytime you mention kids, my heart just goes out.

So what are some of the take home messages? Asthma likes to come in two broad flavors, categories, allergic and non-allergic.

And you can imagine the most common type is that allergic subtype.

And it's gonna be around 80 to 90% of almost all asthmatics there.

So if I'm a caregiver and my loved one is having an asthma attack and they don't have their medication, is there anything they can do to help them in that moment?

So to put it in the more common, although we're going to discuss why the titling is important, but they are at some level on the alcoholism scale, be it social, be it full-blown alcoholism.

And I think, you know, the whole point is that it's a disorder.

And I think that's very important because it's a diagnosis.

And it's very important to emphasize that, you know, when you just use the terminology alcoholism, I mean, there's a stigma that applies to it.

that you could prevent this.

You're doing it because you enjoy drinking.

And that's far from the truth.

that's a problem.