That's So Random!

Summary

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Podcast Summary: Dr. Chapa’s OBGYN Clinical Pearls

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

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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.

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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  • Historical routine for inherited thrombophilias like factor V Leiden is now outdated.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)

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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)

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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.

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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)

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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”

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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 |

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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.

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Transcript

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[Co-host]

That's so random.

[Dr. Chapa]

Well, podcast family Every once in a while we cover some random little tidbits of info that cover some random question or some random patient encounter that we actually dealt with. Now, we've called these things in the past, different names. We've called them twofers, where we do two for two. We've called them a cornucopia of information and we've called them some other stupid things. But in this episode, which is very. Guys, stick with me, stick with me because we're going to cover one random OB question that I received today regarding recurrent pregnancy loss and its workup. We're going to cover one random, I mean really random, but super clinically applicable question regarding unilateral breast swelling in a patient with SLE who is non lactational. All right, so let's just check off the box there. No, she's not breastfeeding and nowhere around this time is she breastfeeding. But. But she has unilateral real breast swelling, like a whole cup size difference, and she has sle. That's random, but it also is very well documented in the literature. And so we're gonna talk about that second random thing. And then the third very random thing that we're gonna cover is this phenomenal, deep, humble, very transparent and a little weird response that I received from a residency applicant who asked me for help. Like, hey, I really wanna go to xy. Will you help me do a mock interview? And I said, hey, whatever, I got a little bit of time, not a lot of time, but let's sit down, we'll cover these things. And I asked a very basic question that I ask a lot of candidates either for medical school or for residency and or for certain committee positions. I mean, it's the same question I routinely ask along with others, but the answer I got was so perfectly random that it just fit with the rest of the other two issues that we're going to discuss. So three issues. One obstetrical, one gynecological, one kind of weird life perspective. That's why we decided to call this.

[Co-host]

Episode that's so Random.

[Dr. Chapa]

What the hell was that was. How did. That's not what I thought that was going to sound like. I said, just as our producer just put in, that's so random. So he said, say that again. I said, well, that's so random. And that's what that came up with. That's. That's what we're doing now.

[Co-host]

That's so random.

[Dr. Chapa]

Oh my gosh. Fine. I don't know if I like that or not. That's kind of weird. One more time. Shall we do it one more time? Why not? This is stupid. One more time.

[Co-host]

That's so random.

[Dr. Chapa]

Ah, I don't know. I kind of like it. I dig it. So now that we've said all that, let's cover this episode, which, you guessed it, the title of, which is that's so Random.

[Co-host]

So Random.

[Dr. Chapa]

Oh, my goodness. We'll be right back. This is Dr. Chapa's OB GYN no Spin podcast.

[Co-host/Producer]

That's so Random podcast family.

[Dr. Chapa]

Welcome back to that so Random. We're going to tackle first the random OB question that happened today. I had one of my medical students with us in our high risk clinic and we had a patient. We're talking about recurrent pregnancy loss. And so I said, all right, name some things that we should check here. So we went through that. She got the first one right. Antiphospholipid antibody syndrome. Check. You know, maybe something's wrong with the uterus. I said, further, explain, like some kind of structural issue. Check. And then she said, oh, we got to check for factor five Leiden. Womp, womp, womp. And that's where the car stopped. And I thought, ah, that is such a perfectly random test to get for recurrent pregnancy loss that is so well entrenched into weird history and tradition that has no clinical value. So let me be very clear. Recurrent pregnancy loss in and of itself is something that we've obviously covered in this show in the past, but by itself, even that definition is questionable now. Everybody gets that. Three pregnancy losses, specifically in the first trimester, that's a no brainer. The question is, what do you do with Two. And is that enough to suffice for a recurrent pregnancy loss workup? And the truth is we don't know. There's no one universal definition. Some use three, some use two. Some have the criteria that it must be consecutive, others say it doesn't have to be consecutive. Why, you could just have dodged a bullet with one pregnancy. But if you've had two other or three other miscarriages, you're not going to rob them of an evaluation just because they've had one successful birth. So I'm going to be very clear. This issue of recurrent pregnancy loss. We do not have a universal consensus as to what this definition is. This was very clearly stated in May of 2024 in the green Journal's clinical exper series, whose title, of course, very fittingly was Evaluation of Recurrent Pregnancy Loss. And it's right there at the intro quote. There is a lack of consensus about the definition of recurrent pregnancy loss among the leading international society guidelines. So it goes into very briefly, is it two, is it three? I don't know. Should it be consecutive? Should it not be consecutive? Doesn't really matter. There is this disagreement. All right, I believe having two first trimester miscarriages is enough to give an evaluation, even if there's an intervening live birth, because there is data to support that. All right, again, if you choose that have got to be three and consecutive, that's very textbook. Then your specificity is obviously is higher. But you're perfectly acceptable to do an evaluation after two spontaneous pregnancy losses, even if they're not consecutive. That's in this clinical expert series. There's plenty of data on that. So knock yourself out. Just be consistent with what you do. Okay? So as it says here, quote, in contrast, observational studies have shown that patients with unexplained recurrent pregnancy loss experiencing consecutive pregnancy losses do in fact have a poorer prognosis than their counterparts. You're like, ah, see, it's got to be consecutive. But hold on, hold on, let me get to the rest. Nonetheless, see there's, there's the switch, there's the pivot point. Nonetheless, clinicians are encouraged to use their clinical discretion and may recommend medical evaluation after two first trimester pregnancy losses if there's enough suspicion that you're gonna find something, end quote. All right, I threw in the if you're gonna find something just to make it easier. So, yeah, so there's no one set criteria now that's for recurrent pregnancy loss in and of itself for antiphospholipid Antibody syndrome. It's actually a very tight criteria because one of the clinical factors for recurrent pregnancy loss through anaphospital event syndrome, one of the clinical features is three or more consecutive first trimester pregnancy losses. And that's the catch, that According to the APA antiphosovid antibody syndrome criteria, quote three or more unexplained consecutive spontaneous abortions before 10 weeks and end quote is one of the clinical criteria. Okay, so overall, in general it can be two or more and it doesn't have to be consecutive. But if you're going to do textbook definition of antiphospital antibody syndrome, then the clinical factor is either unexplained death of a normal fetus beyond 10 weeks. Remember, it's also some premature morbidity. In other words, a delivery that happens specifically at or before 34 weeks due to eclampsia, severe preeclampsia or some other form of placental insufficiency including severe fetal growth restriction. Right. So preterm bad hypertensive mojo and or small baby as a reflection of placental insufficiency. That's a clinical criteria. Or three or more unexplained consecutive spontaneous abs prior to 10 weeks. That's for antipholic antibody syndrome. Now that's just an aside. I just wanted to define that because that's not where we're going. But the specific question had to do with, with Factor 5 Leiden and or other thrombophilias. Okay, Because I remember that that was a thing like maybe 10, 15 years ago or you got a stillbirth, got to do a anti phospholipid eval and that's correct. And throw in some thrombophilias. That is not correct. ACOG addresses this in the recurrent miscarriage guidance that hey, thrombophilias give you clots. There's no data or sufficient data that it's going to give you a stillbirth. Unless there's other things in the history that support a thrombophilia. Nor does thrombophilia give you recurrent pregnancy loss. Okay, so in this clinical expert series, let's go back to this from May of 2024. It's very clear here of what to do. Number one. Yes. Look for structural abnormalities. Number two. Yes. Look for antiphospital bit antibody syndrome. Number three, definitely check for some kind of genetic carrier state in the parents. That's fine. You can either do genetic testing of the products of conception with microarray or you can check the parents to see if there's potentially something going on there in terms of a something that becomes unbalanced that could lead to a recurrent pregnancy loss. Although it's always best to actually check the process of conception by microarray. That's the best. Okay, so parental testing can definitely increase the chance of finding something because a parental balance translocation can end up being unbalanced in the child. So yeah, definitely check that. Yes, you can check for overt hyper or hypothyroidism. That's agreed. That's definitely worth checking for. And one thing that's mentioned in here specifically is this issue on hematological factors like thrombophilia. Let me read this directly from this clinical expert series again from May of 2024 because I don't want to misquote it, but it's exactly what we stated. Inherited thrombophilias give you clots, they give you VTEism, they give you pulmonary embolism, PEs, but they don't give you recurrent pregnancy loss. Quote. The acog, ASRM and the European Society for Reproductive Evidence suggest against inherited thrombophilia testing in the setting of recurrent pregnancy loss. Let me say it again. The European, the two American, that's ACOG and ASRM recommend against inherited thrombophilia testing for recurrent pregnancy lost. Why? There is not a consistent association between factor V leiden homozygosity, prothrombin G20 210a homozygosity, heterozygosity for Factor 5 or heterozygosity for prothrombin or protein C, protein S deficiency in the literature, end quote. All to say, those things are super important if somebody throws a clot. They are not important for rpl. Okay, so the little snippet, the take home message is, quote, we do not recommend testing for inherited thrombophilia as part of the workup for rpl. End quote. That is based on the clinical expert series from the college. Of course we'll post this link in our show notes. But it's not just them. This is reflective of what ACOG says separately in its guidance on recurrent miscarriages, that yeah, the evidence is just not there. Nor is it there for methylene tetrahydrofolate reductase. That's not gonna do that. You know, that whole issue potentially, potentially has some cardiovascular issues, but even the relationship from methylene tetrahydrofolate reductase and venothromboembolism is extremely rare. It's Very poor and conflicting. So short answer is, when my medical student said, let's check for factor V Leiden, that's where we stopped it, because. No. So I said, first of all, wow, I guess you're reading because that is in some old commentaries and some suggested testing, but that is actually kind of random. That's actually not appropriate for recurrent pregnancy loss.

[Co-host/Producer]

That's so random.

[Dr. Chapa]

Yeah, it's a good thought, but no. So inherited thrombophilias do not explain recurrent pregnancy loss. Are we good? Okay, so I just wanted to cover that very quickly. I think we've kind of ended that one because we've got other things to go on. So remember, we're going to cover one random OB thing, which was this one. Should we check for inherited thrombophilias for rpl? The answer is no. Now we're going to leave that alone. And now let's tackle our second random issue, which is from one of our residents who just graduated. So she sent me a text today, said, hey, FYI, got a patient who has lupus, and she came in with legit unilateral breast swelling. What's up? And it's like, it's not lactational. It's visibly enlarged, like a whole cup size. Is this potentially a lupus thing? And now put this in context. I'm seeing patients, I'm running around doing things, and I'm like, oh, my gosh, I just got the most random boob question that is so good and clinically applicable. I have to do an episode on it. That. That's so good.

[Co-host]

That's so random.

[Dr. Chapa]

So perfectly random. So deep. And I'm like, yeah, I've actually seen this. This is a thing. And there's actually case reports that have covered this and talked about this. And so I responded back, wow, in the middle of my day, I actually needed this kind of weird, random question because, yeah, let's talk about it. So let's take a quick break. We'll let that simmer on the inherited thrombophilias and recurrent pregnancy loss. And we come back, we're going to tackle this issue of unilateral breast swelling in a patient with lupus. What do we do with that? I'm gonna tell you when we come back. Can I take your order?

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[Dr. Chapa]

Do you mean eventi? No, I mean water. He means aventi.

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[Dr. Chapa]

Venti is large.

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[Dr. Chapa]

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[Dr. Chapa]

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[Dr. Chapa]

Learn [e-mail] that's so random. So now we're going to tackle this random gin question that came to me from one of my previous residents who's killing it. By the way. She's doing great in private practice. Good for her. And can I just say what a great relationship we have? I mean this is the way medicine should be. I still get calls and text messages, as we should, you know, from residents that graduated five, six, ten years ago. It's great. I love it. Anyway, so if they go on to do their own fellowship or they're doing something else, I get these great follow up calls and it's just that's the way medicine should be. So anyway, thank you for doing that. So back to the question. Patient who is non lactational unilateral breast swelling and she has sle. Are those related? The answer is absolutely, absolutely no question. Because there's a variety of pathophysiological issues here that can be at play. One is if there's some kind of vasculitis in the venous drainage of the breast and or clot of small breast draining veins, you can get unilateral breast swelling. Now, to be very clear, we're going to tackle three main boxes here. One is vascular, the next is actual autoimmune breast attack. That's called lupus mastitis. That is a thing. And then we're going to tackle, of course, the main thing that you have to look for that is not some kind of malignancy. And so imaging is of course part of that. So you've got to image the breast, hands down, no question. In addition to, of course, physical exam and a good history. Now let's just clear the air. Let's just set the stage here, set the table so we can get through this. And then I'm going to give you the random life perspective, the last kind of random tidbit, and we're going to call it a day. This patient, non lactating. Let's. There's no breast trauma. There's nothing weird that happened to the nipple. Like, hey, by the way, I got my nipple pierced three days ago. And now potentially it's an infectious issue. Nope, nothing like that. No weird nipple trauma. Okay. And sometimes nipple trauma happens during, you know, you know, kind of the hokey pokey and if you know what I'm talking about, hey, I don't get, I don't judge if everyone fulfills their sexual relationships in whatever way they want to, as long as it's consensual. But biting of the nipple or small contusions to the nipple can happen, which can introduce bacteria. You can get non lactational mastitis. And so you've got to be able to go through that on a good history. Okay, so first of all, the biggest thing, we have to check the box, make sure it's not some kind of weird malignancy, regardless of age. So if they're under 30, breast ultrasound is great. And of course, if they're over 30, consider a diagnostic tomosynthesis, a 3D mammal, along with ultrasound to make sure nothing looks really weird. If there is some kind of weird mass in there that requires core biopsy, that's hands down. So you've got an image that goes without saying, that's on the big box of malignancy, so don't ignore it. And that's with or without lupus, for heaven's sakes. That's just if there's unilateral breast cancer, swelling, you've got to check the box that it's not potentially related to a malignancy. That's easy. Specifically with lupus is this issue of vascular issues either as a vasculitis or potentially as a small clot of things that drain the breast. That can include big things like the subclavian, like the axillary drainage, the more median breast drainage. So there's a variety of ways to do this. You can do color Doppler, although it's, you know, it's a lot to take a look at all the venous drainage, or you can hit it with one big image like a CT venogram of the chest of the breast. That's great. You've got to look is there some kind of blockage in the drainage? All right, so outside of ultrasound and, and regular old diagnostic mammography, Doppler ultrasound is not a problem. But sometimes getting to some of those spots, especially like if you're looking for the subclavian, that's difficult because of the bony landmarks, then you got to do something else. Now whether that's a contrast venogram of the breast, you can do CT venogram, you can do an Mr. Venogram, all of those are perfectly acceptable. Okay, so doppler or venogram is to look for the, the, the, the drainage of the breast because you can actually get a little clot in patients who have inherited thrombophilias or just a natural propensity to clot because of the autoimmune condition like sle. Okay, so look for the breast, look for bad things first and then look for vasculature, look for vasculitis and, or small clots that can affect drainage of the breast. So you get this kind of breast oedema, this swelling. So once Again, contrast Venography, CT Venogram or Mr. Venogram of the breast and or chest wall. Just talk to your radiologist, tell them what's going on. Go brother. I need you to look at some drainage of that one sided breast and I need you to make sure that there's nothing blocked in there. Okay. Once you check that and I do these together, especially if they have an issue like lupus, and I've done this two that I can think of twice before in our lupus patients. I'm like, and I've seen this and they've both been negative, which leads us to the third, which is the autoimmune nature of SLE itself and it's a diagnosis of exclusion, although you can very well get a biopsy to prove it. Okay, Now, I don't usually get a breast biopsy. However, lupus mastitis has a very characteristic pattern of inflammation. Encore biopsy. I usually don't do that. If I'm satisfied that the mammogram and or breast ultrasound and the CT shows no abnormal blockage of the veins, if I'm comfortable with that, then I say look as I did with the two cases I took care of within the last 15 years, that's it. This is probably lupus mastitis. I don't want to do a core biopsy. There's no evidence of cancer. Let's get you some high dose steroids. Treat this as a flare. Because sometimes lupus can attack the breast. Lupus can attack the fatty tissue of the breast. And while we can do a biopsy to prove it, both of my patients said I'm good, I don't think I need that. Let me just do a course of steroids and see if it gets better. And they did. So it is okay to do an empiric trial of steroids and or up their immunosuppressive medications, if they're on it, to take away the local autoimmune inflammation of the fatty tissue of the breast. Okay, that is called lupus mastitis. Actually the true medical description of that, based on histology, it's a paniculitis like, of like penis of the fatty area, but that actually applies to the breast. Okay. And if you do a core biopsy, the characteristic finding is that inflammatory process, there's a lot of this dense lymphoplasma, acidic infiltrate, maybe a little bit of fat necrosis and vasculitis that is characteristic of lymphocytic lobular paniculitis. So it's a form of lupus mastitis? Yes, absolutely. Related to sle. It's basically a lupus flare in the boob. Okay? Very random, but very real. And the issue is anybody with unilateral breast swelling, number one, rule out bad things, Number two, rule out some kind of clot somewhere, number three, if applicable, which wasn't in this case, rule out infection, even though infection typically is going to present with a wedge shaped kind of in the distribution of a lobule erythema. And of course, consider, consider this possibility of an autoimmune mastitis. Now, there is case reports in the data, guys, where they actually diagnosed lupus as this sole unilateral breast presentation. That's not typical. It's pretty rare, but it's an easy check to check C3, C4 levels, check double stranded DNA, look for NFLB antibody syndrome. And in these cases, if you're gonna diagnose lupus based on the breast presentation, that pretty much needs a biopsy because you wouldn't do that as a default in this case that we're talking about. In the two patients I've had, the patient already had a known diagnosis of lupus, so that fit the picture. But if you're gonna label somebody as having lupus mastitis, then you pretty much need to do a biopsy if they do not have a history of sle. Okay, So I found that so, so interesting. And I'm like, yeah, I've seen it. That is a thing. And so of course we covered this very exact same idea for my resident. So rule out something bad, rule out something from the vasculature infection wasn't an issue here. And then the last is rule out an autoimmune flare either by biopsy or empiric course of steroids and or adjusting of the of the lupus meds for immunomodulation. And it should work. But how random is that?

[Co-host]

That's so random.

[Dr. Chapa]

Yeah, pretty darn random. Podcast family, I'm going to leave you with once again the very random answer that I got with a residency applicant and then it's called it a day. I just found this so deep and I hope it makes you smile, it gives you good perspective because it kind of just. I was kind of quiet and stunned in my chair when I heard this very thing from this mock interview. All right, so I'm sitting across from this medical students interested in doing this OBGYN residency. You won't get into air. Doesn't matter. And I said, let me ask you this typical question that I ask everybody, even for job positions. What you're going to do is kind of stressful. What do you like to do to put things in perspective and. Or to de. Stress and at first and very pensive and said, well, let me give you my typical answer, which I'm sure you always hear, and then I'll give you my very personal. And I'm almost don't want to tell you this, but I'm going to be honest, you ask. I'm going to tell you what I do to really give me perspective and put my quote unquote problems into better view.

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[Dr. Chapa]

Let's hear it. Well, of course I like to spend time with my family. I'm like, yeah, check the box. You know, I like to walk the dog. I'm like, oh, you got a dog? I got a dog. Check the box. Yeah, I like to stream. He likes. He wanted to stream documentaries. I'm like, yeah, okay, great. That's a good de stressor. And then I said, well, so what's the personal thing? And he goes, well, it's a little random, so let me just prepare you. But I promise you, I'm not nuts.

[Co-host/Producer]

It's so random.

[Dr. Chapa]

And I said, okay, I'm ready if it's random. Let's hear it. What do you do? So. Well, actually, one of my mentors from my church told me to do this, and it keeps me in perspective. And so I've learned to do this. I'm like, oh, well, what is that, guys? Told you. Pretty random. He goes, well, 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 hold. Stay with me here, Stay with me here and go to the local city cemetery park and don't disturb anybody's private time. There was family, but go and take a look at some of the headstones and read the headstones. And as you find children buried there, toddlers buried there, the elderly buried there based on their birth and death date on their headstone, 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? Is that really that big of a deal? Knowing my time here is very finite now. I was like, wow, that's actually a pretty deep answer.

[Co-host/Producer]

That's so random.

[Dr. Chapa]

And it's actually not that random because I showed him my little tattoo that I have in my arm, which is memento mori, y'.

[Sponsor Announcer 5]

All.

[Dr. Chapa]

That is remember you are mortal. Remember death. And which was, again, that very, very topic, what he was doing. I said, are you kidding me? I did a tedx on this. I have a TED talk on this very issue called memento mori. That's a little plug there for my TED Talk. But I loved it. I'm like, you know what? I got to be honest, I haven't really heard that from an applicant. I get the typical. I like to go on dates or go on walks or whatever. And so the walk through the cemetery was so perfectly humble and transparent and what a life perspective and just a little touch of random. I'm like, man, I've got to include this in here.

[Co-host/Producer]

That's so random.

[Dr. Chapa]

Because even though it sounds random, couldn't we all learn from that? I'm like, wow. Not to mention the fact, though. So anyway, we talked. I'm like, I really admire that. I think that's a cool answer. You know, just don't be that creepy guy walking around the cemetery like, hey, I saw this guy. I saw this guy keep walking up and down the cemetery. It's kind of, kind of weird. But to put things in perspective, how beautifully, beautifully humble, transparent, and random is that?

[Co-host/Producer]

That's so random.

[Dr. Chapa]

I love it. Just a little life perspective there. Podcast family. Hope it makes you smile. We have covered the show, which is our title, and our purpose was to be kind of random. One OB thing, one gynecology thing, and one life perspective thing. Yep, that's right.

[Co-host]

We call this that's so Random Podcast Family.

[Dr. Chapa]

I hope that made you smile. Hope we gave you a little bit of tidbits of info that you'll find useful in your day to day podcast family. As always, we are thankful for you. We're glad you're part of our podcast community, Michael. Now that we've done all that, let's take it home.

[Co-host]

That's so random.

[Dr. Chapa]

All right, that's enough of that. We'll see you on the next episode. This has been Dr. Chapa Zobi Gyn. No Spin podcast Podcast Family. Thank you for your support. Thank you for listening. And as always, we'll see you on another episode of the no Spin Podcast. Sam.