A routine mammogram can change everything—especially when a letter arrives labeling you “high risk.” We sit down with nurse practitioner Jill Flores, whose career spans labor and delivery to advanced breast care, to unpack what that label actually means, how risk models work, and how a high-risk breast clinic turns numbers into a practical plan you can follow without losing your sanity. Jill explains the intake process that starts with a cancer risk assessment, walks through why 20% lifetime risk is the threshold for enhanced screening, and shows how mammograms, whole-breast ultrasound, and MRI can be sequenced to shrink the window where cancer hides.

We dive into genetics beyond BRCA—think CHEK2, ATM, and comprehensive multigene panels that also inform risks for colon, kidney, endocrine, and skin cancers. You’ll hear how decisions about prophylactic surgery are made, why “genetic risk” isn’t destiny, and how shared decision-making respects both data and personal values. Jill also addresses a frustrating reality: insurance coverage for high-risk MRIs is inconsistent, even when patients meet criteria. She shares how our team advocates through appeals, aligns schedules to reduce barriers, and keeps the focus on early detection and longer survival.

Lifestyle isn’t an afterthought here—it’s a lever. We cover how Mediterranean- and DASH-style eating, steady exercise, weight management, and low alcohol intake can reduce risk through better hormone balance and lower inflammation. We talk candidly about anxiety, how to spot meaningful changes, and why having a reachable nurse navigator matters. Men are part of the conversation too, with tailored imaging and genetic counseling when indicated. If you’ve ever wondered whether you or a loved one should pursue a high-risk assessment—or how to make the system work for you—this conversation delivers a clear, compassionate playbook.

If this resonated, follow the show, share it with someone who needs clarity, and leave a review to help others find it. Ready to check your risk or set up a plan? Call our high risk nurse navigator at 636 530 5512.

Ever wondered how hospitals afford those multi-million dollar machines that save lives? The answer might surprise you.

Dan McCormack, Vice President and Executive Director of Development for St. Luke's Hospital, pulls back the curtain on healthcare philanthropy in this eye-opening conversation. What emerges is a fascinating look at how donor dollars become the lifeblood of modern healthcare innovation when insurance reimbursements fall woefully short.

While universities like Harvard sit atop $50 billion endowments, your local hospital likely operates on razor-thin margins—sometimes just 1-2% above breaking even, if not in the negative. Medicare and Medicaid typically reimburse only 60-90 cents on the dollar for services rendered. This financial reality creates an impossible situation: how does a hospital acquire a $4 million linear accelerator for cancer treatment when barely staying afloat?

The answer lies in the profound connection between grateful patients and the institutions that heal them. Unlike university donations driven by alumni pride or cultural giving motivated by community enrichment, healthcare philanthropy taps into something more personal—the deep gratitude that comes from having your life saved or improved. As McCormack eloquently puts it, "What I'm actually doing is giving them an opportunity to feel good" by allowing donors to transform their hard-earned money into healing for others.

What makes this conversation particularly valuable is its honest exploration of both sides of the philanthropy equation. We hear about the delicate art of fundraising without making relationships feel transactional, while also understanding why even small donations make meaningful differences in healthcare delivery. From the psychology of giving to the uncertain future of nonprofit tax status for hospitals, this discussion offers rare insights into how philanthropy shapes the healthcare we all depend on.

Ready to make an impact? Visit the St. Luke's website and click "I Want To" in the upper right corner to discover how your contribution—whether $25 or $25,000—can transform patient care in your community.

What happens when a park ranger eats a raw crawfish on a dare? According to infectious disease specialist Dr. Matthew German, it can lead to a rare parasitic infection typically only seen in Tibet. This surprising case exemplifies why the most important qualities in medicine are persistence and doubt.

Dr. German joins oncologist Jason Edwards for a fascinating journey through the unexpected twists and turns of infectious disease diagnosis. With decades of experience treating everything from HIV to COVID-19, Dr. German shares how diseases often don't follow textbook descriptions, and why algorithms alone can't replace clinical judgment. "You have rules or guidelines, but they're not laws," he explains, emphasizing the dangers of pigeonholing diagnoses.

The conversation explores how non-infectious conditions frequently mimic infections, requiring doctors to maintain broad differential diagnoses. From autoimmune disorders like Familial Mediterranean Fever to immunotherapy side effects causing pituitary insufficiency, these medical mysteries demand both extensive knowledge and investigative persistence. Dr. German recounts his experience during the HIV epidemic's evolution - from the limited effectiveness of early AZT monotherapy to today's life-changing triple therapy regimens.

The physicians also tackle challenging topics including public mistrust in medicine, the complexities of doctor-patient communication across different educational backgrounds, and emerging threats like H5N1 avian influenza. Throughout their discussion, they return to a central theme: medical humility. Even brilliant doctors make mistakes when they become too certain of their diagnoses without considering alternatives.

Whether you're a healthcare professional, student, or simply fascinated by medical mysteries, this conversation offers valuable insights into how infectious disease specialists approach complex cases. The next time you hear hoofbeats, remember it might not be horses or zebras - sometimes it's a crawfish-borne parasite!

The modern hospital experience has dramatically transformed over recent decades, and few understand this evolution better than hospitalists - physicians who specialize exclusively in caring for hospitalized patients. Dr. Lin Liu, head of internal medicine at St. Luke's Hospital, takes us behind the scenes of this relatively young medical specialty that emerged around 1996.

"Hospitalists are the unsung heroes of acute care," Dr. Liu explains, describing how these physicians navigate increasingly complex cases in today's healthcare landscape. While patients once followed their primary care doctors into hospital settings, the hospitalist model has created specialists who excel at managing acute conditions efficiently and safely. This shift hasn't been without challenges - patients initially resisted the change, but the benefits have become increasingly apparent.

What's particularly fascinating is how hospitalized patient demographics have shifted. At Dr. Liu's facility, the median patient age ranges from 75-80 years old, reflecting both improved healthcare access and longevity. These older patients present unique challenges, often carrying multiple chronic conditions alongside acute issues. Modern medicine has created a situation where "somebody who may have died from heart failure in 1985 at the age of 65 is living to 85" while accumulating additional medical concerns.

Dr. Liu offers valuable insights into why length of stay matters as a quality measure, not merely a financial consideration. Each day in the hospital exposes patients to risks including delirium, falls, infections, and deconditioning - studies show patients can lose 10% of their strength daily. The seven-on, seven-off schedule common among hospitalists provides continuity of care while preventing physician burnout, creating a system that benefits both providers and patients.

Beyond clinical care, we discover Dr. Liu's passion for building community through a hospital soccer club that brings together healthcare workers across disciplines. The conversation concludes with a thoughtful examination of medical orthodoxy and the importance of questioning established practices. Whether you're a healthcare professional or simply curious about what happens behind hospital walls, this episode offers rare insight into the specialized world of hospital medicine.

Listen now to understand why hospitalists play such a crucial role in modern healthcare and how they're working to improve patient outcomes while navigating the complex challenges of today's medical landscape.

Michelle Eichelmann, Executive Director for Oncology Services at St. Luke's, shares her journey from chiropractor to healthcare administrator and discusses the challenges of running a cancer center in today's healthcare environment.

• Originally from St. Louis with a doctorate from Logan College of Chiropractic
• Specialized in symptom management and acupuncture for oncology patients before transitioning to leadership
• Oversees medical oncology, radiation oncology, infusion centers, research, tumor registry, and navigation
• Identifies cost containment as a major challenge while maintaining quality care
• Explains that standardized treatment guidelines (NCCN) dictate cancer therapies, not cost considerations
• Discusses how hospitals often operate at financial losses while continuing to serve communities
• Describes the shift toward value-based medicine and quality metrics driving reimbursement
• Emphasizes transparent communication and trust-building as essential leadership qualities
• Shares optimistic but cautious perspective on AI's potential to improve healthcare efficiency

The Friends of St. Luke's philanthropic organization helps fund millions of dollars in free care annually. To contribute, visit the Office of Development at St. Luke's website.

The science of vaccines has never been more contentious or politically charged than it is today. What started as a medical breakthrough has become a flashpoint in our cultural divide, leaving many parents confused about what to believe.

In part two of this thoughtful conversation with pediatrician Dr. Lisa Ryan, we cut through the noise to examine vaccine hesitancy from multiple angles. We begin by tackling common concerns about vaccine ingredients like thimerosal and aluminum, explaining what these substances actually do and why modern vaccine formulations have largely addressed these worries. Dr. Ryan shares her perspective as a healthcare provider, revealing the frustrations of trying to communicate evidence-based information to families whose minds are already made up.

The discussion takes a fascinating turn as we explore the mathematical approach to vaccine decisions, breaking down risk assessment using real numbers. How do you weigh a 27 in 100,000 hospitalization risk against a 1 in 10,000 chance of vaccine reaction? We distinguish between the decades of safety data behind childhood immunizations and the newer COVID vaccines, acknowledging that different vaccines warrant different considerations.

Perhaps most striking is Dr. Ryan's concern that we're witnessing a dangerous regression in vaccine acceptance. "My biggest fear is that these vaccines will be pulled off the market," she reveals, highlighting how the politicization of COVID vaccines has spilled over into attitudes about established childhood immunizations. We discuss reliable information sources like Children's Hospital of Philadelphia and vaccine expert Paul Offit, while exploring how even artificial intelligence struggles to find legitimate scientific evidence against vaccination.

Whether you're a parent making decisions for your child, a healthcare professional navigating difficult conversations, or simply someone trying to understand both sides of the debate, this episode offers a balanced, evidence-based perspective on what Dr. Ryan calls "done science" – areas where the research is so thorough that reopening debate serves little scientific purpose.

The fears parents face when making healthcare decisions for their children can be overwhelming, especially when it comes to vaccines. In part one of this candid conversation with pediatrician Dr. Lisa Ryan, we dig into the complex world of vaccine hesitancy and why it continues to grow despite decades of scientific evidence supporting vaccine safety.

Dr. Ryan shares her frontline experience with parents' most common concerns, particularly the fear that multiple vaccines might "overwhelm" a baby's immune system. She offers a fascinating perspective that puts this worry into context: a baby's first breath exposes them to more antigens than all vaccines combined. Parents often make decisions based on emotional, gut reactions rather than data—a very human response when it comes to protecting our children.

Perhaps most compelling is Dr. Ryan's observation that "vaccines are victims of their own success." Today's parents haven't witnessed the devastating effects of diseases like polio, measles, or severe rotavirus. Our grandparents' generation vividly remembered summers when neighbors suddenly found themselves in iron lungs from polio—creating an urgency for vaccination that modern parents simply don't feel. This absence of visible threat makes the theoretical risks of vaccines loom larger than the now-rare diseases they prevent.

We also explore the infamous MMR-autism controversy, tracing its origins to Andrew Wakefield's discredited 1998 study and examining why autism diagnoses have increased (hint: it's not vaccines but broader diagnostic criteria and better screening). The conversation takes a surprising turn when discussing how pediatric practices handle vaccine refusal, with Dr. Ryan explaining why many doctors cannot maintain effective relationships with families who fundamentally distrust their medical guidance.

Whether you're a parent with questions about vaccines, a healthcare professional navigating difficult conversations, or simply curious about this contentious topic, this episode offers thoughtful, nuanced perspectives that acknowledge both the science and the very real emotions driving healthcare decisions.

What happens when NFL legend Deion Sanders has his bladder removed? How do doctors decide between watchful waiting and aggressive treatment for prostate cancer? And why are testosterone levels declining across the population?

Dr. Nimrod Barashi, a urologist at St. Luke's Hospital, takes us on a fascinating journey through the world of urological health in this episode of Doc Discussions. With his unique international background—born in Venezuela, educated in Colombia, and trained at prestigious American institutions—Dr. Barashi brings a global perspective to common but often misunderstood conditions.

The conversation begins with an in-depth look at bladder cancer through the lens of Deion Sanders' recent diagnosis. Dr. Barashi explains why Sanders required complete bladder removal despite having non-muscle invasive disease, detailing the three reconstruction options patients face after cystectomy. His clear explanation of warning signs—particularly blood in the urine—serves as a crucial reminder that early detection saves lives.

When the discussion shifts to prostate cancer and baseball star Ryan Sandberg's recent death at 65, Dr. Barashi carefully outlines the risk-stratified approach modern urology takes. From active surveillance for low-risk disease to the balancing act between quality and length of life in treatment decisions, listeners gain practical knowledge about this common cancer.

Perhaps most relevant to many male listeners is the final segment on testosterone replacement therapy. Dr. Barashi addresses the apparent decline in testosterone levels across the population, explaining diagnostic criteria, treatment options, and the surprising ways low testosterone impacts overall health beyond just sexual function.

Throughout the episode, Dr. Barashi's patient-centered philosophy shines through—we treat symptoms, not numbers. This approach reminds us that while medical technology continues to advance, the art of medicine remains deeply human.

Have you noticed changes in your urinary habits or experienced symptoms that concern you? Don't wait—reach out to a urologist for proper evaluation. Your quality of life matters, and as Dr. Barashi demonstrates, modern urology offers more options than ever before.