Podcast Summary: Dr. Chapa’s OBGYN Clinical Pearls

Episode: That's So Random!
Date: November 12, 2025
Host: Dr. Chapa
Co-host: [Unnamed]

Episode Overview

In this lively and engaging episode titled "That's So Random!", Dr. Chapa leads listeners through a series of three intentionally eclectic, yet clinically significant topics:

1. Recurrent pregnancy loss and thrombophilia testing (OB)
2. Unilateral breast swelling in systemic lupus erythematosus (GYN)
3. A memorable, humble perspective on stress from a residency applicant (Life/Learning)

Designed as a “cornucopia” of pearls for medical trainees and practitioners, the episode’s tone is energetic, unscripted, and sprinkled with good humor.

Key Discussion Points & Insights

1. Recurrent Pregnancy Loss: Should We Test for Thrombophilias?

[04:49 – 14:29]

• Case Prompt: Dr. Chapa recounts a student suggesting factor V Leiden testing for recurrent pregnancy loss.

  • "Womp, womp, womp. And that's where the car stopped." (Dr. Chapa, 05:47)

• Definition Debate:

  • No universal consensus exists on what defines recurrent pregnancy loss (RPL):
    • Some guidelines use 3 losses, some 2, some require consecutiveness, some don’t.
    • Dr. Chapa notes, "There is a lack of consensus about the definition of recurrent pregnancy loss among the leading international society guidelines." (Dr. Chapa quoting Green Journal, 07:00)
  • Clinicians are encouraged to use their discretion, with two losses reasonable for evaluation.

• Workup Recommendations:

  • Evaluate for structural abnormalities, antiphospholipid antibody syndrome, genetic causes, and overt thyroid disorders.
  • Historical routine for inherited thrombophilias like factor V Leiden is now outdated.

• Major Takeaway:

  • Testing for inherited thrombophilia (including factor V Leiden) is not recommended for RPL workup in the absence of other risk factors.
  • "Inherited thrombophilias give you clots, they give you VTEism, they give you pulmonary embolism, PEs, but they don't give you recurrent pregnancy loss." (Dr. Chapa, 11:50)
  • Citing ACOG, ASRM, ESHRE:

    “Suggest against inherited thrombophilia testing in the setting of recurrent pregnancy loss.” (Dr. Chapa reading from guidelines, 12:55)

• Memorable Conclusion:

  • Not all historically entrenched practices are evidence-based.
  • "So the little snippet, the take home message is, 'We do not recommend testing for inherited thrombophilia as part of the workup for RPL.'" (Dr. Chapa, 13:40)

2. SLE & Unilateral Breast Swelling: A Real, Random Pearl

[18:21 – 27:55]

• Clinical Question:

  • Resident with a lupus patient presenting with non-lactational unilateral breast swelling.
  • "It's visibly enlarged, like a whole cup size. Is this potentially a lupus thing?" (Dr. Chapa paraphrasing the resident, 14:39)

• Dr. Chapa’s Response:

  • "Yeah, I've actually seen this. This is a thing. And there's actually case reports that have covered this and talked about this.” (Dr. Chapa, 15:39)
  • Main causes to consider:
    1. Malignancy: Rule out by imaging (US if under 30, diagnostic mammogram or tomosynthesis plus US if older); core biopsy as indicated.
    2. Vascular Etiology: SLE-related vasculitis or small vein thrombosis can impair breast venous drainage.
       • Evaluation: Doppler US, CT/MR venogram as needed.
    3. Lupus Mastitis (Autoimmune attack): Rare, diagnosis of exclusion.
       • Characteristic features on biopsy: "A lot of this dense lymphoplasma, acidic infiltrate, maybe a little bit of fat necrosis and vasculitis that is characteristic of lymphocytic lobular paniculitis." (Dr. Chapa, 24:55)

• Approach and Management:

  • Exclude malignancy and vascular causes first.
  • If those are negative and history fits SLE, empirical steroids or adjusting immunosuppression may resolve lupus mastitis.
  • "It's basically a lupus flare in the boob. Okay? Very random, but very real." (Dr. Chapa, 25:27)
  • If SLE diagnosis is not previously established, biopsy is required before labeling as lupus mastitis.

• Memorable Point:

  • "Anybody with unilateral breast swelling, number one, rule out bad things, Number two, rule out some kind of clot somewhere, number three... consider this possibility of an autoimmune mastitis." (Dr. Chapa, 26:30)

3. Life Perspective: A Residency Applicant’s Surprising Answer

[27:55 – 32:19]

• Mock Interview Story:

  • Dr. Chapa asks a candidate, "What do you like to do to put things in perspective and/or to de-stress?" (Dr. Chapa, 28:00)
  • After giving standard answers, the applicant offers a “random” but deeply personal response:

    "Whenever I'm kind of stressed or I think I'm really facing a big problem, one of my mentors told me that I should find my local city cemetery... and go and take a look at some of the headstones and... it kind of puts things in perspective that the big problems of today and my problems that I'm dealing with now, one day, is it really going to matter?..." (Residency applicant, retold by Dr. Chapa, 29:51–31:02)

• Dr. Chapa’s Reaction:

  • Deeply moved, shares his own “memento mori” tattoo and TEDx experience on mortality perspective.
    • "Remember, you are mortal. Remember death." (Dr. Chapa, 31:03)

• Message for Listeners:

  • "How beautifully, beautifully humble, transparent, and random is that?" (Dr. Chapa, 32:19)
  • Encouragement to reframe daily stresses and gain perspective.

Notable Quotes & Memorable Moments

• On Medical Dogma:

  • “So my medical student said, let’s check for factor V Leiden, that’s where we stopped it, because. No.” (Dr. Chapa, 13:18)

• On SLE and Breast Swelling:

  • “It’s basically a lupus flare in the boob. Okay? Very random, but very real.” (Dr. Chapa, 25:27)

• On Perspective:

  • “Whenever I think I’m really facing a big problem... I should find my local city cemetery... it kind of puts things in perspective.” (Residency applicant, 29:51–31:02)
  • “Remember, you are mortal. Remember death.” (Dr. Chapa, 31:03)

• On the Show’s Theme:

  • "One OB thing, one gynecology thing, and one life perspective thing. Yep, that’s right. We call this that’s so Random." (Dr. Chapa, 32:36)

Key Timestamps

• [04:49] – Start of content: Introduction to today’s OB topic (recurrent pregnancy loss)
• [11:50] – Clear explanation against inherited thrombophilia testing for RPL
• [18:21] – Introduction to SLE & breast swelling case
• [24:55] – Description of lupus mastitis and histology
• [29:27] – Memorable mock interview and the applicant’s perspective practice
• [31:03] – Discussion of “memento mori”

Summary Table

| Segment | Topic/Message | Quote | Timestamp | |-----------------------------------------------|-------------------------------------------------------------------------------------------------------|----------------------------|--------------------| | Recurrent Pregnancy Loss | No role for inherited thrombophilia (e.g., factor V Leiden) testing in the workup | “...they don't give you recurrent pregnancy loss.” (Dr. Chapa) | 11:50 | | SLE & Unilateral Breast Swelling | Rule out malignancy/vascular cause; consider lupus mastitis and empiric steroids if indicated | “...a lupus flare in the boob. ...Very random, but very real.” | 25:27 | | Life Perspective from Residency Applicant | Visiting cemeteries for perspective; memento mori | “...it kind of puts things in perspective that the big problems of today ... one day, is it really going to matter?” | 31:02 |

Final Thoughts

This episode delivers on its promise of providing “random,” clinically rich pearls across OB, GYN, and professional development. Dr. Chapa’s conversational and humorous style makes the science approachable, and the memorable life lesson at the end adds a thought-provoking human touch.