Austin Chiang, MD MPH

Don’t squander your privilege to vote. Too many people died for democracy and your right to vote (which obviously didn’t always exist for everyone). Submitted my ballot at the beginning of the month. If you don’t know how to register, simply Google Register to vote. There are a multitude of avenues. ... This post is brought to you by no one but your conscience. #vote #vote2020 #election #democracy #america

I might regret saying this... But trading the Acadia spruce trees for biliary trees got me wondering if I could ever do an eternal vacation. You see, a change of scenery was both necessary and overdue (2nd week away in 2.5 years). I needed to take a step back from procedures, patients, emails, vanity metrics, social media drama...all of it. I needed to be reminded that not everyone cares/worries/rejoices about the same things I do. I needed perspective. ... (I mean as much as I could get during a pandemic year with everyone in masks lathering up on hand sanitizer and political signage on every lawn) But it also reinforced something else important: I crave mental stimulation and the feeling that I have something to offer my community and others...a purpose. And for me, there’s no more tangible feedback of making a difference in someone’s life than picking up the scope and doing the stenting, sewing, clearing, closing, diagnosing, treating I’ve spent years to learn. #doctorlife #gastroenterology #perspective #purposedrivenlife #endoscopy #mindset

Final recharge before back to doctoring... Besides, I can’t pretend to be a lifestyle blogger forever. #acadianationalpark #nature #recharge #lifestyle

BRB: Out of office, trying to prioritize me. This is the second week I’ve taken off 2.5 years after starting my faculty position. I needed it. And before you congratulate or shame me, I know it’s my fault for not taking time off to recharge. ... Honestly it probably won’t be enough in both time and quality. I’m still unable to go home to Taiwan because of the pandemic, and besides, as you can see...it’s still hard to disconnect fully. I’m sure you understand when I say even when away, I still get texts, emails, notifications, and FOMO kicks in...so for me, complete serenity is hard to grasp even when on vacation. I had to step away a moment... from being a doctor... from social media... from the city... from the news... So here I am, in Acadia for the weekend, trying to enjoy the foliage. Wanted to go abroad but it was too hard to plan in a pinch. Admittedly, even though I’m here, I sometimes really don’t want to open this app (and other ones) out of frustration from comparing my job, my schedule, my ideas, my look, even my mental fortitude to others... While I’m not one to speak publicly divulge the nitty gritty of my own struggles, just know that you are not alone. #worldmentalhealthday #mentalhealth #mentalhealthmatters #selfcare #acadianationalpark #mindset #depression

Unprecedented. This week, the Editors of 3 leading peer-reviewed science/medical journals (Science @sciencemagazine, The Lancet, The New England Journal of Medicine @nejm ) published unprecedented editorials on pro- and anti-science candidates this election. (Scientific American @scientific_american too but they’re not a peer-reviewed journal) Swipe to read. Epic sweatshirt by my friend @lab_shenanigans ... #election2020 #vote #science #health #trump2020 #bidenharris2020 @ Austin Chiang, MD MPH

Sometimes you learn just how incredible an organ when it malfunctions. Reflecting on the significance of the recent Nobel Prize announcement awarding the scientists who identified the hepatitis C virus (see my last Reels ), cirrhosis as a result of hepatitis C may soon be a thing of the past. When the liver becomes so severely damaged from virus-induced inflammation, it gets replaced by scar tissue and it’s normal function is compromised. To illustrate, some of the signs... and symptoms of cirrhosis include: Spider angiomata, gynecomastia, and hypogonadism - vascular skin findings, enlarged breasts, and shrunken testes in men from poor estrogen metabolism Jaundice - yellowing of the skin from build up of bilirubin Ascites - fluid accumulating in the abdomen due to impaired blood flow thru the liver leading to hydrostatic and osmotic pressure changes Fetor hepaticus - bad breath from build up of dimethyl sulfide Splenomegaly - enlarged spleen from pressure buildup Varices and caput medusae - engorged blood vessels from poor blood flow through the liver Coagulopathy - unusual blood clotting behavior Encephalopathy - confusion and lethargy due to build up of ammonia and other substances Hepatopulmonary and hepatorenal syndromes - other effects on the lungs, kidneys (and heart too) ...and more! Anyway IMO the liver is one of the most fascinating organs, and I have to give it up to my hepatology and liver transplant colleagues for sorting through this pathophysiology day in and out! #liver #guthealth #humanbody #science #hepatitis #cirrhosis #medicine #healthyliving

Money doesn’t always go where to where it’s most needed in medicine. I think the vast majority of us enter medical school with an idealistic vision to help people without limited resources. And where there are money decisions, there’s politics. Money/politics might not always dictate clinical decisions, it certainly has its impact. ... Here are 2 examples: 1 Let’s look at cancer funding and cancer burden. Some of the most heavily funded cancers are arguably overfunded by the government and nonprofits relative to other cancers that confer an overall greater burden in terms of cancer deaths or disability. Incidentally, some of these underfunded cancers like lung, liver, and oral cancer carry a self-inflicted stigma like smoking/alcohol/chewing tobacco. Source: Kamath SD, Kircher SM, Benson AB. JNCCN. 2019; 17:7. Carter AJR, Nguyen CN. BMC Public Health. 2012; 12:526. 2 I often talk about endoscopic weight loss therapies on here, because despite the clinical benefit and potential downstream cost savings, general awareness and coverage of these technologies is lacking. Lack of awareness is in part due to limited funding from these more niche device companies, which also translates to limited understanding/coverage by insurance companies. So when people say stop caring about money, politics and stick of medicine... medicine simply doesn’t operate in a vacuum. #insurance #publichealth #cancer #politics #healthpolicy

You see, it’s not perfect but it’s our best shot at protecting ourselves (pun intended ) Obviously I’m talking about the flu vaccine. I don’t want to get the flu as much as I don’t want to give it to anyone else. And if 2020 has taught us anything, it’s about doing whatever we can to protect each other...there’s a reason why it’s a requirement for virtually all health professionals (with some exceptions) to continue caring for patients. Truth is, I am curious to know wha...t the flu season will look like this year. We’re paying more attention to washing our hands and wearing masks that perhaps we will see less of the flu this year...I hope. #influenza #patientsafety #fluvaccine #flu #vaccineswork

Seek discomfort If learning acquiring new knowledge and new experiences, by default it should be unfamiliar and maybe uncomfortable. I’m no cowboy when it comes to medicine, but between being spoonfed the agenda that is school/training and the oath to do no harm with my clinical decisions, I’d say being a physician has made me even more risk-averse. This month marks the 1 year anniversary of one such risk I took in starting to post on @tiktok and that journey h...as been rewarding so many ways. The least of it being media mentions, I have walked away with so many fun memories educating, raising money for good causes like @trevorproject, and of course meeting new friends even some who I’ve idolized for years. Seriously, I still remember the first dance video I posted that I knew would invite a whole lot of ridicule from my inner circles from people around me...but in turn I proved to myself that I was capable of doing something I never thought I could. As the adage goes, no risk, no reward. While much of that is true with any medical intervention, I’m just trying to apply this to my life outside of medicine exploring outside my favorite genres of food, music, art, film. Of course what inspired this sentiment is l one of my all-time favorite YouTube channels: @yestheory , whose slogan with @seek.discomfort preaches saying yes to those unfamiliar situations. If you don’t know them, go watch their stuff. (Not sponsored but I would love to meet the crew one day ) #yesfam #seekdiscomfort #norisknoreward #tiktok

Not that we needed any proof of her tenacity but Justice Ginsburg was first reported getting surgery to remove a pancreatic tumor in 2009 (11 years ago...beating the odds by a long shot!) I remember watching her documentary RBG and still she was working out and lifting weights in her 80s. Thankfully I’m 1000% confident Justice Ginsburg will be remembered for her trailblazing work on women’s rights and gender equality and NOT her diagnosis. We have lost several public f...igures to pancreatic cancer, but you might be surprised that not all of them suffered from the same type of pancreatic cancer. This and other misconceptions clarified in a new YouTube video, which will hopefully raise awareness about this terrible disease. While many of us lament her loss and postulate how her absence migjt impact our nation’s future, someone reminded me yesterday that she would want us to wipe our tears and focus on the fight. Let’s go. #pancreaticcancer #rbg #ruthbaderginsburg #cancer #health #alextrebek #stevejobs #youtuber #publichealth #notoriousrbg

#myhealthcantwait We keep moving because cancer won’t wait... chronic disease won’t wait... ... your health can’t wait. Postponing procedures and discouraging non-urgent visits to the doctor will likely cause undetected or progressive diseases to only get worse. In March, breast, colon, and cervical cancer screening dropped 94% from the year prior (EHRN.org), an issue @anjalimalikmd and I spoke to @phillyinquirer about this Summer. Like all things in medicine, it’s ALWAYS a balance between BENEFIT of care versus RISK of care. The past months have taught us the proper precautions, and in many geographic regions, centers have resumed operations. @ahsm_org has partnered with @jnj to raise awareness through this campaign. Use hashtag #myhealthcantwait to share why health can’t wait in your field. Visit myhealthcantwait.com for resources (for both patients and professionals). TALK to your doctors and health professionals to see if you have health issues that require immediate attention. A conversation will only help! L to R: Porsche, endoscopy tech Eileen, endoscopy nurse Me Rowena, nurse anesthetist CRNA Mo, advanced endoscopy fellow #prevention #cancer #breastcancer #coloncancer #covid #publichealth #doctor #primarycare #keepmoving #healthy #healthylife

Just enough is often good enough. Too much of a good thing can really backfire. Sometimes i approach something with so much painstaking detail it very predictably throws me into a funk and I just can’t move forward. The parallels of this habit with my clinical job are apparent. I was doing an endoscopic ultrasound fine needle aspiration procedure ...a procedure I do frequently by passing a needle through the gut wall to biopsy tumors in the gut or pancreas and potentially ...diagnose them as cancers. Phil, with the microscope, is a cytotechnologist who smears the specimen on a slide and looks for diagnostic material on a slide and reports back after each pass whether he thinks I’ve obtained enough tissue for diagnosis, or if I need to insert the needle back into the tumor. The process is called rapid on-site evaluation. Once I feel I’ve gotten enough for a cell block, that’s it. No more extra passes. I stop there. The same should apply to taking care of yourself and others. Doing more than enough can sometimes invite unnecessary chaos. #pancreaticcancer #guthealth #perfectionist #toomuch #cancer #diagnosis

Thank you. I can feel the shift from dwelling on problems to focusing on solutions once again. Sometimes I wonder who is on the other side of the screen, and all your kind messages have given me the lift I needed coming out of the holiday weekend. Every individual gesture doesn’t go unnoticed. What they say is true: can’t offer much positivity (or education) without having some saved up myself. So thanks for restoring some balance to my little noggin. #balance #selfcare #wellness #motivation #mentalhealth