Shadowing Practice: A man hiked in the woods. Every brain cell got cooked. - Learn English Speaking with Video
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K.A is a 49-year-old man presenting to the emergency room with fever, headache, and confusion.
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His speech was garbled, his vision was blurry.
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Something was wrong with his brain.
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An MRI of his head showed that something was abnormal, but it didn't give any clues as to what was happening.
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The brain and the spinal cord are surrounded by a liquid that cushions and protects it called the cerebrospinal fluid .
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Doctors stick a needle into K.A.'s back to draw some of that fluid to send to a laboratory to test, so that they can get some more information.
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When they looked at it, it was yellow and cloudy.
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It's not supposed to look like that.
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And when the lab results returned, it shows that there's a huge amount of white blood cells in it.
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These aren't supposed to be in the CSF.
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And this gives doctors some clues as to what's happening to him.
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Five years earlier, KA wasn't feeling well.
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He'd wake up every day and feel bloated.
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At first his wife thought it was funny, and she started calling him sausage fingers.
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He noticed that he was gaining weight disproportionately to how little he was eating every day.
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And every time he'd use the bathroom, he'd notice a mass of foamy bubbles in the toilet.
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At a doctor's visit, his wife realized this wasn't funny anymore.
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KA had gained 40 pounds, but almost all of this was water.
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When the doctor squeezed his leg, it was like squeezing memory foam.
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This isn't supposed to happen.
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This kind of fluid overload is seen when someone's organs are failing.
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A blood test reveals two things.
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First, KA's kidneys have shut down.
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They're not filtering his blood anymore.
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The bubbles in his urine are proteins that are just bypassing the kidneys, and his edema, the fluid buildup, is because his kidneys aren't removing wastes from his body anymore.
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The second is that Ka's immune system is attacking his kidneys, that's why they're shutting down.
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The blood test finds that his white blood cells have created antibodies that specifically target his kidneys for destruction.
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If this keeps up, the damage done will be permanent.
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This is called membranous nephropathy, nephro referring to kidney, opathy referring to disease,
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and membranous describing how the kidney looks under a microscope when the immune system is attacking it like this.
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Medicines can fix this.
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KA was given two.
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The first is a steroid.
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This is a general anti-inflammatory.
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It blunts the immune system.
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But it's not enough by itself.
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The second medicine goes into the white blood cells.
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It tells their genes to stop producing signal chemicals.
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This makes it so that the immune system can't communicate amongst itself.
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Both of these together should stop KA's immune system from attacking his kidneys, allowing them to heal and enabling Ka to live his normal life again.
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And things seemed to be okay.
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But three years later, there was more protein in his urine than ever before.
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His fluid overload is so severe now that his blood pressure is always high.
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Now it's severely impacting his heart.
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His kidney damage was getting worse.
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His immune system was still destroying his kidneys.
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Two more medicines were given.
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One stops white blood cells from growing, stops them from functioning, and it forces them to destroy themselves.
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The second medicine gets into the DNA of white blood cells and inserts chemical parts that completely invalidate the entire cell.
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Doctors aren't shutting down the production of signal chemicals anymore, they're depleting the white blood cells in his body.
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This is the last resort to save what's left of Ka's kidneys.
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He received a few doses of these medicines over 18 months, and his kidney function held steady.
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All of this was working, but something was still wrong.
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Hey, have a quick question.
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Have you learned a few things in this video so far?
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If you have, I'd really appreciate it if you aren't subscribed yet to subscribe
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and come back to see the video that I post next month too.
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I make these videos for fun, and I do them because I genuinely like to.
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It's always one of the highlights of my day.
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I've published on average one a month every month since 2017, and I do these to teach how we think in medicine by telling stories of patient cases.
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I'm very thankful to have the opportunity to make these for you.
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Appreciate you.
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20 months after treatment, which is 4 months before he's presenting to the emergency room, K.A went on a hiking trip with his wife.
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In the evenings, after they were done, he'd notice welts all over his arms and legs.
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They were itchy, sometimes painful.
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The trip was like this every day, but he was totally fine when he got home.
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A few weeks later, he started seeing flashing lights.
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He thought maybe he hadn't gotten enough sleep, but then a horrible pain emerged on the left side of his forehead.
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At the hospital, doctors did a brain MRI.
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Nothing was found.
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Everything was normal.
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His kidneys were healing, but blood tests suggested that he was dehydrated.
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They gave him IV water.
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Two days pass, and he got better.
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They sent him on his way, but very clearly dehydration wasn't his problem.
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A week later, Ka was back in the hospital because his speech was nonsensical.
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He was confused.
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He didn't know where he was.
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One kind of stroke is when a blood clot gets lodged into a blood vessel of the brain.
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This chokes off blood flow and starves that part of the brain of oxygen.
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There's just minutes before permanent damage settles in.
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When doctors did imaging of Ka's brain, It kind of looked like he was having a stroke, but it wasn't clear, it was borderline.
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But there was no time to wait.
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Medicine, that immediately breaks blood clots by thinning the blood, were given.
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It seemed to work.
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KA got a little bit better.
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But he appeared to still have problems.
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It was hard for him to find the right words to say, and he was still confused.
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But by that hospital administration's metrics, he was good enough to go home.
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No more immediately completely life-threatening problems, so let's schedule you an appointment for follow-up." And he was on his way.
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As the weeks passed, KA started seeing floaters on his left side.
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He had to lay down in bed with an eye mask
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because light would make him feel like a hammer was smashing his skull.
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He had to wear earplugs because all sound would amplify an echo.
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At the ophthalmology eye doctor's office, KA was found to have eye inflammation.
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The left was worse than the right.
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The pattern and where the inflammation was inside the eye were very specific.
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And this was concerning.
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KA had a history of his immune system attacking his kidneys.
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If his eyes have inflammation, this could mean that it's attacking his eyes now.
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KA was given steroid eye drops.
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A mixed sedative, Tylenol, and caffeine combination pill were given for his headache.
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This calms down the brain, reduces inflammation, and constricts blood vessels going to the brain to limit excess blood flow that could cause headache.
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In over two weeks, KA's pain went away.
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His vision improved, he didn't need to wear the eye mask anymore.
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But a week later, KA suddenly felt weak on the right side of his body, and the right side of his face was drooping.
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He could only slur his words.
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At the hospital, again.
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Clinically, it looked like he was having a stroke again, but brain imaging returned normal, no stroke.
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Two days in the hospital passed, KA could speak normally again, so he was sent home.
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Nothing wrong was found.
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But over the next week, KA's wife noticed that he would have staring spells.
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Things would last just for a minute, but he would stop moving.
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His eyes would be wide open, he wouldn't blink, he wouldn't respond to anything, and after a minute, he'd snap out of it, and he couldn't remember anything that had happened over the last hour.
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He started having a fever, and his episodes of slurred words would return every few hours.
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At the hospital, again.
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Brain imaging was normal, blood test results were normal.
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Nothing looked wrong, but very clearly, something was wrong.
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KA had gone to the same hospital seven times in the last four months.
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The doctor this time remembered him from a previous visit.
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When he looked at the medical record, he realized that no one here ever found out why any of these things were happening to KA.
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This doctor pulled KA's wife aside and told her, there might be a better hospital, maybe you could say, more adequately equipped, to figure out what's wrong.
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It's just on the other side of the city, and she agreed to the transfer, and he's brought to the emergency room, where we are now.
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In this emergency room at the second hospital, doctors re-evaluated KA.
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All of his vitals were normal.
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He didn't look well.
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in his face had wasted away, indicating malnutrition.
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A mental status exam found that he couldn't name the days of the week backwards.
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He named a month, and then said the days forward.
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When he was asked to remember three words, he could only remember one after five minutes.
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He said that nine quarters was $4.25.
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His vision was blurry, and he had trouble moving his eyes, but he knew where he was.
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He could say the word hospital sometimes.
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Other times, he'd stare off into the void as if he were trying to speak, but couldn't.
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tests were normal, urine and serum toxicology negative.
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A brain MRI showed subtle changes, but it's not clear what any of this means.
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Given this information, and KA's past medical history, the overactive immune system attacking his kidneys, and the four immune suppressing medicines that he was given,
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there's a few things that doctors want to do immediately.
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A lumbar puncture found lymphocytic pleocytosis, pleo from Greek referring to a very large quantity, phyto meaning cell and osis meaning a disorder,
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and lymphocyte being a particular type of white blood cell, a large quantity of white blood cells causing a disorder.
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This means that his immune system is trying to respond to something.
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Regardless of the fact that it was nuked by those four medicines, it looks like it's still responding potentially to an infection of his.
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His CSF was yellow and cloudy.
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It's not supposed to look like that.
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The problem is, there's no telltale signs of which infection this is.
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It could be a virus, it could be bacteria, it could be both, it could be something different.
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Doctors come up with an early plan.
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Give KA an antiviral medicine, give him three antibiotics and B vitamins just in case of neurodegeneration from that malnutrition.
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And then watch him in the hospital.
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Do this now, because the infection can and will get worse in the coming days.
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In the meantime, they draw blood and order many different tests.
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Some of these tests will take days to return.
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An ophthalmologist examines his eyes.
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They saw that fluid was swelling into his optic nerves, connecting his brain to his eyes.
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The next day, doctors noticed that KA's speech was slurred.
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None of his words made any sense.
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He would scream and cover his eyes until the lights were turned off
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and the window blinds were closed because he was so sensitive to light.
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On the second night at the hospital, KA was finally able to get a good night's sleep.
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And this is where the medical team was totally thrown off.
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The next day, hospital day three, KA opened his eyes.
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He stood up, he stretched, and then he started walking around like nothing was wrong, like nothing had happened.
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He was calm and collected.
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Doctors asked him questions.
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He responded in full clarity, no problems.
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He could remember the three words after five minutes.
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He could name the days of the week backwards.
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Nine quarters is $2.25.
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And when they asked him what was going on through his mind the last few days, he said that he knew he was in the hospital because he wasn't feeling well,
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but he couldn't remember that doctors had asked him to do any of those things that he just did.
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One thing that he wanted doctors to know was
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that his vision started getting weird after he spent a lot of time outdoors, hiking with his wife, hunting with his colleagues.
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Every time he'd come back from these, he'd notice welts all over his arms and legs.
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He thought these may have been bug bites, but he wasn't sure.
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He had asked the other hospital about this, but they never found anything definitively.
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But what is definitive is that KA appeared healthy suddenly, but his vision was still blurry.
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The studied eye exam the following day found that only his left optic nerve was swollen, and that the inside of his eyes looked markedly different, a big improvement from two days prior.
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And around this time, the blood tests and CSF lab tests had returned, and this screwed everything up.
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When he presented to the emergency room, he had meningoencephalitis.
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Meningo referring to the meninges, the membrane protecting the brain and the spinal cord, Encephal, referring to the brain,
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both his brain and the membrane surrounding it were inflamed.
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And words matter.
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Meningitis, the inflammation of the meninges, usually presents with headache, stiff neck, fever.
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But brain function is totally normal.
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Ka's brain wasn't normal at presentation.
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Meningoencephalitis is meningitis with a brain that can't function,
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can't talk, can't think, can't respond appropriately and visual changes with swollen nerves means that the brain and nervous tissue are inflamed,
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and this is what he had at presentation.
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And his condition rapidly improved once he came to this hospital and was started on antiviral medicine, three antibiotics, and B vitamins.
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Doctors had written a problem list to match his symptoms, and they need to rule each one out in order to find out what's happening.
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The blood and CSF test results give them some direction.
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First, Ka had an autoimmune problem, and this means two things.
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The first is that his immune system could be attacking more than just his kidneys.
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It could be attacking the blood vessels in his brain.
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That can cause problems that look like a stroke, which he had at the hospital a few weeks earlier.
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A blood test can find this, but that test was negative.
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So whatever it was that caused that stroke was something else.
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So this wasn't his problem.
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The second issue from autoimmunity stems from the latter two medicines that he was given for membranous nephropathy.
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When these shut down the immune system, it puts him at risk for rare infections.
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So if Ka got better after being given one antiviral, three antibiotics, and B vitamins,
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and if he was predisposed to infection because of a prior illness, then this means that his meningioencephalitis is because of infection.
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But which infection?
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These medicines have side effects, you can't keep them indefinitely on all five.
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And if you stop the right medicine too early, then you'll grow a medicine-resistant strain of the pathogen without knowing what caused this problem in the first place.
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But here's a big problem.
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When doctors tried to grow bacteria from his blood in CSF, nothing appeared.
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This could mean that his problem isn't bacteria, but it could also mean that it's a secret bacteria that can't be grown in a petri dish.
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Meningoencephalitis pathogens are only found at best 30-60% of the time.
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there's an actual chance that they're not going to be able to find what's wrong, but doctors still need to reason out what Ka doesn't have.
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Bug bites give the clue.
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Viruses.
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West Nile from mosquitoes.
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Ka's in the northeastern United States.
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Lots of mosquitoes there.
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This can cause his problems, but antibodies in the CSF and viral RNA in the blood were negative, so he doesn't have this.
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All other mosquito-borne and tick-borne viruses local to the northeast were tested for.
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They can cause similar neuroinvasive viral encephalitis, but all of these were negative.
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Shingles and herpes viruses can cause similar-looking illness involving eye and brain, but his brain MRI didn't have characteristic features of any of these.
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Blood and CSF tests for these sometimes aren't accurate.
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The inflammation in his eyes don't look like the patterns usually associated with these illnesses, and it's unlikely that the particular antiviral medicine
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that he got would have had an improvement this profound in such a short amount of time.
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While a viral illness is not completely off the table, doctors look at all the possible bacterial species that could be the problem.
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Hospital labs can't grow every bacteria from blood and CSF samples.
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Some that cause problems aren't easy to grow.
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When they did try, they weren't able to grow any species from his samples.
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Reasoning out which bacteria it wouldn't be, mycobacteria, which can cause tuberculosis, can cause optic nerve edema and uveitis,
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but they also cause movement disorders and issues moving the eyes.
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And the antibiotics that were given to him don't really destroy this kind of bacteria.
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There's a spiral shaped bacteria called a spirochete, one species is well known that causes syphilis, named Treponema pallidum.
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This causes uveitis, and late stage disease can cause neurologic signs and symptoms.
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But this is easily tested for, and it was done, and it was negative.
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Finally, the last test.
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Borrelia burgdorferi, the spirochete that causes Lyme disease.
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This is a disease that comes from bacteria transmitted by ticks.
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KA is in the region of the country where Lyme Connecticut is, where the name of the disease is from.
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KA's problem started after he went on hiking trips with his wife and hunting trips with his colleagues,
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all activities outdoors in places where there's ticks.
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This was KA's most likely problem.
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It causes uveitis and optic neuropathy.
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Lyme disease can cause lymphocytic pleocytosis.
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It can cause facial nerve problems looking like a stroke.
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It can inflame the meninges, all signs and symptoms that he had been suffering from over the last several months.
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One of the antibiotics that he was given acts directly on Borrelia, and this explains how he suddenly became better after he got it.
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But when they tested him for Lyme disease, they didn't find any antibodies to Borrelia burgdorferi.
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He also didn't report the kind of rash that you often, but not always, see with Lyme disease.
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But maybe that's okay.
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One of the immunosuppressants that he received for his membranous nephropathy can delay the body's antibody formation against Borrelia burgdorferi.
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The problem is, when they did imaging of his head and his spine, none of the pictures looked like what you would get when one has Lyme disease.
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And over the days, they kept repeating the blood test, only for it to keep coming out negative for Lyme disease,
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meaning that their entire problem list was totally crossed out, and this advanced hospital couldn't figure out what was wrong.
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What could this be?
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If this isn't Lyme disease, but it has similar features, but just slightly different, then is it possible that it's another species of Borrelia?
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Special research laboratory testing was ordered.
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gene sequences of particular known bacteria were done on Ka's blood and CSF.
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These are bacteria that have only been described in a handful of human cases.
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No standard clinical lab tests exist.
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In truth, only a high-powered academic institution with labs willing to look deeper would be able to do this.
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But when the results returned, they found out what it was.
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In 1995, Japan, a group of researchers were investigating the tick Ixodes persilcatus.
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This is one that carries Borrelia burgdorferi.
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You can get bit by this one, and you can get Lyme disease.
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Spirochetes have a body part that helps them twist through their environment called an endoflagellum.
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When the scientists looked further at a sample of Ixodes ticks,
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they found that there were these remnants of endoflagella that were distinctly different than what's found in Borrelia burgdorferi.
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This is like finding the bone of an animal in a human burial site.
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When they looked at genetic samples, they found distinct parts of genes that were not related to any known Borrelia species at that time.
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However, other parts of the genes show that whatever it was that had these endoflagella remnants was related to Borrelia.
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The study demonstrated that there exists a previously unknown Borrelia species inside the Ixodes persilcatus tick,
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but not much more was heard about this until 2009.
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Eastern Russia, a place well known to have tick-borne disease, 46 patients had come in to a regional hospital with fever,
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headache, chills, fatigue, vomiting, and muscle aches after known tick exposure.
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By this time, doctors and scientists in the area were well aware that local Ixodes ticks harbored many different bacterial species.
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When the Russian Central Research Institute of Epidemiology conducted the study
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in conjunction with another tick familiar academic hospital in the northeastern United States,
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they formally reported the first human cases of this particular bacteria that was discovered in Japan 14 years earlier.
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Its name is Borrelia Miyamotoi.
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Borrelia Miyamotoi illness was first reported in humans in 2009.
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The bacteria was first described in 1995.
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Just because we named it and documented human cases, doesn't mean that it didn't exist before then.
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It's just that we hadn't found it yet, and we didn't have the awareness, the techniques, and the technology to describe it and define it.
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And just a couple of years later, in 2012, the first described Borrelia miyamatoi case in the United States was published,
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happening in the Northeast, just a few states away from KA.
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And interestingly enough, this patient had so many striking similarities with KA, they had taken the same immunosuppressant medicine,
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suffered the same subacute meningoencephalitis, and had a lymphocytic pleocytosis in the CSF that both suddenly improved when antibiotics were given,
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and the blood test revealed that that KA had had this infection for several months.
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And now that doctors found the exact causative agent, they have an idea of which antibiotics were doing the work, and they know how to proceed with KA's treatment.
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The reason this case is important is because disease-carrying ticks have been migrating both inside the US and across continents.
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Incidence and prevalence of Lyme disease is increasing, and if we know that these ticks have many different kinds of bacteria inside,
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then it really is important for you to take precautions to prevent tick bites on you.
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If you live in an endemic area, use insect repellent, wear long sleeve shirts and pants, check your body, clothes, gear and pets for ticks after being outside,
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and it could be outside that's just even in your backyard.
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And remove attached ticks as soon as you see them, don't wait for someone else to do it.
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If we operate under the assumption that you could get bacteria
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that may not be detectable when you see your doctor because it's not something that's easy to test for, which could then go untreated, just like in KA's case,
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then protecting yourself and preventing this becomes the most important thing that you can do.
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I'm not here to scare you about this.
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You can still do something about this for yourself.
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KA's case brings up a couple different issues that people today are likely very familiar with.
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The first is that this was not an easy diagnosis.
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The hospital that happened to figure out Borrelia Miyamotoi happened to be one of the top research hospitals in the entire world.
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That's linked to one of the top medical schools in the entire world, meaning they had access to the most advanced labs in the entire world.
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And most importantly, they had people who were willing to look deeper.
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And even then, there was a window of time where it looked like they were going to miss this diagnosis.
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There's no standard clinical test for Borrelia miyamatoi, at least at the time that this patient was diagnosed.
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Now, I've been alive long enough and doing this long enough to have the hypothesis
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that if this man went to any hospital in this part of the country, there's a 95 to 100% chance that Borrelia miyamatoi would have never been found in him.
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There's still a chance
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that he would have gotten the right antibiotics for the right amount of time fixing all of his problems, and that's where that 5% comes from.
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And so this brings us to the second issue.
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There's people who feel that they have something wrong.
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They know that they have something wrong with them, but no one has been able to give them a definitive answer.
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Now despite being in medicine, I experienced this myself once.
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And I've talked about this before, this video on my second channel, but long story short, I had a self-inflicted problem that I wasn't thinking of.
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It's not malicious, it was an accident that I wasn't paying attention to.
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And it led to me having the worst insomnia I've ever had for almost two years.
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And I was given the runaround, even at a major city academic hospital specialist center.
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Now, I was lucky I found it and fixed it myself.
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It was a vitamin deficiency, but many people aren't as fortunate and aren't able to do that.
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Now, inside this topic of people having problems and not getting the right help, there's two things.
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The first is in context of Lyme disease.
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The diagnosis isn't simple, and this is where issues come from.
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People need to have both the risk of exposure to ticks carrying Lyme disease
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and the clinical symptoms and clinical manifestations of Lyme disease.
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Sometimes that bull's eye rash doesn't show up.
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Sometimes you're bitten by a tick.
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That's not the species that carries Borrelia.
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And if you are bitten by that tick, if it's not on you for long enough, which is around 24 hours, it's not known to transmit the bacteria in saliva.
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And sometimes you're bitten by that tick and it doesn't even have Borrelia in it.
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Now the added factor to this is that the blood test for Lyme disease isn't always accurate, so some people might have gotten a false positive rather than a true positive,
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meaning that they didn't actually have Lyme disease, even though the blood tests said that they did.
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They received antibiotics.
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But because it wasn't the problem, they got antibiotics they didn't need, and then they're still sick.
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So they think they have chronic Lyme disease.
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There's a post-treatment Lyme disease syndrome in some people who really
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did have Lyme disease where the Borrelia bacteria fragments induce an autoimmune reaction.
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The communication from doctors a lot of times isn't very good about this.
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And I think people might be familiar with the, Oh, but did you really get Lyme disease?
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Question that one might get.
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The second issue is when someone like KA genuinely has a problem, but it's so rare
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that it takes an ultra specialist at an elite institution that's
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in a location where the associated disease is endemic to find it.
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An average Ixodes tick has many different bacteria inside, including many different species of Borrelia,
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and they will have multiple variants of each species too.
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There's one thing that we use in medicine, and it's this idea that many of a patient's problems can be explained by a simple, single diagnosis.
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This helps prioritize decision making, especially in the most common setting, where you're not the only patient that we're seeing.
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The problem list that the doctors came up with, 4KA, demonstrated this.
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And it's true, patients can have more than one problem, but human bodies are robust.
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Our natural facilities can handle many things to maintain homeostasis.
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I think in the context of chronic diseases, there can be a communication issue, and there are some doctors who are absolutely the right person for you as a patient,
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and there's definitely some who are definitely not the right person for you.
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And I do hope that you're able to find the absolute right person, just like how KA was able to in this case.
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The last thing I want you to be aware of is
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that there are people who will try to sell you false hope on the internet through supplements and all of those.
374
You have to have your own due diligence to be able to see through all of those.
375
The antibiotic doing the work was one that was used to treat Lyme disease.
376
KA was sent home with this antibiotic to be given intravenously, but he started getting a rash on his face, so they switched to a different one.
377
Three weeks after discharge, at the follow-up, all of his symptoms had resolved, except his vision was still blurry.
378
But three months after that, his vision had slowly begun to improve as he was able to make a full recovery.
379
Thanks so much for watching.
380
Take care of yourself and be well.
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Vocabulary and speaking notes for this lesson
This video has 380 sentences and 5135 words to shadow. The speech runs for 27:19. The speaker talks fast, about 188 words per minute, so expect linked and reduced sounds. Only 81% of the words are among the 3,000 most common in English, so the vocabulary is demanding.
Key vocabulary in this video
15 words from the video worth learning, with pronunciation and meaning:
| Word | Pronunciation | Meaning |
|---|---|---|
| immune adjective | /ɪˈmjuːn/ | Exempt; not subject to. |
| antibiotic noun | /ˌæn.taɪ.baɪˈɑ.tɪk/ | Any substance that can destroy or inhibit the growth of bacteria and similar microorganisms, generally transported by the lymphatic system. |
| tick noun | /tɪk/ | A tiny woodland arachnid of the suborder Ixodida. |
| infection noun | /ɪnˈfɛkʃən/ | The act or process of infecting. |
| fluid noun | /ˈflu.ɪd/ | Any substance which can flow with relative ease, tends to assume the shape of its container, and obeys Bernoulli's principle; a liquid, gas or plasma. |
| inflammation noun | /ɪnfləˈmeɪ̯ʃən/ | The state of being inflamed. |
| refer verb | /ɹɪˈfɜː/ | To direct the attention of (someone toward something). |
| nerve noun | /nɝv/ | A bundle of neurons with their connective tissue sheaths, blood vessels and lymphatics. |
| headache noun | /ˈhɛdeɪk/ | A pain or ache in the head. |
| symptom noun | /ˈsɪm(p)təm/ | A perceived change in some function, sensation or appearance of a person that indicates a disease or disorder, such as fever, headache or rash; strictly, a… |
| virus noun | /ˈvaɪ.ɹəs/ | A submicroscopic, non-cellular structure that consists of a core of DNA or RNA surrounded by a protein coat, that requires a living host cell to replicate, and… |
| illness noun | /ˈɪl.nəs/ | An instance (episode) of a disease or poor health. |
| gene noun | /d͡ʒiːn/ | A theoretical unit of heredity of living organisms which may take several values and (in principle) predetermines a precise trait of an organism's form… |
| fever noun | /ˈfivɚ/ | A higher than normal body temperature of a person (or, generally, a mammal), usually caused by disease. |
| diagnosis noun | /daɪəɡˈnəʊsɪs/ | The process of, or an instance of, identification of the nature and cause of a medical condition or illness. |
Phrasal verbs you will hear
| Word | Meaning |
|---|---|
| shut down verb | To close, terminate, or end; to stop operating, either permanently or temporarily. |
| figure out verb | To come to understand; to discover or find a solution; to deduce. |
| find out verb | To discover, as by asking or investigating. |
| come up with verb | To manage to produce, deliver, or present (something) by inventing, creating, thinking of, or obtaining it. |
| follow up verb | To take further actions remaining after an event; to continue, revisit, or persist; especially, to maintain communication or verify. |
| bring together verb | To cause people to do something together; to bring about togetherness. |
| bring up verb | To mention. |
| calm down verb | To become less excited, intense, or angry. |
Grammar in this video
The structures the speaker uses most, with the exact words from the video:
| Structure | In the video |
|---|---|
| Conditional sentences if + clause, will/would + verb — a condition and its result | If you have, I'd really |
| Present perfect have/has + past participle — a past action that still matters now | have shut · have created · Have you learned |
| Passive voice be + past participle — the focus is on what happens, not who does it | was garbled · are surrounded · is seen |
| Relative clauses who / which + clause — extra information about a person or thing | treatment, which is · mycobacteria, which can · people who were |
Pronunciation to watch
The speaker uses 92 contractions and reduced forms, such as didn't, wasn't, aren't. Say them the short way, as you hear them.
- The “th” sounds: northeast /noːˈθɪjst/, northeastern /ˌnorˈθiː.stɚn/, threaten /ˈθɹɛt.n̩/
- The “sh” and “zh” sounds: infection /ɪnˈfɛkʃən/, inflammation /ɪnfləˈmeɪ̯ʃən/, chef /ʃɛf/, rash /ɹæʃ/, exposure /ɪkˈspəʊ.ʒə(ɹ)/
- Long words — get the stress right: antibiotic /ˌæn.taɪ.baɪˈɑ.tɪk/, inflammation /ɪnfləˈmeɪ̯ʃən/, institution /ˌɪn.stɪˈtʃuː.ʃən/, laboratory /ˈlæb(ə)ɹəˌtɔɹi/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/
How to practise with this video
- Listen to the whole video once without speaking and note the words you do not know.
- Start at 0.75× speed, shadow it sentence by sentence, then go back to normal speed once it feels easy.
- Record yourself and compare with the original, paying attention to words like immune, antibiotic, tick.
What is the Shadowing Technique?
Shadowing is a science-backed language learning technique originally developed for professional interpreter training and popularized by polyglot Dr. Alexander Arguelles. The method is simple but powerful: you listen to native English audio and immediately repeat it out loud — like a shadow following the speaker with just a 1–2 second delay. Unlike passive listening or grammar drills, shadowing forces your brain and mouth muscles to simultaneously process and reproduce real speech patterns. Research shows it significantly improves pronunciation accuracy, intonation, rhythm, connected speech, listening comprehension, and speaking fluency — making it one of the most effective methods for IELTS Speaking preparation and real-world English communication.