Information and education surrounding the world of healthcare for the novice, the nurse, and the nerd hosted by a board certified nurse practitioner. <br/><br/><a href="https://intheloopwithnadja.substack.com?utm_medium=podcast">intheloopwithnadja.substack.com</a>
In the Loop with Nadja Wlasiuk
Claim This Podcastby Healthcare education for the novice, the nurse, and the nerd.
5.0(4 reviews)
15 episodes
Updated Daily
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27
Podcast Authority
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Podcast Overview
Information and education surrounding the world of healthcare for the novice, the nurse, and the nerd hosted by a board certified nurse practitioner. <br/><br/><a href="https://intheloopwithnadja.substack.com?utm_medium=podcast">intheloopwithnadja.substack.com</a>
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🇺🇲
Publishing Since
1/8/2025
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Recent Episodes
May 27, 2026
Episode 15: ECG Primer-Why Lead Placement Matters
<p>In this episode, we’re breaking down the electrocardiogram—ECG or EKG (same thing).</p><p>This should be simple.</p><p>It is.And it isn’t.And it matters more than people think.</p><p>This is one of the most commonly used tools in medicine, but it’s also one of the most misunderstood when it comes to fundamentals.</p><p>We’ll cover:</p><p>* What an ECG actually measures</p><p>* What all the “squiggly lines” represent</p><p>* The basic complexes: P wave, QRS, and T wave</p><p>* How to read an ECG in a consistent, systematic way</p><p>* What each lead is really showing you (think: different camera angles)</p><p>* The difference between limb leads and precordial leads</p><p>* Why electrode placement is NOT optional if you want accurate data</p><p>Here is a clinical example inspired by The Pitt and how poor placement can miss a life-threatening diagnosis</p><p></p><p>Quotes you can’t argue with: </p><p>“Bad data is s**t data”</p><p>“Women are misdiagnosed for heart attacks all the time”</p><p>“It turns out women want to live” </p><p>“EKG is a great tool if you use it right”</p><p>Regarding electrode placement and breast tissue: </p><p>The current recommendations and available evidence: <a target="_blank" href="https://www.ahajournals.org/doi/10.1161/circulationaha.106.180200"><strong>Kligfield et al., 2007 </strong></a>found that reproducibility of ECG measurements was slightly increased when electrodes were placed on top of the breast.</p><p>Another patient preference study (<a target="_blank" href="https://emj.bmj.com/content/31/10/851.short"><strong>Wallen et al., 2014</strong></a>) found that 52% of women preferred on-breast placement, 38% were indifferent, and only 10% preferred under-breast placement.</p><p>Nonetheless, the current <a target="_blank" href="https://www.ahajournals.org/doi/10.1161/circulationaha.106.180200"><strong>AHA/ACC/HRS guidelines</strong></a> suggest placing electrodes beneath the breast is the most common practice and is thought to reduce amplitude attenuation caused by higher torso impedance from overlying breast tissue. However, placing V4 under the breast can cause V5 and V6 to be positioned too inferiorly (below the horizontal plane of V4), which may alter voltage amplitudes used in diagnosing ventricular hypertrophy. Importantly, whichever method is used, consistency between serial ECGs is critical. If electrodes are placed under the breast, ensure V5 and V6 remain at the horizontal level of V4 rather than following the inframammary fold downward and in patients where intercostal space palpation is difficult (e.g., obesity), the sternal notch-to-xiphoid length can help locate the 4th intercostal space which is approximately 67% of the sternal notch-to-xiphoid distance.</p><p>UCSF PlaySafe Sports Medicine Program: <a target="_blank" href="https://playsafe.ucsf.edu/content/ucsf-playsafe-sports-medicine-program"><strong>https://playsafe.ucsf.edu/content/ucsf-playsafe-sports-medicine-program</strong></a></p><p>UCSF PlaySafe Cardiac Physicals: <a target="_blank" href="https://playsafe.ucsf.edu/playsafe-cardiac-physicals"><strong>https://playsafe.ucsf.edu/playsafe-cardiac-physicals</strong></a></p><p>The Electrocardiogram at 100 Years: History and Future: <a target="_blank" href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.065489"><strong>https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.065489</strong></a></p><p>The Invention of Electrocardiography Machine: <a target="_blank" href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6881865/"><strong>https://pmc.ncbi.nlm.nih.gov/articles/PMC6881865/</strong></a></p><p>Einthoven’s Triangle: <a target="_blank" href="https://aclscertification.org/acls-einthovens-triangle/"><strong>https://aclscertification.org/acls-einthovens-triangle/</strong></a></p><p>Please visit Life in the FastLane: <a target="_blank" href="https://litfl.com/ecg-library/basics/"><strong>https://litfl.com/ecg-library/basics/</strong></a></p><p><strong>My Favorite ECG books:</strong></p><p>Rapid Interpretation of EKG’s, Sixth Edition 6th Edition by Dale Dubin</p><p>Sparkson’s Illustrated Guide to ECG Interpretation by Jorge Muniz</p><p>12-Lead ECG: The Art of Interpretation Second Edition by Tomas Garcia</p><p>EKGs for the Nurse Practitioner and Physician Assitant by Maureen Knechtel</p><p>ECG Mastery: the Simplest Way to Learn ECG by Kuhn, Lang, Wiesbauer</p><p>Produced by: Nadja Wlasiuk, DNP, APRN, FNP-BC, CCK</p><p></p> <br/><br/>Get full access to In the Loop with Nadja Wlasiuk at <a href="https://intheloopwithnadja.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4">intheloopwithnadja.substack.com/subscribe</a>
March 11, 2026
Episode 14: From Thailand to UCSF: The Journey to Electrophysiology Fellowship
<p>In this episode, I sit down with Dr. Jakrin “Joe” Kewcharoen, a Clinical Cardiac Electrophysiology fellow at UCSF to explore the journey of becoming a heart rhythm specialist and the important role fellows play in patient care at academic medical centers.</p><p>Dr. Kewcharoen shares his unique path from Thailand to the United States and explains how international medical graduates navigate the U.S. training system while pursuing highly competitive specialties like cardiology and electrophysiology.</p><p>The conversation also provides an inside look at how electrophysiology fellows work alongside attending physicians, nurse practitioners, nurses, and the broader care team in the EP lab. Fellows are already trained cardiologists who perform procedures, evaluate patients, and continue developing advanced procedural skills under expert supervision.</p><p>Dr. Kewcharoen also discusses the rapidly evolving field of electrophysiology, including new technologies that are transforming arrhythmia care and the complex puzzle-solving involved in treating ventricular tachycardia.</p><p>About the Guest</p><p><strong>Dr. Jakrin “Joe” Kewcharoen</strong></p><p>Dr. Kewcharoen graduated from Chulalongkorn University in Thailand in 2017 and moved to the United States in 2018 to pursue postgraduate medical training.</p><p>He completed his Internal Medicine residency at the University of Hawai‘i, followed by a Cardiovascular Disease Fellowship at Loma Linda University. He is currently completing a Clinical Cardiac Electrophysiology Fellowship at UCSF.</p><p>Dr. Kewcharoen has been highly active in academic research, with over 100 peer-reviewed publications during his medical training. His research focuses on electrophysiology procedural outcomes, sudden cardiac death in the community, and inherited arrhythmia syndromes such as Brugada syndrome, a genetic disorder associated with life-threatening arrhythmias.</p><p>At UCSF, he is currently involved in several research projects examining sudden cardiac death using a unique autopsy-based cohort, helping researchers better understand the cardiac and non-cardiac causes of sudden death.</p><p>Outside of medicine, Dr. Kewcharoen enjoys weightlifting, basketball, playing guitar, and board games.</p><p>Topics Discussed</p><p>* What electrophysiology fellows actually do in the EP lab</p><p>* The pathway from medical school to electrophysiology training</p><p>* Differences between medical training in Thailand and the United States</p><p>* Challenges and opportunities for international medical graduates</p><p>* The team-based care model in electrophysiology</p><p>* Pacemakers, defibrillators, and catheter ablation</p><p>* The future of arrhythmia care and emerging technologies</p><p>* Ventricular tachycardia ablation and complex arrhythmia management</p><p>Educational Resources</p><p>Understanding Electrophysiology</p><p><a target="_blank" href="https://my.clevelandclinic.org/health/articles/24039-electrophysiologist">What is an electrophysiologist?</a>:<strong> </strong><a target="_blank" href="https://my.clevelandclinic.org/health/articles/24039-electrophysiologist"><strong>https://my.clevelandclinic.org/health/articles/24039-electrophysiologist</strong></a></p><p>Pacemakers and Defibrillators Explained</p><p>What is a pacemaker?:<strong> </strong><a target="_blank" href="https://www.ucsfhealth.org/treatments/pacemaker"><strong>https://www.ucsfhealth.org/treatments/pacemaker</strong></a></p><p>What is an implantable cardioverter defibrillator (ICD)?: <a target="_blank" href="https://www.ucsfhealth.org/treatments/implantable-cardioverter-defibrillator"><strong>https://www.ucsfhealth.org/treatments/implantable-cardioverter-defibrillator</strong></a></p><p>What is Brugada Syndrome?</p><p>Brugada syndrome is an inherited condition that predisposes individuals to ventricular arrhythmias and sudden cardiac arrest, often diagnosed through characteristic ECG patterns.</p><p><a target="_blank" href="https://www.sciencedirect.com/science/article/pii/S2405500X2101080X?utm_"><strong>https://www.sciencedirect.com/science/article/pii/S2405500X2101080X?utm_</strong></a></p><p>Suggested Further Reading</p><p>• Research on arrhythmia risk in Brugada syndromeWide QRS complexes have been associated with a higher risk of major arrhythmic events in patients with Brugada syndrome. <a target="_blank" href="https://pmc.ncbi.nlm.nih.gov/articles/PMC7011812/?utm_"><strong>https://pmc.ncbi.nlm.nih.gov/articles/PMC7011812/?utm_</strong></a></p><p>• Atrial fibrillation and arrhythmia risk in Brugada syndromeResearch has shown that atrial fibrillation may increase the risk of serious arrhythmic events in patients with Brugada syndrome. <a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/31353765/"><strong>https://pubmed.ncbi.nlm.nih.gov/31353765/</strong></a></p><p>Produced by: Nadja Wlasiuk, DNP, APRN, FNP-BC, CCK</p> <br/><br/>Get full access to In the Loop with Nadja Wlasiuk at <a href="https://intheloopwithnadja.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4">intheloopwithnadja.substack.com/subscribe</a>
February 25, 2026
Episode 13: An Update with Nick and Lydia
<p>⚠️ This episode contains discussion of cancer treatment, radiation, and survivorship anxiety.</p><p>Welcome back to In the Loop with Nadja Wlasiuk!</p><p>If you listened to Episode 10, you remember when Nick shared his rare cancer diagnosis. That episode held a lot of uncertainty. We didn’t know exactly how treatment would unfold. We just knew life had changed.</p><p>In today’s episode our conversation feels different.</p><p>Nick and my daughter, Lydia, are home after completing treatment in New York at Memorial Sloan Kettering consisting of six weeks of chemotherapy and radiation, including proton therapy. As a clinician, I understand the treatment plan, the radiation dosing, the surveillance scans. But as a mom, I experienced this in a very different way.</p><p>This episode is about what happens when the appointments slow down. When the scans are clear. When everyone says, “You’re done.”</p><p>Because sometimes that’s when the fear shows up. Sometimes that’s when the side effects peak. Sometimes that’s when you realize you look different, feel different, and have to renegotiate what normal means.</p><p>We also talk about Lydia’s experience, not just as a partner, but as a person navigating her own emotional reality while supporting someone she loves.</p><p>This isn’t just a medical story. It’s a human one.</p><p>Nick and Lydia, I’m so glad you’re home.</p><p>🎧 Missed the Beginning? Listen to Episode 10: <a target="_blank" href="https://intheloopwithnadja.substack.com/p/episode-10-nick-and-the-rare-cancer"><strong>https://intheloopwithnadja.substack.com/p/episode-10-nick-and-the-rare-cancer</strong></a></p><p>Honey Hounds: <a target="_blank" href="https://www.honeyhoundsmusic.com/"><strong>https://www.honeyhoundsmusic.com/</strong></a></p><p>In This Episode We Discuss:</p><p>* What daily radiation actually feels like</p><p>* Proton therapy vs photon radiation</p><p>* Delayed side effects after treatment completion</p><p>* Chemotherapy-related tinnitus and fatigue</p><p>* Radiation effects on nasal tissue and hair follicles</p><p>* Circulating tumor DNA (ctDNA) testing</p><p>* Surveillance imaging and scan anxiety</p><p>* Fear of recurrence</p><p>* The emotional transition into survivorship</p><p>* The partner experience — and why caregivers deserve space too</p><p>What is proton therapy: </p><p>Proton vs Photon Therapy: <a target="_blank" href="https://www.moffitt.org/taking-care-of-your-health/taking-care-of-your-health-story-archive/proton-radiation-therapy-vs.-photon-radiation-therapy-for-standard-care"><strong>https://www.moffitt.org/taking-care-of-your-health/taking-care-of-your-health-story-archive/proton-radiation-therapy-vs.-photon-radiation-therapy-for-standard-care</strong></a></p><p><strong>What is circulating tumor DNA (ctDNA)?</strong></p><p>ctDNA testing looks for fragments of tumor DNA in the bloodstream and is increasingly being studied as a tool for detecting minimal residual disease and monitoring recurrence.</p><p>The Transition from Treatment to Survivorship</p><p>Many patients report that the weeks following treatment completion can be emotionally complex. Fear of recurrence, delayed side effects, and identity shifts are common. Surveillance typically includes:</p><p>* Scheduled PET scans and MRIs</p><p>* Physical exams</p><p>* Symptom monitoring</p><p>* Ongoing specialty follow-up</p><p>Cancer Survivorship: <a target="_blank" href="https://www.cancer.org/cancer/survivorship.html"><strong>https://www.cancer.org/cancer/survivorship.html</strong></a></p><p>Managing your emotions after cancer treatment: <a target="_blank" href="https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-survivor/art-20047129"><strong>https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-survivor/art-20047129</strong></a></p><p><a target="_blank" href="https://www.cancer.org/support-programs-and-services.html"><strong>https://www.cancer.org/support-programs-and-services.html</strong></a></p><p><strong>For Partners & Caregivers:</strong>Supporting someone through cancer affects you too. Explore caregiver support resources here:</p><p><a target="_blank" href="https://www.cancer.org/cancer/caregivers.html"><strong>https://www.cancer.org/cancer/caregivers.html</strong></a></p><p><a target="_blank" href="https://www.cancercare.org/tagged/caregiving"><strong>https://www.cancercare.org/tagged/caregiving</strong></a></p><p>Survivorship is not a finish line.</p><p>It is a new phase-one that requires vigilance, resilience, and often a recalibration of what normal looks like.</p><p>Thank you for being here for this part of the journey. </p><p>Produced by: Nadja Wlasiuk, DNP, APRN, FNP-BC, CCK</p> <br/><br/>Get full access to In the Loop with Nadja Wlasiuk at <a href="https://intheloopwithnadja.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4">intheloopwithnadja.substack.com/subscribe</a>
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