Podcasts about Acute

Acute kidney injury is one of the most common complications seen in hospitalized patients, yet it's a topic that often leaves nursing students overwhelmed by lab values and terminology. In this episode, I'm breaking down the three types of AKI and showing you how to recognize the clues that help distinguish one from another. We'll talk through: - Common causes - Important assessment findings - Key lab values - Complications to watch for when kidney function begins to decline. We'll also review how urine output, fluid status, creatinine, BUN, potassium, and other findings fit together so you can stop memorizing isolated facts and start understanding the bigger picture. Nursing school gets easier when you have a system to help you identify what to focus on as you study, and to connect the dots so you can see that bigger picture. I get you started building that system in my free Nursing School Survival Blueprint, where I share the key shifts you can make which separate struggling students from thriving ones.

1º Encontro TdC - Simpósio Anual de Atualização em Clínica Médica Um dia inteiro de Clínica Médica, com temas cuidadosamente selecionados para responder à pergunta que mais importa: o que muda minha prática?Se você é residente, médico recém-formado, especialista ou estudante de Medicina e gosta da forma como o TdC discute medicina baseada em evidências, esperamos você em São Paulo no dia 22 de agosto.Garanta sua vaga através do link: https://www.tadeclinicagem.com.br/eventostdc/1-encontro-tdc/Nordman Wall e Flávio Barbieri convidam Carolina Mendes para discutir o conceito e manejo da insuficiência hepática crônica agudizada, do inglês Acute-on-Chronic Liver Failure (ACLF), quadro clínico que vai além da cirrose hepática descompensada, somando disfunções orgânicas e maior mortalidade. Referências em breve.

In this edition of the CTSNet podcast, The Lifeline, host and nurse educator Jill Ley, Clinical Professor at the University of California San Francisco School of Nursing, Founder of the Essentials of Cardiac Surgical Resuscitation, and former Cardiac Surgery Clinical Nurse Specialist at California Pacific Medical Center in San Francisco, CA, USA, speaks with CTSNet Associate Editor—Cardiac Andrea Steely, an Assistant Professor of Cardiac Surgery in the Division of Cardiothoracic Surgery at the University of Utah Health, Salt Lake City, Utah, USA. Together, they examine the management of acute aortic emergencies. Chapters  00:00 Intro  00:44 Emergent Conditions  04:07 Symptoms for Diagnosis  09:19 Left vs Right Arm Blood Pressure  10:37 Preop Management Quality Assurance  15:45 Intraoperative Management  20:04 At-Risk Patients  22:34 Summarizing Points  The discussion covers clinical management of emergency conditions, Type A vs Type B dissection, and imaging. Key topics included diagnostic strategies to ensure early detection, clinical symptoms for conditions, and the importance of measuring both left and right arm blood pressure. The session also addressed heart rate and blood pressure control in preoperative settings, the importance of a multidisciplinary approach, intraoperative management, and fluid management. Finally, they cover at-risk patients. Every month, The Lifeline features intensive care specialists sharing their expert insights into the rapid and effective management of critically ill cardiac surgical patients. Don't miss next month's episode!   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Dhineli Perera speaks with infectious diseases physician Josh Davis about the management of acute COVID-19 in the community. They discuss the major risk factors for severe disease, the evidence behind oral antiviral therapies, and the patients most likely to benefit from treatment. Read the full article in Australian Prescriber.

Send us Fan MailA Gluten Free PodcastEpisode 248My guest on today's episode is substance abuse, eating disorder and trauma specialist psychotherapist, Alexis Fosler. We'll explore the link between trauma, eating disorders, addiction and the gut/brain axis. We'll also share how individuals living with coeliac disease can incorporate various tools to deal with these issues to manage the stresses in their lives.What we'll cover:* How Alexis and I connected through a mutual friend* The stresses of living with coeliac disease and being strictly gluten free* Alexis' personal background and role as a former corporate executive and what led Alexis into working in addiction, trauma and eating disorders* Finding a mentor* Insights Alexis gained from retraining as a psychotherapist being exposed to a broad spectrum of people living with addictions and mental health issues* Currently studying obesity and  ultraprocessed foods and its impact on* Acute versus chronic stress* Complex trauma and modern stressors in our lives* Homeostasis and allostasis* How our nervous system adapts to stress over time* Allostatic load and the cumulative load of stress and challenges over time on our mental and physical health* How stress impacts our endocrine system* Is there a healthy level of stress?* Sympathetic and parasympathetic nervous system* Effects of stress on our appetite and food habits* Cortisol, dopamine and other chemicals being activated during stress* The complexities of our stressors and how we deal with stress in our brains and bodies* Hypervigilance and avoidance when living with coeliac disease and adhering to a strict gluten free diet* Eating disorders in people with coeliac disease* The fear of food, restrictive eating and coeliac disease* Link between eating disorders and disordered eating* When to seek help when the stresses of living strictly gluten free* The relationship between addiction, eating disorders and disordered eating* Maladaptive behaviours in addiction* Emotional regulation's role in addiction, eating disorders and disordered eating* Dopamine's role in our habits and compulsions* Chronic deficits in our dopamine system and alterations in our dopamine systems* Complexities of dealing with recovery in addictions* Approaching various addictions, eating disorders and disordered eating with various approaches* Various approaches to recovery: pharmacological, talk therapy, cognitive flexibility, somatic interventions and changes of environment* Importance of breath work* How to create new neural pathways to retrain brain * Alexis' PHD and thesisLinksFollow Living Free on InstagramLiving Free TodayPromises HealthcareTrauma, Eating Disorders and Addiction Youtube videoARFID and coeliac disease researchConnect with Alexis' mentor, Reshie - https://www.linkedin.com/in/reshie-joseph-a770a358/ Join A Gluten Free Podcast Facebook Group 

An approach to dyspnea (shortness of breath), including the dyspnea pyramid to remember the differentials, as well as key investigations that help identify the cause, as well as common patterns in the history and physical examination. PDFs available here: https://rhesusmedicine.com/products/assessment-or-interpretationConsider subscribing on YouTube (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Dyspnea?0:19 The Dyspnea Pyramid2:50 Dyspnea History & Physical Exam Patterns4:43 Dyspnea InvestigationsLINK TO MNEMONICS:https://www.youtube.com/watch?v=p-XE7PiwGgE&list=PLGNSE_HvIV4t7a33bbHN1fq-j_tge0GmpLINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/Please remember this podcast and all content from Rhesus Medicine is meant for educational purposes only and should not be used as a guide to diagnose or to treat. Please consult a healthcare professional for medical advice. ReferencesBMJ Best Practice (2025) Evaluation of dyspnoea in adults. BMJ Publishing Group.BMJ Best Practice (2025) Acute dyspnoea. BMJ Publishing Group.National Institute for Health and Care Excellence (2025) Breathlessness. Clinical Knowledge Summaries (CKS).MSD Manual Professional Edition (2025) Dyspnea. MSD Manual Professional Edition.StatPearls (2024) Dyspnea. In: StatPearls. Treasure Island (FL): StatPearls Publishing.Parshall, M.B., Schwartzstein, R.M., Adams, L., Banzett, R.B., Manning, H.L., Bourbeau, J., Calverley, P.M.A., Gift, A.G., Harver, A., Lareau, S.C., Mahler, D.A. and O'Donnell, D.E. (2012) An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea. American Journal of Respiratory and Critical Care Medicine, 185(4), pp.435–452.

With us Wednesday was Dr. Maureen Barber-Carey, executive vice president and Robert Barber, senior vice president of the Barber National Institute. Our guests discussed the children's acute partial hospitalization program and its relocation to 1319 Sassafras.

Struggling with unexplained fatigue, brain fog, pain, or inflammation? The hidden cause could be your breast implants… and here's what you can do about it.

There's currently much hand-wringing that our arsenal of precision and long-range weapons has been depleted to the point where we may be unable to continue combat operations against Iran, let alone deter – and, if necessary, win – a war with Communist China. Understandably, the Pentagon is reluctant to provide sensitive information on the topic. But leaks and congressional testimony suggest there's truth to the speculation.  If so, it's the predictable result of “strategic arson” perpetrated by Chinese dictator Xi Jinping. His Russian and Iranian allies' attacks on Ukraine and Israel, respectively, came after consultations in Beijing. And they have diverted our policy-makers, consumed our warriors' energies and materiel and overwhelmed inadequate military production lines.  The Trump administration and Congress are scrambling to expand our defense industrial base. The question is: Will China's next arson in “World War Xi” wait until we do so?   This is Frank Gaffney. 

The following article of the Entrepreneurs industry is: 'How C-Suite Perception Gaps Damage Customer and Employee Loyalty' by Matías Fernández, Chairman & CEO, Acute Talent. 

The two big questions of the moment: can the NHS handle future heatwaves and will Andy Burnham's premiership spell positive change for the service? In this episode of Health on the Line, Adam Brimelow dives into the significant shifts in health leadership under prime minister Andy Burnham. With Yvette Cooper stepping in as the new secretary of state, Burnham is set on a transformative agenda for health and social care. But can he deliver? To find out, Adam's joined by Mark Fisher, former chief executive of Greater Manchester ICB and Jane Merrick, policy editor at The i newspaper. And the NHS is feeling it this summer with heatwaves putting enormous pressure on services. It's clear that proactive summer and heatwave planning are crucial for healthcare systems – so, as our summers continue getting hotter, how can the NHS get it right? To explore the challenges, Adam caught up with Matthew Hopkins, Acute and Ambulance Network director at the NHS Alliance and Dr John Martin, chief executive at South Western Ambulance Service NHS Foundation Trust. Hosted on Acast. See acast.com/privacy for more information.

[00:00] Introduction — what's new in rotator cuff research [00:39] Breaking down the new JAMA Internal Medicine paper: a Finnish population-based study of 600+ patients (ages 40–75) who received bilateral shoulder MRIs [01:00] Key finding: imaging findings were nearly identical between asymptomatic (96%) and symptomatic (98%) patients; full-thickness tears were the only finding more common in symptomatic patients (14% vs. 6%), and even that difference lost statistical significance after adjustment [01:32] What it means: most rotator cuff MRI findings are normal, age-related changes — and MRI may be overused when the clinical diagnosis is already clear [02:22] The "hair loss" analogy: a tear is often a normal part of aging, not automatically something that needs fixing [02:55] The "50-to-60-year-old house inspection" analogy for interpreting an MRI report [03:41] Can you just watch a rotator cuff tear? Reviewing natural history data out of Washington University (Yamaguchi, Keener) [04:02] Partial-thickness tears: roughly one-third progress over 5–7 years. Full-thickness tears: roughly half progress over 5 years [04:50] Bottom line: if a patient is asymptomatic and fully functional, there is no indication to intervene — annual reassessment is reasonable [05:27] Physical therapy as first-line treatment — does it actually work, and how? [05:47] The mechanism: rotator cuff strengthening counterbalances the deltoid, maintaining subacromial space during overhead motion [07:21] PT success rates by diagnosis: ~70% for full-thickness tears, ~95% for impingement/tendinopathy and partial-thickness tears [07:55] When is surgery the right answer? Distinguishing acute traumatic tears from degenerative tears [08:10] Acute traumatic tears (e.g., a fall) are generally treated surgically [08:26] Degenerative tears that fail 6–12 weeks of non-operative management are reasonable surgical candidates [08:53] Tear location matters — tears involving the "rotator cuff cable" carry more biomechanical load and may be more likely to fail non-operative treatment [09:07] Timing is rarely urgent — most degenerative tears can be addressed within 6 months to a year without changing outcomes [10:22] Acute traumatic tears in younger, active patients: counsel surgery within 2–3 months; short delays (including during COVID) didn't appear to change outcomes [10:59] Injections: is a steroid shot still a good first option? [11:15] How corticosteroid injections work — and why they're different from narcotics (reducing inflammation vs. masking the pain signal) [13:05] General guidance: one or two injections is reasonable; by the third without improvement, it's time to discuss surgery [14:00] The data linking 5+ injections to higher retear rates — and why confounding by sicker, more chronic patient populations makes this hard to interpret cleanly [15:15] PRP (platelet-rich plasma): does it actually work for the rotator cuff? [16:11] Referencing this month's American Journal of Sports Medicine review — PRP shows mixed, short-term pain relief for impingement and partial-thickness tears, roughly comparable to physical therapy [16:52] The cost consideration: PRP is cash-pay, often $3,000–$4,000, for benefits similar to physical therapy alone [17:48] Deciding on surgery: introducing the Rotator Cuff Healing Index (age, tear size, muscle quality, bone quality, and shoulder demand) as a clinical decision tool [19:22] Why not just jump straight to a reverse total shoulder replacement for everyone with a good repair success rate? [19:57] Repair vs. reverse: repair typically preserves better strength and function for younger, active patients; reverse offers excellent pain relief but carries bigger stakes if complications (dislocation, infection) occur [21:37] The mystery of imaging that shows a tendon hasn't fully healed — yet the patient feels great and the shoulder functions well [23:23] Tendon transfers as an option for irreparable tears in younger, active patients without arthritis [23:50] The lower trapezius transfer explained — how it works and its ~80% success rate [24:53] Wrap-up and where to subscribe Key Takeaways • A positive MRI finding does not automatically mean a rotator cuff tear needs to be fixed — most changes seen on imaging are normal, age-related findings, and imaging findings are similar in symptomatic and asymptomatic patients. • Natural history data suggests roughly one-third of partial-thickness tears and about half of full-thickness tears will progress over 5–7 years — most do not need urgent intervention. • Physical therapy — specifically targeted rotator cuff strengthening — is genuinely effective, not just a placeholder step, with especially strong success rates for impingement and partial-thickness tears. • Surgical timing is rarely an emergency for degenerative tears; acute traumatic tears in younger patients warrant a shorter window (2–3 months). • Corticosteroid injections are safe and effective for short-term relief when used judiciously (generally one to two); repeated injections (5+) are associated with higher retear rates, though this is confounded by patient population. • PRP is safe but not regenerative for the rotator cuff — its benefit is comparable to physical therapy, at a meaningfully higher out-of-pocket cost. • The Rotator Cuff Healing Index can help predict repair success and guide the choice between repair and reverse total shoulder replacement, particularly in older patients. • Lower trapezius tendon transfer is a strong option for younger, active patients with irreparable tears and no arthritis, with roughly 80% success in appropriately selected patients. Please subscribe to our podcast at Apple PodcastsCheck out our website on Simplecast

Dr. Austin Baraki joins me to challenge the popular narrative that testosterone levels are collapsing across society and to examine what the available evidence actually shows.Austin joins me to discuss:• Whether men's testosterone levels have declined dramatically in recent decades• Where the testosterone-decline narrative originated• Why viral claims often move faster than the evidence• How obesity, alcohol consumption, sleep loss, and socioeconomic deprivation can affect testosterone• Whether pesticides, fluoride, plastics, deodorant ingredients, seed oils, or polyester clothing meaningfully affect testosterone• The relationship between red meat, cholesterol, saturated fat, and testosterone• Why many environmental and lifestyle factors matter more for overall health than for testosterone specifically• How the testosterone conversation also applies to women• Whether differences within the normal physiological testosterone range meaningfully affect muscle growth or health• Why temporary hormonal increases after strength training do not necessarily produce more muscle growth• Acute changes in testosterone, growth hormone, insulin, and cortisol• When someone should consider having their testosterone levels checked• Which health conditions should be evaluated alongside possible hormonal concerns• Why laboratory results need to be interpreted alongside symptoms and clinical context• Why testosterone replacement therapy can be both overprescribed and underprescribed• And much moreFollow Austin on Instagram:@austin_barbellmedicineCHAPTERS02:10 The Testosterone Decline Myth06:37 Breaking Down Viral Claims08:03 An Evidence-First Framework11:15 Sponsor: Active Life12:26 Rapid-Fire Testosterone Villains16:24 Saturated Fat and Testosterone20:06 The Real Risk From Plastics21:52 Sponsor: MacrosFirst22:55 Seed Oils and Testosterone33:08 The Health Factors That Matter Most35:15 Obesity, Sleep Apnea, and Testosterone36:47 Alcohol and Lifestyle Evaluation37:44 Sleep Loss and Testosterone38:46 Extreme Diets Versus the Big Levers40:35 Optimization Versus Real Life42:07 Symptoms and Clinical Probability44:28 Specific Versus Vague Symptoms46:57 Misdiagnosis and Proper Medical Workup49:50 Hormonal Responses to Strength Training55:10 Why Laboratory Results Need Context01:01:44 Women and Testosterone Therapy01:06:31 Why TRT Is Mis-Prescribed01:09:32 When to Test Your Testosterone01:11:31 Final Thoughts and Book RecommendationSUPPORT THE SHOWIf this episode helped you better understand testosterone, hormonal health, or testosterone replacement therapy:• Subscribe and check out more episodes• Share the episode on social media and tag @andrewcoatesfitness• Send it to someone who is worried that modern life is destroying their testosteroneFOLLOW ANDREW COATESInstagram: @andrewcoatesfitnesshttps://www.andrewcoatesfitness.comPARTNERS AND RESOURCESRP STRENGTH APPUse code COATESRP:https://www.rpstrength.com/coatesJUST BITE ME MEALSUse code ANDREWCOATESFITNESS for 10% off:https://justbitememeals.comMACROSFIRST — FREE PREMIUM TRIAL• Download MacrosFirst• Begin setting up your account• When asked, “How did you hear about us?” enter: ANDREWKNKG BAGS — 15% OFFhttps://www.knkg.com/Andrew59676VERSA GRIPPShttps://www.versagripps.com/andrewcoatesTRAINHEROIC — FREE 90-DAY TRIAL• Visit: https://www.trainheroic.com/liftfree• Reply to the email you receive or email trials@trainheroic.com• Let them know Andrew sent youL1 BIOMECHANICS AND ASSESSMENT COURSEUse code COATES:https://pro.activelifeprofessional.com/assessmentworkshopevents

Ryan talks about his experiences with a nerf football, we decide what color math, English, science and history are and and we give the best advice for autoblow. We are joined by Dodds to discuss the angle of penis and some embarrassing stories. We make the White Monster Sandwhich we saw on tiktok. all this and more on this weeks Clever Name Podcast

Livestream with Yuri RashkinLINKS:https://rashkinreport.substack.com/https://podcasts.apple.com/gb/podcast/rashkin-report/id1183073638----------ACTIVE CAMPAIGN:https://car4ukraine.com/campaigns/50foruahttps://car4ukraine.com/campaigns/summer-sunshine-trucks-2026-silicon-curtain----------We are raising funds for 5 of 15 Vampire DronesSilicon Curtain for Kupiansk Vampires. Dzyga's Paw, together with Jonathan Fink, is joining forces to raise $40,000 to provide the Khartiia Brigade with Vampire Drones.https://dzygaspaw.com/silicon-curtain-for-kupiansk-vampiresThese heavy bombers are designed to destroy manpower and equipment, as well as for remote mining. The Vampire UAV, manufactured by Skyfall, has proven itself to be one of the most effective weapons in the Kupiansk direction. Skyfall is one of Ukraine's largest defense tech companies, producing Vampire bomber drones, various modifications of Shrike FPV drones, P1-SUN, Shahed drone interceptors, communication systems, and components.----------SUPPORT THE CHANNEL:https://www.buymeacoffee.com/siliconcurtainhttps://www.patreon.com/siliconcurtainhttps://www.gofundme.com/f/scaling-up-campaign-to-fight-authoritarian-disinformation----------TRUSTED CHARITIES ON THE GROUND:Save Ukrainehttps://www.saveukraineua.org/Superhumans - Hospital for war traumashttps://superhumans.com/en/UNBROKEN - Treatment. Prosthesis. Rehabilitation for Ukrainians in Ukrainehttps://unbroken.org.ua/Come Back Alivehttps://savelife.in.ua/en/Chefs For Ukraine - World Central Kitchenhttps://wck.org/relief/activation-chefs-for-ukraineUNITED24 - An initiative of President Zelenskyyhttps://u24.gov.ua/Serhiy Prytula Charity Foundationhttps://prytulafoundation.orgNGO “Herojam Slava”https://heroiamslava.org/kharpp - Reconstruction project supporting communities in Kharkiv and Przemyslhttps://kharpp.com/NOR DOG Animal Rescuehttps://www.nor-dog.org/home/-----------

Why Your Stroke May Not Be Causing Your Brain Fatigue For a long time after my brain surgery, I assumed my body worked like this: the stroke happened in my head, so whatever went wrong afterward would also happen in my head. Fatigue, brain fog, slow thinking all of it filed under “neurological,” all of it explained by the injury I already knew about. That assumption turned out to be wrong, and the way I found out was almost accidental. About eighteen months after my brain surgery, I had thyroid surgery to remove a nodule so large it had pushed my windpipe and esophagus six centimeters out of place. I had no idea it was there. No lump I could see, no difficulty swallowing or breathing that I’d noticed. It was found only because I had a chest X-ray to rule out an infection, and a doctor spotted something that had nothing to do with why I’d walked in. What followed was a slow, confusing recovery from that second surgery, and a wave of fatigue I automatically blamed on my brain, because that was the injury I already understood. It took time to realize the fatigue might be coming from somewhere else entirely: my thyroid. Hormones and Stroke Recovery: The Connection Nobody Talks About I brought this experience to Dr. Robert Hedaya, a Clinical Professor of Psychiatry at Georgetown University Medical Center and a pioneer of functional medicine psychiatry, to understand what actually happened, and to ask a bigger question: how many other stroke survivors are dealing with fatigue, brain fog, or mood changes that they’ve written off as “just the stroke,” when the real driver is a hormonal system that’s quietly stopped working properly? Hormones and stroke recovery turn out to be far more entangled than most of us are told. As Dr. Hedaya put it plainly: the brain is a hormonal organ. Thyroid hormone, cortisol, testosterone, estrogen every one of them acts directly on brain tissue, and every one of them can be knocked off balance by the stress of a major medical event. Why “Normal” Thyroid Bloodwork Can Still Mean Something’s Wrong One of the most important things Dr. Hedaya explained is that a “normal” TSH result doesn’t rule out a thyroid problem, especially after a stroke. TSH is a signal sent from the pituitary gland, and if a stroke has affected the brain’s signaling pathways, the pituitary itself may not respond the way it should. A survivor can have genuinely low thyroid hormone while their TSH sits comfortably inside the standard reference range, because the system responsible for raising that number in response to a deficiency isn’t functioning correctly. He also raised a striking data point: population studies suggest the average TSH in a healthy population is closer to 1.4, yet most labs still use an upper reference limit of 4.5, a range wide enough, statistically, to miss a real problem. His advice for survivors going into a GP appointment: ask specifically for TSH, free T4, free T3, and reverse T3, not just the standard single-marker test, and come prepared with symptoms written down if a doctor pushes back. A Nodule That Grew in Silence The brain is a hormonal organ. It’s an immune organ. It’s a neurological organ… there’s not one hormonal axis when it’s abnormal that cannot cause neurological or psychiatric problems. -Dr. Robert Hedaya My own nodule is a case study in exactly this kind of silent progression. Dr. Hedaya explained that because it grew inward rather than outward, it never created the visible lump most people associate with a thyroid problem, and because it didn’t press on my vocal cords or laryngeal nerve, I never developed the hoarseness that might have flagged it sooner. My body adapted gradually, and the fatigue that eventually surfaced was easy to misattribute to the injury I already knew I had. Cortisol, Stress, and the Difference Between Pain and Suffering Beyond the thyroid, Dr. Hedaya walked through the role of cortisol, the body’s primary stress hormone, and why survivors often struggle to answer a deceptively simple question: “Are you stressed?” His distinction between pain and suffering is worth sitting with: pain is often unavoidable, but suffering is shaped by the story we tell ourselves about a situation, and a stroke can compromise the very brain systems that regulate that stress response in the first place. Testosterone, Estrogen, and the Brain’s Need for Hormones to Rewire The conversation closed on sex hormones, testosterone and estrogen, relevant to both men and women, and their role in neuroplasticity. Dr. Hedaya drew a direct comparison to adolescence: the teenage brain rewires itself while hormone levels are surging, and the same principle applies after a stroke. A brain trying to rebuild pathways needs adequate hormonal support to do that work. Without it, recovery can stall in ways that have nothing to do with effort or physiotherapy. What You Can Do About It If any of this sounds familiar fatigue that doesn’t track cleanly with other recovery milestones, or symptoms a doctor has waved off as “just stress,” Dr. Hedaya’s PNIE (psycho-neuro-immuno-endocrinology) questionnaire is a useful starting point. PNIE Questionnaire download: https://drive.google.com/file/d/1S7kC5uMFgBfS-gWcUOIHp0kOjGnrzZK5/view?usp=sharing If thyroid function specifically is what you’re navigating, the earlier conversation with Dr. Elena Zinkov, “Stroke Fatigue and Thyroid,” goes deeper into that piece (https://recoveryafterstroke.com/stroke-fatigue-and-thyroid/). And for more from Dr. Hedaya, the first conversation on photobiomodulation and stroke recovery is a good companion listen (https://recoveryafterstroke.com/photobiomodulation-stroke-recovery/). Getting your body back after a stroke is rarely just about the brain. My book, The Unexpected Way That A Stroke Became The Best Thing That Happened, goes further into the mindset shifts that came out of my own recovery (recoveryafterstroke.com/book). And if this podcast has helped you, you can support its continuation at patreon.com/recoveryafterstroke. This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. Hormones, Fatigue, and the Brain: Dr. Robert Hedaya Returns (Interview) A baseball-sized thyroid nodule hid in plain sight after Bill’s stroke. Dr. Hedaya explains the hormone testing every survivor should ask for. Support The Recovery After Stroke Podcast Bill’s Book: The Unexpected Way That a Stroke Became Thethe Best Thing That Happened Highlights: 01:45 Hormones and Stroke Recovery 02:11 Understanding Thyroid Function and Its Impact 17:07 Navigating Thyroid Health with Healthcare Providers 27:09 The Role of Stress and Cortisol 39:09 Nutrition’s Impact on Brain Recovery Transcript: Hormones and Stroke Recovery Bill Gasiamis (00:00) And they noticed a massive lump in my throat and my esophagus and my windpipe were pushed six centimeters. And they said to me, well, can you swallow? Can you breathe? Can you do it? And I was like, yeah, I’m all fine. There’s nothing wrong with my throat. that was the first sign that there was something wrong with my thyroid Bill Gasiamis (00:19) Welcome back to Recovery After Stroke. I’m Bill Garciamas, and today I’m joined again by Dr. Robert Hedeya, clinical professor of psychiatry at Georgetown University Medical Center and a pioneer of functional medicine psychiatry, whose highland approach to brain health first brought him onto the show for our conversation on episode 404, where we discussed, amongst other things, photobiomodulation, a type of transcript. cranial laser therapy helping some stroke survivors recover lost function. He’s back today for a conversation I wanted to have for a while, the hormonal side of stroke recovery. We’re going to talk about thyroid function, cortisol, and stress physiology, and sex hormones like testosterone and estrogen, and why every one of these systems can directly affect how well and how fast your brain recovers. I’ll also share my own story of a thyroid nodule that grew undetected, which was discovered after my brain surgery completely by accident. if this conversation resonates with you, my book, The Unexpected Way That a Stroke Became Thethe Best Thing That Happened goes deeper into the mindset shifts that shaped my own recovery. You can find it at recoveryafterstroke.com/book. And if you’d like to help keep this podcast going, you can support it financially at patreon.com/recoveryafterstroke. Bill Gasiamis (01:46) Robert Hedaya, welcome back to the podcast. Dr Hedaya (01:49) Thank you for having me, Bill. Understanding Thyroid Function and Its Impact Bill Gasiamis (01:51) thank you for being here. The last conversation we had was very well received. And it’s always difficult in a one hour interview to ask all the questions that we could possibly ask about the brain and stroke recovery and all the things that people go through. And… I’ve got a lot of other questions that are related to the brain and the link between other parts of the body and the brain, because we have this sense. Well, I did at least when I was first diagnosed that whatever happens in my head is kind of isolated, that it just impacts my head. But there seemed to be some other impacts and cascading effects. that were occurring, uh, that I didn’t know were linked to the brain injury, Dr Hedaya (02:45) Yeah. Bill Gasiamis (02:46) maybe indirectly, but they were perhaps. But one thing specifically that happened to me about, uh, 18 months after my brain surgery was I had thyroid surgery to remove a nodule on my thyroid. And when I was going through the recovery after that, surgery, I noticed that I had fatigue and I thought it was neurological fatigue related to my brain surgery. But it took a long time to develop an understanding that perhaps that batch of fatigue was related to my thyroid. And then that got me thinking all sorts of things. know, if the thyroid also causes the same neurological fatigue that brain injury causes, what people might be missing this in their healing from a brain injury, they might have a compromised thyroid and not know about it. So the first question is, what is a thyroid? What does it do? And why does it cause neurological fatigue? Dr Hedaya (03:54) Okay. So thyroid gland sits in the neck, right? There’s two lobes, there’s one on the right, one on the left, a little kind of island in the middle called the isthmus, and and it controls many functions, metabolism overall, energy overall, just broadly speaking. now it affects the immune system. It’s affects the nervous system. It affects the gastrointestinal system, it affects the muscles, it affects the heart, right? It affects the skin, it affects the nails, it affects the hair. You know, and I could go on and on and on. Okay? Bill Gasiamis (04:34) Wow. Dr Hedaya (04:35) Now the interesting thing about this is that this be a little technical, but the thyroid puts out a hormone called T4 or thyroxine, and this is a little molecule with four iodines in it on it, and that Gives you about 20% of the activity of your thyroid hormones in your body. But then that T4 goes all over the body to different tissues, and each tissue can has its own system to change that T4 into T3 by removing an iodine. T3 has 80% of the thyroid activity. So that means each tissue in the body can control how much thyroid it. It’s using and needs, right? And and has available to it. Okay. So that means the brain, the heart, the liver, the lungs, every tissue has its own enzyme that allows it to kind of modulate how much thyroid, right? Now, so why does that cause neurological fatigue? Well, thyroid in the brain affects neurotransmitters like adrenaline in the brain, which is called nor norepinephrine, noradrenaline. in order for that to work. The T3 has to be in the right amount for the receptors for the noradrenaline to be structurally correct so they can transmit the signal. It’s necessary for production of energy in all the brain cells. It helps the immune system in the brain. It carries molecules from here to there in the brain. it affects serotonin transmission in the brain, so mood regulation, anxiety, obsessiveness, depression. You know, those are just some of the functions of the brain, but it affects every cell in the bane in the brain. So you’re gonna, if your thyroid is off, most likely you’re gonna have some kind of brain problems, particularly, you know, when your thyroid is off, the tissues in your body that are most compromised or most stressed, that’s probably where it’s gonna show up, right? And in the case of stroke, that’s where it’ll show up. Bill Gasiamis (06:44) So it’s possible then, is it possible to overlook it? Is it very obvious that your thyroid is out of, well, is dysregulated or is not working properly? Dr Hedaya (06:56) Well, in general it’s easy to detect. And if you want, I’ll tell you how. So Bill Gasiamis (07:04) Yeah. Tell me how. Dr Hedaya (07:07) so there’s some blood tests that are simple and then s some symptoms. so for most people this holds. When your thyroid is low, you know, you’re gonna be cold easily, you’re gonna have dry skin, brittle nails, hair will fall out. Muscles will be weak, thinking will be slow, movement will be slow, getting up from a chair will be more difficult, going upstairs will be more difficult, your heart rate will slow down, you’ll be constipated. Those are the most common symptoms. If your thyroid is overactive, then you could be have palpitations, oily skin, acne, oily hair. Diarrhea, you know, kind of the opposite. The thing that’s a little confusing with the thyroid is sometimes overactive thyroid can show up and look like it’s underactive symptomatically, or vice versa. So you really need the labs. And the labs are TSH, which is thyroid stimulating hormone, and that’s tells you what the brain is doing. And then free T4. That’s the amount of T4 that’s kind of floating around free, not bound to protein, so it can actually do its job. The way I think of it is like, you know, a lot of the thyroid home is sitting on a bus. It’s not free, it’s bound to protein. Can’t do its job. But the stuff the thyroid this that’s out of the bus or not on a protein, that can do its job. That’s the free T four. And then the free T three, right, which carries eighty percent of thyroid activity. And then the last one is a reverse T3 because sometimes if your tissues in your body are making too much thyroid or getting too much thyroid, they’ll actually, instead of taking the iodine off the T4 molecule on the right side, they’ll take it off on the left side, or vice versa. So they make a fake T3 that doesn’t work. And this way they short circuited okay, you got all this T3. Well, let’s make it into a fake, fake T3 so it can’t do anything. So reverse T3 is also very important. And then you want to measure body temperature. Usually it’ll be low. And then, you know, a physical exam. Those are the ways to do it. If you wanted to go even deeper, you could do some genetic testing. There are genes that will tell you whether you’re converting the T4 to T3 in the brain. Adequately, or maybe you’re more likely to be slow in that regard. So you can have normal numbers in your blood, but your brain might be hypothyroid, right? And there are actually a lot Bill Gasiamis (10:05) Uh-huh. Dr Hedaya (10:05) of studies showing that hypermetabolic, like high doses of free T3, actually reverse treatment-resistant depression because it’s it’s thought that there’s a local in-brain. hypo-low thyroidism. You can have low thyroidism in your heart, in your muscles, but not in the other tissues, you know, because I told you every tissue can control how much it’s making. So if you have a genetic vulnerability, then you you might more be in general be more likely vulnerable to depression or to ADD or to anxiety, things like that. Bill Gasiamis (10:42) Wow. Are you blowing me away? I didn’t expect to hear any of the things that you just said. X. Um, some of the things that you described, the, uh, some of the symptoms that you described, had those intermittently in and out all the time, other than a thyroid nodule, which is what I had, which was obvious on a scan. Dr Hedaya (11:05) Yeah. Bill Gasiamis (11:06) What other things caused the thyroid to not function? correctly. So is there lifestyle factors that interfere with the thyroid gland and therefore, you know, then have the cascading effect and take off, take all those other things or some of those other things offline. Dr Hedaya (11:28) So there a number of causes, right? So first of all, let’s take someone who has had a stroke or chronic illness, right? So you’re under stress and that affects your stress hormones, your adrenal glands, cortisol, etc. Well, if your adrenals kind of poop out, then maybe your body says, Well, I can’t handle all this thyroid, even though the amount is normal, it’s like too much. I can’t handle it, so it’ll make less thyroids. Now you develop a hypothyroidism. You could develop it just because all the chemicals in the environment, the ha the hormone interrupting chemicals, there are hundreds of those. you could develop it ’cause of nutritional deficiencies like tyrosine is necessary to make thyroid hormone, copper, you know, things like that. I can’t tell you offhand which which nutritional factors, but people can look that up, what nutritional factors are important. To make thyroid hormone. and then infections like, for example, Lyme disease causes Hashimoto’s thyroiditis, which is an autoimmune where your immune system’s actually attacking your thyroid. COVID vaccination, like the Pfizer and the Moderna vaccine, if you are genetically vulnerable, can also cause your immune system to attack your thyroid. So there are many, many causes, plus there are inherited genetic vulnerabilities and it It’s not always low thyroid, sometimes it’s high thyroid, hyperthyroidism, like Graves’ disease, right? You can have antibodies Bill Gasiamis (13:01) Mm-hmm. Dr Hedaya (13:02) that are actually stimulating thyroid activity as well. Bill Gasiamis (13:06) Wow. The environmental toxins. we talking about all day, every day household use kind of environmental toxins? I imagine the external of the house, they’re kind of out of our control, right? We’ll talk about like, you know, like pollution or things that are associated to things that are caused that we don’t necessarily control, but internally inside the house or what we expose ourselves to that we can control. what would some of those environmental toxins Dr Hedaya (13:38) Well Bill Gasiamis (13:39) be? Dr Hedaya (13:40) so for example, you know, in your produce, you know, there are pesticides, or in the man made materials in your car or the man made materials in your home. Let’s say you bought a new home and you have, you know, some kind of synthetic floors or furniture with synthetic materials or materials that are natural that are treated with chemicals for various reasons. Those things all can be not everyone is, but many of them are called homes. hormone interruptors because they actually can change the way your hormones function. You know? So we’re the truth is we’re bathed in these chemicals. They’re everywhere. And very hard to escape them. The best thing you can do is kind of try to detox them using a healthy diet, a lot of crucifer vegetables and lots of vegetables, above ground vegetables that are grown in healthy soil. Without pesticides, organic preferably, right? and then there are supplements you can take, such as metagenics makes something called UltraClear Plus, which helps support the liver, and its detox functions. You know, some people are more vulnerable than others, but you know, these thyroid nodules you like you have, they’re very, very common now. Very common. And that’s you know. In large measure, I think these hormone interrupters that are interfering with how the the thyroid follicles in the thyroid gland are operating. Bill Gasiamis (15:13) Is it possible to have thyroid nodules and not know about it? I, I Dr Hedaya (15:18) Yeah. Bill Gasiamis (15:19) say that because I had nodules that were the size of a baseball, apparently in my throat that were growing inwards, that didn’t make a lump outside of my throat, which Dr Hedaya (15:33) Yeah. Bill Gasiamis (15:34) I was not aware of. And the way they found it was they did a chest X-ray after brain surgery because I wasn’t recovering well. to check my chest to see if there’s an infection. And they noticed a massive lump in my throat and my esophagus and my windpipe were pushed six centimeters. Dr Hedaya (15:52) Wow. Bill Gasiamis (15:53) I’m not sure what that is in inches. And they said to me, well, can you swallow? Can you breathe? Can you do it? And I was like, yeah, I’m all fine. There’s nothing wrong with my throat. But that was the first sign that there was something wrong with my thyroid before that. there was no sign of it. I ask that because either I’m totally oblivious or it is possible to have thyroid nodules and not know it. Dr Hedaya (16:23) Well, most people don’t know it. Now yours is so massive, but I think it’s kind of what you said is how it grew. If it grew towards your vocal cords or your laryngeal nerve or something, you would have had some pretty bad hoarseness or something like that. But it grew I guess backwards so it didn’t interfere that much. And I guess your s your body adapted gradually over time. You know, yes, it’s very possible for sure. Very common. Bill Gasiamis (16:49) And how would somebody interact with a general practitioner, for example, now to go through the process of understanding, A, their thyroid health and whether or not they have any nodules. Navigating Thyroid Health with Healthcare Providers Dr Hedaya (17:02) I mean in other words, given what we’ve talked about, how should they approach their doctor basically? Bill Gasiamis (17:07) Yeah. Dr Hedaya (17:08) I guess I would say go to AI, get a list of the symptoms of low thyroid or high thyroid or all of them, check them off. So then when you go to the doctor you have a list, check your temperature, check your pulse, although the doctor will should check that. And then you could say, look, I have these symptoms, or maybe you don’t have any. But if you do, you have these symptoms, and clearly thyroid hormone levels can affect the brain. And I’d like a TSH, a free T4, a free T3, and a reverse T3. That’s it. And if they Bill Gasiamis (17:45) Okay, perfect. Dr Hedaya (17:46) say, no, no, we don’t need to do that, you know, a lot of times what they do, they’ll just do a TSH. Or they won’t do the reverse T3. They don’t, unfortunately, look at the thyroid gland in a dynamic way. They say, the TSH is fine. If your thyroid was low, your TSH would go high. We don’t need to do the rest. But that’s not true. That’s not true at all. Because especially if you had a stroke, your pituitary function may be compromised. Your TSH may be fine or low and your low thyroid. As matter of fact, in the last interview, the case that I talked about, who referred me to you, she actually had a low TSH, but she had a very low, I think it was a free T4. Or free T3 or both, whatever it was, but she had too little thyroid hormone, and her pituitary couldn’t respond because of the stroke. Bill Gasiamis (18:37) understood. So that’s a great list of Dr Hedaya (18:37) So so be you have to be dogmatic and you say to the doctor, look Even put into even put into AI and say, look, if the doctor comes back to me and argues against these tests, what should I say? You gotta be prepared because the doctor will steamroll you. You know, that they only allow this, they only allow that, I’ll only do the free T4. Well, that doesn’t tell you how much has been converted to T3, free T3, and it doesn’t tell you, even if the free T3 is normal, that doesn’t mean you’re not overproducing thyroid and and dis you know, and neutralizing it with the reverse T three. So, you know I mean I I mean I think it’s s so important that a thorough look is is really important. If you have the symptoms, you know. Bill Gasiamis (19:22) I agree with you. That list of to-dos, I’m gonna put that on the show notes. People can go and get that list if they don’t wanna go into AI themselves or they haven’t got the time or whatever. They can just download it from there. And then they’ll be able to take that and begin a conversation with their general practitioner. What’s interesting is that I’m in Australia, you’re in the United States. My general practitioner is pushed back when a… when a patient will turn up and say, I have these tests? They’ll say, well, no, you don’t have any condition that is obvious that you need these tests. So it’s not covered. So you don’t need to do it. So my next suggestion to them is no problem. Order the tests and I’ll pay for them. Now it’s not ideal, but if you’re not going to do them for me and I need to know, cause it’s my health, I’m going to pay for them. So just tell me how much it is and I’ll find a way and I’ll make it happen and I’ll pay for it. So that’s another option. Dr Hedaya (20:17) Yeah. But if you go in with your symptom list, right, and you say, Well, that’s not true, because these are the symptoms, you know, that I have, here they are, right here. You can take a look, you know. And then the last thing I’ll say, this gets even more tricky, is the reference range, I’m sure in Australia, but certainly in the United States, the reference range basically is of the TSH, the pituitary home. Is 0.5 to 4.5, meaning you anywhere in that range and your TSH is normal. That is a bad reference range. And I know it to be a fact because I I I guess I won’t waste your time with it, but I did a study on a hundred people and with a very sensitive thyroid test called a TRH stimulation test. and I was able I hired a statistician to calculate this. And say, well, I don’t want to keep doing this test on everybody. What TSH predicts an abnormal TRH stimulation test? And he came back and said to me, Well, once the TSH is over 1.4, it starts to increase your odds of having an abnormal TRH stimulation. So I said, okay, so 1.4 TSH is my cutoff, right? That’s in my mind. I said, okay, that’s that’s my cutoff, that’s when I get suspicious. Later, several years later, a paper came out, a large, large study, called the NHANES Study, Nurses Health, and I’m not sure what it stands for. Thousands of people followed over many, many years, over decades, and they found the mean TSH in the US population is 1.4. So, right where I what right where my study found. So that means statistically, it is not. impossible to have the upper limit of the reference range being at four point five because statistically the upper limit is never more than two standard deviations. So even if your standard deviation is 1.4, which it can’t be, you you’re not going to reach 4.5, right? Unless you have a it’s called a bimodal distribution curve. If you have that, then you’d say, well, it it could be. But we don’t have that with thyroid. So that reference range is wrong. The upper limit of the reference range should be 2.5. And about half the endocrinologists in the United States believe that. And half say, no, no, no, don’t change it. So that’s another sticky point because, you know, easily people get a result and they’ll go to the doc and say, no, the reference range is 4.5. You’re normal. Then you could say, well, look, I have these symptoms, and they could do a literature search. What’s the normal reference point? What in in the N A N HANES N-H-A-N-E-S study? It’ll show you 1.4. and you could take be prepared to go to the doctor and say, Well, here’s a study that suggests that the reference range may be incorrect. and I have symptoms by the way. We don’t treat the lab, we treat the person. So could we give a trial? Just a trial, there’s no harm done, you know, trial. Let’s see let’s start at a very low dose. Let’s see how I feel. Maybe I’ll get better. I’ll come back in a month. Bill Gasiamis (23:45) Yeah, I love that. It’s really good advice, especially coming from someone who is a doctor who think is thinking on the same way as me, for example, the patient. Because that’s like a match made in heaven. And that’s so rare to be able to get that. Often, my challenge to my general practitioner was well, the reference range isn’t that average of a sick population, because it’s usually a sick population that comes to see you to get bloods. It’s It’s not the most healthiest people that come to see you to get bloods. And that’s kind of how I try to like start the conversation of convincing a general practitioner to do a test that they’re reluctant to do. And when I say they’re reluctant, I’m not in there every day. I’m not in there every week. And I’m not putting stress on the system to an extent where I’ve been over using the system. I’m not at all. in there once, twice a year, maybe, you so if I’m in once, twice a year, well, then, I’m not mucking around. Like I’ve come there to investigate something that I’m suspecting is wrong with me. It’s my body. I’m feeling something. had a bit of a look online. This is what I suspect. Don’t try and convince me out of my thinking or my instinct more better. Why don’t we just, work together to get to the bottom of it. If it is something it is, if it’s not, it’s not, and that’s okay. Not a big deal. I’m better to know. then not no, I think, you know, it’s better to be safe than sorry in my mind. Dr Hedaya (25:16) Yeah. I would I would only think only correction I would make is the reference ranges generally are made on normal populations. Now now the thing is who’s normal anymore? Number one. Number two, that’s a statistical norm that doesn’t tell you anything about your genetics. your vulnerabilities, it’s not an individualized statistic. I mean it’s it not an individualized thing. What’s your normal range? And are you out of your normal range? Nobody can answer that, right? Unless you had previous data before you were ill. And you say, well look, I’ve been running at a 1.1 for five years or 10 years and now I’m at 3.2. That’s a big change. Well, you know you’re stressed. Well yeah maybe but here are my symptoms. Always come back to your symptoms. Bill Gasiamis (26:11) Got it, got it. Dr Hedaya (26:12) No. Bill Gasiamis (26:13) You use the word stress just now and my general practitioner says, I might go in and some bloods might be out of whack or some things might be not feeling great. And he’ll say, are you stressed? And I’m like, well, I’m not stressed. like, I’m not stressed in any way that I can say is worse than normal. For example, I’m Dr Hedaya (26:35) Mm-hmm. Bill Gasiamis (26:36) just, you know, I’m attending to my clients at work. picking up the kids from school, I’m, you know, making sure the bills are paid. Like I’m just doing the normal things that I always Dr Hedaya (26:48) Right. Bill Gasiamis (26:48) do, which tend to be stressful. And somehow when we talk about stress, cortisol seems to come into the conversation. Dr Hedaya (26:57) Mm-hmm. The Role of Stress and Cortisol Bill Gasiamis (26:58) And I don’t know how to respond to a general practitioner who says to me, am I stressed? Because I’m not experiencing something extreme or dramatic. in the months before I came to see him. So can we have a conversation a little bit about stress, cortisol, what is stress, what is cortisol, are they linked? Tell me about that, give me your thoughts. Dr Hedaya (27:21) Okay. Okay, so this is a multi-layer system. Okay, it starts with your perception and your of a situation and the story you tell about you the story you tell yourself about the the situation and your need for control of a situation and as opposed to saying I’m in the flow of the universe and All right, this is you know, this is the way it is, and I’ll adapt to it. Not so easy by the way, but it’s a much healthier way because most things will not stress you. Now, pain, let’s say you stepped on a nail, you’re gonna have stress, okay? Totally stressful, etc. But there’s a a difference between pain and suffering. Most of our problem is suffering. Suffering is a result of thinking patterns. perspectives of yourself and the world and the future and blah blah blah. I could talk about that for a long time. And that is probably one of the most important places to intervene and to train yourself, etc. Now, once this thing is registered as stress, it goes through back to the hypothalamus and the pituitary where all those hormones are controlled, the hypothalamus and pituitary in the brain, now you’ve God forbid, you’ve had a stroke. Those things may be affected, therefore, those systems may not be working well. In that case, you may not be able to handle stresses that you used to handle. You may not you may not have those shock absorbers. So, how do you measure this? I think the way you measure it again are symptoms, and typically it would be low cortisol and low DHA, d DHEA, and low pregnenolone. And the symptoms would be a lot of fatigue, right? Maybe poor wound healing, muscle aches, body pains, getting sick more easily, cognitive slowing, depression, anxiety, extreme exhaustion, salt cravings, in unstable temperatures, you know, I would say yeah You know, th loss of appetite in severe cases, you know, dizziness on standing. Okay. So those are the low adrenal output things. Now how d how do you measure and again, you think you have a problem, go to an AI thing, make that list, check it off, whatever applies, and you know, work yourself up symptomatically and then ask well, okay, what what are the best tests here? What are the best test. Now the way I test it is I get morning I got a morning like eight to nine a.m fasting ACTH and cortisol. It’s gotta be in the morning around between eight and nine a.m. fasting. I also at the same time get a D, like David, H E A and a D H E A sulfate, and then I also get a pregnenolone. And if I think there’s any kind of sex hormone problem that I want to check, then I will check a free testosterone, FSH, LH, and The testosterone measures the free testosterone is very unreliable. So if it comes out low, you want to do it two more times to double check that. But the other measures are pretty reliable. And then you’ll you’ll know the other thing you can do is you could do something called a Dutch test, which is a urine test that’ll look at your cortisol through the day, or an adrenal saliva test. It’s ASI, alleval adrenal saliva index, the Dutch test. or the ASI, both good tests. and those will tell you what’s going on through the day. Like if you’re not sleeping, it could be because your cortisol high at night, you know. Wake up horrible or in pain. Could be because your cortisol is really low in the morning. Really low. You can’t even get out of bed, you know, can’t get going, right? So these are all all things that you can do to measure and then you can replace these hormones and That’s one thing to do. The other thing to do is to work on how you manage stress. There are millions of ways of doing that, right? From meditation to heart math to Bill Gasiamis (32:05) Mm-hmm. Dr Hedaya (32:06) yoga to you know, there’s just a lot a lot a lot of ways to Bill Gasiamis (32:10) Yeah, let’s go back for a moment and talk about testosterone because when I hear testosterone, I’m hearing you say to a male that I need to have testosterone in my body and at certain levels, et cetera. And sometimes it can fall out of whack and you need to get it tested. I had mine tested recently. It’s all good. But women also need testosterone. Tell me about that. Dr Hedaya (32:35) Yeah, so I was I was thinking of both male and female when I said it, Bill Gasiamis (32:38) Yeah. Dr Hedaya (32:39) because it’s it’s you know, women who are postmenopausal can have it’s much more common to have a low free testosterone loss of libido, you know. testosterone the studies which I’ve reviewed a few times, you know, there’s a debate does it affect the mind, the brain, you know. It seems to have an effect on well being, on vitality muscles, sex drive obviously, libido erectile function, brain cognitive function, some mood effects, etc. So I I think it’s important now i it it has to be managed in women as well as men. You know, in in women testosterone is a step on the way to estrogen as it is in men, right? And in the metabolism, right? So it it should certainly be assessed in everybody. Bill Gasiamis (33:39) Yeah. And estrogen, mentioned estrogen. Now, one of them in my mind, it seems to be more associated again to women, estrogen, especially. And, and then men also have estrogen, need estrogen. Dr Hedaya (33:55) Men also have estrogen. I haven’t studied it so I couldn’t tell you, but I imagine it’s doing something. it probably turns men into better leaders after they’re fifty, is my guess. Let Bill Gasiamis (34:08) more emotionally intelligent. Dr Hedaya (34:10) more emotionally intelligent, less testosterone, you know. You know, I I I Bill Gasiamis (34:15) You know what? That’s a good theory. We’ll run with that for now. I might relate to that, know, who knows. Dr Hedaya (34:22) Yeah. I I think Bill Gasiamis (34:24) Awesome, awesome, so… Dr Hedaya (34:24) Yeah, so w for for women on estrogen, it depends, you know, who are you assessing? Are you that’s a whole complex subject, you know. Is it a young woman who’s menstruating? Does she have premature ovarian failure, endometriosis, ovarian cysts, insulin resistance, they all kind of travel together, methylation problems, they travel together. is it someone who’s perimenopausal where she’s starting to lose progesterone and getting a lot of PMS? That’s pretty easy. You can replace the progesterone. Is it postmenopausal a woman who’s just kinda lost the estrogen, lost the progesterone? You know, if there’s a family history of cognitive decline or dementia or something like that, there’s great evidence that transdermal estrogen and some oral progesterone bio bioidentic, not synthetic, is great and reduces the risk for lots of disorders later in life for women. You know. So there’s a whole you know, there’s a whole way of working all that up, depending on who who you’re looking at. But very important. Now so the let me Bill Gasiamis (35:31) Yeah, I love it. Yeah. Dr Hedaya (35:34) say this. The important thing here, and this is maybe the most important thing. Someone’s had a stroke, they’re obviously tremendously stressed. You have to look at all the hormones. You can’t the brain is a hormonal organ. It’s an immune organ. It’s a neurological organ. I used to teach psycho, neuro, immuno, and the chronology at Georgetown for a number of years. Okay? And the brain and hormones, you can’t separate it. So if the brain is under stress, the hormonal axes are under stress, and there’s not one hormonal axis when it’s abnormal that cannot cause neurological or psychiatric problems. Okay? So you must, as part of the work of anyone who’s had stroke. You must look at the endocrine, the hormonal axis. You know, you must look at it. Why? Because if you’re trying to recover from a stroke and you don’t have adequate hormones, it’s gonna be much, much harder. Much, much harder. Right? But Bill Gasiamis (36:37) Peace. Dr Hedaya (36:38) if you have if you have the the hormones at good levels, okay, now the the brain has that. If it has its nutrients, it has that, you know, okay, now it can do something, you know. What happens, think about it this way. What happens in adolescence? The brain is being rewired, the body’s growing, brain is rew being rewired. Where are the hormones? The hormones are skyrocketing. They’re necessary for the rewiring. You had a stroke, you’re trying to rewire brain, you gotta have adequate hormones. Bill Gasiamis (37:10) I love it. This is the thing that people miss. You know, we talk about the gap in stroke recovery. Acute phase gets handled Dr Hedaya (37:19) That’s Bill Gasiamis (37:19) 99 % of the time really well. People get patched up and they get sent home in some kind of alive state, whether they are fully functional Dr Hedaya (37:27) Yeah. Bill Gasiamis (37:28) or working towards it or whether they are less functional and working towards being more functional, like some kind of stage Dr Hedaya (37:35) Mm-hmm. Bill Gasiamis (37:36) of you’re alive and you’re good enough to go home. And then there’s no information after that. So how do we assess address? How, what do we know? What do we not know that we need to know? And this is kind of what this conversation is, right? It’s like, okay, here’s Dr Hedaya (37:53) Yeah. Bill Gasiamis (37:53) a whole bunch of things we’ve just discussed. There might have been things that you heard for the first time. Don’t let that, get in the way of your curiosity and investigate the thing that pricked your ears up, whether it was a symptom that Dr. Hedaya mentioned and just do a little bit more work in understanding what that is, take that to your general practitioner and begin the conversation of taking responsibility for your recovery. And in my mind, like there’s gotta be like a foundational thing that people can do to intervene that doesn’t cost most of the time anything extra. And that helps encourage and nourish the brain in overcoming these challenges, but then has the a cascade effect of having the same positive outcome on all the other organs and hormones. And that to me is nutrition. So like, if you’re, if you would suggest to somebody how they might start thinking about their nutrition as opposed to what they might have been doing before stroke, how do you begin that conversation? And what are the two or three fundamental things that they need to consider? about nutrition. Nutrition’s Impact on Brain Recovery Dr Hedaya (39:11) Okay, so If it doesn’t grow that way, don’t eat it. I never saw a bread tree. I didn’t see an ice cream tree or a Twinkie tree. Okay. So if it doesn’t grow that way, don’t eat it. Balance your plate. Balance your plate. And actually our coach, Caroline Hade, is putting out an ebook. I don’t know, should be out at a week or two or three weeks. It’s like, I don’t know, four or five dollars or something. and that will tell you exactly how to balance your plate. and then I would say very important to have three meals and maybe, depending on your how insulin resistant you are, maybe additionally two snacks. and per day, but keep your calories you don’t want to be overweight, okay, because if you’re overweight, you know, that’s a That’s its own risk factor for brain problems, right? but you can’t lose weight in a day, you’re stressed, you’re hungry, you’re tired, you eat the carbs, you know, everybody struggles with that. But that that is one of the biggest enemies of eating eating eating these processed carbs that we all love is one of the biggest enemies of your health. One of the biggest enemies of your health for sure. Bill Gasiamis (40:35) Okay, there are some great resources that people can again look into how to eat to heal the brain. And we didn’t have to have a deep conversation about that. But I love Dr Hedaya (40:45) Mm-hmm. Bill Gasiamis (40:45) what you said about balancing the plate. And if it didn’t grow that way, don’t eat it. It’s such a simple thing. If it comes in a packet on a shelf in a supermarket with all fancy pictures Dr Hedaya (40:59) Yeah. Bill Gasiamis (41:00) and stickers and a list of ingredients, like it’s probably not nutritional. of food. It’s probably something that’s going to make inflammation worse. It’s probably something that’s going to give you the type of energy that is not helpful. It’s probably going to have a whole bunch of other things. And that’s kind of my approach to healing and recovering my brain. It’s one of the first things I did was just look at my nutrition, immediately stop smoking and drinking. mean, I know it should go without saying, but sometimes you have to have a stroke for it to actually sink in and make sense. and don’t have any alcohol at all. I’m talking about forever if you can, but I didn’t have alcohol Dr Hedaya (41:46) Yeah. Bill Gasiamis (41:47) for at least the first four or five years. And now in the next five years or so, maybe I had one glass per year, just because I was, in an event where it was, everyone was drinking and it was almost necessary to have sip or half a sip or act as if I was drinking. So with that, I think we’ll wrap up this conversation today. There’s been a lot for people to digest, go back and listen to it a second time. And a third time that we have some resources in the show notes. And Dr. Hedaya, thank you for joining me again. And I look forward to our conversation that’s coming up in a few weeks time where we’re going to talk about toxin load and neuroplasticity. Dr Hedaya (42:29) Beautiful. Thanks so much for the opportunity, Bill. I hope I hope people get something out of this and they pursue what they need to pursue. Bill Gasiamis (42:36) Well, that’s a wrap on this conversation with Dr. Robert Hedeya. If there’s one thing to take from today’s interview, it is this. The brain is a hormonal organ and recovery isn’t just about the brain healing in isolation. Thyroid, cortisol, testosterone, estrogen, all of it is connected, and all of it is worth checking if your recovery has plateaued in ways that don’t quite make sense. Dr. Hadea’s free PNIE questionnaire is linked in the show notes. Download it, work through it, and take it with you to your next GP visit. If you want to go deeper on the thyroid piece specifically, go back and listen to the earlier episode with Dr. Elena Zinkov on stroke fatigue and thyroid. And if you missed it, the first conversation with Dr. Hedeya on photobiomodulation is a great companion to this one. if this episode has helped you, share it with someone who needs to hear it. That’s genuinely the best way to help this show reach more survivors. My book, The Unexpected Way That a Stroke Became the Best Thing That Happened, is available at recoveryafterstroke.com/book. And if you’d like to support the show financially, you can do so at Patreon by going to patreon.com/recoveryafterstroke. Until next time, take care of yourself and don’t assume it’s just a stroke. The post Hormones, Fatigue, and the Brain: Dr. Robert Hedaya Returns appeared first on Recovery After Stroke.

Dr. Tommy Wood, BM, BCh, PhD, is a professor of neuroscience at the University of Washington and an expert on brain health, neuroplasticity, and cognitive performance. Dr. Wood explains how to use specific forms of exercise, dietary strategies, and compounds to enhance the rate and stability of mental and/or physical skill development. We also discuss science-based tools to preserve cognitive function, reduce dementia risk, and offset loss of memory after a concussion or other brain injury. This episode provides practical, science-based tools for learning new information and skills and for improving your overall ability to learn. Read the episode show notes at hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman David: https://davidprotein.com/huberman Function: https://functionhealth.com/huberman Rorra: https://rorra.com/huberman Timestamps (00:00:00) Tommy Wood (00:04:05) Neuroplasticity; Neurogenesis; Synaptic Pruning (00:11:11) Aging & Neuroplasticity; Familiar vs Novel Tasks (00:14:33) Protocols Book; Sponsor: David (00:16:49) Aging, Training & Processing Speed (00:21:56) Enhancing Neuroplasticity with Age, Tool: Motor & Cognitive Challenge (00:26:56) Learning New Skills, Dance, Sports, Arts; Psychological Benefits of Challenge (00:36:50) Flow, Clutch States; Virtuosity (00:46:59) Power of Practice (00:50:55) Sponsor: AG1 (00:52:14) Tools for Focused Work & Learning; Distractions (01:00:17) Nutrition for Brain Health, Dementia; Critical Nutrients (01:06:56) Nutrient Timing, Supplementation; Omega-3s, Tool: Blood Tests (01:16:41) Sponsor: Function (01:18:19) Enhancing Brain Health, Nutrition & Supplements (01:23:10) GLP-1s, Peptides, Supplements & Evaluating Efficacy (01:32:56) Stimulants: Feeling vs Performance (01:37:18) Exercise & Enhancing Cognitive Function, Tool: Optimize Exercise Volume (01:43:18) Long-Term Cognitive Health & Exercise, HIIT (01:47:17) Sponsor: Rorra (01:48:31) Cortisol Benefits, Acute vs Chronic Stress (01:54:24) Resistance & Aerobic Exercise, Brain Gray & White Matter, Cognitive Health (02:03:37) Cognitive Decline, Dementia, Alzheimer's Disease, Modifiable Risk Factors (02:09:47) Shingles Vaccine & Dementia Risk; Tool: Avoid Illness for Cognitive Health (02:18:28) Concussion, Traumatic Brain Injury (TBI), Creatine (02:24:04) Treating TBI, Supplements, Physical Therapy (02:32:16) Strongman Competition (02:38:51) Zero-Cost Support, YouTube, Spotify & Apple Follow, Reviews & Feedback, Sponsors, Protocols Book, Social Media, Neural Network Newsletter Disclaimer & Disclosures Learn more about your ad choices. Visit megaphone.fm/adchoices

What actually helps when you're in the middle of acute grief and every day feels impossible? In this episode, I continue my two-part series on acute grief by sharing 10 practical strategies that supported me and the thousands of widows I've coached. My goal isn't to help you avoid grief, but to make the early days feel a little less overwhelming and a little more manageable. Get full show notes, transcript, and more information here: https://www.coachingwithkrista.com/373 Follow me on Instagram: https://www.instagram.com/lifecoachkrista/Mentioned in this episode:You're Invited to Grief Essentials LIVEJoin us for 8 weeks of expert guidance, practical tools and a community of widows who understand. Next live group begins August 4 – September 22, Tuesdays from 12:30-1:30pm Central Click here to learn more and sign up: https://the-widowed-mom-podcast.captivate.fm/grief-essentials-live Join us for Grief Essentials Live here Check Out Widow We Do Now? Wherever You Get Your Podcasts!

Send us a text if you want to be on the Podcast & explain why!A sudden shoulder pop during a heavy lift can mess with your head fast. We sit down with Dr. Coleman to map out what a smart, trainer-friendly response actually looks like when you or your client has acute shoulder pain and still wants to train safely.We talk about where a coach's scope begins and ends, why “never train anyone with pain” is unrealistic in the real world, and how to separate DOMS from true tissue irritation. Dr. Coleman shares a simple decision-making framework built around time and trend lines: how symptoms should change from day 0 to day 7, what it means when progress stalls at 10 to 14 days, and why a three-week plateau is often your referral point. We also dig into practical red flags, and why the shoulder can feel more ambiguous than a clearly swollen ankle or Achilles.On the training side, we get specific about movement selection. You'll hear how to use “target tissue” to decide whether an exercise is helping or just poking the bruise, when isometrics can be a better move than more reps, and which pressing positions tend to flare anterior shoulder or biceps tendon irritation. We also tackle the stretching debate, breaking down mobilize versus stabilize so you can make better calls instead of following trends.If you coach strength training, CrossFit, or general fitness, this is a clear, usable playbook. Subscribe, share this with a trainer friend, and leave a review with the shoulder issue you want us to cover next.Want to become a SUCCESSFUL personal trainer? SUF-CPT is the FASTEST growing personal training certification in the world!Want to ask us a question?  Email info@showupfitness.com with the subject line PODCAST QUESTION to get your question answered live on the show!Website: https://www.showupfitness.com/Become a Successful Personal Trainer Book Vol. 2 (Amazon): https://a.co/d/1aoRnqANASM / ACE / ISSA study guide: https://www.showupfitness.com

In this week's episode, Blood editor Dr. James Griffin interviews Drs. Haris Sohail and Lucas Kühne on their latest articles published in volume 147 issue 21 of Blood. In this CME article titled, "Retrospective, Real-World Study of IV Iron Use to Treat Iron deficiency Anemia During Acute Infection",  Sohail et al show that IV iron given during acute infection with iron deficiency anemia is associated with improved 14-day and 90-day survival as well as hemoglobin recovery. Although this report has the limitations of a retrospective study, these findings challenge current practice and support randomized trials that include patients with infection. In "Revisiting Clinical Response and Refractoriness in Immune Thrombotic Thrombocytopenic Purpura", Kühne et al show in a multicenter registry study of 204 patients that refractoriness during caplacizumab treatment in immune TTP is uncommon and, when observed, is typically associated with confounding clinical factors. These findings underscore the importance of careful clinical reassessment and evaluation for alternative etiologies in patients with delayed platelet recovery, rather than attributing such cases to true treatment resistance.

In this episode, we discuss the SOHO trial, a large multicentre randomised controlled trial comparing high-flow nasal oxygen with conventional oxygen therapy in patients with acute hypoxaemic respiratory failure. We cover the trial methodology, the key findings on 28-day mortality and intubation rates, and what the results mean for practice in both ICU and ward settings.

In this episode the guys break down five weird and common things people do that cause or worsen chronic pain — poor sleep, inflammatory diet, macro and micro deficiencies, dehydration, and shallow breathing. They cover the difference between acute pain and chronic pain, how movement pattern issues are almost always the root cause, and why the experience of pain can be just as real as the physiological signal. They also get into Arthur Saxon pressing 370 pounds overhead with one arm in 1905, eating 24 eggs and 10 pounds of meat a day, the genetics study showing hyper responders gain three times as much muscle as average responders, Sal going back to jiu jitsu and the whole family trying the Organifi parasite cleanse, Manukora honey on mat burns, and how poor sleep is the number one injury predictor — worse than skipping a warmup. Then they coach live callers submitted through mplivecaller.com. MAPS Upper Lower:⁠ https://mapsupperlower.com⁠Code: LAUNCH for 40% off. Includes male and female programs, workout videos, exercise demos, coaching videos and live coaching with Cole. Mind Pump Fitness Coaching:⁠ https://mindpumpfitnesscoaching.com⁠1.9 NASM CEUs SPONSORS Organifi (natural parasite cleanse):⁠ https://organifi.com/mindpump⁠Code: MINDPUMP for 20% off. Run two cycles 15 days apart. Discussed on air — Sal's whole family has started doing it. Manukora Manuka Honey:⁠ https://manukora.com/MINDPUMP⁠Code: MINDPUMP for up to 31% off plus $25 in free gifts with the Starter Kit. Discussed on air for wound healing and anti-inflammatory properties. Eight Sleep (Pod 5 Ultra) : ⁠https://eightsleep.com/mindpump⁠Code: MINDPUMP for up to $350 off. HSA/FSA may qualify — qualified customers save about 30% on average through Truemed. Truemed is for qualified customers. HSA/FSA tax savings vary. LINKS Submit a live caller question:⁠ https://mplivecaller.com⁠ Mind Pump Store:⁠ https://mindpumpstore.com⁠ Maps Fitness Products:⁠ https://mapsfitnessproducts.com⁠ Instagram: @mindpumpmedia 0:00 - Intro 2:20 - 5 weird things you do that make chronic pain worse 5:45 - Acute pain vs. chronic pain and why movement pattern issues are almost always the root cause 12:32 - Weird cause #1: Poor sleep — why it's worse for injury risk than skipping your warmup 16:00 - Weird cause #2: Diet and inflammation — Sal's gluten reaction and how to test for food intolerances 19:31 - Weird cause #3: Macro and micro deficiencies — protein, fat, magnesium and vitamin D 22:53 - Weird cause #4: Water intake — why hydration directly changes pain perception 26:52 - Weird cause #5: Shallow breathing — how breathing patterns keep muscles chronically tight 34:12 - Arthur Saxon — 370lb one-arm press in 1905, 24 eggs for breakfast and 10 pounds of meat at dinner 43:01 - Genetics study: hyper responders gain three times more muscle than average in six months 47:17 - Sal back at jiu jitsu, Manukora honey on mat burns and the whole family on parasite cleanses 1:00:32 - Caller: Candy (California) — went from 34 to 28% body fat eating more, freaked out and cut calories, gets a coach 1:16:26 - Caller: Jessica (Massachusetts) — 9 months postpartum, eating disorder history, 1742 calories, redlining 1:32:36 - Caller: Ruth (New Jersey) — 55 years old, chronic dieting history, gut issues derailing reverse diet 1:45:14 - Caller: Angela (Washington) — trainer and business owner, 20% body fat, chasing goals and needs a new direction  

Group A strep in the pediatric ED: from strep throat to invasive disease and toxic shock. Host: Ellen Duncan, MD, PhD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Group_A_Strep.mp3 Download Leave a Comment Tags: Infectious Diseases, Pediatrics Show Notes Background Group A strep = Streptococcus pyogenes — gram-positive organism that colonizes the pharynx, but also the perianal and genital mucosa (worth remembering when the source isn’t the throat). Extremely common. The episode cites an estimated ~289 million cases/yr of strep pharyngitis in children 5–14 (NIH). For a U.S.-specific, verifiable anchor: the CDC estimates strep throat drives ~5.2 million outpatient visits/yr in people

What if some of the most frightening parts of acute grief are actually completely normal? In this episode, I begin a two-part series on acute grief by sharing ten things I wish someone had told me after my husband died. My goal isn't to make acute grief hurt less, but to help you stop wondering if you're grieving "wrong" when your mind and body respond in ways you never expected. Get full show notes, transcript, and more information here: https://www.coachingwithkrista.com/372 Follow me on Instagram: https://www.instagram.com/lifecoachkrista/Mentioned in this episode: Check Out Widow We Do Now? Wherever You Get Your Podcasts!You're Invited to Grief Essentials LIVEJoin us for 8 weeks of expert guidance, practical tools and a community of widows who understand. Next live group begins August 4 – September 22, Tuesdays from 12:30-1:30pm Central Click here to learn more and sign up: https://the-widowed-mom-podcast.captivate.fm/grief-essentials-live Join us for Grief Essentials Live here

Guest: Professor Brendan Kelly

THE HOMEOPATHY HEALTH SHOW The Art of Acute Prescribing & Sensory Case-Taking – A Conversation with Marcus Christo Episode Summary In this engaging and inspiring episode, we welcome Marcus Christo, one of the UK's most respected homeopaths, educators, and acute prescribing specialists. Drawing on more than three decades of clinical practice, teaching, and public service, Marcus shares the principles that have shaped his unique approach to homeopathy—from the bustling clinics of the Glastonbury Festival to educating the next generation of practitioners. This conversation explores the power of sensory perception, the importance of efficient case-taking, and how mastering acute prescribing can transform both practitioner confidence and patient outcomes. In This Episode We Explore A Journey into Homeopathy • Marcus's unexpected path into homeopathy through Great Ormond Street Homeopathic Hospital • The influence of Charles Elliott, Physician to the Queen • Early inspirations from local homeopaths and herbalists • Building a lifelong career dedicated to teaching and practice The Travelling Homeopaths Collective • The origins of the Glastonbury Festival homeopathic clinic • Treating hundreds of patients in busy festival environments • Working alongside St John Ambulance and other healthcare services • Bringing homeopathy to the public through outreach and education The Art of Sensory Case-Taking • Applying Aphorism 84 through the use of all the senses • Observing hearing, smell, taste, appearance, and behaviour during consultation • Asking open questions and allowing the patient's story to unfold naturally • Recognising key symptoms without unnecessary complexity Mastering Acute Prescribing • Why acute prescribing builds practitioner confidence • Understanding the complete disease journey • The importance of etiology and current modalities • Clinical examples demonstrating the effectiveness of acute remedies Teaching, Training & Professional Development • Educating homeopaths through practical, experience-based learning • Encouraging confidence in fast-paced prescribing situations • Supporting practitioners to simplify complex cases • Inspiring the next generation of homeopaths The Future of Homeopathy • The need to attract younger practitioners into the profession • Adapting homeopathy to modern regulations and public expectations • Raising awareness through festivals, education, and community outreach • Preserving the essence of classical homeopathy for future generations About Our Guest Marcus Christo FSHom is an internationally respected homeopath, educator, and Fellow of the Society of Homeopaths, recognised for his outstanding contribution to the profession. He is the founder of the Travelling Homeopaths Collective and has spent more than three decades teaching acute prescribing, sensory case-taking, and practical homeopathy to practitioners around the world. Known for his work at Glastonbury Festival and his dynamic teaching style, Marcus continues to inspire homeopaths through education, clinical excellence, and his commitment to making homeopathy accessible to the wider public. About the Homeopathy Health Show The Homeopathy Health Show - co-hosted and produced by Atiq Ahmad Bhatti and Naila Cheema - is the world's #1 homeopathy talk show, reaching a global audience through the UK Health Radio Network and all major podcast platforms. Atiq Ahmad Bhatti, a 4th Generation Homeopath, Teacher, Educator, and Global Ambassador for Homeopathy, is joined by Naila Cheema, an experienced Homeopath and Nutritionist. Together, they bring thoughtful conversations, expert insights, and a shared passion for holistic healing to every episode. Connect with the Hosts Atiq Ahmad Bhatti - Homeopath, Educator, Broadcaster Online: www.liketreatslike.co.uk Instagram: @like_treatslike Facebook: @liketreatslike YouTube: like_treatslike Naila Cheema - Homeopath, Nutritionist, Educator Online: https://homeopathynaila.com Instagram: @homeopathnaila Facebook: @Neeli.KC Stream Now Across All Platforms UK Health Radio: https://ukhealthradio.com/program/homeopathy-health/ Podbean: https://homeopathyhealth.podbean.com/ Apple Podcasts: https://podcasts.apple.com/us/podcast/homeopathy-health-with-atiq-naila/id1715524908 YouTube: https://www.youtube.com/@like_treatslike/featured Spotify: https://open.spotify.com/show/17rSCmlPGDkiSCyHePLPFx?si=51c640498df84727 Join Our Global Community of Listeners Hosted by: Atiq & Naila Top 5% Podcast Worldwide (ListenNotes Global Ranking) #1 Global Talk Show on Homeopathy Audience in 60+ Countries Real conversations. Real stories. Real homeopathy. Unlock the power of natural remedies to restore balance and vitality. Inspiring guests, expert insights, and global voices shaping the future of holistic medicine. Tune in, stay inspired, and explore the world of homeopathy with us. Homeopathy in Practice Explore webinars, masterclasses, education, and practitioner resources at: https://homeopathyinpractice.co.uk Join our global Facebook community @homeopathyinpractice    

A multicenter randomized clinical trial in Finland has found that, among patients initially treated with antibiotics for uncomplicated acute appendicitis, the rate of recurrence and appendectomy at 10-year follow-up supports the use of antibiotics. In this episode, host Rick Greene, MD, FACS, talks with Paulina Salminen, MD, PhD, FACS(Hon), from the University of Turku in Finland, who is lead author of the study, Antibiotic Therapy for Uncomplicated Acute Appendicitis Ten-Year Follow-Up of the APPAC Randomized Clinical Trial, in The Journal of the American Medical Association.   Talk about the podcast on social media using the hashtag #SurgicalReadings

In this episode of the SRP Podcast, hosts Denise Straiges and Alastair Gray dive deep into one of homeopathy's most misunderstood concepts: what does real healing actually look like—and what should clients truly expect when working with a homeopath?From Hahnemann's original writings to modern practice debates, they unpack the difference between gradual health restoration and quick-fix protocols that can overwhelm the vital force. Whether you're a practicing homeopath, a student, or someone considering working with a homeopath, this conversation will reshape how you think about outcomes in homeopathy.Episode Highlights✔️ What Does "Cure" Really Mean?Exploring Hahnemann's definition from the footnote to Aphorism 1 and why the word carries more complexity than popular marketing suggests.✔️ Acute vs. Chronic: Different ExpectationsWhy healing trajectories differ dramatically between short-term conditions and long-standing chronic disease patterns.✔️ The Vital Force Does the WorkUnderstanding how remedies function as keys rather than force—and why gentle intervention beats bombardment every time.✔️ Case Study: An Eight-Year Healing JourneyA detailed look at one young man's path from multiple diagnoses (EOC, Crohn's, PANDAS) to improved health—complete with acute flares that signaled progress, not regression.✔️ "Fake Homeopathy" vs. Hahnemannian PracticeHow to identify simplified protocol homeopathy practices vs. rigorous, principle-based treatment—including warnings about excessive nosode protocols and "detox" regimens.✔️ Miasmatic Disease in ContextWhy Hahnemann's thinking evolved from syphilis observations to the broader concept of chronic miasms—and what that means for modern practitioners.✔️ Mansplain CornerLight-hearted but pointed discussion about online discourse, unsolicited expertise, and the responsibility that comes with public homeopathic education.Mentioned in this Episode:

Acute confusion is often one of the first signs something is wrong. The sooner you identify the cause, the sooner your patient can get the treatment they need. Hit play to review 3 common causes to keep an eye out for. ___________________ ⁠Nursing School Survival Blueprint⁠ - Feeling overwhelmed or unsure how to approach nursing school? Download this free Blueprint to understand exactly what's working against you — and what to do instead. Straight A Nursing Study Resources⁠⁠ - ⁠Check out everything Straight A Nursing has to offer, including free resources and online courses to help you succeed!

Submit your question and we'll answer it in a future episode!Join our Patreon Community!https://www.patreon.com/badassbreastfeedingpodcastSPONSOROriginal Sprout. Original Sprout carries safe and effective styling, body and hair care products that are safe for babies and great for adults. Use code BADASS26 at www.originalsprout.com for 25% off of your purchase.Do you have stress in your life?  Who doesn't, right? But the big question is…will stress impact your milk supply?  Is it the number 1 killer of milk supply?  Tune in today as Dianne and Abby talk about different types of stress and what stress really does to milk supply.  If you are feeling stress around anything, you don't want to miss this episode.If you are a new listener, we would love to hear from you.  Please consider leaving us a review on iTunes or sending us an email with your suggestions and comments to badassbreastfeedingpodcast@gmail.com.  You can also add your email to our list and have episodes sent right to your inbox!Things we talked about:Question about cavities [4:36]The BIG giveaway [13:50]#6 and #7 on the Top 10 list [14:36]Talking about stress [16:06]What really happens with stress [21:30]Ways to help with the stress [23:48]Acute stress vs chronic stress [30:35]The big takeaway [32:04]Things we talked about or Episodes we think you should check out!https://badassbreastfeedingpodcast.com/episode/getting-a-good-latch-2/https://badassbreastfeedingpodcast.com/episode/normal-sleep-behavior-with-rebecca-michi/Set up your consultation with Diannehttps://badassbreastfeedingpodcast.com/consultations/  Check out Dianne's blog here:https://diannecassidyconsulting.com/milklytheblog/Follow our Podcast:https://badassbreastfeedingpodcast.comHere is how you can connect with Dianne and Abby:AbbyTheuring ,https://www.thebadassbreastfeeder.comDianne Cassidy @diannecassidyibclc,  http://www.diannecassidyconsulting.comMusic we use:Music: Levels of Greatness from We Used to Paint Stars in the Sky (2012) courtesy of Scott Holmes at freemusicarchive.org/music/ScottHolmes

This podcast will discuss acute abdominal pain in pediatrics, with a focus on an approach to this presentation, important differential diagnoses to consider, associated red flags, and initial investigations based on history. The podcast was created by Dr. Stephanie de Waal, a first year Emergency Medicine Resident at McMaster University, in collaboration with Dr. Mel Lewis, a Pediatrician at the Stollery Children's Hospital in Edmonton. There are no conflicts of interest to disclose by the authors.

Are your blood markers telling you and your doctor the whole story? Chronic inflammation is the silent driver behind nearly every major disease, and the good news is that your lifestyle choices decide the outcome. Don't wait for a life altering diagnosis to take action.In this episode of Salad With a Side of Fries, host Jenn Trepeck breaks down how blood markers move, how preventable diseases develop, and why epigenetics means your genes are not your fate. If you have ever felt like your health was out of your hands, this episode will change the way you think about your daily choices.What You Will Learn in This Episode:✅ Why chronic inflammation is considered the root cause of virtually every major illness and how oxidative stress accelerates disease progression in the body.✅ How epigenetics reveals that your lifestyle choices, not just your genetics, impact disease-related genes.✅ What specific blood markers to track for heart disease, type 2 diabetes, liver disease, and kidney disease, and realistic timelines for improving them.✅ How to advocate for yourself in a medical system still rooted in a prescription-first approach, and how to ask your doctor for the time and space to make disease prevention changes first.The Salad With a Side of Fries podcast, hosted by Jenn Trepeck, explores real-life wellness and weight-loss topics, debunking myths, misinformation, and flawed science surrounding nutrition and the food industry. Let's dive into real-life wellness and weight loss, including drinking, eating out, and skipping the grocery store.TIMESTAMPS:00:00 Preventable diseases don't have to be your story and what blood markers can and cannot tell you05:55 The most common diseases: heart disease, type 2 diabetes, and cancer and how they are linked to lifestyle choices06:46 Epigenetics explained: how your daily habits turn disease risk genes up or down17:21 Lifestyle choices, from gut health to the brain to the endocrine system, impact every organ system20:10 Oxidative stress and free radicals explained: the science behind chronic disease25:01 Lifestyle choices that support overall health rather than disease and healthcare 3.0, being your own advocate32:12 Discussion of food with no labels; vegetables, fruit and lean meat36:19 Movement as disease prevention: why sitting all day quietly drives chronic illness more than we realize41:06 Longevity, community, connection, sleep, and stress management as overlooked pillars of health42:05 Blood marker timelines: how fast insulin, A1C, cholesterol, and blood pressure respond to lifestyle changesKEY TAKEAWAYS:

In this first deep dive, Christopher Cogle explores the evolving landscape of acute myeloid leukaemia (AML). He discusses the challenge of translating research into real-world outcomes, emerging immunotherapies, precision diagnostics, and how innovations such as the Acute Leukemia Methylome Atlas may reshape AML management in the future.  Timestamps:  00:55 – Research Gaps  03:50 – Biologics  05:46 – AML Atlas  09:15 – Immunotherapy 

Shakings Coming (1) (audio) David Eells – 6-24-26 IT WILL SHAKE THE WORLD! Lynne Johnson 5-27-26 IAM, King Yeshuya wants you, My people to know that all will erupt soon in Iran. President Trump is playing a waiting game with the radicalized left in the IRGC for there are many factions vying for control. Trump is ensuring that when the United States military strikes Iran, the United States will have very few casualties. Trump doesn't want American casualties, therefore the United States is intending to use all intelligence being fathered to ensure few American casualties. When the U.S. Military strikes, there will be no doubt that the IRGC, in its radical form, is no longer in existence. Once assured of the success of this campaign, Trump will have the military pull back to the general areas away from Iran. Very shortly after the United States military pulls back from Iran, then Israel will strike. First, Damascus, Syria (a weapon depot) destroying it. Next, Israel will move against Iran's nuclear facilities along with their weapon depots. These strikes will effectively end Iran's nuclear program. Once this is concluded, then very shortly look for the First Event of MY Judgments (again these events of Mine, King Yeshuya, are not those of Tribulation, which are far worse, for a much longer time frame), the California earthquake which will shake the world as this earthquake is massive in size and in effect. I AM, King Yeshuya tells you this again so that you MY children, MY Believers are warned to plan, to prepare for what is soon to occur. IAM always warns ahead through MY prophets and messengers. Listen to My Words, heed My Warnings for they are to help protect you and your families. Continue MY children to come to ME in prayer, stay in MY Word, stay focused, stay calm. Come directly to ME, King Yeshuya with your queries. I AM will gladly answer you. IAM loves you MY children. Your King Yeshuya, the King of Kings and Lord of Lords, the Alpha and Omega, the Beginning and the End, the Most High, Commander of heaven's hosts and armies, the Lion of Judah, the Prince of Peace. Scriptures: Psalm 20:7 NKJV “Some trust in chariots and some in horses, but we will remember and trust in the name of the Lord our God.” Isaiah 43:2 NKJV “When you pass through the waters, I will be with you; and through the rivers, they will not overwhelm you. When you walk through fire, you will not be scorched, nor will the flame burn you.” Ezekiel 7:7 NKJV “Doom has come to you, you who dwell in the land; the time has come, a day of trouble is near, and not of rejoicing in the mountains.” Isaiah 17:1 NIV “A prophecy against Damascus: “See, Damascus will no longer be a city but will become a heap of ruins.” Isaiah 13:9 NKJV “Behold, the day of the Lord comes, cruel with both wrath and fierce anger, to lay the land desolate; and He will destroy its sinners from it.” Isaiah 13:6 NKJV “Wait, for the day of the Lord is at hand! It will come as destruction from the Almighty.” John 14:29 NKJV “And now I told you before it comes, that when it does come to pass, you may believe.” Lamentations 3:25 NKJV “The Lord is good to those who wait for Him, to the soul who seeks Him.”   FAMINE WILL EXTEND WORLDWIDE Lynne Johnson – 5-9-26 I AM, King Yeshuya, would like MY people to know that it is soon for the “Iranian Conflict” to conclude. It will end as IAM has stated; the United States will deploy missiles, which will effectively end the IRGC Regime's control over Iran. Then the United States will pull back their military, leaving destroyers, aircraft carriers, and such in the area. Shortly after the United States military is pulled back, Israel will strike Damascus, the other weapon depots in Syria, then strike Iran's nuclear facilities and weapon depots. Israel will present the truth with proof that Iran fully intended to finish the building of nuclear bombs to destroy Israel. There will be the usual outcry, but no one will “lift a hand” against Israel, for all of the surrounding Arab nations know the truth. They also know that they were not safe from Iran's nuclear attacks. Again MY children, this is your marker to know that you only have a short time to finish getting your food, to prepare for what is coming, MY First Event – Judgment upon California. Do not put off procuring your food, your other necessities. Use cash as much as possible and by going to different stores. Do not discuss storing food with ANY OTHERS as IAM has clearly stated unless you have spoken directly with ME, King Yeshuya, the King of Kings and Lord of Lords to find out who you are able to trust. Ensure that you get your answer from ME, BEFORE you talk with others. If you choose not to listen to ME here, you and your family will suffer harm. People will become desperate quickly for food – any food that they are able to find. They do not wish to share, and they will harm others to get food. Those who have not done so recently or at all, are to read Jeremiah – ALL OF IT! You will see what hunger does to people. There will be few people who you will be able to trust now, so be discreet and come to ME, King Yeshuya to find out who you can SAFELY SHARE YOUR FOOD WITH. You must also accept MY answer as final. IAM alone sees the hearts, minds, thoughts and intentions of ALL people! You do not. You must also understand that the famine will extend worldwide. It will not be located only in specific cities, areas, or countries. With the famine, there will be deaths and then pestilences due to these deaths. IAM will give you more specific detail on this soon. FOR NOW YOUR JOB IS TO PREPARE. COME DIRECTLY TO ME WITH YOUR QUESTIONS AS I AM WILL GLADLY ANSWER YOU. MY BELOVED CHILDREN, STAY IN PRAYER TO ME, STAY IN MY WORD, STAY FOCUSED, STAY CALM. Your King Yeshuya, the King of Kings and Lord of Lords, the Most High, the Alpha and Omega, the Beginning and the End, the Lion of Judah, the Prince of Peace Scriptures: Isaiah 17:1 NKJV “The burden against Damascus. “Behold, Damascus will cease from being a city, and it will be a ruinous heap.” Luke 21:11 NKJV “And there will be great earthquakes in various places, and famines and pestilences; and there will be fearful sights and great signs from heaven.” Psalm 9:8 NKJV “He shall judge the world in righteousness, and He shall administer judgment for the people in uprightness.” Ecclesiastes 8:6 NKJV “Because for every matter there is a time and judgment, though the misery of man increases greatly.” Psalm 76:8 NKJV “You caused judgment to be heard from heaven; the earth feared and was still.” Deuteronomy 8:6 NKJV “Observe the commands of the LORD your God, walking in obedience to Him and revering Him.” Proverbs 15:11 NKJV “Hell and Destruction are before the Lord; so how much more the hearts of the sons of men.” Psalm 112:5 NKJV “A good man deals graciously and lends; he will guide his affairs with discretion.” Deuteronomy 32:24 NKJV “They shall be wasted with hunger, devoured by pestilence and bitter destruction; I will also send against them the teeth of beasts, with the poison of serpents of the dust.” Romans 12:12 NKJV “Rejoicing in hope, patient in tribulation, continuing steadfastly in prayer,”   GOLDEN DOME MR POOL X - *GOLDEN DOME went fully operational on June 14, 2026.** Not announced. Not disclosed. ACTIVATED. Posted By: Lymerick 6-23-26 www.rumormill.news/269653   Mr. Pool @MrPool_QQ

Low back pain is everywhere—but the best care is often beautifully simple.

AP correspondent Ed Donahue more people are facing hunger threats.

Episode Summary:In this engaging and informative episode of the Pain Matters Podcast, hosts Sudheer Potru, DO, FASA, FASAM, and Co-Host Zafeer Baber, MD, sit down with renowned chronic pain advocate, Tom Norris. With a four-decade-long journey through the challenges of chronic pain, Tom shares his invaluable insights regarding the newly drafted Acute Low Back Pain Guideline** (drafted by the Pacific Northwest Evidence-based Practice Center at Oregon Health & Science University (OHSU EPC) and the American Academy of Pain Medicine), recently submitted to Pain Medicine Journal and currently under review. His unique perspective underscores the critical need for clear communication and collaboration between clinicians and patients, especially in the context of guideline development and healthcare delivery. Throughout the discussion, the trio delves into practical strategies for managing acute and chronic pain, emphasizing the importance of patient-centered communication, the role of alternative therapies, and the power of support groups. Tom candidly discusses his military background and how it has shaped his ability to advocate effectively for himself and others within the medical community. The episode also explores the significance of understanding non-pharmacologic pain management techniques, such as virtual reality, acupuncture, and Tai Chi, and the need for greater awareness and education on these options. Anchored by Tom's wealth of experience and wisdom, this episode serves as a robust resource for both healthcare providers and patients seeking to enhance their pain management approaches.  Key Takeaways:Patient-Centered Communication: Building trust and understanding between clinicians and patients is crucial in effectively managing pain and implementing guidelines.  Integrative and Alternative Therapies: Non-drug approaches like acupuncture, virtual reality, and Tai Chi can be beneficial in managing pain, but public awareness about these methods is limited.  Support Groups' Role: Connecting with others facing similar pain challenges can provide essential support and insights, offering solace and practical advice.  Empowering Patients: Patients should proactively educate themselves, prepare questions for their providers, and seek various treatment avenues to optimize their care.  Guideline Development Insight: Having patients involved in the creation of medical guidelines ensures that the recommendations are practical and resonate with those they are designed to help. *Views expressed by our guests are their own and do not necessarily reflect those of the hosts, their institutions, or the American Academy of Pain Medicine. **The Pacific Northwest Evidence-based Practice Center (PNW-EPC) at Oregon Health & Science University (OHSU) is partnered with AAPM for the development of an evidence-based clinical practice guideline on the assessment and management of acute low back pain (ALBP). This project was financially supported by the Food and Drug Administration (FDA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award [FAIN] totaling $1,999,980.00, with 100 percent funded by FDA/HHS. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, FDA, HHS, or the U.S. Government. The funders had no decision-making role in designing and conducting systematic review, data collection, analysis, and interpretation of the data or approval privilege on the recommendation and good practice statements. As requested, the FDA provided nonbinding feedback and technical support to the guideline panel and methodological team. A methodologically rigorous systematic review  on assessment and management of ALBP was conducted by the PNW-EPC to provide evidence for guideline development. An independent, multidisciplinary guideline development used evidence from the systematic review to formulation evidence-based clinical recommendations to the guide assessment and management of ALBP.  

Brain Endurance Training and mental fatigue may be the missing link limiting your physical performance, and this episode reveals how your brain, not your body, could be the true bottleneck. In this high-impact conversation, Dr. Greg Jones sits down with Dr. Christopher Ring, Professor of Psychology at the University of Birmingham, to explore how cognitive load, stress, and perception of effort directly influence endurance, recovery, and overall performance.In this episode, you'll learn how mental fatigue can reduce physical output, why your brain acts as a “governor” on performance, and how Brain Endurance Training (BET) can help increase resilience, delay fatigue, and improve both cognitive and physical capacity. Dr. Ring explains the science behind perceived exertion (RPE), how stress impacts the nervous system, and why traditional training has overlooked one of the most critical components of performance.We also explore how modern lifestyles—especially screen time and cognitive overload—may be silently reducing exercise capacity, and how targeted brain training protocols can reverse these effects. Whether you're an elite athlete, a high-performing professional, or someone looking to improve focus and endurance, this episode provides a science-backed framework for building a more resilient brain and body.If you're looking to break through plateaus in performance, reduce fatigue, and train smarter, this episode offers a powerful and practical blueprint grounded in cutting-edge research.

Prehospital blood is one of the hottest debates in trauma resuscitation — and the evidence just got a lot more interesting. In this episode, Drs. Patrick Georgoff and Ayman Ali sit down with Dr. Ed Barnard, UK defense professor of emergency medicine and author of the landmark SWIFT trial, and Dr. Juan De Chesney, trauma surgeon and pioneer in prehospital blood programs, to break down what we actually know about getting blood to patients before they hit the doors. The SWIFT trial — the largest prehospital whole blood RCT to date — found no superiority of whole blood over component therapy, but the story is far more nuanced than a negative headline suggests. From the logistics of carrying blood on a helicopter to the stark reality that only 1.8% of US ground EMS carries any blood products at all, this conversation exposes both the progress and the enormous gaps that remain. Hosts: Ayman Ali, MD: Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital.  Patrick Georgoff, MD @georgoff: Patrick Georgoff is faculty in the Department of Surgery at the Duke University School of Medicine where he serves as an Associate Professor of Trauma, Acute, and Critical Care Surgery and Trauma Medical Director. He is a leading educator and creator for Behind the Knife, a premier digital education platform and podcast advancing surgical training through innovative, high-yield multimedia content. Juan Duchesne, MD: Juan Duchesne is a trauma surgeon and Professor of Surgery serving as the Trauma Medical Director and Division Chief at the University of Mississippi Medical Center. His pioneering contributions to the field—particularly in whole blood and balanced resuscitation practices—have been honored with numerous accolades.  Ed Barnard, PhD FRCEM FIMC RCSEd, @edbarn @DefProfEM: Ed Barnard is an emergency physician and UK Defence Professor of Emergency Medicine, RCEM/NIHR Associate Professor, and Affiliated Assistant Professor at the University of Cambridge. He has sub-specialty training in pre-hospital and academic emergency medicine and possesses extensive experience in trauma, anaesthesia, and critical care across both civilian and military settings. His contributions to the field have been honored with five national research awards and a PhD - undertaken with the US Army in San Antonio, TX. This episode was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Date: June 12, 2026 Guest Skeptic: Mr. Ross Fisher. Ross is a paediatric surgeon, presentation guru (P-Cubed), and long-time friend of the SGEM.  Reference: Talan et al. Nonoperative Treatment of Appendicitis and Implications for Emergency Department Management: A Narrative Review. Ann Emerg Med. June 2026 Case: A 29-year-old healthy man presents to the emergency department […] The post SGEM#512: When you go your way, and I Go Mine – Surgery or Antibiotics for Acute Appendicitis. first appeared on The Skeptics Guide to Emergency Medicine.

A guide to diagnosing, imaging, and managing acute renal colic and nephrolithiasis in the ED. Hosts: Brian Gilberti, MD Avir Mitra, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Nephrolithiasis.mp3 Download Leave a Comment Tags: Kidney Stones, Urology Show Notes 1. CLINICAL CORE & PHYSIOLOGIC FRAMEWORK Epidemiologic Risk Profiles Lifetime incidence parameters hover around 1 in 11, presenting with a prominent male sex skew. Peak demographic manifestation concentrated within the 30–60 age band. High-yield temporal parameter: 50% recurrence vector within a 5-year post-initial-insult window. Mineralogical Composition Vectors Calcium oxalate crystals represent the predominant structural matrix. Struvite configurations (magnesium ammonium phosphate matrix) account for 1–2% of cohorts. Struvite stones function explicitly as infection-driven configurations secondary to upper tract proliferation; higher distribution index noted in female cohorts. Etiological & Modifiable Relational Dynamics Profound systemic dehydration or low baseline fluid throughput states. High-sodium diet structures and heavy animal-protein consumption loads. Positive genetic/familial history variables. Relative risk modulation: Each variable independently operates to expand baseline risk by a factor of 2x to 3x. Pathophysiologic Symptom Complexes Acute, sudden-onset, maximum-intensity (10/10) unilateral flank pain. Classic structural radiation vector tracking downward toward the ipsilateral groin/genitourinary dermatomes. Distinctive behavioral marker: Renal colic pacing/writhing behavior with zero antalgic position availability. Concomitant autonomic triggers: Nausea and emesis manifest in 50% of acute presentations. Physical Exam Discordance Metrics Severe subjective distress contrasted with a characteristically soft, completely non-tender abdominal palpation exam. CVA tenderness is completely variable and lacks reliable negative predictive value. Atypical Presentation Classifications Vague, poorly localized abdominal pain presentations occurring in up to 20% of active cases. Isolated lower urinary tract irritative signs including acute frequency or severe urgency. Incidental & Asymptomatic Dynamics Silent intrarenal or ureteral stones found incidentally. Longitudinal tracking demonstrates up to 33.3% of initially asymptomatic cohorts convert to fully symptomatic renal colic within a multi-year tracking window. 2. EXCLUSION DIAGNOSES & CRITICAL PATHWAY RED FLAGS Vascular Mimics: AAA rupture/expansion. This is a mandatory exclusion pathway in elderly cohorts presenting with acute flank or back pain. Physical tracking requires active exploration for an expansile, pulsatile abdominal mass. Gynecologic Emergencies: Ruptured ectopic pregnancy. Demands universal screening protocols via rapid beta-hCG testing in all female patients of childbearing potential presenting with lower abdominal/pelvic localization. Infectious Upper Tract Decompensation: Acute uncomplicated pyelonephritis. Differentiated via persistent high spikes, high fevers, systemic shaking chills, and profound pyuria. Genitourinary Structural Crises: Acute testicular torsion. Mandates a thorough, explicit scrotal/testicular structural exam if the flank pain radiates into the scrotum. Gastrointestinal and Adnexal Torsional Confounds: Acute appendicitis variants, acute mesenteric/bowel ischemia, and ovarian torsion syndromes. 3. LABORATORY TESTING & PHYSIOLOGIC EVALUATION Urinalysis Interpretation Nuances Microscopic or gross hematuria presents in approximately 66% to 90% of acute cases. Critical Pathological Caveat: Complete absence of hematuria documented in 20% to 33.3% of confirmed, acute obstructing ureteral stones. Diagnostic rule: A pristine urinalysis with zero red blood cells is entirely insufficient to exclude acute ureterolithiasis. Urinary pH as a Composition Clue Consistently low urinary pH parameters (pH < 5.5) point strongly toward a uric acid crystalline composition. Elevated urinary pH parameters (pH > 7.5) indicate the presence of urease-producing microbial pathogens, pointing toward a struvite infection stone. Infectious Screening Metrics Active tracking for marked pyuria, positive leukocyte esterase, and bacterial nitrites to rule out an obstructed, infected upper urinary tract system. BMP Immediate quantification of baseline serum creatinine to establish accurate eGFR values. Targeting detection of post-renal AKI from bilateral obstruction, unilateral obstruction in a single functioning kidney, or severe volume depletion. CBC Evaluation for marked leukocytosis. Physiologic Nuance: Mild-to-moderate white blood cell count elevations frequently represent non-specific stress demargination driven by severe pain and repetitive vomiting. High-grade white blood cell shifts demand immediate exclusion of systemic bacteremia or an infected, obstructed urinary system. Adjunctive Lab Pathways Rapid qualitative urine hCG testing. Reflex urine culture execution whenever urinalysis metrics display significant inflammatory profiles or clinical suspicion of UTI is high. 4. IMAGING MODALITIES & ALGORITHMIC CLINICAL SELECTION Non-Contrast CT Diagnostics Gold standard; diagnostic sensitivity and specificity parameters exceed 95% for stones >2 mm. Provides precise quantification of stone diameter (mm), exact localization (proximal, mid, or distal ureter), and degree of secondary hydronephrosis. Excellent structural visualization for detecting or ruling out alternate retroperitoneal, vascular, or intra-abdominal pathologies. Contrast-Enhanced CT Protocols Indicated when alternative intra-abdominal surgical pathology is highly suspected over isolated renal colic. Retains diagnostic capability to identify urinary tract stones >3 mm even within contrast-enhanced phases. NCCT Structural Architecture Limitations Standard stone protocol CT scans are executed in a prone position without IV contrast enhancement. It does not opacify the ureteral lumen. Presents a cumulative radiation exposure penalty when utilized serially across recurrent ED presentations. POCUS / Radiology Ultrasound Direct stone visualization capabilities are modest, operating at approximately 50% to 60% sensitivity, and is highly dependent on anatomical positioning at the extreme proximal ureter or the UVJ. Secondary obstruction tracking: Demonstration of hydronephrosis operates at a high sensitivity of approximately 80%. POCUS Clinical Utility Metrics Eliminates ionizing radiation exposure and allows immediate, rapid real-time execution directly at the patient’s bedside. Confirmation of significant hydronephrosis within a classic clinical presentation yields high post-test probability for stone presence while lowering suspicion for vascular catastrophes like a AAA. KUB Radiography Extremely poor overall diagnostic sensitivity, hovering around 57%. Fails to image radiolucent configurations (pure uric acid matrices) or small stones measuring

Welcome to the Daily Disciple Podcast. As daily disciples, we seek to adore and follow Jesus, our teacher, into the abundant life that he offers. Because we find Jesus irresistible, fascinating, and incredibly practical, we want to be students of his scripture. Today's episode is found in Luke 17 "Acute Observations."

CardioNerds (Dr. Billy-Joe Mullinax, Dr. Dinu Balanescu, and Dr. Jane Ehret) discuss risk stratification in acute pulmonary embolism with Dr. Stavros Konstantinides, Chair of the 2019 ESC Pulmonary Embolism Guidelines. Using a real-world case, this episode explores how modern PE care has moved beyond “massive” and “submassive” labels toward a dynamic, physiology-based approach. The discussion highlights the limitations of static risk scores, the importance of right ventricular dysfunction and biomarkers, and why normotension does not imply stability. Special emphasis is placed on intermediate-high risk PE, early identification of impending hemodynamic collapse, and the role of lactate, serial reassessment, and PERT teams in guiding escalation of care. Audio editing by CardioNerds intern, Joshua Khorsandi.The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Stable blood pressure does not mean low risk in PEHypotension is a late finding. Patients may have severe RV failure, hypoxia, and tissue hypoperfusion while remaining normotensive — a key concept behind “normotensive shock.” Risk stratification in PE must be dynamic, not staticLegacy scores like PESI and Bova provide a snapshot and predict 30-day mortality, but they do not capture short-term trajectory or impending hemodynamic collapse. Intermediate-high risk PE is a dangerous and heterogeneous groupPatients with RV dysfunction, positive biomarkers, tachycardia, hypoxemia, and elevated lactate may have in-hospital mortality approaching 15%, rivaling STEMI. Lactate is a critical but underutilized marker in PEElevated lactate reflects tissue hypoxia and early circulatory failure and may identify patients at risk for collapse before blood pressure declines. PERT enables physiology-driven, patient-centered PE carePERT teams operationalize continuous reassessment, integrate imaging, labs, and clinical trajectory, and allow timely escalation — shifting PE management from rigid categories to real-time decision-making. Notes Drafted by Dr. Jane Ehret. 1. What is the contemporary framework for risk stratification in acute pulmonary embolism? Modern PE risk stratification prioritizes hemodynamics and right ventricular (RV) function rather than clot burden. The 2019 ESC Guidelines classify PE into high risk, intermediate risk (low vs high), and low risk, based on: Hemodynamic status, RV dysfunction on imaging, and Cardiac biomarkers. This framework emphasizes early mortality risk but requires clinical context to guide escalation decisions. 2. Why is normotension insufficient to define “stability” in PE? Blood pressure is a late marker of circulatory failure in PE. Patients can maintain normal BP through Tachycardia, Increased sympathetic tone, and RV compensation. Many patients with preserved BP may already have shock physiology, including hypoxemia, elevated lactate, and RV failure — sometimes referred to as “normotensive shock.” 3. How should intermediate-risk PE be conceptualized clinically? Intermediate-risk PE is heterogeneous, ranging from patients who do well on anticoagulation to those who deteriorate rapidly. Intermediate-high risk PE is defined by RV dysfunction on imaging and positive cardiac biomarkers. Clinical features such as tachycardia, increasing oxygen requirement, and elevated lactate identify patients at highest risk within this group. 4. What are the strengths and limitations of commonly used PE risk scores? Legacy scores are useful for initial risk categorization but are static and limited in predicting short-term deterioration. Most scores were developed to predict mortality or complications at fixed time points rather than dynamic clinical trajectory. 5. What are the commonly used risk scores and clinical tools in PE, and what is each designed to predict? ESC Risk Stratification Algorithm: Identifies high-risk PE by hemodynamics. Uses PESI or sPESI in normotensive patients to distinguish low-risk from non–low-risk PE. Uses RV dysfunction and biomarkers to differentiate intermediate-low from intermediate-high risk. Forms the basis of many institutional PE pathways. PESI and sPESI: Validated to predict 30-day mortality. Widely used to identify low-risk patients appropriate for outpatient management. Heavily influenced by age and comorbidities. Bova Score: Predicts 30-day PE-related complications in normotensive patients. Composite PE Shock Score (CPES): Predicts normotensive shock in hemodynamically stable PE patients. Pulmonary Embolism Progression (PEP) Score: Predicts progression from intermediate-risk to high-risk PE within 72 hours of diagnosis. PE Short-term Clinical Outcomes Risk Estimation (PE-SCORE): Predicts clinical deterioration or death within 5 days of PE diagnosis. Hestia Criteria: Identifies low-risk PE patients safe for outpatient treatment. Wells' Criteria and Revised Geneva Score: Determine pretest probability for diagnostic triage. PERC Score: Rules out PE in very low-risk patients. 6. What is the role of biomarkers in PE risk stratification? Troponin and natriuretic peptides reflect RV myocardial injury and strain. Current guidelines treat biomarkers as binary (positive vs negative), despite risk being continuous. Biomarkers are most helpful for: Initial risk classification. They are less useful for: Short-interval monitoring and Detecting rapid clinical deterioration. 7. Why is lactate an important physiologic marker in PE? Lactate reflects global tissue hypoxia and impaired perfusion. Elevated lactate may identify patients with: Early circulatory failure and Increased risk of imminent hemodynamic collapse. Lactate is not currently included in ESC risk algorithms but may add important prognostic information in intermediate-risk patients. 8. How does trajectory influence decision-making in PE management? Risk stratification should be viewed as a dynamic process, not a one-time label. Worsening clinical trajectory may include: Rising heart rate, Increasing oxygen needs, Rising lactate, and Progressive RV dysfunction. Serial reassessment is essential for timely escalation of care. 9. What role do Pulmonary Embolism Response Teams (PERT) play in risk stratification? PERT facilitates: Multidisciplinary decision-making and Integration of imaging, biomarkers, and clinical physiology. PERT is most valuable for: Intermediate-risk and high-risk PE and Patients with complex comorbidities or uncertain trajectory. PERT enables a shift from category-based to physiology-driven PE care. References 1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3):1901647. Published 2019 Oct 9. doi:10.1183/13993003.01647-2019 2. Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives. J Clin Med. 2022;11(9):2533. Published 2022 Apr 30. doi:10.3390/jcm11092533 3. Choi WH, Kwon SU, Jwa YJ, et al. The pulmonary embolism severity index in predicting the prognosis of patients with pulmonary embolism. Korean J Intern Med. 2009;24(2):123-127. doi:10.3904/kjim.2009.24.2.123 4. Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. doi:10.1001/archinternmed.2010.199 5. Chen X, Shao X, Zhang Y, et al. Assessment of the Bova score for risk stratification of acute normotensive pulmonary embolism: A systematic review and meta-analysis. Thromb Res. 2020;193:99-106. doi:10.1016/j.thromres.2020.05.047 6. Zhang RS, Yuriditsky E, Zhang P, et al. Composite Pulmonary Embolism Shock Score and Risk of Adverse Outcomes in Patients With Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(8):e014088. doi:10.1161/CIRCINTERVENTIONS.124.014088 7. Zhang RS, Alam U, Sharp ASP, et al. Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(2):e013399. doi:10.1161/CIRCINTERVENTIONS.123.013399 8. Ehret J, Wakefield D, Badlam J, Antkowiak M, Erdreich B. Development of the Pulmonary Embolism Progression (PEP) score for predicting short-term clinical deterioration in intermediate-risk pulmonary embolism: a single-center retrospective study. J Thromb Thrombolysis. 2025;58(2):243-253. doi:10.1007/s11239-024-03051-5 9. Weekes AJ, Raper JD, Lupez K, et al. Development and validation of a prognostic tool: Pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE). PLoS One. 2021;16(11):e0260036. Published 2021 Nov 18. doi:10.1371/journal.pone.0260036 10. Zondag W, Hiddinga BI, Crobach MJ, et al. Hestia criteria can discriminate high- from low-risk patients with pulmonary embolism. Eur Respir J. 2013;41(3):588-592. doi:10.1183/09031936.00030412 11. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107. doi:10.7326/0003-4819-135-2-200107170-00010 12. Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004;44(5):503-510. doi:10.1016/j.annemergmed.2004.04.002 13. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144(3):165-171. doi:10.7326/0003-4819-144-3-200602070-00004 14. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2(8):1247-1255. doi:10.1111/j.1538-7836.2004.00790.x 15. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6(5):772-780. doi:10.1111/j.1538-7836.2008.02944.x

Send us Fan MailIn this episode, we discuss how to identify and manage the acute complications of sickle cell disease. Written by Dr. Yi Hui Luo (Internal Medicine Resident). Reviewed by Dr. Véronique Naessens (Hematologist) and Dr. Sanabelle Zaabat (General Internist). Support the show

In this episode, we review the high-yield topic of ⁠ Acute Abdomen from the Gastrointestinal section at ⁠⁠⁠⁠Medbullets.com⁠⁠⁠⁠⁠⁠Follow⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets

UnBecoming Part 3 - The Hallway. (May 14, 2026)You look over at the light streaming in through your bedroom window. It's not the soft light of the moon; it's artificial light. Street lights. You're not home, you're back home. In the same twin bed you slept in during high school, watching the same trees dance in the wind, the same shadows play on the same hardwood floors you played on, talked on the phone in circles on, those floors have witnessed you.And now you kneel on them. You pray on them, whispering down toward them, you walk in tight circles on them, not on a call, but as a form of meditation, feeling God's Love in every step. Calling His Name with every step. Asking to be shown, to be provided the next step- whether to divorce or not. Whether to move or not? To the beach, perhaps.You're conflicted. But the floor is not. The room is not. It's bare. It's clean. It's small, but tidy. You can hear yourself think here, even as you are trying to get out to that place beyond thoughts, where the real answers come from. The Peace you feel as you listen past your thoughts and look over their shoulders, brings about sleep.Just as you drift, you are startled awake. Was that a crash? Did something fall? Did someone fall? You listen… for the children. For your parents. Acute. Aware. It was nothing. You soften back into the mattress, resting on your back, not yet asleep again,CRASH.Definitely something that time. Definitely someone. Your heart rate rises faster than you can. You jump up, grabbing your phone with shaky hands, instinctively yelling, 'DAD!' the one you worry about the most. The one you've called on the most. The one who understands. Before you can even enter the hall, you see his feet sticking out of his door. God. >>>> UNBECOMING.https://www.curlynikki.com/unbecoming.html

Can an algorithm actually give you your life back? A recent Stanford paper revealed that using large language models at home yields massive efficiency gains—up to 176%. For busy surgeons drowning in clinical duties and administrative bloat, every reclaimed second is priceless.In this episode of Behind the Knife, Ayman and Patrick sit down with Christian Péan—an orthopedic trauma surgeon, Duke's Executive Director of AI and IT Innovation, and the Founder/CEO of RevelAi Health. He's also a Core faculty member at the Duke-Margolis Institute for Health Policy. Dr. Péan breaks down how naturally skeptical surgeons can adopt AI to save time, shares his granular daily workflow, and discusses his mission to cure physician burnout through tech. Whether you are a tech enthusiast or a total skeptic, this episode gives you the practical playbook for integrating AI into your surgical career today.Hosts:- Ayman Ali, MDAyman Ali is a PGY-4 at Duke Hospital and current Behind the Knife fellow.- Patrick Georgoff, MD @georgoffPatrick Georgoff is faculty in the Department of Surgery at the Duke University School of Medicine where he serves as an Associate Professor of Trauma, Acute, and Critical Care Surgery and Trauma Medical Director. He is a leading educator and creator for Behind the Knife, a premier digital education platform and podcast advancing surgical training through innovative, high-yield multimedia content.- Christian Péan, MD @DrChristianPeanChristian Péan is faculty in the Department of Orthopaedic Surgery at the Duke University School of Medicine where he serves as Executive Director of AI and IT Innovation. He is the Founder and CEO of RevelAi Health, a health technology company advancing the transition to value-based care in musculoskeletal health with conversational AI. He is also author of the popular substack Techy Surgeon.  https://www.revelaihealth.com/https://techysurgeon.substack.com/Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this video, Dr. Ruscio discusses 8 benefits of taking butyrate, a fat molecule with gut and systemic healing properties. Butyrate is produced by gut bacteria, but it is often low in different chronic health conditions. Supplementation has been shown to improve a variety of gut conditions, including IBS, IBD, and SIBO, as well as chronic inflammation and brain health. Doctor Ruscio also discusses some simple dietary strategies to increase butyrate production naturally.    ✅ Start healing with us! Learn more about our virtual clinic:  https://drruscio.com/virtual-clinic/