The Weekly Check-Up Podcast

Most rashes are benign. If they are viral, they resolve spontaneously, and if they are bacterial they may require antibiotics. However, some rashes have been more elusive to understand and treat. These more chronic skin rashes are long-lasting, often inflammatory disorders requiring ongoing management to control symptoms like itching, redness, and pain. Common types include eczema, psoriasis, acne, and rosacea. Their underlying cause is complex, driven by autoimmune responses, genetics, and environmental triggers. These conditions significantly impact quality of life, necessitating personalized, long-term treatment.

Cataracts, which are the age-related changes of the eye’s natural lens, are the leading cause of reversible blindness worldwide and among older adults in the U.S.  As proteins in the lens break down over time, they cause the lens to be less transparent and less able to change its shape. The lens can’t contract into a ball for near vision or flatten for distant; images become cloudy, blurry, less bright, and less colorful. Untreated advanced cataracts can lead to total blindness, which amazingly can still be reversed with surgery. Current estimates are that four million cataract surgeries are performed annually in the U.S., and the surgery is considered the safest invasive procedure done on humans. On this episode, we'll take a deep dive into the most common surgery performed in the U.S. today.

The US rural healthcare crisis is a quiet emergency affecting roughly 60 million people — one-fifth of the population — who face higher mortality rates, systemic hospital closures, and severe specialist shortage. Over 700 rural hospitals (roughly 30% of the national total) are currently at risk of closing due to financial shortfalls. Since 2005, more than 190 rural hospitals have closed while another 25% have closed their maternity wards. While 20% of Americans live in rural areas, only 10% of US physicians practice there. Rural residents face higher rates of premature death from heart disease, cancer, and stroke compared to their urban counterparts. Suicide rates are significantly higher in rural areas, particularly among adult men and children. While only one-third of motor vehicle accidents occur in rural areas, they account for two-thirds of all accident-related deaths. This episode explores the rural healthcare crisis.

The facts are staggering. Lung cancer remains the number one cancer killer of both men and women. 230,000 new lung cancer diagnoses are expected in the US this year.  The average annual cost of treating advanced or metastatic lung cancer is astronomical, often exceeding $200,000 per year. Lung cancer screening with low-dose CT scans is severely underused in the U.S. with less than 20% of the millions of eligible high-risk former and current smokers getting tested. Lung cancer screening works.  It’s safe and effective. It saves lives. It saves healthcare dollars as the cost of treating advanced cancer continues to skyrocket.  On this episode, we'll try to understand how to increase use of this inexpensive test that can save more lives and money than any other in healthcare.

One hundred years ago, medical researchers noted that upper-body obesity was associated with high blood sugar (diabetes), high blood pressure (hypertension), and hardening of the arteries (atherosclerosis.)  Fifty years later the term "metabolic syndrome" was coined. In 1988,  a prominent researcher introduced Syndrome X, in which he claimed that the underlying problem with obese, diabetic, hypertensive patients with heart disease was related to the body becoming unresponsive or resistant to the effects of their own insulin. The X was used to highlight insulin resistance was then a medical mystery.  Today, we've come to understand insulin resistance as the underlying mechanism causing type 2 diabetes, obesity being its primary cause.

The American healthcare system is in crisis characterized by high and rising costs, fragmentation, poor access to care, administrative complexity, and workforce shortages. Costs are passed on via ever rising premiums, deductibles, and out-of-pocket expenses for insured individuals. Meanwhile, factors like administrative burden, a fee-for-service model, and limited access to primary care contribute to widespread medical debt and a fear of financial ruin for many who are underinsured or uninsured. Our once admired healthcare system is failing despite the U.S. spending much more per capita on healthcare than other wealthy nations. On this episode, we see how all this is affecting people personally.

Among the many reasons I chose the specialty of medical oncology is that cancer can present anywhere in the body, manifest any symptom, affect anyone, and its clinical course often presents conundrums for our inner Sherlock Holmes or Dr. House. “The Weekly Check-Up” radio show launched the year I retired from my clinical practice. I didn't realize how important a role it would play in my continued sanity as I navigated the next phase of my professional career. Like my cancer practice, “The Weekly Check-Up” callers cover the entirety of human anatomy and physiology, and there is always a puzzle to solve. This  episode features a diverse set of topics that keep the radio show and these podcasts both entertaining and informative. - Dr. Bruce Feinberg, host of “The Weekly Check-Up Podcast.”

Medical historians endlessly debate the greatest medical advancements. Among them are vaccination credited to Jenner in 1796; anesthesia credited to Crawford-Long in 1842; antibiotics with Fleming’s discovery of penicillin in 1928; and X-rays credited to the Curies and Roentgen in 1895. Then you have organ transplantation, public health improvements, insulin, the microscope, germ theory, and the discovery of DNA by Watson and Crick. “The Weekly Check-Up Podcast’s” list concludes with computerized tomography, the fiber optic endoscope, and percutaneous coronary intervention or PCI. Together these discoveries resulted in a quantum leap in disease prevention, diagnosis, and treatment, as we'll hear on this episode.

The use of sound or acoustic energy in medicine has evolved from the ancient diagnostic method used by ⁠Hippocrates by placing his ear to the chest. However, we had to wait 2,000 years for the invention of the ⁠stethoscope⁠. Today, acoustic energy is used in diagnostic imaging called ultrasound that has revolutionized obstetrics and cardiology, while therapeutic applications of sound have resulted in shockwave lithotripsy to break up kidney stones, destroy tumors. This episode explores new uses of sound energy.

Great trauma systems do not prevent trauma; they limit the carnage, disability, and chaos that are its consequence. Preventing trauma is the work of public policy and organizations like the Georgia Trauma Foundation. Seat belt laws, helmet laws, and air bag requirements have saved literally millions of lives.  But technology, policy, education, and awareness have limits. Reckless driving, driving while intoxicated, and the use of cell phones while driving are some of the root causes that speak to a crisis of personal accountability and the inherent irrationality of the human condition.  Worse, they decry hubris, selfishness, and lack of civility that jeopardizes not just the driver’s life, but the passengers and bystanders who are placed at risk. 

If you’ve ever gone with your gut to make a decision or felt butterflies in your stomach when nervous, you’re likely getting signals from an unexpected source: your second brain. Hidden in the walls of the digestive system, this brain in your gut is revolutionizing medicine’s understanding of the links between digestion, mood, behavior, health, and even the way you think. Add increased understanding of the influence gut bacteria has on disease and health, called our microbiome, and we may begin to grasp that our gut or gastrointestinal system has a much more complex role in human health beyond nutrition and energy, as we learn on this episode.

The hormonal chaos women experience month after month from menarche through menopause is due to natural, fluctuating levels of hormones like estrogen and progesterone that can impact mood, energy, and even physical health. These hormonal shifts affect internal chemicals called neurotransmitters that can lead to mood swings, anxiety, brain fog, and fatigue. They may be a normal part of the female life cycle that spans Menarche, Menstruation, Pregnancy, Postpartum, Perimenopause and Menopause, but they are often referred to as the “stages of chaos” as we'll hear more about on this episode.

The 2002 Verizon advertising campaign launched the slogan: Can you hear me now? The phrase resonated not only because of the universal experience of poor reception quality of cellular networks, but due to an emerging zeitgeist of disaffection with modernity, technology, impersonal communication, and isolation. Healthcare consumers embody this frustration, propelling them to call in to “The Weekly Check-Up Podcast.” The pain points are myriad: poor provider communication, confusing insurance benefits, fear, vulnerability, and feelings of being dismissed or unheard. It all results in dissatisfaction with care and a significant emotional toll.

Heart failure has a long history in medicine. It began with the Greek physician Galen in 200 AD. In 1300, Ibn Nafis established the foundation upon which William Harvey made his revolutionary conclusion some 400 years later. Harvey noted that blood circulates continuously left to right through the lungs by the pumping or propelling action of the cardiac muscle, thus making the heart the center of the cardiovascular system.  Today, heart failure remains a major public health problem and a leading cause of death affecting 26 million people worldwide. On this episode, Dr. Feinberg explores heart failure management with two specialists: Dr. Ugo Egalum, a cardiologist, and Dr. Kyle Thompson, a cardiothoracic surgeon.

The all-too-familiar topic of school shootings remains the focus of endless debate. While we all wring our hands at the perceived inability to stop this horror, there are folks focused on what can be done to limit the death and injury while the problem itself remains intractable, with more than 43,000 children exposed in 2022 alone. One such shooting occurred less than 60 miles from Dr. Feinberg’s home in Atlanta on September 4, 2024 at Apalachee High School in the city of Winder, Georgia. On this episode, Dr. Feinberg talks to first responders Kevin Locke, who was on site at Apalachee High School, and Crystal Shelnutt, of the Georgia Trauma Commission, to understand what can be done to limit the carnage of school shootings and other types of traumatic injury. The interview also includes perspectives from Cheryle Ward, executive director of Georgia Trauma Foundation, which invests in trauma care in Georgia, including the Stop The Bleed campaign, which works to get Stop The Bleed kits in schools throughout the state. Donations to the Georgia Trauma Foundation can be made here.

Vision is the dominant of the five senses the body uses to interpret its surroundings. The organ of vision is the eye which is composed of a series of lenses and spaces that give focus to images, just as a camera does. It is composed of the cornea, lens, and the aqueous and vitreous humor, each of which contribute to perfecting the focus of the light received by the retina, analogous to the film of the camera.  Given how critical the eye is to the understanding of our surroundings, it is heavily protected by a bony orbit and allowed near omni-directional movement made possible by six eye muscles and three of the 12 cranial nerves.  Vision can be disturbed if the light can’t be focused, if the retina can’t receive the light, if the optical nerve is impaired, or if the eye muscles cannot move synchronously. All of which require an intact blood supply and orbit.  On this episode , we'll be joined by Dr. Joseph Hyatt, an ophthalmologist and eye specialist, as we talk to callers about varied issues impairing their vision.

For centuries, family doctors delivered babies, cared for them as children, and managed them later as adults. Today, the human medical journey is most often managed by specialists, with children cared for by pediatricians.  From post-pandemic developmental delays, obesity, and declining rates of vaccination in younger children to mental health crises, and opioid and substance use in older children to screen addictions across all ages, the role of the pediatrician has never been more critical.

On this episode, we continue our exploration of the body’s circuitry moving from the heart and its circuitry disruptions causing arrhythmias to the brain where circuitry disruptions cause seizures. Maybe you’ve witnessed a seizure in a family member or friend, or you’ve seen them portrayed on TV or in a movie like the Paul Muni classic, “The Last Angry Man.” Whatever your exposure, your understanding is likely more informed by fiction than by fact. Thought for millennia to represent demonic possession causing its victims to be shunned and feared, seizures today are well understood, successfully treated and in some cases cured.

The complexity of the human body makes it perfect fodder for analogies and metaphors to explain its workings. The urinary tract removes liquid waste, gaining its analogy to plumbing and urologists as plumbers. The muscles and bones of the skeletal system are not unlike the beams and girders of a building, resulting in orthopedists being called carpenters.  All of which begs the question: Who are the electricians, and what body system do they manage? It turns out that our body’s electrochemical circuitry is quite complex and only recently understood well enough that it could be manipulated. The next two episodes will address two distinct circuitry problems managed by different specialists. This episode will address diseases of the heart circuitry, which result in abnormal heart rhythms like atrial fibrillation.

The external human ear is a shell-shaped structure composed of cartilage covered by skin that lies on the lateral aspect of the head. Inside the head lie the middle and inner ear. All together they are the organ of hearing or audition and equilibrium or balance. When it comes to common disease associations, the outer ear is skin cancer, the middle ear is otitis media or earaches, and the inner ear is hearing loss, tinnitus (hearing sound when no source is present often referred to as ringing in the ears), as well as vertigo or dizziness.  Patient complaints about their ears are more expansive. They’re too big, they stick out, they itch inside, they’re full of wax, they hurt, they don’t pop, they feel clogged, etc. We’ll hear all of that and more on this episode.

The skin is the largest organ in the body, covering its entire external surface. The skin’s structure is an intricate layered network that serves as the body’s suit of armor protecting against everything from bacteria and fungus to ultraviolet (UV) light, to chemicals and mechanical injury, while also regulating temperature and hydration. In aggregate cancers of the skin are the most common cancers. Fortunately, they can be prevented, screened for, and when found early, as most are, cured. On this episode, we’ll hear from callers with questions touching on each of these issues.

The expression “the cure is worse than the disease” is often associated with cancer treatment and rightly so as the first decades of cancer care were as likely to shorten a patient's life as lengthen it.  Most of us have some past or recent experience that justifies the statement. Due to these experiences, we conclude that anything bad that happens to someone once their cancer treatment begins is the result of the treatment, as the callers on this episode make abundantly clear.

Cancer is among the most complex of diseases. For 5,000 years, cancer was thought to be just one disease. Over time, thinking changed, and cancer was viewed as different diseases distinguished by the organ in which it arose. The advent of the microscope revealed cancer to be a cellular disease, different in each of the 200 cell types in the body. The unraveling of the human genome revealed that mutations in genes that governed cell behavior transform the cell to cancer. This episode reveals that the increasing complexity of the nature of cancer has resulted in the increasing complexity of its treatment.

The foundations of trauma care in America began with caring for injured military personnel during war. During the Civil War, President Lincoln drove creation of the first trauma manual. During World War II, researchers started going into the battlefield to study care processes and clinical outcomes. The Korean and Vietnam Wars brought advances in medical transportation, including use of helicopters. On today’s episode, experts in the field of trauma care join Dr. Feinberg as we hear from callers who share their personal stories and concerns about trauma care.  

At the biological level, aging results from the impact of the accumulation of molecular and cellular damage over time. This leads to a gradual decrease in physical and mental capacity, a growing risk of disease and ultimately death. These changes are neither linear nor consistent, and they are only loosely associated with a person’s age in years. The diversity seen in older age is not random, it’s about your genetics, how you are able to live and how you choose to live.

The phrase “caveat emptor” comes from Latin and means “let the buyer beware.” It originated as a legal principle in ancient Rome. Before the Industrial Revolution, caveat emptor became the common law for most land sales and purchases. It is based on the idea that buyers usually have less information about the product than the seller. In healthcare, the patient as a consumer of healthcare always seems to be at a disadvantage for information from those selling services, whether they be insurance companies, hospitals, doctors, pharmaceutical companies, etc. On this episode, we’ll hear from callers who feel ill informed, betrayed, and hoodwinked by a system cloaked in jargon and complexity.

Effective communication is essential in any business, but even more so in healthcare. The effects of poor communication in healthcare can have extremely serious consequences. Poor communication results in misdiagnoses and other medical mistakes that can easily lead to avoidable health complications and the death of patients. Health literacy refers to the ability of individuals to obtain, understand, and use health information and services to make informed decisions about their health and well-being.

Few body parts have been as useful to our function and the representation of our world as has the foot. In literature, a person’s manner or speed of walking or running is known as the fleet of foot. The historical military definition of an infantryman is a foot soldier. In measurement, a unit of linear measure equal to 12 inches is referred to as a foot. However, for this edition of the podcast, we will focus on the following definition: the lower extremity of the leg below the ankle on which a person stands or walks.

When we think of the body's organs, we think of the heart, lungs, kidney, and liver.  When we think of the body's systems, we think of nervous and vascular. The musculoskeletal system is an organ system that provides structure, support, and movement to the body and much more. It consists of bones, muscles, joints, cartilage, tendons, and ligaments. On this episode, we explore the various aspects of the musculoskeletal system. 

Possibly the most intricate and elegant of the body’s functions is the immune system. It's designed to recognize and protect your body or “the self” from all that is not the self, such as bacteria, viruses, even splinters. It can also run amok reacting to non threatening invaders like peanuts or even "the self" in what is called auto-immune disease like rheumatoid arthritis. Among the ways in which the immune system isolates foreign invaders is a process called inflammation.  On this episode, we hear from callers whose concerns introduce us to the complexity of the immune response. 

The differential diagnosis is a systematic method used by physicians to specifically identify or explain a patient's clinical complaint where multiple explanations are possible. Akin to a police who-done-it procedural, the differential diagnosis uses the evidence of symptoms, clinical signs, patient history, family history, and medical knowledge to find the culprit. On this episode, we’ll explore the use of the differential diagnosis.

Research shows that self-advocacy in healthcare can lead to significantly improved health outcomes, including better quality of care, increased patient satisfaction, reduced symptom burden, and a greater sense of control when patients actively participate in decision making about their goals, treatment, and needs.  However, self-advocacy is often misinterpreted to include self-diagnosis, self-prescribing, and reliance on Dr. Google.  On this episode, we’ll examine the many facets of self-advocacy.

Atop the textbook list of medical emergencies are the following: bleeding uncontrollably (including coughing or vomiting blood); breathing problems (difficulty breathing, shortness of breath); change in mental status (unusual behavior, confusion); fainting or loss of consciousness; chest pain for two minutes or more; feeling of committing suicide or murder; and accidents and injury (including poisoning, burns, smoke inhalation, and near drowning). On this episode, we talk with three callers whose situations challenge the textbook list of medical emergencies.

There is a unique emotional conflict with diseases of the brain and central nervous system, a need to understand and put a label on the process and a dread or denial when that label is placed.  Whether it’s schizophrenia or dementia, depression or ALS, the pronouncement of the label is as fraught as the absence of one. On this episode, we’ll hear from patients who struggle with both the fear and functional loss of neurodegenerative disease.

The first joint replacement surgeries were performed 135 years ago in Germany, shortly followed by efforts in France and England using rubber and steel joints. Refinements in materials and methods progressed slowly, but by 1969 the FDA finally approved the first hip prosthesis, the technical name for the artificial joint. In 2025, it is projected that 2.5 million Americans will undergo hip and knee replacement surgeries with countless more undergoing replacement surgeries of other joints.

Out-of-network doctors or hospitals, surprise billing, limited benefits, and off-formulary medication are all-too-familiar healthcare hurdles. The list of potential financial disasters awaiting the healthcare consumer is so profound it has earned its own name on the list of medical complications: financial toxicity.  Possibly more than other consumer sector, healthcare is fraught with buyer beware situations at every turn.

The impact of diabetes in America today is nothing short of apocalyptic. It’s a scourge, an epidemic, a catastrophe, a preventable tragedy of enormous proportion, and none of these statements are exaggerations. More than half the country is pre-diabetic or diabetic,  and more than 3/4 of Americans are obese. The extent of obesity in American youth suggests the trend is likely to worsen.

The penis refers to the male sex organ, which combines with the testis and prostate gland to complete the male sex anatomy. It’s a relatively simple organ comprised of the head or glans, the shaft, and the base, which surround the urethra through which urine and semen flow. Despite its anatomical and physiological simplicity, its cultural influence remains profound as does its central role in men’s health.

Throughout the history of man, most disease was a medical mystery characterized as either a divine response to sin and disobedience, an imbalance of bodily humors, or an unknown pestilence. As we recently learned from Covid, mysteries still persist in medicine. And those who were fond of the TV show “House” may recall that medical mysteries are often of a personal nature. On this episode, several callers share their own.

When you think about blood, what comes to mind? Blood contains the elaborate systems for clotting and immune regulation that prevent us from bleeding to death or dying from infection. Blood is also integrally linked to the lungs where oxygen and carbon dioxide are exchanged, as well as to the heart, arteries, and veins through which it flows. Blood is life.

Cholesterol was the first measurable biological marker of heart disease discovered in medical research. Biomedical research became obsessed with cholesterol. In fact, studies of cholesterol’s role in disease have garnered 13 Nobel Prizes. This episode touches on what we know about cholesterol, what we don’t know, and the mythology that has been built around it and around the drugs that treat excess amounts of cholesterol.

“Don’t talk with your mouth full” is an expression we’ve all heard. And if we have children or younger siblings, we’ve also spoken it.  Did it arise out of decorum so the listener is not visually confronted with half eaten food or worse, spat upon? Or was it addressing the resulting mumbled and garbled speech? Or was it a medical admonition to prevent choking? The origins are unclear, but it’s fascinating to give consideration to our human design that has food, water, and air all having a common entry point into the human body.

Complementary and alternative medicine (CAM) encompass a broad set of practices and beliefs that are outside evidence-based medicine as they are rarely subjected to well-designed and well-conducted multi-phase clinical trials. On this episode, we focus on a variety of CAM practices that share a common thread in the belief that their benefit is achieved through detoxification: the removal or rendering harmless things in the body which lead to ill health.

In 1660, a German physician first described an itch as an unpleasant sensation that inevitably prompts the desire to scratch. Itching and scratching were believed inseparable from one another. Together they constitute a cycle whereby the former is the cause and the latter is the effect. This cycle can become viscous whereby scratching creates an inflammatory response, which induces more itching. Identifying the cause of an itch becomes paramount as the cycle must be broken and prevented if possible.

On this episode, we focus on the critical function the lungs serve in the exchange of carbon dioxide for oxygen.  Respiration or breathing is an involuntary action that occurs in the lungs, a critical organ for living, that we too often take for granted as we inhale air contaminated by smoke, chemicals, and microorganisms.

For thousands of years, urine was the primary tool physicians used to diagnose disease. It was referred to as the divine fluid and the window to the body. Tasting of urine to detect sweetness was common practice in the diagnosis of diabetes, giving it its medical name: diabetes mellitus. Mellitus is Latin for honey. On this episode, we explore the urinary tract, the organs that produce then excrete urine.

Veins are low pressure pipes that remove waste and carbon dioxide from our bodies’ cells, while arteries are high pressure distributors of nutrients and oxygen. Arteries get more attention as their associated disease states are responsible for life threatening conditions like heart attacks and strokes. But veins should not be overlooked as we will learn in this episode.

Signs and symptoms – observations of changes in our body that compromise our sense of wellness – are nature’s way of warning us that our bodies are under stress. However, they can be difficult to navigate. On this episode, we discuss when to ignore and when to act. 

Breast cancer has been at the forefront of cancer research and prevention strategies. On this episode, we discuss the changing treatment paradigm of earlier systemic therapy and the ever-increasing issues that have developed around surviving a disease that just decades ago was a death sentence.

Few medical concepts have so captured the public’s attention with its promise of eternal life and eternal youth as has regenerative medicine. On this episode, our callers discuss the first widely commercialized applications of regenerative medicine: platelet rich plasma and stem cell injections.