Podcasts about afib

Dave Asprey and Gabby Reece Talk Testosterone Therapy, Scream Cream, Autism as a Superpower, Cancer Protocols, and Surviving Fame in This Double Interview Episode Mega-Episode time! Your hormones might be causing symptoms you've been blaming on aging, stress, or your heart. This double interview episode gives you a real look at biohacking from two different angles: cutting-edge longevity science and the lived experience of hormone optimization after 50. Watch this episode on YouTube for the full video experience: https://www.youtube.com/@DaveAspreyBPR Host Dave Asprey sits down with Gabby Reece, an American athletic icon, wellness entrepreneur, and one of the most influential voices in women's health, fitness, and performance. A former professional beach volleyball player who became Nike's first female spokesperson and shoe designer, Gabby set volleyball records at Florida State University that still stand today, and her signature Nike shoe line famously outsold Air Jordan during its release. She has since built a career at the intersection of performance and longevity, co-founding Hamilton House, Laird Superfood (NYSE: LSF), XPT, and HIGHX, and hosting both The Gabby Reece Show and the Proof of Practice podcast alongside leading voices in women's health and evidence-based performance. She is also a New York Times bestselling author. In this episode, Gabby turns the tables and interviews Dave herself, creating a rare two-way conversation between two people deeply immersed in human performance and biohacking. Dave and Gabby dig into how mitochondria function as quantum systems that shape everything from cognitive performance to spiritual perception, why autism can come with genuine neurological superpowers, and what actually happens in the body when hormone levels shift after 40. Gabby shares her personal protocol, including weekly testosterone injections, an estradiol patch, and a compounded hormone cream that most people have never heard of, and explains how correcting her hormones, not her thyroid, resolved a heart arrhythmia doctors initially missed. The conversation also covers Dave's approach to cancer protocols, why he avoids GLP-1 drugs despite their longevity benefits, the peptides he actually uses for mitochondrial renewal, and how cyclical ketosis, fasting, and a carnivore-leaning diet fit into a sustainable performance strategy. They also talk about AI's growing role in personalized longevity research, sleep optimization while traveling, and the supplement and functional medicine protocols Dave relies on daily. You'll Learn: Why Gabby's heart arrhythmia turned out to be a hormone problem, not a cardiac one, and how testosterone fixed it when nothing else worked What "scream cream" actually is, how it works through vasodilation, and why doctors quietly prescribe it during hormone replacement therapy How mitochondria function as quantum systems and why improving their function can sharpen intuition, focus, and perception Why Dave believes autism comes paired with real cognitive advantages once the physical burden of the condition is addressed What Dave would actually do if diagnosed with cancer, from antifungal protocols to high-power infrared light and early detection screening The peptides Dave uses for mitochondrial renewal, including SS31 and lesser-known Russian bioregulators like epitalon and pinealon Why Dave avoids GLP-1 drugs despite believing low doses carry real longevity benefits How cyclical ketosis, fasting windows, and a carnivore-leaning diet support sustainable long-term metabolism Why surrender, not control, was the hardest and most expensive lesson of Dave's career Gabby's advice for raising confident daughters and why she believes success is less about deserving it and more about how you steward it Thank you to our sponsors! - Beyond Wonderland Conference | Oct 13 - 14, 2026. Get your ticket now at wonderlandconference.com. - Visit www.myvitalc.com/davesfav to unlock Dave's discount - Fatty15 | You can get an additional 15% off their 90-day subscription Starter Kit by going to fatty15.com DAVE and using code DAVE at checkout - Omni-Biotic | Discover your formula at OmnibioticLife.com. Take 20% off your first order with code ASPREY. Dave Asprey is a four-time New York Times bestselling author, founder of Bulletproof Coffee, and the father of biohacking. With over 1,000 interviews and 1 million monthly listeners, The Human Upgrade brings you the knowledge to take control of your biology, extend your longevity, and optimize every system in your body and mind. Each episode delivers cutting-edge insights inhealth, performance, neuroscience, supplements, nutrition, biohacking, emotional intelligence, and conscious living. New episodes are released every Tuesday, Thursday, Friday, and Sunday (BONUS). Dave asks the questions no one else will and gives you real tools to become stronger, smarter, and more resilient. Keywords: testosterone therapy, hormone replacement therapy, HRT for women, weekly testosterone injections, scream cream, compounded testosterone cream, vasodilation, AFib hormones, heart arrhythmia, menopause symptoms, thyroid vs testosterone, mitochondria quantum biology, biohacking, Dave Asprey, autism superpowers, cancer protocols, serrapeptase, nattokinase, peptides longevity, cyclical ketosis, carnivore diet, Gabby Reece, longevity for women, anti-aging hormones Resources: • Learn More About The Hamilton House At: https://hamiltonhouse.co/ • Watch Gabby's Podcast At: https://www.youtube.com/@GabbyReece • Get My 2026 Clean Nicotine Roadmap | Enroll for free at https://daveasprey.com/2026-clean-nicotine-roadmap/ • Dave Asprey's Latest News | Go to https://daveasprey.com/ to join Inside Track today. • Danger Coffee: https://dangercoffee.com/discount/dave15? • My Daily Supplements: SuppGrade Labs (15% Off) • Favorite Blue Light Blocking Glasses: TrueDark (15% Off) • Dave Asprey's BEYOND Conference: https://beyondconference.com • Dave Asprey's New Book – Heavily Meditated: https://daveasprey.com/heavily-meditated • Join My Substack (Live Access To Podcast Recordings): https://substack.daveasprey.com/ • Upgrade Labs: https://upgradelabs.com Timestamps: 00:00 – Trailer 00:52 – Gabby Interviews Dave 02:58 – Fatherhood and Teenagers 12:25 – Autism and Superpowers 17:02 – Quantum Biology & Biohacking 24:03 – Autism Epidemic and Hope 35:01 – Joe Rogan Feud 48:04 – Death, Immortality, Living to 180 56:24 – The Four F's Framework 1:04:55 – Cancer Prevention and Detection 1:18:20 – Travel Biohacking Tips 1:31:46 – Nothing You Can't Hack 1:41:23 – Peptides Deep Dive 1:52:33 – The Human Upgrade Podcast Starts 1:59:35 – Advice at Eighteen 2:10:03 – Fame and Holding Back 2:22:44 – Hormone Replacement Therapy 2:31:31 – Pursuit Over Happiness 2:43:02 – Advice for Tall Women See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Cardiologist and electrophysiologist Dr. Gregory Marcus, chair of the American Heart Association scientific statement writing group, reveals evidence on coffee/caffeine and cardiovascular health. He discusses how earlier assumptions that caffeine triggers arrhythmias are complicated by genetics, individual risk factors, and mostly observational research. Marcus reviews randomized and observational findings: the CRAVE trial showed no increase in premature atrial contractions but more premature ventricular contractions on coffee days; a trial in post-cardioversion patients found less atrial fibrillation with daily coffee. Observational data suggest lower risks of type 2 diabetes, heart attack, stroke, and AFib among coffee drinkers, while heart failure risk may be lower at low intake but higher around 4–5 drinks/day. He cautions against extrapolating benefits to energy drinks, discusses additives like sugar, touches on alcohol, cannabis, Mediterranean/DASH diets, pollution, and evolving AFib treatments, wearables, and pacing/ablation technologies.

Show notes at pharmacyjoe.com/episode1157 In this episode, I'll discuss differences in heart rate in patients with sepsis and AFib between phenylephrine and norepineprhine.

This week we speak with Dr. Ted O'Leary, Co-Director of Adult Congenital Heart Disease Electrophysiology at Boston Children's Hospital about a recent publication he authored on the use of pulsed field ablation (PFA) for the transcatheter ablation management of complex atrial arrhythmias in ACHD patients. How does PFA work and what are some of the potential advantages and disadvantages of this novel ablation energy technology? What are the advantages of a variable loop catheter in this setting? Is PFA going to supplant radiofrequency current for standard "SVT" ablations one day? These are amongst the questions reviewed with Dr. O'Leary this week. DOI: 10.1161/CIRCEP.125.014619

Justin Kaufman joins us for this episode of Everyday Ultra, and this one goes DEEP. From sobriety and rebuilding his life through endurance sports to becoming a 12x ultramarathoner, 2x Ironman, and someone taking on 12 ultras in 12 months.Kaufy has built a completely different approach to what it means to train, recover, and perform at a high level. Kaufy gets into the mindset, habits, and philosophy behind it all—and there are some seriously unconventional takeaways.In this episode you will learn:​ How sobriety completely changed Kaufy's relationship with endurance sports​ The high-volume, Norwegian-inspired training philosophy behind his massive mileage​ Why sleep, food, and recovery come BEFORE training​ How back-to-back long runs build the durability needed for ultras​ His wild fueling strategy, including HUGE carbohydrate intake and the legendary maple syrup method ​ Adjusting hydration, sodium, and carbs for heat, elevation, and race conditions​ Training for the long term while managing health, AFib, and race anxiety​ The mental toughness that comes from overcoming some of life's hardest battlesSHOW LINKSWant to be coached by me and my team to crush your next ultramarathon in our 1:1 coaching program?⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠Book a free call here⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ with one of our coaches to see if we are a good fit!Want to work with me to crush your next ultramarathon in our group coaching program? Sign up for our group coaching program here:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠https://www.theeverydayultra.com/group-coaching⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow Joe on IG:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/joecorcione/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Everyday Ultra YouTube Channel:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠https://www.youtube.com/channel/UCUelKGeptWZivD6yRIDiupg⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Try Mount to Coast shoes, designed specifically for ultramarathons, and get 10% off your order with code EVERYDAYULTRA by ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠going to the link here⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠.Try HYPERLYTE Liquid Performance running nutrition and get 15% off your order when you use code EVERYDAYULTRA at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.hyperlyteliquidperformance.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Try PlayOn Pain Relief Spray and get 20% off with code EVERYDAYULTRA at⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠playonrelief.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Try Janji apparel at ⁠⁠⁠janji.com/everydayultra⁠⁠⁠Create running routes easily with Footpath, the app designed to help you manage routes simply. Download for free and get a free trial at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠footpathapp.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠/everydayultraIncrease your recovery and performance with FivePointFive breathing exercises and get a 20% discount with code EVERYDAYULTRA20: :⁠⁠⁠⁠⁠⁠https://fivepointfive-ambassadors.onelink.me/KWZR/htluyd8z⁠⁠⁠⁠⁠Free Supplement Guide for Ultrarunners: ⁠⁠⁠https://docs.google.com/document/d/1Mhp3vKx1uJPU1-i9F03BVzZdDRiUHCk85HF7pjthoVM/edit?usp=sharingJustin's Instagram: https://www.instagram.com/morningkaufy/

OPENER: Stephen A Smith DESTROYS WNBA After HIDING BRITTNEY GRINER'S DIRTY SECRET! Defend Sophie Cunningham! - 5:11 Brandon Gill Gets Witness To Admit Who DEI Punishes - 5:13 “I went to court to argue what a woman is” — Sall Grover at ARC 2026 -1:00 Jason Arday Whistleblower: ‘People Knew The Truth And Covered It Up' - 4:00 Quick, easy, worthless: Students let AI do the thinking | Principia Scientific, Intl. - Text It's Time to Save America - 10:00   HEALTH NEWS Arginine Supplement May Strengthen Immune Response to Cancer and Viral Infections Yeast food supplement helps immune cells fight cancer more effectively Physical activity linked to lower stroke and death risk in adults with atrial fibrillation Phthalates may contribute to high blood pressure in pregnant women Daily Collagen Supplement Alters Bone-Related Blood Markers in Female Runners, Study Says Arginine Supplement May Strengthen Immune Response to Cancer and Viral Infections Rockefeller University, August 10, 2026 (Natural News) A study published in the journal Cell reports that arginine, an amino acid found in protein-rich foods and produced by the body, may help the immune system recognize and respond to cancer and viral infections. The research found that low arginine levels were linked to reduced production of MHC-1, a protein that displays abnormal cellular signals to T cells, according to the report. In mouse models, arginine-rich diets were associated with fewer colon tumors and milder influenza and SARS-CoV-2 infections, the researchers reported. The findings add to prior work linking declining immune function to cancer progression. When arginine is scarce, cells struggle to produce MHC-1 proteins, which appear on the surfaces of cells throughout the body and display foreign or abnormal proteins to T cells. Researchers repeated the dietary studies using mouse models of influenza and SARS-CoV-2, conditions previously associated with unusual levels of different amino acids. One of the most dramatic patterns to emerge was that arginine was the most depleted amino acid in all of these diseases. Not only did mice with an arginine-rich diet have milder symptoms from viral infections, giving the mice arginine after influenza infection improved their outcomes too. Yeast food supplement helps immune cells fight cancer more effectively Trinity College Dublin & University College Dublin, July 9 2026 Researchers from Trinity College Dublin (TCD) and University College Dublin (UCD) have shown for the first time that a food supplement made from yeast helps the body to make stronger immune cells that can fight cancer. The research teams found that adding a yeast-based supplement to the food of obese laboratory mice changes how their immune cells grow and help to make better cancer‑fighting cells. Mice were fed a standard or high fat diet supplemented with yeast beta-glucan for 4-12 weeks and then their immune system was challenged by different types of cancer cells (colorectal, skin and breast cancer). The study also tested whether yeast supplementation could overcome immune dysfunction caused by obesity and whether protective effects persist after weight loss. Crucially, this dietary intervention restores anti-tumor innate immunity in obese mice and reverses long-term immune memory defects that persist even after weight loss, a major unmet clinical challenge. Physical activity linked to lower stroke and death risk in adults with atrial fibrillation Arctic University of Norway, August 5 2026 (News-Medical) Being physically active was linked to a lower risk of stroke and death for adults with atrial fibrillation, or AFib, according to new, independent research published in the Journal of the American Heart Association. AFib is a quivering or irregular heartbeat that occurs in the heart's upper chamber known as the atria. According to the American Heart Association, it can lead to blood clots, stroke and other heart-related conditions. The prevalence of AFib in the U.S. was estimated at 4.48% of the adult U.S. population. The study tracked more than 87,000 adults in Norway for about 15 years, capturing information about AFib, stroke and death from national health registries. What did the analysis find? Compared to adults who were inactive, adults with a low, moderate or high level of physical activity had a 9%, 19% and 18% lower risk of stroke, respectively. Having a low, moderate or high level of physical activity was associated with an 11%, 18% and 22% lower risk of death from any cause, respectively. For people with AFib, staying active was tied to living an average of 0.5 to 1.2 years longer compared to those who were inactive Phthalates may contribute to high blood pressure in pregnant women Harvard School of Public Health, August 10 2026 (News-Medical) Phthalates, which are chemicals found in plastics, personal care products and hundreds of other consumer goods, may contribute to high blood pressure in pregnant women, according to a study published in the Journal of the Endocrine Society. The researchers measured phthalate exposure and blood pressure in 338 pregnant women at three points during pregnancy. They analyzed whether higher levels of these chemicals-individually and in combination-were linked to higher blood pressure or an increased risk of pregnancy-related high blood pressure disorders. The authors found that pregnant women with higher urine concentrations of fragrance-associated phthalates and those in personal care products had higher systolic and diastolic blood pressure markers of an increased risk of hypertensive disorders of pregnancy. About 13% of participants in the study developed a pregnancy-related high blood pressure disorder. Women with higher levels of certain phthalates, especially those found in personal care products, tended to have higher blood pressure later in pregnancy. Daily Collagen Supplement Alters Bone-Related Blood Markers in Female Runners, Study Says Fitchburg State University, University of Connecticut & Mayo Clinic, August 4 2026 (Natural News) A four-week randomized, double-blind, placebo-controlled trial found that female distance runners who took 20 grams of collagen peptides per day showed an approximately 5.1 percent rise in P1NP over four weeks, a blood marker of bone formation, while the placebo group showed no such change, according to a study published in Frontiers in Nutrition. The collagen group also showed a drop in IL-6, an inflammatory protein linked to bone breakdown, while placebo levels held steady or rose, the study reported. The trial included 22 female runners ages 18 to 35 who ran at least 35 miles per week, and no adverse effects were reported. Collagen is the most common and abundant protein in the body, accounting for about 30 percent of total protein content and providing structural support to bones, tendons, ligaments, and other connective tissues, according to published research.       Discussion about this episode

In this episode of The Consummate Athlete Podcast, Peter interviews Dr. Nigel Stephens is a Consultant Cardiologist at the Institute of Sport, Exercise and Health and Honorary Consultant Cardiologist at The British Olympic Medical Centre. He has speciality in sport cardiology and the athlete's heart.    We discuss:  Are Cardiovascular conditions like AFIB more common in Enduranec Athletes?  What is Atrial Fibrillation (AFIB)  Do Athhletes with AFIB and other conditions have stop cycling training and racing?  Are there things that help reduce or prevent cardiovascular conditions in Endurance Athletes like cyclists 

Send Zorba a message!Zorba opens up about his recent surgery, and what led to it. He helps a caller with a question about dealing with AI on health websites. He gives advice to a listener regarding liver health, discusses why the PSA test for prostate health is seen as controversial, and we hear from the pesky Grammar Cops.Support the showProduction, edit, and music by Karl ChristensonSend your question to Dr. Zorba (he loves to help!):Phone: 608-492-9292 (call anytime)Email: askdoctorzorba@gmail.comWeb: www.doctorzorba.orgStay well!

Send Zorba a message!Zorba opens up about his recent surgery, and what led to it. He helps a caller with a question about dealing with AI on health websites. He gives advice to a listener regarding liver health, discusses why the PSA test for prostate health is seen as controversial, and we hear from the pesky Grammar Cops.Support the showProduction, edit, and music by Karl ChristensonSend your question to Dr. Zorba (he loves to help!):Phone: 608-492-9292 (call anytime)Email: askdoctorzorba@gmail.comWeb: www.doctorzorba.orgStay well!

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Karin G. Johnson, MD, FAAN, who served as the guest editor of the August 2026 Sleep Neurology issue. They provide a preview of the issue, which publishes on August 3, 2026. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Johnson is a Professor in the Department of Neurology at the University of Massachusetts Chan School of Medicine–Baystate and the Sleep Medicine Division Chief at Baystate Medical Center in Springfield, Massachusetts Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @drsleepykarin  Full episode transcript available here Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast.  Dr Albin: All right, welcome all. For the first time ever in the history of Continuum Audio, we are coming to you live from Chicago here at the AAN annual meeting. And now over to your host, the one and only editor-in-chief, Dr. Lyell Jones.  Dr Jones: Welcome, everybody. My name is Lyell Jones, editor-in-chief of Continuum, and I'm here today with Dr. Karin Johnson, and we're interviewing Dr. Johnson for the upcoming and recently published issue of Continuum on Sleep Neurology. We have been doing Continuum Audio for a while, but we're doing something different this time. As our listeners online can tell, we are recording this for the first time ever with a live studio audience at the American Academy of Neurology annual meeting in Chicago, Illinois. So, this is a fun experience for us. I hope it's been fun so far for you, Dr. Johnson.  Dr Johnson: Great to be here.  Dr Jones: It's great to have you. So, before we get into the interview, I do wanna introduce our team here for the live recording of the podcast. You've already heard Dr. Casey Albin's voice. Dr. Casey Albin is an associate professor of neurology at Emory University. Also serves as one of our associate editors at the journal and one of our Continuum Audio interviewers. So, she's going to be working the crowd today. Let's have a round of applause for Dr. Albin. And our guest of honor today is Dr. Karin Johnson. Dr. Johnson is a professor of neurology at UMass Chan Medical School and, Baystate Medical Center in Massachusetts. She is a world-renowned expert in sleep neurology and is the guest editor for the most recent issue of Continuum on Sleep Neurology. Dr. Johnson, welcome. Why don't you introduce yourself to our audience?  Dr Johnson: You did a great introduction, but I'm a clinical sleep medicine specialist. Spend my days seeing patients, taking care of people with narcolepsy, sleep apnea, restless legs, everything that comes my way. And then I have a side interest in doing sleep medicine advocacy, especially for permanent standard time.  Dr Jones: And we may get to that. I mean, that might be part of our conversation today. So, you've now read all of the articles in this issue, and it's a really great issue. There's a lot of new developments in sleep neurology. There are some updates for clinicians, people who see patients with sleep disorders that I think are, are timely and important updates. You have this unique view because you have just read all of these articles, really good articles by expert authors. When you read through these, Dr. Johnson, what was the biggest, what was the biggest thing that surprised you?  Dr Johnson: I think the biggest surprise for me is just so many changes in, in all of these articles. I realized how easy it was for us to make a journal that is so different from a few years ago. Whether it's Dr. Stahl's obstructive sleep apnea and new ways to think about endotyping sleep apnea that is gonna have treatment implications or the new treatments that are out there like tirzepatide, the changes that we're having with restless leg treatment. I particularly wanted to have a chapter on circadian neurology that Dr. Abbott did a great job really highlighting how if we think about the timing of when we give meds, the timing of when we eat, how that really can help neurological health, brain health, overall health, as well as mental health and cognition, especially as the AAN thinks about brain health as a whole, not just treating our patients, but how we can treat the population of people by improving sleep. I like how we hit on all these different areas in this issue.  Dr Jones: And I don't know how you managed to do it. They're just a small number of articles. We cover a lot of existing territory with well-characterized diseases, with new advances. But there's a lot of new stuff in sleep, and so somehow, it's all packed in there. It's really impressive. One of the things I was gonna ask you about was an evolution, and this has been a number of years now in how we manage restless leg syndrome. When I was training, it was all about dopamine agonists, and that was your first line. And over time, the evidence has supported moving away from that, and now we have more recent guidelines that have come out, and it's really the alpha-two delta-one calcium channel antagonists. How is that transition going? Do you still see people in practice who come in on dopamine agonists? How is that going? How's the field responding to that?  Dr Johnson: That's one of my most frequent restless leg consults. So even though it's been years since I have really initiated dopamine agonists in my patient, every day we get in people often on very high doses of dopamine agonists, and their doctors have just been escalating and escalating these meds over the years, and they come in with horrible augmentation. Their symptoms are much worse than they used to be, happening earlier in the day. And so, trying to get these patients off of these meds that are addictive, the way I like to teach about it is these dopamine agonists are the Fioricets of the sleep world. We know they work great, but in the long run, the patients are gonna be worse overall. And so, it's so hard to get people off these dopamine agonists, just like it's so hard to convince a headache patient that they don't need their Fioricet and that they're gonna be better off if we can get them off of it. What I think has really changed is we have more options to use. So, the alpha-delta-like agonists like gabapentin are now considered first line, but there's a lot of patients who they just don't work well enough with or they don't tolerate. And so, what do you do in that case? It's easy when that works, but and, when that doesn't work, we are being much more aggressive these days with iron replacement, potentially even trying to push ferritin levels in refractory patients up to three hundred, and using IV iron rather than just oral iron to get over the absorption issues to get the brain levels high enough. Motor stimulators, little cuffs that kind of go around the leg and stimulate the peroneal nerve in a certain way that not only can give people immediate relief, but also some data that suggests that over time it actually lessens their restless legs. We have agents like dipyridamole that work on the adenosine system in a sort of new novel pathway at addressing restless legs. And then the opiates, often meds like methadone or Suboxone can be used in some patients. But as we're getting more of these other options, often we don't need to go to those levels because we do have more to work with.  Dr Jones: So, the key point is lots of options. We're not starting with dopamine agonists anymore. And I think the fact that you're still seeing a lot of patients who have been initiated on that probably tells us there's an education gap field that we need to work on. So, another thing that I noticed reading through the issue was, and this feels like a change over the last few years, is the availability and the tendency to use in-home sleep apnea testing as opposed to formal, traditional in-lab. And that feels like a great new option, and maybe that increases and improves availability for patients who need access to the test. But how do you work through that?  Dr Johnson: So, I love in-home testing. We've been using it for over a decade. Other parts of the country where insurances didn't sort of mandate it are now being more mandated. I think the real change happened for a lot of places over the pandemic when labs closed down. But I think it's good because it brings a lot more patients to us. They get tested, they get tested quicker. People who would say, "I would never go into a lab. Oh, I'll do a home study." So, it just does bring more people in, and it gets them to treatment that they need that can really be life-changing. But it's not for everybody. The biggest people are people that have other bad pulmonary issues. If you're on oxygen therapy, you should not be getting a home study. That really should be a group of people that come in the lab. Similarly, if you have bad COPD, you probably should be getting a full in-lab study, so we can get more monitoring. Central sleep apnea is an interesting one. It can be very hard in some cases to differentiate the centrals and obstructive nature as well on a home study. Doesn't mean you can't do a home. So, if it's a person that just can't get an in-lab study easily, maybe you start with the home. If it looks purely obstructive, and you're all set, then you got an answer, and you can move on. But if you get back a home study that looks questionably central, they're gonna need to come into that lab. So, if you already know they're high risk because they're on narcotics, cause they have congestive heart failure, it's usually worth going straight to the lab. But again, you may consider a home study based on the patient. Patients that really cannot use the equipment can also be an issue. So, if they've had a debilitating stroke and have no one to help them put on that device, or cognitively they just can't handle the device, they're gonna be someone who's gonna benefit from coming into the lab and getting the help from the techs. So, those are the big populations that you might go starting for a home. And then the other thing that confuses a lot of people, the home is only for diagnostics. It really isn't for treatment. So, I have patients that say, "Oh, like, you can just titrate my CPAP with a home study." No. So if it's a treatment decision where they're not doing well on treatment, or I need to figure out do they need CPAP or BiPAP or IVAPS or one of these more complicated treatments, those are people that are gonna need to come into the lab to get that treatment portion of the evaluation.  Dr Jones: What a great summary. That's like everything I needed to know about who do I need to bring into the lab and who do I think maybe could do an at-home study. Really great. And speaking of devices, I think all of us who see patients in the room here and our listeners out there online have experienced patients, and this feels like a very recent phenomenon to me, are coming in with their commercial at-home wearable device. And they have printouts sometimes, and they show me their phone, and they give me some numbers that I don't really know how to interpret. Reading through this issue, I learned a couple of great new words. I learned about orthosomnia, right? So, people who become so preoccupied with their sleep, it keeps them awake at night, literally, right? I mean, it's a complete paradox. I learned about nearables, so things that aren't necessarily wearables that are just in the room while the patient is sleeping that monitor proxies for sleep quality, sleep stage, and other things. And I frankly, I'm not really sure what to tell patients. So, what do you tell patients who come in with all the data? Like, or how do you tell patients to use these?  Dr Johnson: I think these devices can go both ways. So, I do kind of say the pros and cons of these devices. I think for a lot of patients, they're empowering. It's getting them to think about sleep, to wanna know how good their sleep is. Are they getting enough sleep? So, if it's used in those ways, it's gonna be very helpful. I actually had a patient last week, and they noted that they're having big desats all night and could show me essentially an overnight oximetry data rather than me having to order it, and I had days of data, which sometimes can be too much. But in this case, it's like, oh, when he was on his side that night, he looked a lot better, so I can use that to give advice to the patient about particular treatments. He actually went down to Mexico, and a doctor friend gave him oxygen therapy while he was there randomly. And we could see on the nights that he had the oxygen therapy, it did really help his central sleep apnea pattern. And so that pushed us towards saying, "Let's qualify you for that up here in the States." So, I think in some cases it can give really important data. Now, I saw a posting on social media the other day of someone saying, "Can I get advice on how to improve my REM sleep? My tracker says I have no REM sleep, and I need to do something about it." There's really not data to support needing to do something about it. And so, I do think it can get some people on these wild goose chases, trying to get to a certain percentage of sleep. And these trackers, they're good in a lot of ways, but they're not perfect. He could be getting REM sleep that the tracker on him does not show. You want to relate it to what symptoms are they having. I think they can be very good for trying something out. So, let's say someone, has their tracker telling them they get five hours of sleep, and they try this intervention, and that helps them show that they got the seven hours of sleep, or they went from no REM to REM and it goes in the right direction. It can help give them that positive feedback that something they're trying, is working. But the absolutes for any given patient, it's hard to over-- What does it mean if it says you've got a 50% score versus a 70% score? That may or may not be meaningful in any given person, but again, they can compare themselves to themselves. If they were a lower score and now they're a higher sleep score because they did something that was meaningful, and that goes along with them feeling better, that can help give them that positive feedback to do something good.  Dr Jones: So, a little bit of a mixed picture.  Dr Johnson: Yeah.  Dr Jones: Sometimes they help. Sometimes they distract. Hopefully- Dr Johnson: And as a provider, sometimes it can be overwhelming because they're like, "Come look at my year's worth of data." And you're like, "No."  Dr Jones: Yeah.  Dr Johnson: You know, let me see one page or two pages of data and be like, "Yep, okay, I get it." Dr Jones: Just show of hands in the audience, who in the room wears a sleep device at night, like a ring or a, some kind of sleep monitoring app? That's about half the audience.  Dr Johnson: This is why they're here.  Dr Jones: So that's really helpful, and I think it is. You want to be supported by the data. You want to be supported by evidence and high-quality biometric evidence. Another big trend, and this has been a number of years in the making, is the understanding, Dr. Johnson, of the relationship between sleep physiology and neurodegenerative disease. One of the things I love about neurology is there's still so much left to learn about the normal physiologic functioning of the brain. So glymphatics and other aspects of sleep physiology that we didn't know about a decade or two ago. When you think about how that relationship has developed, sleep physiology, maybe sleep disorders and neurodegenerative disease, how has that changed your approach to talking to patients? Do you counsel patients differently now because of what we understand better about that?  Dr Johnson: Yeah, I mean, we are still limited with our data. We have so many studies that show the associations between whether it's not enough sleep, too much sleep, or having a sleep disorder like obstructive sleep apnea, and that being a risk factor for stroke or Alzheimer's or Parkinson's. But we still sort of lack the treatment trials that necessarily say, "If you treat obstructive sleep apnea, you're gonna have less dementia," or, "You're gonna be less likely to have that stroke." So, we have a lot of physiological studies, a lot of reasons why it makes sense, but we don't have that final, nail in the coffin to say, "If you do this, you'll definitely be better." So, we know certain groups are more at risk. If you have obstructive sleep apnea and you are symptomatic, you seem to have higher cardiovascular risk. If you have a person who's had a stroke and we find a milder case of sleep apnea, and they're someone that's totally asymptomatic. They say, "I sleep fine. I feel fine." There's not great data to say, "If you treat your sleep apnea, you're gonna be less likely to have a stroke." Now, if they come in and they're sleepy and their sleep apnea is really severe, and they have more hypoxic burden, which is also more connected with a lot of these risks, I'm going to say, "I think you are in the higher risk group of sleep apnea people who it's probably gonna be more likely to help your cardiovascular risk, your dementia risk." We can counsel them, and then it's really a personal decision. Some people are like, "No way. I'm never gonna use a CPAP machine, ever." And other people are like, "You know, my mom had a stroke. My dad had Alzheimer's. I want to do every possible thing I can to make it less likely that I have this outcome that I want to avoid." And so, you're going to take that in to, you know, do you want to try this treatment or not? It's a lot easier when you have outcomes that you can follow, like, "If I try CPAP, does my blood pressure get better? Do I stop having AFib attacks?" It's a lot harder when, will I or not get Alzheimer's ten years down the road or have that stroke?  Dr Jones: It's hard to get people to do things for kind of an abstract prevention down the road, but could be important. Are there trials going on that are going to assess this data?  Dr Johnson: Yeah. We currently have a big trial getting people right away, right after their stroke, on CPAP, and not only looking at prevention, but also looking at recovery outcome. It's been running for several years. Hopefully, we'll get enough data to close out the study coming up.  Dr Jones: We'll look forward to that.  Dr Johnson: Yeah.  Dr Jones: So, I'm really excited to get to our audience here, but before we do that, I do want to ask Dr. Johnson one more question. Dr. Johnson is famous for her advocacy for sleep in general, but specifically related to Standard Time. So, let's do a little experiment here. I didn't warn Dr. Johnson about this, so we'll see how she does. She does a ton of advocacy. She's a pro. So, pretend like we're in DC, and I'm a senator, and we just got in an elevator. You're going to give me your elevator pitch on what we should do.  Dr Johnson: So, you know, sleep is one of the few essential things in life. We need to eat, we need to drink, we need to have clean air, and we need to sleep and when we improve sleep, we can improve basically every outcome, whether it's academics, whether it's productivity, whether it's our physical health, our mental health. And the problem is we structure our lives in a way that really keep people, and especially our teenagers, from getting the sleep they need. And one of these structural things we do is permanent daylight savings time. Essentially, what you're doing is you're putting the sun out later, makes it harder to go to bed. I was just talking to someone, the sun's going down at 9:00, and you need to get your kid to sleep at 7:30, 8:00 so they can get the amount of sleep they need. That is almost an impossible task because their circadian rhythms are being pushed later, they can't fall asleep on time. Then you're setting their clocks an hour earlier, so when that alarm clock is going off at 6:00 AM in the morning, it's actually 5:00 AM in the morning. You're squeezing sleep from both sides, and it's basically impossible to get enough sleep. A lot of people think the only problem with daylight savings time is twice a year with the changes, and there are certainly harms related to that. So, a lot of people think if we went to permanent daylight savings time it would be better, and we got rid of those changes. What they don't realize is that permanent circadian misalignment by setting the sun more ahead, at 1:00 to 2:00 instead of at noon causes the sleep and circadian disruption all year round that leads to increased incidents of strokes, of heart attacks, of obesity, of cancer, of suicides, of depression, of worse academic grades. Again, pretty much every outcome you have there that relates to brain health, we have now data that shows that it's worse. And so, we can improve our lives if we can go to permanent Standard Time.  Dr Jones: You convinced me. How about that? If there were any skeptics in the room, I doubt there are any left. We only went to like the fifth floor there, and she... I'm like, "I'm voting for this. Whatever, whatever this bill is, I'm gonna vote for it." So, I'm excited to get to the audience here. Before we get to questions and answers, and we want you to get your questions ready for Dr. Johnson. I do have a couple of trivia questions. And we've been doing this for a little while now on the podcast. The first trivia question actually relates to arts and culture.  Dr Jones: What famous artist used transitions between sleep and wake states to inspire his art? Anybody know?  Guest Speaker 1: Is it Van Gogh?  Dr Jones: Not Van Gogh that I know of. There in the back.  Guest Speaker 2: Picasso.  Dr Jones: Picasso, not that I know of. Right here.  Guest Speaker 3: Salvador Dali.  Dr Jones: Salvador Dali. We have a winner. Thank you for your answer. So apparently, I read this. Salvador Dali would sit in a chair holding onto a metal key and wait until he fell asleep, and it would fall out of his hands and drop into a bowl, and it would wake him up. So, then he would pick it back up, and he would go in and out of sleep trying to generate hypnagogic hallucinations, basically, and he would use that to inspire his art. And you think about his art, maybe that kind of makes sense. All right, now I've got a neurology trivia question. Okay, so maybe we're a little more comfortable with the neurology trivia in here. What is the center in the brain that is responsible for REM sleep atonia?  Guest Speaker 4: The receptor is for erection in the lateral hypothalamus.  Dr Jones: That is not correct. REM sleep atonia. Right here.  Guest Speaker 4: Emilio Malgona, Hyannis, Massachusetts. Dorsal raphe nucleus.  Dr Jones: We'll give you credit for that. Very good. Excellent. So, the-  Dr Johnson: Well, no. That's actually the serotonin. He's talking about another one.  Dr Jones: Oh, I thought I heard, I thought I heard-  Dr Johnson: You heard dorsal  Dr Jones: ... I heard dorsolateral tegmental nucleus of the pod.  Dr Johnson: Not quite.  Dr Jones: You get a prize anyway, sir, just for, just for answering. Thank you very much. All right. So, we're all warmed up here. So, Dr. Albin, what do you think? Should we get some questions from the audience?  Dr Johnson: All right, we've got some questions.  Guest Speaker 5: I have a statement and a question.  Dr Jones: Please tell the podcast your name again, sir.  Guest Speaker 5: Steve Spar, New York City. The tyranny of the morning people. You don't want people, you don't want the sun to go down too late because it'll keep people up longer. I spent my whole life fighting people like you. I am a nighttime person. Why do I have to go to sleep earlier? I want to go to sleep later. I want to wake up later. I don't want to wake up at 7:00 in the morning. I want to wake up at 10:00. There's a certain tyranny that we must use circadian rhythms of the majority, and it persecutes people like me who are night people.  Dr Johnson: So that is a great question.  Guest Speaker 5: What say you?  Dr Johnson: What say me is actually the harms of daylight savings time are actually to the night owls, and don't really affect the morning people. I can still go to sleep on time and get up on time without that pressure of needing to go to work. The night owl people, they can't fall asleep until later. They want to sleep in earlier, but we're forcing them to get up an hour earlier for work and school. And because we're doing daylight savings time, you're not getting the morning light you need, you're getting too much light at night, and you are more sensitive to a delay in your circadian rhythm, which makes you even more of a night owl and increase the degree of social jet lag. So, we actually see that the harms and risks of things like depression, cardiovascular risks are much greater in night owls than they are in normal people or morning larks. And this is again why the risks are the highest for our teenagers, who are essentially all night owls. You're making it harder for them to fall asleep on time. You're making them more and more of a night owl that it becomes more out of line with our standard social schedule. So, what we can do for a night owl is say to our schools, say to life that we want to change our society norms of getting up early. But that has nothing to do with daylight savings time. That has to do with how we make our schedule Dr Jones: All right, next question. And introduce yourself to the audience.  Guest Speaker 6: Sure. I'm Sanjay Rathi from New Haven area, Neurology. Movement disorders, Parkinson's disease, sleep disruptions, sleep-regulating REM, RBD issues, what are your recommendations? And as things get worse, what additional intervention should we do?  Dr Johnson: Yeah, I think it's hard with a lot of our neurodegenerative disorders, it's a two-way sleep. The disorders themselves often worsen sleep quality, have decrease in their sort of circadian amplitudes, and so that can affect sleep ability. And so, trying to do the things that promote sleep, like getting lights down in the evening, keeping things dark and quiet, doing cognitive behavioral sort of therapies if that's needed can all be helpful. Very high incidence of obstructive sleep apnea or other sleep-disordered breathing, whether it's Parkinson's or other neurodegenerative disorders, so evaluating and treating that if need be. And some of these people, especially as they get later on, you may end up considering medication for insomnia because their underlying disorders was causing it and there's, and you're not going to CBTI your way out of it. We do have the new orexin antagonist sleep agents, which are more recommended for older people and probably safer agents than your Z drugs and some of the other sleep meds out there. So, some people should be on some of those meds if their sleep is so disrupted. I've seen some sleep studies where it's basically like wake, sleep, wake, sleep, wake, sleep all night long. And it's like, wow, you really cannot sustain sleep, and we think it's not just a behavioral thing. I think it is part of their underlying Parkinson's and underlying disorders that can really cause major sleep disruption.  Dr Jones: It's a great question. Before we get more from the audience here, Dr. Albin, I'm just curious, you know, you got some questions from online. Don't know if any of those stood out to you. And the other thing is, I think about your practice, Dr. Albin, as a neurointensivist, there's some great content in this issue on how to maintain an adequate sleep environment in the hospital and the importance of that for the acute episode, maybe for some long-term outcomes. When I was reading the article, I didn't really didn't think about the ICU setting. That must be-- what do you do in the ICU?  Dr Albin: Well, we happen to have a question about just that. Dr Jones: Well, there you go  Dr Albin: From Dr. Manners of Baltimore, Maryland. "What meds should I be giving patients in the ICU or the inpatient setting to preserve or recalibrate their sleep-wake cycles? Is there anything that we can do besides just getting them out of bed during the day?"  Dr Johnson: Meds are always hard cause as sleep doctors, we're usually the last one to recommend meds. But there are situations and scenarios where meds may be appropriate. I can't say what's one better than the other, and some of the meds we have probably aren't even available as options in the hospital. So, the, you know, again, the orexin antagonist may be a good class to try to use, but they may not be an option. There was a good study that looked at empowering the patient and whether or not the ICU patients are empowerable. But they give a card to the patients in the hospital and say, "Tell your nurse to turn off my TV and my lights. Do I need all the blood draws all throughout the night, or can it be put off to the morning?" And trying to empower the patient to ask for these things and do some of the behavioral things. And they found that doing that did improve the duration of sleep, did reduce some of the number of awakenings that people ended up having at night. So, I think the ICU is a very particular population where there's a lot of things you can't get rid of. But certainly, turning on the lights, turning off the lights, and trying to limit noises as much as you can, in those night hours, trying to give some sense of a 24-hour day. The other thing is feeding is really important to circadian rhythms. I had a patient that had a brain bleed and, after it, she just her circadian rhythms were just off, and part of it was she was getting tube feeds through the night. So, one of the very first interventions we did was to move her timing of her feeding so that it wasn't in sleep, and that really did help make a difference in getting her back on a pattern, along with light therapy and other behavioral techniques as well.  Dr Jones: It's a great question.  Dr Albin: Absolutely. I mean, I think that validates just that we spend a lot of time actually asking like, "Can we feed people during the day?" Or, "Can we, can we limit the amount of baths that are happening at 3:00 in the morning?" We also had another one from the audience that came from Dr. Lavina Singla of Mississippi, and I think a lot of our patients are asking this question. Is melatonin addictive?  Dr Johnson: Is melatonin safe? Is melatonin addictive? I think with any sleeping aid, people become addictive to what they perceive is the outcome. So, if they said, "This got me to sleep, and now I'm sleeping great, I don't want to come off of it." And so, you get this to meds that are truly addictive, but even meds that aren't felt to have that addiction, there is certainly a behavioral change. And that's a lot of what cognitive behavioral therapy is working with these patients on, is challenging that belief of maybe it isn't the med, maybe it's your internal belief and your worry about doing this. One thing about sleep is sleep happens when you are relaxed and calm and not worried. When you're worried about thinking that thing you're worried about is whether or not you're getting sleep, then you don't sleep. In terms of melatonin, if you don't need to use it, I wouldn't use it. If you are gonna use it, I'd try to use as low doses as possible. Do we know all the risks? We don't know. And especially I think there are potentially more risks in a growing child than, maybe someone who isn't having the same sort of hormonal, needs and growth needs. But then again, if you have, let's say, a kid with autism and melatonin helps him sleep, I'd much rather use melatonin than a lot of other agents, and if that really changes their functionality, that probably is very good for them and better than having them not get sleep. So, I think you have to weigh each individual situation and combine it, especially with the behavioral approaches so that hopefully this is not a long-term addictive thing you're on.  Dr Jones: So, it's complicated. Sounds like it.  Dr Albin: Not a straightforward answer.   Dr Jones: I thought that was gonna be just this hard no, but I guess it is something you have to think about. So, I want to really take a minute here to thank Dr. Karin Johnson, who has been our interviewee for this episode of the Continuum Audio Podcast sleep issue just came out. Really want to encourage our subscribers, our listeners, and our studio audience here to enjoy it. Thank you, Dr. Johnson, for joining us today. I want to give a big round of applause to Dr. Casey Albin for managing this crowd. Thank you to our listeners. Thank you to our subscribers. Thank you to you all for coming today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.   

A comprehensive meta-analysis published in Digital Medicine examines years of research on wearable accuracy across generations of the device. For fitness professionals, the findings offer a clear, evidence-based answer to a question members ask everyday: how much should I actually trust my watch? This Episode Covers: - A major new meta-analysis breaks down Apple Watch accuracy across generations of the device - Heart rate and AFib detection prove highly reliable, often within one beat per minute of clinical devices - Sleep and step count land in the "moderately accurate" range - Calorie burn and VO2 max are the least reliable metrics — sometimes off by 100% - What this means for how operators talk to members about their wearable data Subscribe to our Newsletter: https://clubsolutionsmagazine.com/newsletter/ Visit our website: https://clubsolutionsmagazine.com Follow us on Facebook: https://www.facebook.com/ClubSolutions Follow us on Instagram: https://www.instagram.com/clubsolutionsmag/ Connect with us on LinkedIn: https://www.linkedin.com/company/club-solutions-magazine Follow us on TikTok: https://www.tiktok.com/@clubsolutionsmag

Electrophysiologist Mohamed Labedi, MD, talks about the newest treatment method for Afib called pulsed-field ablation. Send us Fan MailSupport the showSarah Bush Lincoln is a 150-bed, not-for-profit, regional health system  located in East Central Illinois.  Follow us on: Faceboook InstagramLinkedIn

Before Bipolar Disorder struck at 25, Ioannis was thriving — a two‑time college graduate, fit, focused, and full of momentum. Then everything collapsed.At 25 he lost his first professional job and plunged into a severe depression, tormented by voices. With no health insurance, he spent two years in a State Mental Institution, trapped in a cavernous abyss that felt endless. Wrong medications battered him with brutal side effects; one even triggered Afib, turning survival into a daily fight.But after his release, the long climb back began. A chance encounter with Cuckoo's Nest star Jack Nicholson lit a spark. From the wreckage, Ioannis forged his Six Point Method — a way to live with an incurable condition without surrendering to it.Today Ioannis shares his story with us.You can find his contact information, his book and an outline of his 6 points here... ioannisskiotes.com▶ WATCH MORE VIDEOS…✅ In the Line of Duty: Cops v's Mental illness | Mark MI Words

From cookoo's nest to living life - Ioannis Skiotes | VIDEO | Mark MI Words

I’m on the road in a 16 foot Penske truck  I’m doing this show from a hotel room in Bolingbrook, Illinois. friend Of The Show Jeff  Zelepugas  joins me and my undisclosed beautiful travel companion Music by The Kinks ? 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This is the story of my rock and roll butler. Welcome to the Rock and Roll Geek Show. 00:00:21 My name is Michael Butler. Thanks a lot for joining me. I really appreciate it. 00:00:25 Today is Friday, July 17th, 2026. It’s 540 when I’m doing this. We’re going to do it shortly because we have people in the hotel room. 00:00:37 A friend of the show is here that I met. We’re in, what town are we in? Bowling? 00:00:44 Bowling? Bowling Brook. Bowling Brook. 00:00:46 Bowling Brook, Illinois. Introduce yourself. It’s Jeffrey. 00:00:50 Jeffrey Zalapugas. Zalapugas. I can’t pronounce his last name. 00:00:54 I don’t know why but Zalapugas. Zalapugas. Zalapugas. 00:01:03 It’s not my pizza name. My pizza name is Paige. So is that an Italian? 00:01:07 Zalapugas. Lithuanian. Lithuanian, ooh. 00:01:10 I don’t know what they say about Lithuanians. Yeah, for sure. If I order a pizza, it’s never that. 00:01:18 What do you mean? It’s never a Lithuanian pizza? No, it’s never Zalapugas. 00:01:21 Oh, it’s Zalapulagas. Zalapulagas. That’s what you’re going to hear going back. 00:01:24 I’ve heard it all. Talk into that microphone. You can’t butcher the last name. 00:01:32 Jeffrey Zalapugas. We’re going to meet up with Jeff Thielicke today. That’s who you were with last time when I was in Milwaukee. 00:01:40 And Chicago. And Manitoba. Oh, you were in Chicago as well. 00:01:43 Yeah. Thielicke got pretty wasted, huh? Milwaukee as well. 00:01:48 Yeah. Hats off to Jeff. He’s a fun guy. 00:01:51 Sure is. As you are as well. He’s a good dude. 00:01:54 I was telling undisclosed, beautiful travel companion Raquel how hilarious you got. You crack me up all the time. Last time you were there, I was cracking up. 00:02:07 Well, we had the gentle giant with us, though. Stirring up the pot. Yeah, your bodyguard. 00:02:13 Yeah, we went to a Mexican place. Did you know he came to? Oh, his wife is here, Winnie. 00:02:18 His beautiful wife, Winnie. Say hi, Winnie. Winnie, did you know he came all the way to see… 00:02:26 Yes, yes, he told me about it. Yes, he told me, yes. You okay with that? 00:02:30 Yes, I was. Where are you from, Winnie? I’m from Africa. 00:02:36 You’re from Africa? What part of Africa? East Africa. 00:02:38 East Africa. What country is in East Africa? Uganda. 00:02:41 What is it? Uganda. Uganda? 00:02:44 Wow. I went to Cape Town, and I went to… Oh, fuck. 00:02:51 Botswana? Botswana, oh, yeah. Is that near Uganda? 00:02:55 No, that’s south, south, south, yes. They had no… In Cape Town, because I wanted to have wild game, I wanted to eat wild game. 00:03:02 Wow. Cape Town, they had all kinds of wild game you could eat. Yes, they do. 00:03:06 Botswana and up there, there was no wild game. Yeah, Botswana is a bit a desert of a desert. There were game reserves, but there was no wild game to eat. 00:03:16 No, no, they don’t. What about Uganda? Oh, Uganda is beautiful. 00:03:19 You have… Is there wild… Can you eat wild game there? 00:03:22 Oh, yes. Springbok was delicious. Yes, you better come to Uganda. 00:03:27 I’ll… Can you have… You have a place I can stay there? 00:03:30 No, I’m kidding. Oh, yes, I do. We had… 00:03:32 I had ostrich carpaccio in Cape Town. Okay. That was the best thing I’ve ever eaten in my life. 00:03:40 Wow. It was so good. You come in Uganda, you’ll eat the luwombo. 00:03:45 Luwombo? Luwombo, yes. What is that? 00:03:49 It’s beef or chicken stewed in banana leaves. Oh, that’s great. Yes, real tender. 00:03:56 Oh, man, I’m hungry. We haven’t eaten today. Zellopagus. 00:04:00 We’ll feed you. Well, it’s nice to meet you, Winnie. Nice to meet you. 00:04:04 So you go back and forth to Africa? Yes, yes, I do. I do. 00:04:08 I had… We had a woman who was a friend… We started off as cleaning our house, but then she became a really good friend and part of the family. 00:04:15 She’s from Cape Town. She goes back. Her husband’s still there. 00:04:19 Her husband stays in Cape Town. She goes back and forth. Now I have my husband here, so I better go see my other family. 00:04:26 You get away from your husband for a while. Does Jeffrey go with you? Yes, for a break. 00:04:30 He hasn’t yet, but we hope to go. You’ve never been to Africa? Not yet. 00:04:34 It’s a hell of a flight. Yes. We got married in Fiji. 00:04:39 I don’t know where that is. Fiji. Is that near Australia? 00:04:43 Yeah, above Australia. Oh, right, yeah. You’ve got to lay flat. 00:04:46 You’ve got to get first class. It’s a shit flight if you don’t lay first class. When I sell the house, we’re going to lay flat in Japan. 00:04:56 Nice. Wow. Yeah, I would love to go to Japan. 00:04:59 Yeah, we’re going to do some drinking and eating in Japan. Come with us. We’re going to go. 00:05:02 It’s beautiful, yes. Tokyo, for sure. Yeah. 00:05:05 We’re going to go to Alcatraz. We’ll let you know where we’re going. Kyoto. 00:05:08 Oh, yeah. We’re going to go to Kyoto, Osaka, maybe even Okinawa. Because they have good beer in Okinawa. 00:05:14 Beautiful place. Yeah. You like sake, brother? 00:05:19 No, I don’t drink sake too much. But I do like a Japanese beer. I’ll take a Sapporo. 00:05:26 Oh, that’s too generic? Well, it depends on which. Now we’re going to geek out on beer. 00:05:30 Because I’ll tell you, if you have a Sapporo 22-ounce can, they’re brewed in Japan. But if you get a 12-ounce can or a bottle of Sapporo, it’s brewed in Canada. It’s by Molson. 00:05:43 Oh, wow. I didn’t know that. Microphone up to your mouth. 00:05:45 Fun fact from Michael Butler. And if you go to a Japanese restaurant, if they have Asahi on draft, that is brewed in Japan. But if you get an Asahi bottle, it’s another Americanized. 00:05:57 It’s like made in America somewhere. What about sake in that goofy barrel? I don’t know anything about sake. 00:06:02 You’re not a sake drinker? My good friend Shaki, Metal Moment, he knows all about it. But I don’t know anything about sake. 00:06:08 How’s he doing? We had dinner. Undisclosed Raquel came. 00:06:13 We had dinner with them on Sunday before we left. Went to a Korean all-you-can-eat place. It was good. 00:06:18 Cool. Glad you reconnected. Yeah. 00:06:21 That was the first time Shaki’s seen me since the shit went down. But yeah. Yeah. 00:06:28 He took it all in stride. Well, good to have friends. Yeah, because his wife was, well, I don’t know if she was friends with the other one. 00:06:37 So she met Raquel, and they were very impressed by how great of a person Raquel was. Well, definitely. This whole mission you’ve been on these last couple of weeks, having a partner in crime, is essential. 00:06:53 So I’m happy for the two of you, and thanks for doing this for Michael. So what brings you to Bowling? What are we at again? 00:06:59 We’re in Bowling Brook, Illinois. The claim to fame was the first indoor amusement park. It’s no longer here. 00:07:07 I saw the Ramones, actually, at that venue called Old Chicago. It’s on YouTube if you guys get bored. But there was a riot afterwards, chair throwing. 00:07:20 Yeah. Oh, nice. And I got one of Didi’s picks. 00:07:23 I should have brought that. Just a brag deal. Chair throwing where they’re like, people wanted to see the punk rock circus or something, and they started to fight with the punk rockers? 00:07:32 No, I don’t know what the uproar was. But there’s some footage of the Ramones walking around Old Chicago in Bowling Brook. Oh, okay. 00:07:41 Maybe I’ll throw that out on the Facebook. You didn’t create that, though, did you? No, I don’t. 00:07:46 No, I did not create it. But let’s not get into that. It’s a running gag. 00:07:51 My brother just became a rock and roll geek, and I asked him about it. He’s like, oh, did I? You’re going to meet him tonight, hopefully. 00:07:59 Oh, good. Did he bring his harmonicas? Well, we were talking about that before we jumped on this cast. 00:08:05 Well, if he gets asked, he needs to be prepared. Well, he doesn’t want to assume. Do I need to bring my harmonicas in case he wants to blow? 00:08:16 Yeah, if they’re handy. He does have them with him, right? He said he wasn’t going to bring them. 00:08:20 Let me look in the truck before we get out of here, and I’ll see. On the way here, go ahead. So Bowling Brook is just a suburb of Chicago. I told you about the claim to fame, the old Chicago, but it’s probably maybe an hour, hour and a half west of Chicago, 00:08:37 just a suburb. You’re pretty much in and out on I-80, but that’s really all Bowling Brook’s about. But we’re going to see a blues band that my brother used to sit in with years ago called the Griff Band, so Don Griffin. So he’s going to do one set, and then somebody’s going to do just 00:08:55 classic rock after that. So we’ve got blues and then classic rock? Blues and classic rock. 00:09:00 All right. Well, good. Where are you coming from? 00:09:04 I live in a town called Lakewood, Illinois, which is next to Crystal Lake. It’s halfway between Chicago and Rockford, as the crow flies. You know Rockford? 00:09:13 I asked beautiful Raquel if she knew what Rockford was famous for. Does she know? She does now. 00:09:23 She knows now. The band that has no past? Yes, exactly. 00:09:28 She thought it was where the famous oysters were from. You’re going to have to. If you guys had time, the Hard Rock Casino has a huge. 00:09:36 In Rockford or in Chicago? In Rockford has a huge. We already passed Rockford. 00:09:41 Yeah, I guess you did, but I mean, you’re not like. I mean, if you were a diehard Rick Nielsen fan. They got Rick Nielsen’s guitars, right? 00:09:49 They got, I’d say, probably 30 guitars, probably 10 outfits. You know, all kinds of, you know. Rick, you know, from Rockford, living in Rockford, has a huge display. 00:10:00 I could probably forward some pictures there. How far is Rockford from here? I don’t know. 00:10:06 Maybe, probably 45 minutes. We got to go back track 45 minutes? No, it’s north and probably a little bit. 00:10:12 It’s probably more due north and probably a little bit east. All right, maybe we’ll see. Or west, rather, sorry. 00:10:19 West, so we got to go back track. We’ll see if we can. I should have mentioned that, but you know that crazy knit jumpsuit that he’s got? 00:10:27 With the, what is it? Is it Glenplaid? With the checkerboards, you mean? 00:10:32 Checkerboards, but kind of like offset. Those pants that he wears? Uh-huh. 00:10:37 You remember when he had the arrow with the red sweater and the goofy hat? Yeah, that’s early, that’s in color. With those knit pants, there’s a pair of those on display. 00:10:46 And a bunch of his guitars. He can’t fit in those anymore. I spent more time taking pictures of that than actually seeing the gig that we were going there to see. 00:10:59 We’re going to Nashville to see them open for GZ Top. Nashville’s great. Joe Pollock invited me to see Cheap Trick and Hart. 00:11:10 That was last year, year before? With the lovely Gina. That was a good time. 00:11:16 Did you go? Yeah, I went. They invited me. 00:11:19 We hung out. Did Robin get up and sing? Love Hurts? 00:11:25 No, I don’t think they did Love Hurts. Did he get up and sing with Hart? I don’t even remember if the kid was there or not. 00:11:30 Robin Jr.? Yeah, Robin Jr. I don’t really recall. 00:11:33 I’ve been to so many gigs. Ann Wilson was in the wheelchair, but I think she’s gotten better since then. We, on the way here, we stopped at the world’s largest truck stop. 00:11:44 You ever been there? I’ve heard of it. I’ve never been. 00:11:46 I was a little disappointed. This is a big shopping mall? Thielicke told us, you need to stop at the world’s largest truck stop. 00:11:54 So we stopped, and it’s not that great. It’s not like you guys have been to the Buc-ee’s, I’m sure, right? That’s what I said. 00:12:01 I said, well, this Buc-ee’s looks as big as this. I like Buc-ee’s better than that place we were at today. Buc-ee’s has all branded stuff. 00:12:10 Yeah, there’s one. Wisconsin has one called Quick Trip. I’m not a Wisconsinian, but on the scale of Buc-ee’s, I don’t know where they fit. 00:12:23 But they’ll have stuff like hard-boiled eggs pickled, stuff like that, weird. Like 110 different kinds of beef sticks. I’m sure the Wisconsinians would know more about it. 00:12:39 But Quick Trip, if you see one, is a little bit of a trip. If we see a Quick Trip, we’ll stop at a Quick Trip. I’m hoping we see a Buc-ee’s, because I would like everybody to experience the Buc-ee’s. 00:12:49 It’s something you should check out once. Yeah, they’re mainly from the south, I think, right? But they’re starting to make a little bit of a jump up north here. 00:12:56 Yeah, I think so. All right, so thank you for meeting up with us, General Paulodoulos. I wouldn’t miss it for the world. 00:13:05 I’ll probably have a beer with you just to get off my sabbatical. There you go. My health sabbatical. 00:13:09 Why are you not drinking right now? I went through some health issues, man. I’m on a bunch of meds, and it doesn’t mix with booze that well. 00:13:16 Do you have a stroke? No, I had AFib about three years ago, and then it came back about nine months ago. And then I had a situation where the blood wasn’t pumping through the heart appropriately. 00:13:29 How did you find that out? Well, I knew it was gurgling, you know what I mean? Were you wearing a watch? 00:13:37 Because if you’re wearing a watch and you have AFib stuff, it’ll blow up. Yeah, so I bought the watch to monitor for it. That’s why I’m wearing one. 00:13:44 Yeah, I started getting it again. And then I had an ablation on May 11th, and I’ve been pretty good since then. What’s an ablation? 00:13:50 They go in there and zap some of the overacting areas of the heart that send electrical pulses to make your heart beat. What do they zap it with? Sound waves or radio waves or something. 00:14:02 And they deaden some of the overactive sites, and hopefully they get the right ones. And since then, they shocked it back in the rhythm and then did the ablation, and I’ve been okay since. So I’ve been staying off the beef, staying off the booze. 00:14:18 Staying off the beef? Yeah, they take you off the beef. Fuck that. 00:14:24 Fuck that shit. Well, they say your good years are between 63 and 73. What’s that? 00:14:31 What do they want you to eat? Chicken, fish, vegetables, fruit. That’s okay, too, but you’ve got to eat. 00:14:38 The beef is… Once in a while. Yeah. 00:14:41 So once in a while. You got money? Not really. 00:14:45 So you better… Sorry, Winnie. If he kicks it, you ain’t going to get much. 00:14:50 You better hope he lives. I mean… I got enough to retire today. 00:14:58 Okay, good. So Winnie’s not going to be homeless until she can die. No, no, no. 00:15:01 She’s… Good. Yeah, yeah. 00:15:03 I’m sure she has her own money. Yeah. You have your own money, right, Winnie? 00:15:07 Yes, I do. Good, good, good, good. She’s got a big compound back in Africa, so she probably, you know… 00:15:12 She mourned for a week and then be back in Africa, probably. But, anyway. Well, I appreciate you coming, Zellablogs. 00:15:18 No worries, man. Thanks for having me. So, friends, we’re trying to get back to New York by Sunday. 00:15:24 We’re taking I-80. I said this yesterday. We’re taking I-80. 00:15:29 So if you’re along I-80 and want to have a beer or something… I think we do get off I-80 at some point, don’t we? Oh, I don’t know. 00:15:36 Very soon, I think. We got two more days. So we’re going to be heading through Pennsylvania, then up to New York. 00:15:42 So if you’re on our route, friends, I’d love to meet up with you and have a beer or something. And, again, thank you to everybody who’s been contributing to this trip. It’s much appreciated. 00:15:55 And it’s been so far so good. Oh, you want a beer? Okay. 00:16:02 I’ll get you a beer. Hold on a second. Now I’m frazzled. 00:16:07 No, I wanted you to have a sip of that fine… Let’s take a sip. Oh, yeah. We’re all drinking, except for Zella Pelugas, 00:16:14 we’re all drinking Modelo in the can and a Yeti knockoff. Yeah, yeah, yeah. Thank you, everybody, for supporting the shot. 00:16:21 Take a sip of this fine Modelo. It’s new. There you go. 00:16:26 Ah! You know what they say. The eighth one of the day is always the best. 00:16:32 This is actually the first one of the day. It’s the first one of the day for me as well. Cheers. 00:16:35 Cheers, Michael August. Cheers. That’s not going to give you a heart attack. 00:16:39 What meds are you on? All kinds of shit, man. I’ll tell you offline. 00:16:43 Okay. Well, thank you for listening, friends. 00:16:46 Rockandrollgeek.com is where you can find the show. Find me on the Facebook, R&R Geek. 00:16:51 Rockandrollgeek Facebook group. Going strong as usual. Thanks to the sheriff. 00:16:57 And find me on the Twitter, R&R Geek. Find me on the Instagram, rockandrollgeek. Don’t ask. 00:17:02 Please keep the donations coming. Without your donations, this show would die a horrible, putrid, stenchful death. And if you get any value out of this, please contribute what you can. 00:17:10 And I thank you for everybody who’s been supporting so far. Zella Palougalos. We’re going to go watch some blues and have some beer. 00:17:17 This is not going to be your only beer for the night. I’ve got a feeling. All right, friends. So I’m going to close out with something that Chris Cappell, 00:17:23 the rockandroll copywriter, sent. We’re playing all songs that have road in the title. And this is from the Kinks 1977 sleepwalker album. 00:17:32 You know what song this is? I don’t. You don’t know the Kinks? 00:17:36 Only the hits. This one is called Life on the Road. Thank you for listening, friends. 00:17:40 I’ll talk to you tomorrow.The post On the road in a Penske truck day five -Bolingbrook, Illinois first appeared on The Rock and Roll Geek Show.

We're rowers.We train hard, eat well, stay lean, and pride ourselves on being fitter and faster than most people our age.So how is it that former elite rowers are almost seven times more likely to develop atrial fibrillation?This episode is personal. I've been through AFib myself, and today I'm sharing what the latest science reveals, what I learned from my own recovery, and what every masters rower should be watching out for.Welcome to Faster with Bill. Let's get into it.

Intracerebral hemorrhage carries high morbidity and mortality, but growing evidence highlights meaningful opportunities for prevention, risk reduction, and long-term recovery. This episode covers key strategies, including blood pressure management, interpretation of neuroimaging markers, and individualized decisions around antithrombotic therapy. It also emphasizes the prolonged recovery timeline and the importance of a holistic, patient-centered approach to improving outcomes. In this episode, Casey S. Albin, MD, FAAN, speaks with Wendy C. Ziai, MD, and Vishank A. Shah, MD, coauthors of the article "Intracerebral Hemorrhage" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Ziai is a professor of neurology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland. Dr. Shah is an assistant professor of neurology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Intracerebral Hemorrhage Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Guest: @VishankShah3 Full episode transcript available here Dr Albin: A patient has suffered an intracerebral hemorrhage. They're taken to the neuro ICU, and they fortunately survive. But the journey does not end there. In fact, in some ways, the journey has just begun. Join us today as we unpack holistic care for ICH patients.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Albin: Hello to our audience. This is Dr. Casey Albin. Today, I'm interviewing Dr. Wendy Ziai and Dr. Vishank Shah about their article on intracerebral hemorrhage. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast. I am so delighted that both of you are joining. To begin, let's just do a brief introduction of who you are and, and a little bit of how you got interested in the topic.  Dr Ziai: Hi, I'm Wendy Ziai. Thank you for having me on this podcast. I am a professor of neurology at Johns Hopkins. I am a neurointensivist, and I think I got primarily interested in this topic through clinical trials that I have been a part of since my fellowship days.  Dr Shah: Hi, everyone. I'm, uh, Vishank Shah. I am also, uh, very thankful for being invited to be a part of this podcast. I'm also a neurointensivist at Hopkins and the fellowship program director here for neurocritical care, and I'm interested in recovery after ICH, and that's why I'm a part of this work.  Dr Albin: Welcome to you both. It is such a treat for me to get to interview fellow neurointensivist, particularly those who have such a wealth of experience. So, I am delighted to dive into this. All right. So, to set the stage for our audience, intracerebral hemorrhage has long been approached with pessimism. But your article really highlights that there are meaningful advantages in prevention and risk stratification and long-term recovery for these patients. Though you both are neurointensivist, this article really emphasizes primary prevention and the holistic long-term care for the survivors. And so, to begin, Dr. Shah, can you just lay out a little bit for our listeners the scope of intracerebral hemorrhage and its community impact?  Dr Shah: Yeah. So, you know, ICH is the second most common type of stroke. There are more than three million new cases of ICH globally each year, and it accounts for thirty percent of all stroke types, but it is the one that has the highest mortality, with more than forty to fifty percent of the patients dying in the first thirty days, and then continued long-term impact on both functional as well as outcomes, as well as survivorship after the early period. And it also disproportionately impacts lower socioeconomic, and then minority races like Blacks, Asians, as well as Hispanic ethnicity. And so, there's a lot of work that needs to be done to reduce the burden of this disease.  Dr Albin: Absolutely. I mean, these can really be devastating for families, and I really am appreciative of your highlighting that there's a lot of disparities, and there's a lot of work to be done to really increase equity to these patients. I think a lot of this goes into really the AAN's focus on brain health and trying to improve some of what we're doing to maintain brain health. And I really wanted to kind of drill down on this because for ICH, there's a lot that can be done upfront as we think about how do we counsel patients who may walk into the office about strategies to prevent ever becoming an intracerebral hemorrhage patient. So, Dr. Shah, can you walk us through a little bit about what neurologists in the community need to be doing to make sure that no one ends up with us in the neurointensive care unit?  Dr Shah: Yeah, sure. So, I think, you know, one of the most important risk factors is, of course, hypertension and long-standing uncontrolled hypertension. And so really recognizing the need for early onset screening with regular blood pressure monitoring at a very early age, particularly in the races that I discussed earlier. And then I think another big part, obesity, metabolic syndrome, and type two diabetes. And I think there's a lot of interesting new work that with the GLP-1 agonist, you know, in a large multicenter cohort studies showing that patients receiving these had a significantly lower reduction risk of ICH. And so, this might be a really important part that, you know, clinicians need to start increasingly recognizing and using in their practice. And then, of course, other risk factors that are common include smoking, diet high in sodium, exposure to air pollution, both indoor as well as outdoor. And so, mitigating all of these risk factors can also reduce the burden of ICH.  Dr Albin: Absolutely. And I really want to highlight that hypertension plays such an important role and that we as neurointensivist, as community neurologists, really need to be creative about ways that we can help people meet those blood pressure target and meeting people in the community where they are, making sure that they're not suffering from side effects from their medication that would prevent them from sticking with it long term. Dr. Ziai, anything else to add about what we can do in the community?  Dr Ziai: So, we really want to emphasize, even in the acute phase, that patients moving forward need to have targeted interventions to reduce blood pressure, smoking, enhance their physical activity, have a diet that is high in fruits and vegetables and low in alcohol and salt, and then promoting weight loss, of course.  Dr Albin: And Dr. Ziai, I'm gonna ask you a little bit about one of the things that maybe not all of our listeners have heard about is this APOE2, APOE4 genetic risk for intracerebral hemorrhage. What's going on there and, and should clinicians be testing for that? Dr Ziai: That's a great question, and it is not one that we currently test people for at least acute ICH presentation. APOE2 and A4- E4 alleles, these give patients a two to three times higher risk of ICH by increasing cerebral amyloid deposition. And if you happen to have APOE2 carrier ship status, then along with other risk factors like white matter disease and vascular risk factors, these predict the onset of new microbleeds even during very short follow-up periods of about two years. And as we know, having cerebral microbleeds are associated with an increased risk of all strokes, ischemic and ICH, but they are one of many MRI markers of small vessel disease, which along with cortical superficial siderosis, does significantly increase future ICH risk. And so even in people who've never had an ICH, if they happen to have an MRI, it may be reasonable to look at the MRI and incorporate this burden of small vessel disease, and especially these hemorrhagic markers into, uh, decision-making about interventions.  Dr Albin: That's a really excellent point. And so, I think that your article did a really beautiful job of thinking holistically about the patient, incorporating clinical markers of their risk for having ICH, but also those radiographic markers. I'm just gonna ask you to summarize those again one more time because not everyone will be familiar with these. So, when you're looking at an MRI, what are the things that you're particularly clued in on that would increase the patient's risk of future ICH?  Dr Ziai: In the past, what we're looking for really is markers of cerebral amyloid angiopathy, which significantly increase a person's risk for lobar hemorrhage in particular. And so, we have a set of criteria called the Boston Criteria, and there's a new version of these, version 2.0. And these, um, incorporate a number of imaging markers that provide a very high sensitivity and specificity to diagnose CAA after an ICH. But even if someone's never had an ICH, and they evaluate that risk-benefit ratio for different cardiovascular prevention strategies. And so, the markers that we're specifically interested in are, of course, microbleeds. But not just having microbleeds, but are they lobar or are they deep? Lobar having a higher risk for lobar ICH. How many microbleeds are there? Is it greater than five, or is it just one or two? Also, cortical superficial siderosis is a marker, a hemorrhagic marker, that does portend a significant increased risk of recurrent ICH, along with having a lobar ICH. And now we have these new markers, which are the white matter hyperintensity multi spot pattern, which requires these hyperintensities on flare imaging in the subcortical area, having greater than at least ten of these multi spots, and also having enlarged perivascular spaces in the centrum semiovale, and having at least twenty of those. And finally, white matter hyperintensities, which can be measured with the physica score or just by visualizing them. We can look at white matter hyperintensities as well as being a measure of small vessel disease.  Dr Albin: Got it. And so just to summarize, we're looking for small vessel disease markers because that puts our patients at higher risk of ongoing future bleeds. And then we're also looking for markers of particularly small vessel disease that's caused by cerebral amyloid angiopathy, which again, because it's having that protein deposition, that puts the patient at risk of those leptomeningeal very small vessels, putting the patient at risk of lobar ICH. Just confirming I've summarized this all correctly.  Dr Ziai: Yes. That was perfect.  Dr Albin: Amazing. Dr. Shah, I'm gonna go back to you. Let's say we have a patient. Let's say this is a sixty-five-year-old man who comes in and they want follow-up and they're... And you're trying to think about they've had an ICH in the past, and they are also at risk for ischemic disease. Let's say they, they have hypertension, they've had a smoking history. They have some risk for ischemic events. And you're trying to think about how do you balance those. Let's say the patient needs to be on aspirin but does have some of those high-risk features on their MRI. Is there any guidance on how we think through preventing them from having a recurrent bleed if they're a high-risk patient, also preventing them from having an ischemic event, which they might be at high risk for as well?  Dr Shah: Yes. So, I think, you know, the first step is of course trying to understand what was the type of bleed. I think that has a very important role, like you mentioned. If it's a lobar hemorrhage versus a deep hemorrhage, the risk of recurrent ICH and ischemic events is very variable. So lobar hemorrhages, there's obviously a higher risk of recurrent hemorrhage events, whereas deep hemorrhage is actually at or behaves sort of like small vessel ischemic strokes and have a higher risk of recurrent arterial ischemic events. So that distinction in itself can help you gauge which patients would be safe and would benefit from these therapies. To begin, and of course, looking for some of these markers on MRI that were mentioned by Dr. Ziai for recurrence of hemorrhage risk. In terms of antiplatelet, the, there is a lot more data now to guide treatment, and we have the RESTART as well as the ESTART trial that showed that starting an, a single antiplatelet after intracerebral hemorrhage did not increase the risk of hemorrhage recurrence. They were very variable in the timing when aspirin was started, and so that remains still a question about what is the safest time point to start aspirin. For example, in the ESTART trial, they started them very early, within the first three days, whereas in  the RESTART it was all the way up to two months after the hemorrhage. And so... But in general, the risk of recurrent ICH was very low with a single antiplatelet agent. And so, if it's needed for ischemic prevention, it's relatively safe broadly across all types of hemorrhages.  Dr Ziai: Yeah. I would just mention that there was also a subgroup analysis of the RESTART trial using MRI. And so, this more than likely included patients with CAA, since 40% of the hemorrhages were lobar in that study, and therefore seeing that there was no increased risk of recurrent ICH in RESTART, it is thought that putting patients back on their antiplatelet therapy is safe.  Dr Albin: That's a really huge takeaway pearl for our listeners, that regardless of whether it's a lobar bleed or a deep bleed, if there is a strong indication, you know, this is not just, oh, because someone gave them aspirin 81, but truly that there is a reason that they need to be on a single antiplatelet agent, it probably benefits them to be on that agent, and there's good data that there's not a huge increase in risk. Summarizing all of that?  Dr Ziai: Great.  Dr Albin: Now, things are gonna get a little bit tricky here, because what if the patient, what if they need to be on dual antiplatelet therapy? Or what if they need to be on anticoagulation? Dr. Ziai, I'll, I'll throw that to you. How do you tackle that patient population?  Dr Ziai: Yeah, the safety of dual antiplatelet therapy hasn't really been studied in patients who've had a prior ICH. Although, in people who've had previous strokes, putting them on dual antiplatelets doesn't seem to increase the risk of ICH, but it does increase extracranial hemorrhage. And so there may be other reasons not to put patients on dual antiplatelet agents. Patients who have cancer and also cardiovascular or cerebrovascular disease, putting them on dual antiplatelet therapy does seem to increase the risk for intracranial hemorrhage. So, I think there is enough of a bias against DAPT therapy in patients who have had an ICH that we would not recommend DAPT for patients with a prior ICH.  Dr Albin: Absolutely. And, and then what about, let's say they have atrial fibrillation, and you know that they have a high CHA2DS2-VASc score, and they are at very high risk of ischemic events, but they've also had a prior intracerebral hemorrhage. Walk us through a little bit, how should we approach that patient? Dr. Ziai, I'm gonna start with you again.  Dr Ziai: Sure. So again, looking at the MRI, which all patients with ICH should have nowadays. If patients do have these hemorrhagic findings, a lobar ICH, evidence of CSS, cortical superficial siderosis, especially if it's disseminated, and also lobar microbleeds, especially if there are greater than five, if they're multiple, then anticoagulation should really be avoided in those patients.  Dr Albin: Absolutely. So, I'm really hearing that when we have a patient with ICH, it is just critically important that we understand is this a hypertensive bleed or is this a lobar bleed that is probably related to cerebral amyloid angiopathy? And getting to that distinction is going to play a major role in our deciding whether or not the patient can be on DAPT or can be on anticoagulation. And then what are some of the strategies for patients that you're referring them to if they really cannot tolerate being on anticoagulation, but they have atrial fibrillation, and they do need some sort of ischemic stroke prevention?  Dr Shah: There's still a lot of controversy, even in non-lobar hemorrhages, about resuming anticoagulation and when that would be safe. HAF trial, there was a reduction in ischemic stroke recurrence, uh, but a significantly higher increase in hemorrhage recurrences. I think that trial included both deep and lobar hemorrhages. So, we still need more data, and I think the ASPIRE trial and maybe a meta-analysis would answer that eventually. But in the meantime, if a, specifically for lobar hemorrhages, which are, uh, thought to be CAA related, if they, uh, and the patient has AFib, you know, where anticoagulation would be contraindicated, a watchman device or, you know, AFib ablation may be some of the other strategies that can be looked into for those patients specifically.  Dr Albin: Right. I think that's a really important point to emphasize, that we don't just don't give up and say, "Oh, you're not a candidate for anticoagulation," but we really reach out to our cardiovascular friends and say, "Hey, what other procedures can you offer that will minimize the risk of recurrence?" You know, we don't want them to have an ischemic event, but we also know long-term that there would be a real risk of anticoagulation. Just reminder to our listeners that there are new procedures, and our cardiology colleagues are always doing new trials and new devices, and so we should really leverage their expertise here. I am in the final minutes gonna just switch gears a little bit from talking about sort of the nitty-gritty of secondary ischemic prevention and secondary hemorrhagic stroke prevention and thinking about there has been this degree of pessimism around ICH patients, and that, you know, they have a much more severe outcome than our patients with ischemic strokes. I think that that is probably a myth that we need to do some debunking around, and I think maybe we need to reframe in terms of thinking about just the trajectory. So, Dr. Shah, walk us through a little bit about what we can expect about the recovery trajectory in ICH compared to those patients who have an ischemic stroke. Dr Shah: Yes. From some newer data and studies, it is becoming clear that recovery after ICH is much slower than we expect. In general, for ischemic stroke, recovery is measured within the first few weeks to up to 90 days. But in ICH, we now know that patients can keep recovering all the way up to six months and even beyond. In general, from just a, a study of heart recovery that occurs after ischemic stroke, there's a steep recovery in the first seven days, and then sort of after that, patients still continue to recover, but it, it starts plateauing where up to 90 days. Whereas with ICH, there is not much recovery in the first 7 to 30 days, but after that, there is a recovery that occurs significantly between day 30 and day 180, and then some patients continue to recover all the way up to one year. The more severe the hemorrhage, the slower the recovery, but there's still some evidence to suggest that even severe hemorrhage patients can recover all the way up to one year out and beyond. This is, of course, in terms of functional recovery.  Dr Albin: I think that's a really important point for our audience. Many of the listeners are residents, they're fellows, they're seeing these patients in the hospital, and they may not see a whole lot of improvement over even 30 days. But to keep in mind that just because the patient has not had a dramatic recovery within that first month that they may be in the ICU and then on the floor does not mean that that patient will never have recovery, and that we reset our expectations that recovery is possible, it's just gonna be slower. And I think that that's not only important for the healthcare team to take in mind, but also for patients and their families to know there is hope here. It's just gonna be slower. Dr. Ziai, looking ahead, what developments in this are you most excited about that you think will move the needle for care for the long-term outcomes and the prevention for these patients? What's ahead in, in ICH?  Dr Ziai: Yeah, I think the research that's going on is very exciting at the moment. We just saw the presentation at the World Stroke Organization conference in the fall of the TRIDENT trial, Triple therapy prevention of Recurrent intracerebral Disease events, meaning strokes. And these investigators found that a single pill, a fixed dose of three blood pressure-lowering agents actually was successful in significantly reducing the risk of recurrent stroke in patients who have had a history of ICH and have just normal or low-grade hypertension. So rather than having patients on multiple antihypertensive agents, it may be possible to have them on a single pill, and may dramatically reduce their stroke risk. So that's exciting. There is also a trial ongoing, ASPIRING, testing whether antiplatelet monotherapy after 24 hours only can reduce the risk of all serious vascular events in ICH survivors. So very early antiplatelets. The SATURN trial, we didn't talk about statins yet, but it is comparing continuation versus discontinuation of statin therapy in ICH patients. And then we have ongoing epidemiological studies that are really needed to understand this interaction between the cardiovascular prevention strategies, the antithrombotic use, the blood pressure targets, and these high-risk neuroimaging markers for ICH. And I think that's gonna be key, personalizing the interventions for these patients.  Dr Albin: So, I love that. And what I'm hearing is that it's really important to think about the personalized approach as well as how do we simplify things. We know that blood pressure control is critically important to the primary and secondary prevention of ICH, but we have to make it easy for patients to do so. Dr. Shah, I want to end with kind of understanding, you know, this was an unusual topic for neurointensivists to talk about. This was really about prevention. It was about long-term survivorship. It was about not what's happening in the neuro ICU. How did you guys get interested in sort of that aspect of care?  Dr Shah: Yeah, so that's a great question. Dr. Ziai has been my mentor since I was in fellowship, so now about eight years that I've been working with her, and this was a project that I started in fellowship with under her mentorship, looking at long-term recovery in ICH patients, and specifically severe patients. Happy that work has received a lot of recognition. It was published in JAMA Neurology. We looked at patients with severe intracerebral and intraventricular hemorrhage, those that survived with an mRS of four and five at day 30, and what happened to them over the course of the year. There was really not much data on recovery after ICH. And we were very surprised to see that up to 40% of patients that were an mRS of four and five, so really, really severely disabled at day 30, recovered to an mRS of zero to three by one year. About one-third of that group that recovered actually achieved functional independence with an mRS of zero to two, which was very surprising, really breaking the myths around the pessimism with ICH. We found that a lot of the baseline comorbidities like diabetes, white matter disease, as well as what happens to them during the acute hospitalization, were adding all of that information to the severity of the hemorrhage significantly improved our ability to predict long-term recovery after ICH. And so that's kind of how we got interested in this work, looking at how factors in the care that we provide in the ICU, as well as what the patients come in with, how all of that could be modified to promote recovery in these patients that are often been forgotten.  Dr Albin: I think that there's one takeaway to our listeners is that this is really a place where there's a lot of hope for recovery, and that the nihilism that has really surrounded ICH is a thing of the past, and we have to move forward with thinking about how do we proactively impact the recovery and counsel the patients and give them hope. Because just as your research shows, there really is the ability that they can attain that functional independence, which is absolutely astounding. It's really amazing. Again, today I've been interviewing Dr. Wendy Ziai and Dr. Vishank Shah about their article on intracerebral hemorrhage. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Please be sure to check out Continuum Audio episodes from this and other issues. Please go and check out. They have a wonderful article with lots of tables and figures, so much data. And again, thank you to our listeners for joining us today. Thank you, Dr. Ziai and Dr. Shah.  Dr Ziai: Thanks very much.  Dr Shah: Thank you.   Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Send Zorba a message!Zorba looks at research linking a drop in U.S. birthrates to the release of the iPhone. Zorba describes his experience singing a song with Karl's band, and talks about how trying new things out of your comfort zone is good for your health. He also helps a caller with toenail fungus, and another listener with atrial fibrillation (AFib) questions. We also hear a joke from Karl's mom, discuss new SNAP benefits policy changes, and talk about "zig-zag eating."Support the showProduction, edit, and music by Karl ChristensonSend your question to Dr. Zorba (he loves to help!):Phone: 608-492-9292 (call anytime)Email: askdoctorzorba@gmail.comWeb: www.doctorzorba.orgStay well!

Send Zorba a message!Zorba looks at research linking a drop in U.S. birthrates to the release of the iPhone. Zorba describes his experience singing a song with Karl's band, and talks about how trying new things out of your comfort zone is good for your health. He also helps a caller with toenail fungus, and another listener with atrial fibrillation (AFib) questions. We also hear a joke from Karl's mom, discuss new SNAP benefits policy changes, and talk about "zig-zag eating."Support the showProduction, edit, and music by Karl ChristensonSend your question to Dr. Zorba (he loves to help!):Phone: 608-492-9292 (call anytime)Email: askdoctorzorba@gmail.comWeb: www.doctorzorba.orgStay well!

In this episode, Ray Cochrane digs into “algorithmic outing,” new research showing that social feeds can infer your sexual orientation before you have consciously come out. He also covers Meta’s privacy-aware AI infrastructure, Alberta’s 466-million-line code scan with Claude, NVIDIA on reinforcement learning, and the many journeys of learning Rust. Along the way, he hits Google DeepMind’s A24 deal, WhatsApp usernames, and scuba-diving cyborg cockroaches. Finally, he looks up with Webb’s puzzling early universe, NASA’s emergency telescope rescue, and a gorgeous aurora from orbit. – Want to start a podcast? Its easy to get started! Sign-up at Blubrry – Thinking of buying a Starlink? Use my link to support the show. Subscribe to the Newsletter. Email Ray if you want to get in touch! Like and Follow Geek News Central’s Facebook Page. Support my Show Sponsor: Best Godaddy Promo Codes Get 1Password Full Summary Cochrane opens with a quick personal update. He hopes listeners had a good holiday weekend, and he shares that he spent his time working his other job at Oregon’s Finest, chatting with people around Portland. Because his Blurbry workweek tends to be solitary, he refills his social meter on the weekends. He then recalls a Saturday night out with coworkers at the Hungry Tiger before turning to the lead story. Algorithmic Outing: When Your Feed Knows Before You Do Cochrane leads with new research from Australia that identifies a phenomenon called “algorithmic outing.” In short, the recommendation systems behind your social feeds can infer your sexual orientation or gender identity and start serving related content before you have worked it out yourself. Importantly, the study is small and qualitative, built on in-depth interviews with twenty LGBTQ+ adults in the Hunter region of New South Wales and published in the journal Gender, Place and Culture. The mechanism is engagement signals: what you like, who you follow, and how long you linger on a post, a metric the industry calls dwell time. Lead researcher Dr. Justin Ellis of the University of Newcastle notes that several participants said the algorithm “knew” they were queer before they did, an experience that felt validating for some but frightening for others in public settings. For Cochrane, the deeper worry is what else that hidden pattern encodes, from upbringing to mental health, and where that data ultimately gets sold. Sponsor: GoDaddy Economy hosting $6.99/month, WordPress hosting $12.99/month, domains $11.99. Website builder trial available. Use codes at geeknewscentral.com/godaddy to support the show. Meta’s Blueprint for Privacy-Aware AI Infrastructure Next, Cochrane turns to a sharp engineering piece from Meta on privacy-aware infrastructure. The core challenge is that a system must understand what a piece of data actually is before any privacy rule can protect it. A field named “age,” for example, might describe a person in one place and a cache setting in another. Meta’s answer deploys a large language model only on the genuinely ambiguous cases, then distills what it learns into fixed, human-reviewed rules. The payoff is concrete. According to Meta, those deterministic rules already handle about 85 percent of the traffic, and only the last 15 percent falls back to the model, which costs roughly 400 times more compute. Cochrane loves this edge-case approach. However, he contrasts it sharply with the AI-everywhere software he wrestles with at his weekend job, which he says the heavy AI reliance genuinely makes worse and harder to audit. Alberta Scans 466 Million Lines of Code With Claude This one comes from Anthropic, and it ties directly to Meta’s theme. A team inside Alberta’s Ministry of Technology and Innovation used Claude to scan 466 million lines of code in about twenty hours, a review Anthropic estimates would have taken humans roughly six and a half years. Notably, they ran around fifty AI agents in parallel, essentially an automated red team and blue team probing the systems at once. For Cochrane, this is the good version of AI in production: cleaning up and locking down real systems rather than running the show unsupervised. NVIDIA on Reinforcement Learning for AI Agents On the AI-building side, Cochrane walks through an NVIDIA developer piece on reinforcement learning for agents. Reinforcement learning rewards a model for good behavior rather than showing it the right answer, much like training a dog with treats. Additionally, he clears up a common mix-up. NVIDIA treats RAG, retrieval-augmented generation, as a separate tool: reinforcement learning changes how a model behaves, while RAG changes what facts it can reach. GitHub Retires Two Gemini Models Meanwhile, GitHub is retiring Gemini 2.5 Pro and Gemini 3 Flash across all of Copilot on July 31. The migration paths are Gemini 3.1 Pro and Gemini 3.5 Flash. Cochrane flags it as a sign of the times, since tools that felt brand new a couple of years ago are already getting sunset. He also wonders how quickly today’s “AI-optimized” chips will turn over as the models keep changing. The Many Journeys of Learning Rust One for the programmers, and Cochrane makes no secret of loving Rust. The Rust blog’s Vision Doc series explores how people actually learn the language, which is built around memory safety and its strict borrow checker. Honest themes surface throughout, including “clone guilt,” where beginners refuse to copy anything, and “silent attrition,” the learners who quietly bounce off. His take stands: getting your brain onto a memory-safe language rewires how you approach a problem. Google DeepMind Partners With A24 In an interesting collision of worlds, Google DeepMind is teaming up with A24, the studio behind Hereditary and Everything Everywhere All at Once. The two call it a first-of-its-kind research partnership, with DeepMind researchers and A24 building creative tools shaped by the artists who use them. Cochrane adds a detail worth noting: Google also invested in A24, so this is money on the table, not just a research handshake. For now, though, the announcement stays deliberately vague, with no named films or products. Google’s $1 Million Africa Indie Game Fund Another one from Google, and it is good news for developers. Google is launching an indie games fund for sub-Saharan Africa, a region whose gaming scene is growing about as fast as anywhere. The fund puts up $1 million across ten local studios, each receiving between $50,000 and $200,000 plus mentorship and hands-on support. Applications close at noon UTC on July 31. WhatsApp Usernames Are Here to Reserve WhatsApp is finally moving off phone numbers as your identity. With usernames, someone can start a conversation with you without ever seeing your number. Starting this week, you can reserve the name you want ahead of the full launch later this year. To claim yours, head into Settings, then Account, then Username. Intel Sets Its Q2 Earnings Date Cochrane flags a date worth watching for anyone tracking Intel. The company reports second-quarter results on July 23, right after market close, with an earnings call at 2 p.m. Pacific. Given recent US government investment and a shifting chip landscape, he is curious how the domestic chipmaker is holding up. Your Smartwatch Might Spot Illness Before You Do Shifting to health, Engadget reports that the wearables-plus-AI wave is starting to deliver. These devices excel at catching the moment your body drifts off its own baseline, often the first nudge to get checked out. A 2025 study from Texas A&M and Stanford suggests smartwatches can detect early signs of COVID or the flu within hours of infection. Additionally, Apple Watch’s irregular-rhythm alerts have flagged AFib correctly about 84 percent of the time. Working Memory and Consciousness Here is a heady one from Scientific American, written by philosopher Henry Taylor at the University of Birmingham. Working memory is the mental scratchpad holding whatever you are doing right now. Taylor opens with the doorway effect, that blank moment when you enter a room and forget why. Intriguingly, when information leaves working memory, it seems to leave conscious awareness at the same instant, a link drawing fresh attention across psychology, philosophy, and neuroscience. Scuba-Diving Cyborg Cockroaches Now for the wild one. Scientists have built tiny diving suits that let Madagascar hissing cockroaches survive underwater for up to three hours, while an unequipped roach suffocates in minutes. The 3D-printed suit feeds oxygen through tubes into the insect’s breathing holes, called spiracles, using a chemical generator with no electronics. This lab already steered the roaches with electrodes, so the diving suit is the new trick on top. Researchers pitch it for search and rescue, though Cochrane notes the reality of the spy bug has already arrived. Quantum Time Runs Backward at Los Alamos Next, a genuine brain-bender. Physicists at Los Alamos, led by Luis Pedro García-Pintos, found a way to make a quantum system look like it is running backward in time. To be clear, time is not literally reversing. Precise measurements just make the system’s evolution appear to unfold in reverse. The useful part is energy: measurement itself becomes a resource in what they call a continuous measurement engine. Cochrane admits the paper drifted further from his reality the more he read. Tall Trees Shrug Off Drought A new study in Science overturns some textbook wisdom. For years, the assumption held that taller trees suffer more in drought because they must lift water higher. However, researchers studying dipterocarps in Southeast Asia found that trees topping seventy meters slowed their growth by about the same amount as short ones during the 2023-2024 El Niño drought. The trick is plumbing: a seventy-meter tree grows base vessels roughly twice as wide as a ten-meter tree, so the real driver of drought stress is subtler than raw height. The Energy Department Purges Conservation Pages This next one frustrates Cochrane. The US Department of Energy deleted roughly 6,000 web pages about energy conservation, and the timing is brutal during a record heatwave. The move followed backlash over New York Mayor Zohran Mamdani urging residents to ease strain on the grid. Fortunately, the Internet Archive and its Wayback Machine preserved the pages before they vanished. For Cochrane, deleting that kind of public information simply does not make sense. Webb’s Puzzling New Universe Heading to space, Quanta Magazine explores how the James Webb Space Telescope keeps finding early-universe objects that should not exist. Those include black holes that grew enormous too fast and hundreds of mysterious “little red dots” around 650 million years after the Big Bang. As astrophysicist Rachel Somerville of the Flatiron Institute puts it, scientists have “almost gone from having too many early galaxies to having too many theories.” The hard part now is figuring out which theory is right. NASA’s Emergency Telescope Rescue NASA has a rescue mission underway for the Swift Observatory, a 2004 telescope that studies gamma-ray bursts. Recent solar storms puffed up Earth’s atmosphere, and the added drag has dragged Swift’s orbit down to about 224 miles, low enough to risk burning up this year. To intervene, NASA enlisted Katalyst Space Technologies of Flagstaff, Arizona, whose LINK spacecraft launched Friday. The plan is to boost Swift back up to roughly 373 miles. A Gorgeous Aurora From Orbit Finally, Cochrane closes on something beautiful. ESA shared a stunning aurora captured from orbit, a shimmering green band of light rippling over the planet. If you have a few minutes, it is well worth a look. Cochrane wraps with housekeeping and a thank-you to GoDaddy for two decades of support, then signs off, wishing listeners a wonderful evening. The post Algorithmic Outing: When Your Feed Knows Before You Do #1869 appeared first on Geek News Central.

Aphasia Communication App: How One Brother Gave a Stroke Survivor His Voice Back For four or five hours, Robert Schmidtbauer’s younger brother lay on the floor of their Wisconsin home, unable to get himself up. Robert found him when he got home from a late shift driving cabs. His brother had been drinking that night, but this wasn’t alcohol; it was a stroke, one that would put him in the University of Wisconsin Hospital for three weeks and in rehab for six months. His brother was already living with ataxia, a rare progressive condition that had taken his ability to walk and had begun to affect his speech. The stroke made it dramatically worse. Today, unless you know him well, you’ll understand only 60 to 70 percent of what he says. It’s usually the end of a sentence, the last few words, the part that carries the point that disappears. Robert became the translator. For years, every visitor, every relative, every tradesperson needed him in the room to fill in the blanks. Then he built something better: an aphasia communication app called Larry’s Speakeasy, priced at nine dollars for life, now used by people in 20 countries. When the Speech Problem Has No Official Name One detail of this story will be familiar to many stroke families: Robert’s brother has never been formally diagnosed with aphasia. The doctors attributed his speech difficulties to the combination of ataxia and stroke and left it there. After a year of speech therapy and his own reading, Robert concluded there was “probably some of that in there,”  but no clinician ever gave the problem a name. That matters, because a diagnosis is often the doorway to resources. Without one, nobody hands you a communication aid, a device funding pathway, or even a list of options. Robert’s brother got speech therapy two or three hours a week while it lasted, some practice phrases to take home, and nothing else. The Gap Nobody Warns Stroke Families About Rehab ends. The communication problem doesn’t. When Robert’s brother came home, the brothers developed their own system: Robert would catch 90 percent of a sentence, ask him to repeat the rest up to three times, and then ask him to spell the words letter by letter. That was the system for years. Robert credits his stint teaching English online to students around the world for training his ear to listen closely. But the system only worked when Robert was in the room. The moment that changed everything was ordinary: a new housekeeper came to quote on cleaning, and Robert’s brother, who runs the inside of the house, couldn’t make himself understood on the details. Robert stood in the middle, finishing sentences. He’d felt like a “third wheel” through his brother’s rehab, looking for a way to genuinely help. Standing in that kitchen, he found it. “I had one person on my wing that no one else in the building could understand but me. And even I had a 50% chance of understanding what he really wanted.” — a care facility director, on why a tool like this matters What Is an Aphasia Communication App? An aphasia communication app is software that speaks for a person whose own speech is impaired a modern, affordable form of what clinicians call AAC (augmentative and alternative communication). Larry’s Speakeasy does two things, deliberately kept simple: Type-to-speak. If your hands still work, you type any phrase or sentence, and the app says it out loud. One-tap phrases. For people with limited hand function, pre-made buttons cover emergencies (“I need to go to the bathroom,” “call the doctor”) and everyday phrases hello, goodbye, and a growing list Robert adds to as users suggest them. The market Robert walked into explains why he built his own. At the affordable end, there’s roughly one comparable app at around $13. After that, the next step up starts near $150 and climbs to $7,000–$8,000 for dedicated equipment that requires training and support to operate. Between a cup-of-coffee app and a small car’s worth of hardware, there was almost nothing. Robert priced Larry’s Speakeasy at $8.99 once, for life. “It’s not here for me to get rich off of,” he says. “It’s my brother, and I want it to help.” Built With AI, in Days, by a Retiree Robert is 67, with a background in television and radio rather than software. He’d spent months learning to work with AI tools and, in his words, cussing and swearing at the computer. When the housekeeper moment landed, he posed a different question to the AI: how can I help my brother’s speech?  And had a working version running within about two or three days, refined over the following months. That’s worth pausing on. The tools to solve a real disability problem at kitchen-table scale now exist for people who aren’t programmers. A determined care partner built, tested, and shipped an aphasia communication app from rural Wisconsin no company, no funding, no advertising. Around 260 people across 20 countries have tried it, and it’s listed as a resource on the National Aphasia Association website. More Than an Emergency Button The use cases stretch well beyond the kitchen: Therapy practice. Practice phrases from a speech pathologist can be loaded into the app and drilled at home with or without a partner. Video calls. Open the app in one window and Zoom or FaceTime in another, and a person who can’t speak clearly can hold a conversation with family anywhere in the world. Robert saw his own mother’s isolation in a care facility years ago; this is his answer to it. Care facilities. An iPad on a care cart could let staff understand residents nobody else can and document requests, which protects residents and facilities alike. Where to Find It The app lives at LarrySpeakeasy.com, with a seven-day free trial before the one-time $8.99 purchase. Try it, and if it helps, it helps, as Robert puts it; there’s no push. Stories like Robert’s are why this podcast exists: ordinary people refusing to accept the gap between what the system provides and what recovery actually needs. If that resonates, my book, The Unexpected Way That A Stroke Became The Best Thing That Happened, shares ten tools for recovery and personal transformation drawn from my own stroke journey and hundreds of survivor interviews; you’ll find it at https://recoveryafterstroke.com/book. And if this show has helped you, you can support it at https://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. Robert Schmidtbauer – Building a Voice for My Brother (Interview) After a stroke, Robert’s brother lost clear speech and had no tools to cope. So Robert built one: a simple app that speaks for those who can’t. Highlights: 00:00 Introduction – Aphasia Communication App 01:21 Challenges in Communication Post-Stroke 05:17 Stroke Experience and Recovery 12:20 Communication Challenges and Solutions 17:43 Creating Solutions Through AI 18:03 Introducing the Aphasia Communication App 21:13 Expanding Accessibility in Care Facilities 27:14 Final Thoughts and Resources 29:19 Bridging Communication Gaps 30:14 Resources for Stroke Survivors Transcript: Introduction – Aphasia Communication App Robert (00:00) If I ask him three times, I still can’t understand it. Like, spell it for me. You know, so I mean, that’s kind of how we got by until I developed this app. Lacunar Stroke New Research (00:10) Hello, everyone, and welcome to another episode of the Recovery After Stroke Podcast. Before we get into it today, I want to say a massive thank you to all my Patreon supporters and to everyone who supports this podcast. You are the reason this show keeps going. And I appreciate every single one of you. If you’d like to help keep these episodes coming, you can support the show at patreon.com/slash recovery after stroke. And if you’re looking for tools to guide you, On your own recovery, my book, The Unexpected Way that a Stroke Became, the best thing that happened, is available at recovery after stroke.com slash book. Now, today’s episode is a little different. My guest is Robert Schmidtbauer. And Robert is not a stroke survivor, he’s a care partner. His younger brother was already living with ataxia, a rare condition affecting his muscles and speech, when a stroke six or seven years ago made communication between the two brothers harder than it had ever been. In this conversation, we talk about what it’s like to be the person who translates for someone you love, what happens when rehab ends and the communication problem doesn’t? And what Robert decided to do about it. Something that might genuinely help other families in the same situation. Challenges in Communication Post-Stroke BIll Gasiamis (01:30) Robert Schmidtbauer welcome to the podcast. Robert (01:33) Thank BIll Gasiamis (01:33) can you give me a little bit of a rundown on you and your relationship with your brother before he had a stroke? Robert (01:42) My brother’s nine years younger than I am, so he’s 56, no, 58 now. And we’ve been living here. He originally got out of high school, went to travel school in Minneapolis, Minnesota, and lived there for a number of years. He has a taxia, and he moved home. to my mother’s house. Let’s see, we’ve been here 16 years now in this house living together. And he moved home about 20 years ago. Not quite, maybe like 18, 18 and a half. The ataxia took away his ability to walk. I’m not sure if you’re familiar with ataxia, but it’s kind of like in the muscular dystrophy realm. And it’s very, very, very rare. he attacks your muscles. depending on the seriousness and the kind, there’s like 20 different kinds. You probably wind up dying from it because it slowly affects your muscles. And the first things to go usually are your extremities. In his case, it was his legs and his speech. So when he moved home, he already had a slight problem talking, not real bad, but my mother built a house and it was very small, just one level. so that she didn’t really have to walk up and down stairs and that type of thing. And so he was basically sleeping in the easy chair when he moved back home. And I lived across the street. So I said, come on and move in with me, because I’ve got this big house. I was a single parent at the time. I have one son. And I said, there’s plenty of room here. You can have a bedroom and live here. Stroke Experience and Recovery And so we lived here. The story behind him and the stroke, I was at the time working as a cab driver at a resort town north of here. And so I would never usually get home on weekends until like four or five in the morning. And I came home, I found him on the floor. And so he had a drinking problem at that time. And I asked him what was wrong. And he said, well, I’m drunk. I well, how long have you been here? he’d been on the floor for like four or five hours. My brother is probably 6’1″, or around 6’2″, 230, 240. I couldn’t lift him up. We bought this house as a duplex. My girlfriend at that time lived and rented from us a basement apartment. Even with the both of us, we couldn’t. get him up. So called the ambulance, we got him in and it obviously wasn’t alcohol, although he had been drinking. He wound up going to, we live in the state of Wisconsin and Madison is in the south part of the state, which is our state capital. They took him to the hospital here and then they flew him to Madison and he wound up there in the University of Wisconsin Hospital, which is a very big progressive type hospital. And he was there, I think about three weeks before he came back to a nursing home here to recover. And so his recovery before he finally got home, I would say, going back to memory, we never really wrote it down, but probably about six months. He was in the nursing home for a good three, four months and then in an assisted living type situation where he had his own room, didn’t have to share it, was going through treatment and rehabilitation before he got home. And so then he came and when he was done with that, then he moved back here. So was about a six month process. BIll Gasiamis (05:37) How long ago was a stroke? Robert (05:40) exactly. I couldn’t tell you to be honest Bill, but somewhere in the realm of six to seven years. I go back, I ran a bar at one time and I’ve been gone from there for four years and this was before that. So I would say between six and seven years ago. BIll Gasiamis (05:57) Before COVID. Robert (05:59) Yeah, before COVID. BIll Gasiamis (06:01) Okay. So when he came back from rehab and the assisted living and came to live at your house, what kind of deficits was he living with? Robert (06:13) Excuse me. He still couldn’t walk. He was already in a wheelchair at that time with a taxia. And that didn’t really change much. was worse, obviously, when he first had the stroke, but the rehab helped him to get back to, I would say more or less where he was before the stroke. As far as being ambulatory, he can still stand up. He can still… function, get into counters and cupboards and things like that. He just, the legs, he just can’t walk. He could crawl on the floor if he had to. And his arms and everything still work, so he could still type. again, this was through rehab, but he pretty much got back to where he was prior to that, except for the speech. the speech became noticeably worse. I would say even at this time, at that time it was really bad, at this time unless you know him and live with him or have known him previously, you’re probably going to understand somewhere between 60 and 70 percent. It’s usually the last part of a sentence or thought is what Most people have difficulty understanding. BIll Gasiamis (07:30) So is it the ataxia and aphasia that he’s dealing with? Robert (07:34) You know, officially he’s never been diagnosed with aphasia. It’s probably more to do with the ataxia combination with the stroke. So the doctor has never really the prognosis or whatever you want to call it. They never really diagnosed them as having aphasia. But after reading up on it and going through therapies, you know, for speech and other things. And that continued for the better part of a year. It’s kind of obvious that there’s probably some of that in there. But as far as a medical diagnosis, official medical diagnosis, we never really got that meaning from any of the doctors. BIll Gasiamis (08:17) Got it. So he came back, he would have had some needs f and you would have had to support him with those, if obviously the walking and then and then whatever other needs. So in that communication early on, were you guys able to actually communicate and you understand what his needs were and help him with what he was asking? Robert (08:40) Yes, there was a point and you being a strokes arrival, you know, I have no idea. have AFib and so, you know, kind of runs in our family. So I knew some of what he was going through, but obviously I don’t know what anybody who’s had strokes, you know, have to go through on a daily basis. watching him, there was a point, especially in the nursing home immediately after in the first several months. I would say that there was major depression. There was a battle. I often quote a movie. There was a line that black actor, what was his name? Older guy that played God. Anyway, came on said one time, you never get busy living or you get busy dying. And so I mean, there came a point. after like the first month where we kind of had a come to Jesus conversation at the nursing home and it was like, okay, because he wasn’t following their recommendations too much. didn’t really, the therapy and stuff, wasn’t too thrilled and excited to do that. so I mean, through this conversation, it was like, okay, like, look, you know, either. You try and make the best of the situation and improve or I can’t help you. It’s like alcoholism or any other drug disease. You really have to want to do it, I think, yourself. And so he’s been dry now for, boy, well, since the stroke, probably close to 10 years now. I mean, he slowed down enough after the stroke, he quit completely. But so, yeah. So I mean, that, you know, the communication. I could communicate with him in hospital. It was harder, obviously, but, you know, I could still understand him. The one thing that helped me out throughout the period that we lived together, especially after the stroke, was I taught English online. So I talked to people from Saudi Arabia. I talked to people, you know. from various countries around the world. And that really helped me because I had to listen closely to them. But there are still times where I will ask him, I get 90 % of it and we get to the last couple of words and I’ve got the gist of it, but it’s like, I don’t understand the last words. He’s come out like, okay, ask me three times. If I ask him three times, I still can’t understand it. Like, spell it for me. You know, so I mean, that’s kind of how we got by until I developed this app. BIll Gasiamis (11:23) Yeah. And it it’s interesting, like you guys all went through rehab, left from hospital, came home, he had a speech issue, and yet you guys didn’t weren’t given a tool or something to help you guys communicate at all. It wasn’t even like a thought for anybody to do that. Robert (11:45) No, there was not. I mean, he had speech therapy when he went to the hospital, but that was an hour, three times a week or two times a week. I mean, it wasn’t an everyday type of thing. So yeah. then exercise is when he came home from there that he would, know, phrases and words and stuff that the therapist would want him to practice at home. And even that was… somewhat of a struggle, because we’re kind of, no disrespect to nationalities, but we’re kind of pigheaded Germans. Communication Challenges and Solutions BIll Gasiamis (12:20) that being said, you come home, you haven’t got the tools, you’re trying to help. your brother, there is times where you can’t understand what he’s saying. And you think, I know, I’ll create my own solution for this problem. And tell me about th the background that you had that helped you solve that problem and the solution that you created. Robert (12:43) Yeah, well, if we go back to, you know, when he came home, because this is obviously been recent, right? It’s because of my background was in television and communications. I worked in television and radio. And so I enjoyed playing with computers when he came home because, you know, we were fairly close family and knew him. I just let him do his thing. you know, and if he asks for help whenever I was there for him. But I always felt like a third wheel going through, you know, the stuff from him, his his rehab. I take him there and do it, but there wasn’t much except for like the speech stuff to help him be repetitive on that. So it felt like kind of a third wheel. So it kind of settled into a pattern, you know, unless he needed help, he’s pretty self sufficient. He has a CNA that comes over a couple times a week to make sure that like, when he takes a shower, he doesn’t fall, you know, that that kind of stuff helps with the dishes or cooks a couple meals and puts it in the refrigerator. But I was looking for ways, you know, and trying to think of what a person could do. Creating Solutions Through AI Well, So I still work, you know, part time. And through television, I had my own production company and did things on the side all the time. And so I like to be creative. And a friend of mine who lives in Chicago had a business and we started playing around with AI for about the last six months now. And it’s not as easy as some people say it is, you know, and especially to learn how to use it. So we started playing around with it. And the frustration level of learning AI got to me after we were into it two or three months. you know, learning how to prop things and explain things to get the result that you wanted, I think is one of the biggest keys for that. And not to go off on a tangent here, but this is how the app and working for my brother really came about. I just needed a break. So it came to a point where I’m cussing and swearing. swearing back at the computer and AI and I’m like, no, no, no, no, we tried to do this like five times. This is really simple. You just change this one thing and you’ve got what I want. But every time I asked it, would change something else. And so I’m like, OK, I still want to continue to learn how to use AI, but I got to just put that aside for a minute and take a day off and not work on that. And so we happened I’ve had, I was a single parent. My son was 13 months when my ex-wife left. And so I raised them by myself. And I’ve had a housekeeper that’s been with me for like 20 years. And she is getting older. She’s like in her late 60s, early 70s now. She fell and she busted her hip. And so we had to find another housekeeper while she was recovering. You know, I said, if you want to come back, you’re more than welcome to, but you know, we’ll find someone else in the meantime. And so we had someone come over to the house and give us a quote on what it would cost us to just tidy up the kitchen and the bathrooms and stuff, because I still work about 30 to 35 hours a week. the same thing that happens over and over again when people and relatives visit us with his speech happened with her. And when I’m around, I’m the go-between. I mean, it’s kind of they understand the 60 % of the first part of his answer. And because he’s around the house all the time and doesn’t leave it, I leave those kind of decisions that I take care of the outside and the lawn and those things that I leave the inside of the house to what he wants. Because he’s the one that spends most of the time, you know, in here. And so I’m answering, you know, I’m filling in the blanks for her. You she’s like, okay. I understand you want the bathroom clean this way, but what was that last part? And so I finished the sentence. I’m like, well, he said this, you know? And it kind of dawned on me at that time, you know, going back to the third wheel feeling, kind of dawned on me at that time. I’m like, okay, what if I asked AI a couple of questions about how I can help him, you know? I mean, and help him with his speech. And that’s basically how the app came about. She gave us a quote that was here for half hour, and that happened half a dozen times. And so after she left, I’m like, all right, I still want to try and continue to learn this. And maybe by doing a different project that I’m not just completely frustrated with at the moment, I can help myself with this other project and help him all at the same time. And so. I just posed the question to you, I use Claude mostly, and I just posed the question to Claude, and it gave me the answer. And from that point on, we, over the last, it’s been a little over two months, two and a half or three months, we refined it, probably ended up in running in about two or three days. Introducing the Aphasia Communication App BIll Gasiamis (18:03) So fundamentally, can you tell me how the app works, what it is and how it works specifically? Robert (18:11) It’s basically whatever you want it to be. And it has everything to do with how functional you still are. It’s not designed to be an end all be all. It can be. If you can’t speak at all, it can be. Because you can either type, depending on your conditioning. Do your hands still work? Can you type? So you can type, there’s a line there as you see, you can type in whatever phrase or sentence that you want, and then it will speak out loud what you type in. And then there’s also for people that are limited in their use of their hands, pre-made phrases. And they range from emergency phrases, I need to go to the bathroom, you need to call the doctor. you know, personal phrases, hello, goodbye, you know, things that, and I just thought up as many as I could. And we’ll add to that as we move through stuff and anybody that has suggestions, like contact, and that’s probably what’s screwing something up is I didn’t have a contact on there. So my email’s on there now that if you have an idea, please feel free to, you know, contact me and we’ll try and put something in for that. So that way, you know, if you have an emergency or you have like the housekeeper, you know, like the situation we are and you know, you need something, all you do is just click on the button and then it will speak that phrase out loud. I just wanted it very simple, very straightforward. And so, you know, it’s designed in the sense of doing it that way. If you want to go to a medical definition of it, you could use it and substitute your own voice completely if you want. But the idea is probably more of a helping situation where anybody going through therapy, like watching my brother go through therapy and coming home with phrases and words that he had to, you could literally you know, hit the button, that phrase would come up and you could practice that or, you know, the speech therapist could give you a list of things that could, if you could still type, you could type that in and then work with that at home. If you didn’t like me and my brother, add me to, you know, to be here to rub through that kind of stuff. But if you were alone or someone couldn’t get over it, you could use it in that realm. And depending on how your rehab went, you could be useful for six months. It could be useful for a lifetime. again, that’s why the prices where it’s at, it’s not here for me to get rich off of. want people to, you know, I want it to help people. It’s my brother and I want it to help. So, you know, if you can afford it, it’s $8.99, $9. And that’s a lifetime deal. So once I get this problem. BIll Gasiamis (21:00) Yeah. What’s the price? Yeah. Expanding Accessibility in Care Facilities Robert (21:13) cleared up that I didn’t know about. You can use it for however long it’s there. BIll Gasiamis (21:19) Yeah, nine dollars. I it thirteen Australian dollars. It’s if it it’s well worth it. Like if you get a you get a tool for nine dollars and you use it forever, like that’s perfectly fine. No issue with that whatsoever. so it it’s Robert (21:31) You know, we are doing something as far as facilities are concerned. I’ve reached out to nursing homes, assisted living places, and I haven’t heard back from any of them yet. I’ve gotten some response on it. It seems favorable, but I haven’t got into any kind of negotiations or anything with them. One of my ideas is like going through with what my mother went through with her dementia, right? Here in Tomahawk, there’s one, two, three, two nursing homes and an assisted living place. And so my brother and I and my son, they had a couple rooms where instead of being out in the general population area with people all around, we could book a room that had a television and a couch and a table and stuff. And we would bring order a pizza or bring in food and spend a couple hours as a family where we weren’t disturbed. And my idea for them is twofold. Number one, seeing as how you could use it on an iPad or a tablet. If you had, I have one of the people that helped me here give me information. I work for a group called Tom Ocunary Interfaith Volunteers. it’s a, we give free rides to senior citizens and people. with disabilities. they can go to the doctor, they can go to the store. And one of the guys was the director at one of these facilities. And he came through to become a director all the way from just being a CNA, which is a very low paying job. It’s the people who clean up the messes, let’s just say, you know, to running the facility for this company. And, you know, he’s like, I had one person on my wing that no one else in the building could understand but me. And he said, even I had a 50 % chance of understanding what he really wanted. To have this, say an iPad that you could have hooked onto your cart when you’re making rounds or something, he said, would have been invaluable. And so not only in that respect to help them with clients that they have, but then they would also have like a legal transcription of something in case something a family said that so and so did this to so and so that was bad or they had a problem of some kind. It could be documented. The other aspect of that was with these rooms I was talking about was, you know, you could literally take the computer and open up just like we are here. You’re going to open up a couple of browser windows. You could put Larry’s you know, speak easy, the interface in one window, you can open up FaceTime on Facebook or Zoom or whatever, you know, communication, let’s say that your daughter lived in Phoenix, Arizona or New York or somewhere. You could get them on the line and you can literally have a conversation back and forth because it would speak out loud through the speaker. And if you were, again, able to type and or hit the phrases, you know, that person over there would hear it come out of the computer. And so you could then keep closer tabs on your relatives. Because I think one of the bigger things, having this experience with our mother, was the isolation and the loneliness. mean, in those days, which is now 15 years ago, I went there every other day for an hour or two. I still had to work and still had other things to do. So, you know, to be able to come home and just sit down at a computer and talk to them would have been real nice. So in a sense of, you know, keeping in touch with your family and that type of thing with friends or whatever. Like my brother was a travel agent in Minneapolis and he’s still got two or three of the people that he worked with that are still in his life. So to be able to, you know, do that and you can hold a conversation with them and catch up and things. So I think that would be those two things combined I think should be, how do I put it, attractive to a facility, not only for the client but also for the facility itself. BIll Gasiamis (25:45) Yeah, yeah. To be able to take an iPad and press a button and have a basic conversation at such a low cost to entry, like that’s really good. I imagine there is already software that’s similar that would Robert (26:00) There’s one that’s, and I can’t remember the name of it, so you’ll excuse me. hope. But there’s one that’s about $13 or $14 right around $12.99 or $13.99. That is similar. But from that point on, the next step up is about $150 all the way up to like $7,000 or $8,000 where you actually have to have equipment at home that… you need to learn and or have help using. So there’s really a pretty big gap in that. That’s just my opinion. My research isn’t paid. There could be other things out there. I know there’s a lot of text to speech and a lot of the tablets and stuff right now. just to be dedicated to, excuse me, you know. people with this, you know, aphasia with recovering from stroke. So I really thought, you know, when I, when I’m a My brother showed him, I’m like, wow, this could really help not just him, but other people. BIll Gasiamis (27:05) Yeah, understood. And Robert, if somebody wanted to get a copy of this or to check it out, where would they go? Final Thoughts and Resources Robert (27:14) Speakeasy.com and again, like I said, there’s a free trial. You could just go there and check it out. And if that, you you decide over the course of that free seven days, if that would help you or not help you, you know, and that way then there’s, there’s no push, you know, I think that’s a week. And so if you’re truly interested in it, you have to remember that, that there’s only seven days to try it out and use it. If it helps, it helps, and if it doesn’t, that’s fine, you move on. BIll Gasiamis (27:43) That’s cool. Yeah. Yeah. Very good. Robert, well, I really appreciate you sharing your story and your challenges that you guys have both had to overcome and the development of this little basic simple tool that solves a problem and and reaching out so that we can let people know so that if they need to solve a problem like that, that is similar and they’re happy to pay nine ninety nine US dollars, then that that might help them. That might be a good way to go about solving a little problem well, a big problem for people in in their home. Robert (28:21) You know, we’ve, it of, asked me something that I did here just recently because we are on the, NAA, the National Aphasia Association website as a resource. We’re on a smaller, it’s called the Stroke Foundation out of Texas, started by a family very similar to your case, a family that has suffered stroke in the family, and it’s a family-run foundation. We have 300, almost 260 something people that have tried it across without any type of advertising just by talking on Facebook and supporters. And also we’re people from 20 different countries now have tried it. So, you know, I welcome them all, you know, just try and if it helps, good for you. And I’m happy that. you do something to help anybody. BIll Gasiamis (29:17) Yeah. Thank you, mate. Thank you for joining me on the podcast. Bill Gasiamis (29:19) Well, there you have it. My conversation with Robert Schmidbauer. A huge thank you to Robert for reaching out and for sharing his and his brother’s story. What stays with me from this one is how simple the whole thing is. Two brothers with a communication gap that the system never closed. And instead of waiting for permission or a diagnosis, Robert sat down and built the tool himself. Nine dollars for life because it’s his brother and he wants to help. If you or someone you love is dealing with speech difficulties after stroke, head to the show notes right now. You’ll find the link to Larry’s Speakeasy there and the app that Robert built at Larry’s Speakeasy.com. There’s a free seven-day trial so you can see it for yourself whether it helps before you spend a cent. And while you’re there, if the episode gave you something, like it, leave a comment. Share it with someone who needs it and subscribe so you never miss another episode. Every one of these things helps more stroke survivors and their families find this show. If you’d like to go deeper on Aphasia, check out my earlier conversation with Tracy Bode, Aphasia Help After Stroke At recoveryafterstroke.com/slash Aphasia Help After Stroke. Tracy Bode. The links will be in the show notes. My book, The Unexpected Way That a Stroke Became the Best Thing That Happened, is available at recoveryafterstroke.com/book. And if this show has helped you and you can support it at patreon.com/recoveryafterstroke I would deeply appreciate it. Thanks for being here. I’ll see you on the next episode. The post Robert Schmidtbauer – Building a Voice for My Brother appeared first on Recovery After Stroke.

Brian has been on a carnivore diet for almost 4 years. He was very overweight most of his adult life. In 2018, he developed A-Fib, and was having 2-3 paroxsymal A-Fib episodes per week before starting carnivore. Lower back and hip pain were so bad that he couldn't sleep longer than a couple of hours in bed at night. Brian also struggled with low energy, mild depression, joint pain, arthritis in his big toe, high triglycerides, low HDL, and low vitamin D. Within a few weeks on carnivore Brian was sleeping all night in bed, joint pain was going away, and he noticed A-Fib episodes were not happening. He lost 60 pounds in the first 3 months and 85 pounds over the first year and has maintained that weight loss since starting carnivore in July of 2022. Brian has gone over 3 1/2 years without a single A-Fib episode. His cardiologist has had him wear a heart monitor multiple times, including once for 30 days, and participate in a stress test and ultrasounds, showing no evidence of going into A-Fib anymore.  In November of 2025 Brian had a CAC scan and it was 0. His HDL is improved and triglycerides are way down. His Vitamin D level is normal, and no longer has issues with joint pain or arthritis in the big toe. Starting carnivore at age 48, Brian is now 52 years old and feeling better than he did in his 30's. Socials: YouTube - @wickivore Timestamps: 00:00 Trailer 00:22 Introduction 05:52 Increasing joint flare-ups 08:07 First heart diagnosis 09:41 Struggles with restrictive dieting 12:49 Discovering the Carnivore Diet 15:58 Discussing keto-friendly foods 20:48 Carnivore diet and joint health 24:30 Finding a flexible doctor 28:35 Personal transformation and health concerns 32:09 Positive changes after diet switch 35:13 Early days of carnivore diet 37:54 Carnivore diet's growing popularity 41:45 Impact of Joe Rogan on Diet Trends 43:41 Avoiding unhealthy products Join Revero now to regain your health: https://revero.com/YT Revero.com is an online medical clinic for treating chronic diseases with this root-cause approach of nutrition therapy. You can get access to medical providers, personalized nutrition therapy, biomarker tracking, lab testing, ongoing clinical care, and daily coaching. You will also learn everything you need with educational videos, hundreds of recipes, and articles to make this easy for you. Join the Revero team (medical providers, etc): https://revero.com/jobs ‪#Revero #ReveroHealth #shawnbaker  #Carnivorediet #MeatHeals #AnimalBased #ZeroCarb #DietCoach  #FatAdapted #Carnivore #sugarfree Disclaimer: The content on this channel is not medical advice. Please consult your healthcare provider.

Episode Summary Do you ever feel like you're practicing on an island, unsure of who to trust for quality CE or where to turn when you hit a wall with a complex case ? In this episode of Dental Digest, host Dr. Melissa Seibert introduces a masterclass in shifting your perspective from single-tooth dentistry to systemic health . Joining the show is Dr. Jeff Rouse, a preeminent authority on airway dentistry, prosthodontist, and Spear Education resident faculty member . Dr. Rouse completely reframes the airway conversation, arguing that most practitioners are getting it wrong by trying to force patients into prefabricated appliance boxes or focusing solely on end-stage sleep apnea . Instead, he explains why airway is fundamentally an anatomical problem . By pushing Frank Spear's facially-generated treatment planning into three dimensions—vertical, transverse, and sagittal—Dr. Rouse demonstrates how a compromised smile design is often a cry for help from an unhealthy upper airway . If you have ever bulked up veneers to camouflage a structural issue that actually required skeletal correction, this conversation will completely change how you treatment plan . Key Takeaways From This Episode Airway vs. Sleep: Why Dr. Rouse deliberately abandoned the word "sleep" in favor of "airway" back in 2008 to focus on early anatomical intervention before long-term neurological damage occurs . The Pitfalls of One-Size-Fits-All Appliances: A critical look at corporately and financially-driven prefabricated appliances in pediatric dentistry that prioritize practice profit over scientific, individualized diagnosis . The 3 Dimensions of Airway Anatomy: How the vertical, transverse, and sagittal boundaries of a traditional denture wax rim mirror the exact dimensions required for healthy nasal breathing . The Numbers Behind the Health: A look at clinical benchmarks, including Eric Doolan's research showing that a bone-to-bone palatal measurement under 30 millimeters guarantees illness, while 34 millimeters or greater promotes health . Recognizing the "Sick" Patient Typologies: The Apnea Patient: Often characterized by snoring, daytime sleepiness, high blood pressure, AFib, and a lack of deep sleep required to clear brain toxins, which is closely linked to dementia and Alzheimer's . Young, Fit Patients: Toned individuals (particularly pre-menopausal women protected by progesterone) who do not exhibit apnea but suffer heavily from functional somatic syndromes like chronic fatigue, IBS, fibromyalgia, migraines, and TMJ disorders . Pediatric Patients: Growing children whose airway deficiencies directly correlate with ADHD and ADD diagnoses, yet are routinely given medications rather than a proper breathing and sleep evaluation . Anatomy Wins the Day: Why normalizing skeletal and dentoalveolar housing should always be the priority, ensuring patients finish treatment not only healthier but with beautiful faces, perfect bites, and stunning smiles . Featured Guest Dr. Jeff Rouse is a prosthodontist in private practice in San Antonio, Texas, and a member of the resident faculty at Spear Education . He previously practiced alongside dental icons Dr. Greg Kinzer and Dr. Frank Spear in Seattle . Dr. Rouse is the co-author of the textbook Global Diagnosis: A New Vision of Dental Diagnosis and Treatment Planning alongside Dr. Bill Robbins, and he lectures internationally on dental aesthetics and airway prosthodontics . Resources & Links Mentioned Elevated GP: Elevate your dental practice by joining Dr. Melissa Seibert's virtual study club. Get twice-monthly CE, access a comprehensive on-demand course library, and connect daily with an elite community of general dentists pushing each other to the next level . Sign up at theelevatedgp.com . Leave a Review, Get a Course: Want free access to Dr. Seibert's short course on class two restorations ? Simply leave a rating and review for Dental Digest, take a screenshot, and email it to doctor.melissacybert@gmail.com.

This hour of Health Talk America hits close to home for millions of listeners. Dr. Adam Brockman answers a caller on Eliquis with AFIB who wants to do more naturally without risking a dangerous interaction. A husband calls in for his wife who has been battling relentless hot flashes well into her sixties despite doing everything right. A frustrated listener asks the question the wellness industry doesn't want you to ask — is functional medicine just another pay-to-play guessing game, and how do you actually find practitioners who deserve your trust? And a caller with aortic stenosis wants to know if aged garlic can help. The answer is yes — and there's a specific formula for it. Plus a health tip so simple you'll wonder why no one told you sooner.

In this episode of Aging Well with VNA, host Kersten Rettig welcomes back retired cardiologist Dr. Melissa Curry for an important and informative conversation about atrial fibrillation (AFib)—a common heart rhythm disorder affecting millions, with nearly 40% of people experiencing it at some point in their lives.Together, they break down what AFib is, why your heartbeat matters more than you might think, and how this condition can impact overall health. While AFib is not typically life-threatening, it can increase the risk of stroke and cause uncomfortable symptoms that affect quality of life. Dr. Curry shares insight into key risk factors—including age, genetics, obesity, high blood pressure, alcohol use, and sleep apnea—and discusses the latest approaches to treatment and management. Most importantly, she offers reassurance that there is hope: with early detection, proper care, and lifestyle changes, AFib can be effectively managed. Whether you're concerned about your own heart health or caring for a loved one, this episode provides practical, reassuring guidance to help you better understand AFib—and take steps toward living well.Learn more about AFib at https://www.stopafib.org/

Are you putting too much trust in your health and fitness tech? In this 5-Minute Check In, we ask: Can your smartwatch really detect AFib and is your ring accurately monitoring sleep? We're diving deep into the scientific data to reveal what these devices actually promise vs. what they actually deliver. Get the insights in just a few minutes.Guests: Dr. Thomas McGinn, SEVP and Chief Physician Executive Officer; Dr. Ankita Sagar, System VP Clinical Transformation and Well-Being; Dr. Phil Chang, Chief Medical and Quality Officer; and Brooke Burgess, System Director Clinical CommunicationsStudies: https://www.jacc.org/doi/10.1016/j.jacadv.2025.102133https://pubmed.ncbi.nlm.nih.gov/41230431/  

This episode is a very real life update about the day I ended up in the emergency room with atrial fibrillation. I thought I was simply tired, busy, and pushing through another packed weekend. Instead, my body was telling me something was seriously off.I'm sharing exactly what AFib felt like, the combination of factors that may have triggered it, and why midlife requires a new level of awareness. This is not about becoming afraid of your body.It's about knowing it well enough to notice when something changes, trust yourself, and get help before you can explain it away.Highlights:(01:39) - Why midlife demands a different kind of attention(04:46) - The first moment I knew something was wrong(06:28) - Blacking out, then still trying to stick to the schedule(08:10) - The urgent care visit that sent me straight to the ER(10:48) - The perfect storm behind my AFib episode(14:45) - Why you cannot be a martyr and save yourself tooQualia Mind - click hereCoupon Code: SHOCKANDYALL (15% off any purchase)Visit Nicole's on demand fitness platform for live weekly classes and a recorded library of yoga, strength training, guided audio meditations and mobility (Kinstretch) classes, as well: https://www.sweatandstillness.comGrab Nicole's bestselling children's book and enter your email for A FREE GIFT: https://www.yolkedbook.comFind Nicole on Instagram:https://www.instagram.com/nicolesciacca/Tik Tok: https://www.tiktok.com/@thenicolesciaccaFacebook: https://www.facebook.com/nicolesciaccayoga/Youtube:https://www.youtube.com/channel/UC1X8PPWCQa2werd4unex1eAPractice yoga with Nicole in person in Santa Monica, CA at Aviator Nation Ride. Get the App to book in: https://apps.apple.com/us/app/aviator-nation-ride/id1610561929Book a discovery call or virtual assessment with Nicole here: https://www.calendly.com/nicolesciaccaThis Podcast is proudly produced by Wavemakers Audio

Join us for an informative discussion on Atrial Fibrillation (AFib), the most common type of irregular heart rhythm affecting millions of people worldwide. Learn how to recognize the signs and symptoms, understand potential risk factors and complications, and explore the latest treatment options available. Whether you've been diagnosed with AFib, care for someone who has it, or simply want to learn more about heart health, this episode provides valuable insights to help you take charge of your cardiovascular well-being.

Can ketogenic therapy help atrial fibrillation? What should you make of the KETO-CTA study? And do higher ketones always mean better results?In this Metabolic Mailbag episode, Dr. Bret Scher answers audience questions about cardiovascular health, ketosis, ketone levels, and how to personalize a ketogenic approach based on your goals and metabolic health. From AFib concerns to cholesterol controversies and troubleshooting low ketone readings, this episode tackles some of the most common questions in the keto community.In this episode, we cover:Ketogenic therapy and atrial fibrillation (AFib)The latest update on the KETO-CTA studyLDL cholesterol, plaque, and cardiovascular riskWhy ketone levels don't tell the whole storyRaising ketones without sacrificing energy or muscleCarbohydrate intake and metabolic flexibilityFasting, protein, and thyroid considerationsMCT oil, exogenous ketones, and other strategies to increase ketosisOne of the biggest takeaways: context matters. Whether you're evaluating cholesterol, ketone levels, or cardiovascular risk, there is rarely a one-size-fits-all answer. Understanding your goals, metabolic health, and individual response is often more important than chasing a specific number.

Primary stroke prevention is a critical opportunity for neurologists, with most stroke risk driven by modifiable factors such as hypertension and lifestyle behaviors. This episode highlights practical tools and strategies, including Life's Essential 8 and contemporary risk calculators, while also exploring evolving approaches to shared decision making and secondary prevention. In this episode, Katie Grouse, MD, FAAN, speaks with Mitchell S. Elkind, MD, MS, FAAN, author of the article "Stroke Prevention" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California, San Francisco in San Francisco, California. Dr. Elkind is the Chief Science Officer for Brain Health and Stroke at the American Heart Association in Dallas, Texas, and a professor of neurology and epidemiology at Columbia University in New York, New York. Additional Resources Read the article: Stroke Prevention Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Guest: @MitchElkind Full episode transcript available here Dr Grouse: Neurologists have generally been more involved in secondary stroke prevention, but primary stroke prevention is increasingly recognized as an important topic of discussion for neurologists. Today, I have the opportunity to interview Dr. Mitchell Elkind, who wrote the article on stroke prevention in the newest Continuum issue on cerebrovascular disease.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Grouse: This is Dr. Katie Grouse. Today, I'm interviewing Dr. Mitchell Elkind about his article on stroke prevention. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast, and please introduce yourself to the audience.  Dr Elkind: Thank you so much, Katie. So, my name is Mitch Elkind, and I'm the Chief Science Officer for Brain Health and Stroke at the American Heart Association and a stroke neurologist by background.  Dr Grouse: Well, I just want to start by saying that I really enjoyed reading this article. I think this is just a really wonderful article I recommend strongly. Such a high yield, an important topic for a lot of us who see patients who are interested in learning about their stroke risks or need help with, uh, stroke prevention after having a stroke. So, I wanted to start. What's changed in the last couple of years? You know, what are some big highlights that you really want to stress that are different from maybe the last time we reviewed this topic?  Dr Elkind: Sure. Well, there's been a lot of development in the field of secondary stroke prevention, for one thing. But even beyond that, I think we increasingly appreciate how important it is to control what we call the social drivers of health on the earlier side, primordial or primary prevention. And that has been a big advance, I'd say. And I would also say, I think it's really important for neurologists to understand some of those questions about primordial and primary prevention. You know, we tend to get involved with patients after they've had a stroke or maybe a TIA, some kind of event. But sometimes we find people who are following for, you know, non-stroke related conditions who have risk factors also. And we can really play an important role in identifying those risk factors and helping to prevent a first stroke or vascular event as well. So, I think it's real important for us to be doctors even before we're neurologists. So, you know, Katie, about ninety percent of stroke risk is modifiable, so we can do a great job as neurologists in preventing stroke. And one of the most important things that we can do is to identify and treat high blood pressure. And recently, actually, the American Heart Association, American College of Cardiology guidelines on the management of hypertension have said that treatment of high blood pressure not only prevents stroke, but it can also help to prevent cognitive decline and dementia. And this is the first time that we've had a class of recommendation one and level of evidence A, the highest level of recommendation we give for the use of blood pressure treatment to prevent dementia. And that's largely based on the results of some large trials that have come out recently showing that you can prevent dementia with blood pressure control. So that's a really exciting link, I think, between cardiovascular risk factor control and subsequent brain health. It just illustrates the role that neurologists can play in, so many conditions outside of stroke as well.  Dr Grouse: That's a really great point, and I want to get a little more into the idea of primordial stroke prevention. Can you tell us a little bit more about what that might be?  Dr Elkind: So primordial prevention refers to addressing how we can prevent risk factors from occurring in the first place, and how can we improve the environments in which people live. You know, we know that only about twenty percent of health outcomes is dependent on what happens between the patient and their doctor in the office. About eighty percent of it is due to what happens in the environments in which we live, work, pray, and play. And so that's what we mean when we refer to the social drivers of health. What is the neighborhood like where somebody lives? Do they have access to healthy food? Do they have places where they can go to exercise? Is there air pollution in the area that may affect their health? You know, one really interesting fact that's become apparent in the last few years is that air pollution is a major risk factor for stroke. Something like a sixth of all strokes can be attributed to the quality of air. And so, what are the things we can do at the broader public policy, community level to reduce the risk of risk factors like high blood pressure and diabetes even before somebody has an event that brings them to the attention of the doctor? So that's what we're thinking about with regard to primordial prevention. It's the earliest stage in prevention.  Dr Grouse: And that's really fascinating. You know, I think an area that we haven't, as neurologists, really put a lot of our time thinking about, but clearly a very important thing. I really appreciated reading your article about how you incorporated the fact that, you know, a lot of these risk factors overlap very, very closely with all the risk factors for various types of cardiovascular events. And I would imagine that the work you've done as the Chief Clinical Science Officer for the American Heart Association has informed a lot of the way you've thought about-Trying to bring all these risks together and think a little bit more holistically about the whole thing. Could you tell us a little bit more about that and the work that you've done on the American Heart Association's Life's Essential 8 score?  Dr Elkind: Sure. I can't take credit for it. It's really work that was done by others at the Heart Association, particularly a cardiologist and epidemiologist named Don Lloyd-Jones. But many other volunteers participated. Life's Essential 8 is our approach to primary stroke prevention and cardiovascular prevention more broadly. We say Life's Essential 8 because it includes four health behaviors and four health factors that people can observe to reduce their risk of cardiovascular disease. The four factors are kind of things like know your numbers, your blood pressure, your blood sugar, your body mass index, right, which is a combination of weight and height, and your cholesterol level. So, know those numbers and keep them within the recommended ranges, and talk to your doctor if they're not. And then four lifestyle behaviors. So, one of them is to eat a healthy diet, and typically that means the Mediterranean diet. It means getting regular exercise, and we recommend 150 minutes a week of moderate to vigorous physical activity. Of course, it means abstinence from smoking or other tobacco products. And the last one, the eighth one, which I was so excited about when we added this, is sleep, recommending at least seven hours of sleep a night. So, I was really excited about this because we used to talk about Life's Simple 7, and then the last iteration of our recommendations included this recommendation for adequate sleep because of the mounting evidence of the importance of sleep to cardiovascular health. But sleep is really a brain function, right? And so, it was really the first, in a way, specific brain function that was added to our recommendations. So that's Life's Essential 8. People can read about it online at heart.org and recommend it to your patients as a simple way for people to understand the best approach to reducing their risk of cardiovascular disease, including stroke.  Dr Grouse: I checked it out myself after reading the article. It's very accessible to patients. It's a great education tool. And they can, you know, see their own score and use that in their own way to, to think about what their risks are and how they can help mitigate and then rescore themselves down the line. There's also, though, on the kind of more the clinician side, the PREVENT calculator as well. Could you tell us a little bit more about how we could use that in approaching this patient population?  Dr Elkind: Yeah. So, I think of Life's Essential 8 as being a patient-focused tool that people can use. PREVENT is really more for clinicians. Anybody can look it up online and enter your data into it. There's a risk calculator online. But the basic idea behind PREVENT and other similar risk calculators is that it's a way to estimate somebody's risk of having a cardiovascular event like stroke or a heart attack or even heart failure by entering information about your health. And we used to think, we used to use something called the ASCVD, atherosclerotic cardiovascular disease risk calculator, or the Framingham score. Framingham Heart Score, for example, was another one. PREVENT is the latest version, and it has several advantages over those earlier types of risk predictors. For one thing, it predicts risk at younger ages as well. It goes down to age 30. It predicts risk over a longer duration of time, so over 30, 10 or 30 years. It eliminates the use of race as an item to put into the calculator and substitutes for that socioeconomic status, so it's not a race base, but a measure of social disadvantage. And it also includes kidney elements, kidney measures. It includes renal function, for example, that weren't included in prior measures, and it can also be used to predict heart failure, which was not part of the original calculators. Another major advantage of the PREVENT study is that it was based on real-world data from about three million patients, many, many more than the 50,000 or so that the earlier risk calculators were based on. So, it has a much more robust data set and therefore allows a bit more precision in the ability to predict future risk of events. And typically, primary care doctors would enter their patient's data, calculate a risk, and then based on the results of the risk calculator, they can make recommendations about what type of medications a person should take or what other strategies they could use to reduce their risk. And so that's the role that PREVENT plays, is really being focused more for the clinician than the patient.  Dr Grouse: Really great tool for us to be aware of. You earlier alluded to the fact that neurologists are in the situation where we sometimes are helping patients with this primary prevention. But you also make a case for why it's in the patient's best interest for us to be involved in, in these conversations when we can, when we have the opportunity. Can you tell us more about that?  Dr Elkind: Shared decision-making is really important because we know that people aren't going to lead the healthiest possible lives if they're not invested in their care. And so, a doctor telling somebody what to do if the patient doesn't want to do it is gonna have limited benefit.So we emphasize the importance of shared decision-making as much as possible. And I think that where this comes up a lot is actually in the situation of, for example, atrial fibrillation, where patients will often be put on a blood thinner. And many people are fearful of blood thinners. They worry about the risk of bleeding. Maybe they know a relative who's had a bleeding complication from a blood thinner, and so they may be disinclined to try it. And so, it's really important to have these discussions about the risks and the benefits of medication and engage the patient in thinking about this. And there are even tools and visual aids that people can look to to help explain some of these complicated concepts to patients. So, these are the kinds of things that reflect implementation science as a way to improve adherence. We know what works in a clinical trial setting often, but the challenge is translating that into the real world and getting our patients to use the medications that we believe scientifically have been shown to be of benefit. I've actually been surprised sometimes at conversations I've had with people, in some cases, healthcare professionals who resist going on blood thinners because of their fear of the complications. And I feel like the evidence is there. Why don't they believe me? And that's why it's really important to have the conversation. Even our peers and colleagues can sometimes question the evidence, and it's important for us to be aware of that.  Dr Grouse: Absolutely. I think that sounds very reasonable to me, and hopefully these tools will help us with making some of these decisions with our patients. Now, turning our attention a little bit to secondary prevention. So, you know, someone's already had a stroke or a TIA, sort of thinking about what we can do to optimize their risk factors for further strokes. You know, I think there has been some changes that have happened, I think, in the last few years that might be affecting some of the decisions we're making and some of the advice we're giving our patients. I wanted to talk a little bit about GLP-1 receptor agonist medications. Is the data there to support use of this either in secondary prevention or even in primary prevention in the case of stroke?  Dr Elkind: There is evidence that supports the use of GLP-1s for stroke prevention. We need more data, though. We need trials that focus only on patients with stroke, for example, there have been studies in patients with cardiovascular disease broadly that include stroke patients. But if you look at the subcategory just of stroke patients alone, the data in that subgroup alone don't always show a benefit. And so, we need more data that's focused on stroke patients alone. So, I think the data are continuing to emerge, but we need more still.  Dr Grouse: Is there any development in the thought about whether we should be putting patients on antiplatelet therapies for incidental, incidentally identified strokes? For instance, if you got an MRI for migraine or for other reasons and you found one, no history of any stroke-like symptoms. Should we be putting these patients on aspirin or any other types of therapies?  Dr Elkind: That's a really great question. And again, it's an area where there's some controversy and really, there's really no definitive data that would support using antiplatelet therapy in people with incidentally discovered infarcts or what we call, you know, whispering strokes or silent strokes. Many stroke neurologists will use antiplatelet agents. This is one of those areas where it's so important to identify the risk factors. As we were saying before, patients who have other neurological disorders like migraine or epilepsy may turn out to have cardiovascular risk factors like diabetes and high blood pressure. That's why it's so important for neurologists to be able to treat those patients or refer them to specialists who can. Patients who have incidentally discovered lesions similarly are a group where we should be looking for risk factors. So, I don't think of it only in terms of do we put them on an antiplatelet or not, but really more holistically, can we identify their other risk factors and address those? Should the patient's information be entered into a risk calculator like PREVENT, for example, so that we can come up with a more global or holistic measure of their cardiovascular risk and address that as appropriate? Because if they are at risk for stroke, they're also at risk for cardiac events, including heart attack, heart failure, sudden cardiac arrest, and so forth. So, I think of it as a, as a great kind of teachable moment or an opportunity to catch somebody and bring them into the healthcare system more broadly and address those other potential risk factors.  Dr Grouse: Speaking of, of risk factors that we often like to think about and work up when possible, in cases where it seems certainly possible the patient had an embolic stroke, but perhaps we've done a few weeks or four weeks of cardiac monitoring, have not found any evidence of atrial fibrillation. What's new and what's the current recommendations for doing further monitoring when there's high suspicion for cardioembolic stroke?  Dr Elkind: This is a really active area of investigation, and guidelines suggest that we should do some cardiac monitoring for atrial fibrillation after an unexplained stroke, but it's not clear how much we should do. Studies generally show that the longer you follow somebody on a cardiac monitor after stroke, the more likely you are to detect atrial fibrillation. It could be as high as thirty percent after a few years. And that's great. And if you detect atrial fibrillation, people usually end up being recommended for a blood thinner. But how extensively we should monitor remains unknown. And I think a lot of the investigation recently has been around the question of, are there other ways to get that information rather than waiting six months or a year for the person to develop atrial fibrillation?It's a little bit funny logically to think a person has a stroke today, a year later you discover atrial fibrillation on the monitor, and you say, "Oh, now I know what caused your stroke a year ago." Right? The temporality, the causality perhaps is off in that case. And so, wouldn't it be better if we could tell what somebody's risk of having another cardioembolic stroke is, or the likelihood that they have atrial fibrillation is at the time that you first see them for the stroke, you know, in the hospital, for example. And so, there's some really new technologies that have evolved like AI or artificial intelligence interpretation of EKGs that can give a really good indication of which people are gonna go on to develop atrial fibrillation. And so, I think we need some more trials in that area to demonstrate that we can detect the risk of AFib and treat that even before it appears on one of those delayed monitors. That's an area that I think is very exciting right now. There's also a further question with regard to how to treat these patients, which is that sometimes atrial fibrillation is a consequence of the stroke itself. So, we can think about what people call known AF, meaning atrial fibrillation that's known about before the stroke even occurs, versus AF that's detected after a stroke, or AF-DAS, people will say. Those may have very different implications for the risk of recurrence and what the person's cardiovascular status is. So, I think what we've learned over the last few years is that atrial fibrillation, it used to be like the slam dunk for a stroke neurologist. It was the easy thing. You know, you had a stroke, you have AFib, you should be on a blood thinner. Now we know that there's lots of different kinds of AFib. There's AFib before stroke, there's AFib after stroke, there's burden of atrial fibrillation. So, some people may have 30 seconds of AFib, some people may have several hours, some people may be in it continuously. It comes and goes, and that can make it challenging to manage. So, we have a lot more work to do to understand this problem better.  Dr Grouse: That also gets me into some other interesting areas that I think there's still some question, you know, how aggressive should you be? How often is it a case of is this correlated or is this causative? For instance, when a patent foramen ovale is, is discovered in patients with cryptogenic stroke. Are there any tools or new developments to help us understand whether these PFOs should be closed in these cases?  Dr Elkind: PFO and stroke is a great story that's been going on for decades. And again, we've made tremendous progress in the last several years. So, it's true that about 20% or so of people have a PFO, and because of that, it can be really hard to say with any certainty whether an individual patient sitting in front of you, that the PFO was the cause of their stroke. Rarely we can have a really high degree of certainty. You know, if somebody has, uh, a DVT, for example, and shortly after that maybe they have pulmonary embolism and then a stroke, and we can say, "Oh, clearly this was a paradoxical embolism," went to the lungs and then some crossed over and went to the brain. That happens really infrequently. Most of the time you're faced with a patient who has a PFO and a stroke, and they may have some other risk factors. There are some tools that we can use to help figure out the likelihood that a PFO is related to a stroke. One of those is called the ROPE score or the risk of paradoxical embolism score that was developed by David Thaler and, uh, David Kent from Tufts and a group of other investigators as well. That score allows one to say what the likelihood is that the PFO was causative of the stroke, and it's based on a person's risk factors such that the younger you are, the more likely it is the PFO caused the stroke. And the absence of risk factors make it more likely that the PFO caused the stroke. So, the higher your ROPE score indicating the fewer other reasons you have a stroke, the more likely the PFO is to be causative. So that can be helpful in identifying patients who may have had a stroke due to their PFO. There are other features that are identified in something called the PASCAL score, which is a way of assessing the degree of shunting and whether or not there's an atrial septal aneurysm that can be used as additional factors that lead to the likelihood that a PFO was causative rather than just incidental. So, by putting this kind of information together, we can kind of do precision neurology or precision prevention by identifying which patients with a PFO are really the ones we need to worry about and do procedures like closure.  Dr Grouse: I look forward to hearing more and learning more as more advances are made in these areas. Dr Elkind: Thank you.   Dr Grouse: And thank you so much for joining us today to talk about your article.   Dr Elkind: Oh, I appreciate it. Thank you for giving me the opportunity. I really enjoyed it.  Dr Grouse: Again, today I've been interviewing Dr. Mitchell Elkind about his article on stroke prevention. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

The underground steroid market is changing fast. We break down new developments in China API production, Operation Pangea, law enforcement focus on online sales, and what it could mean for PED users moving forward. Plus, we answer your listener questions on estrogen management, Anavar use, TRT+, growth hormone dosing, Masteron, AFIB, stubborn fat loss, and much more. Hosted by Dave Crosland and Scott McNally 0:00 Welcome Back to Drugs n Stuff 0:45 Testosterone Production Industry Update 3:00 China API Production Changes Explained 8:45 Operation Pangea Disrupting the Steroid Market 11:25 Law Enforcement Targets Online Steroid Sales 14:45 Is the U.S. Still Investigating? 17:20 Support Our Sponsor - True Nutrition 18:00 How Important Is Keeping Estrogen In Range? 23:10 Can You Use PEDs If You Have AFIB? 25:15 Can You Build Muscle With Resistance Bands? 28:15 Are People Overusing Lab Work? 31:45 Anavar Only On Training Days? 34:20 First Steroid Cycle vs TRT Plus 36:15 Getting Rid Of Lower Abdominal Fat 39:00 The Worst Cycle We've Ever Heard 43:30 YK-11 Real World Listener Feedback 45:00 2 IU vs 10 IU Growth Hormone 48:45 Using Gear After Massive Fat Loss 51:30 High Masteron Cycles And Aging Skin 53:45 Can Steroids Cause Carpal Tunnel? 55:15 Cialis For Pumps And Contest Prep 57:00 Crack On! 57:30 Dave's Story Of Being A Fugitive UK Blood Work Get your Labs done by Dave in the UK : https://evalbloodanalysis.com/home/ Support the Podcast Patreon — Help keep the show growing. Even $5/month makes a difference. https://www.patreon.com/thinkbigbodybuilding Sponsors TRUE NUTRITION — Custom supplements for serious lifters Use code THINK to save https://www.truenutrition.com/THINK STROM SPORTS — Performance supplements trusted by athletes UK: https://tinyurl.com/ydmbfa54 US: https://stromsportsus.com Supplement Source Canada — Top brand supplements with fast shipping http://www.supplementsource.ca Merch Official THINK BIG Merch — Train, represent, support the brand https://think-big.printify.me/products

HEALTH NEWS   Study links low vitamin C levels in the blood plasma to reduced brain connectivity Study: Tart Cherry Supplementation Alters Muscle Protein Profile After Exercise Socioeconomic factors may leave more lasting imprint on children's brains than IQ or parenting style Fasting-mimicking diet reduces gum disease inflammation Low blood pressure shows strongest link to Alzheimer's disease   Study links low vitamin C levels in the blood plasma to reduced brain connectivity Hirosaki University (Japan), June 10 2026 (News-Medical) Previous research has uncovered associations between diets higher in vitamin C and lower risk of cognitive impairment in older adults. However, few studies have looked directly at vitamin C levels in blood plasma and potential associations with brain structure and connectivity within brain networks. To help fill that gap, Nagaya and colleagues analyzed magnetic resonance imaging (MRI) scans and plasma vitamin C levels of 2,044 adults over the age of 64. Specifically, they measured the volume of each participant's gray and white brain matter (accounting for individual differences in total brain volume between participants). They also evaluated connectivity within the default mode network, which is associated with several cognitive functions, such as attention and autobiographical memory. After statistically accounting for other factors the researchers found that participants with lower plasma vitamin C levels tended to have lower gray matter volume, as well as lower connectivity within the default mode network. These findings suggest the possibility that optimal levels of vitamin C in blood plasma could potentially support cognitive function and counteract cognitive decline. However, the findings do not confirm any such cause-effect relationship between vitamin C levels and brain health.   Study: Tart Cherry Supplementation Alters Muscle Protein Profile After Exercise University of Exeter (UK), June 11 2026 (Natural News) Researchers recruited 34 healthy, recreationally active young men and assigned them to receive either a placebo, a low-dose tart cherry concentrate, or a high-dose tart cherry supplement, according to the study report. Participants consumed their assigned supplement for seven days before completing a muscle-damaging workout and continued supplementation for three days afterward, for a total intervention of 10 days. The study found that tart cherry supplementation significantly altered the muscle's protein profile following exercise-induced damage. Changes were observed in proteins involved in muscle structure, contraction, cellular repair processes, and immune-cell activity within muscle tissue. These findings suggest that tart cherry polyphenols may influence the way muscles respond to and recover from the stress of exercise. Researchers also detected significant increases in hippuric acid, a compound produced when gut microbes break down polyphenols from tart cherries and other plant foods. Participants with higher levels of hippuric acid tended to maintain better muscle function following exercise-induced damage.   Socioeconomic factors may leave more lasting imprint on children's brains than IQ or parenting style Washington University in St. Louis, June 11 2026 (Medical Xpress) After analyzing hundreds of biological, psychological, social and environmental factors related to children's development, researchers at Washington University School of Medicine in St. Louis found that a family's financial situation and the resources and opportunities in a child's neighborhood had the strongest connection to brain development. Socioeconomic factors accounted for about 16% of the variability in measures of children's brain function—far more than IQ, parenting style and health history.  As part of the study, the researchers analyzed brain scans from nearly 12,000 children ages 9 to 10 to see how a child's environment, health and regular activities are related to brain development. Of the hundreds of factors examined, the team found that the socioeconomic status of a child's family had the strongest relationship with that child's brain structure and function. Further, the parts of the brain that reflect socioeconomic factors were the same areas most sensitive to sleep and stress, suggesting that socioeconomic disadvantage affects the brain indirectly through disrupted sleep and chronic stress. Of the top 40 variables linked to brain function, 37 were socioeconomic, and of the top 40 tied to structure, 35 were socioeconomic. These included the social and economic resources in the child's neighborhood, akin to the overall wealth of an area. Strong influences included family income, homeownership, poverty rates and access to transportation. The remaining top variables were related to sleep, screen time and stress.   Fasting-mimicking diet reduces gum disease inflammation Kings College London, June 11 2026 (Eurekalert) People who follow a short-term low-calorie diet may have reduced markers of inflammation associated with gum disease. A new study by King's College London highlights how lifestyle modifications could be important alongside plaque control in managing gum disease. The research included 28 patients from across hospitals in Spain, split into two groups – those who followed a five-day restrictive diet, versus a control group who continued their usual diet. Patients who fasted ate 1,100 calories for two days, then 750 calories for three days. The sixth day gently introduced more calories with soft foods – then their diets returned to normal by the seventh day. This was repeated three times in six months, with patients reporting the diet easy to stick to. After six months, samples were analysed from the patients' blood and gingival crevicular fluid – liquid that comes from the small space between your tooth and gum, which helps gums stay healthy and fight germs. Those who fasted had reduced markers of inflammation in samples from blood and gum tissue compared to those whose diets stayed the same, including lower levels of C-reactive protein, a general indicator of inflammation around the body. The fasting group also had reduced molecules linked to inflammation specifically in the gums, compared to controls.   Low blood pressure shows strongest link to Alzheimer's disease Michigan Technological University, Jun 10 2026 (News-Medical) Numerous types of cardiovascular disease and CVD risk factors were linked to a higher risk of Alzheimer's disease, with low blood pressure showing the strongest connection, according to a new analysis published today in the Journal of the American Heart Association What are the key findings of the analysis? Adults with hypotension (low blood pressure) were about three times more likely to develop Alzheimer's and nearly twice as likely in the All of Us study when compared to individuals who did not have low blood pressure. Across both datasets, adults with high blood pressure (hypertension) were 1.6 times more likely to have Alzheimer's disease, compared to people without hypertension. Participants who had a previous stroke had a 1.5 times higher risk for Alzheimer's disease in the UK Biobank and 1.85 times in All of Us. Those with irregular heartbeat (or atrial fibrillation, also called AFib) were about 1.5 times more likely to have Alzheimer's disease compared to those without AFib.    

Drs. Dasgupta and Sarswat review how ATTR cardiomyopathy remains under-recognized despite its prevalence in older patients with heart failure, emphasizing clinical red flags across cardiac and systemic manifestations. They outline a practical diagnostic pathway that prioritizes early identification using light-chain evaluation, bone scintigraphy, and genetic testing to distinguish transthyretin subtypes and initiate timely, disease-modifying therapy.

Thank you for joining us for our 2nd Cabral HouseCall of the weekend!   I'm looking forward to sharing with you some of our community's questions that have come in over the past few weeks…   Thank you for tuning into this weekend's Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right!   Kim: What would cause my son to cough hard for hours after eating? He has done this for a year. He is 28 and said he is to the point where he just does not want to eat. Should he do the CBO protocol?      Anonymous: Hi Dr Cabral, I came across your podcast a few months ago and have been listening daily to catch up on past episodes for general health education. Thank you for the valuable information you share. I would appreciate your guidance on diet and lifestyle for the following situation. My partner, a 31-year-old male, recently had an eGFR test done, and his result increased from 70 to 77. His father passed away in his 40s due to kidney failure, so this is a concern for us. We live in the Caribbean, where it is humid year-round. He strength trains 3–4 times per week and plays basketball once weekly, but I'm unsure if his cardio levels are sufficient for long-term kidney and overall health.       Christine: Hi Dr. Cabral, Thank you so much for everything you do! Your IHP program and your podcast have been life changing for me. I have a question about creatine. I've noticed when I take it, my appetite completely plummets and food does not even taste good. And when I cut out creatine, the appetite comes back within a day. I take around 1g for reference, and I'm 5'1 and 115 lbs if that needs to be taken into consideration. What could be the possible reasons for this? Thank you! Christine       Tricia: Good morning, Dr Cabral - hope you are well! I take many of your supplements with some being from the longevity line. I'm wondering if it is okay to take these ongoing for years or should we take a few weeks break from time to time? Are they as effective when used long term? The supplements I'm taking are your renewal system, eye health, hair supplements. Thank you for your guidance!      Matt: Hi Dr Cabral, I'm a healthy 45yo, strength train 3x per and 2 days of jiujitsu. I had my first ever episode of AFIB and it occurred about 5 min after taking a growth hormone peptide Tesamorelin. I went to the ER the next day and came out of it on my own within 14 hours of when it started and haven't had an episode since. They ran all kinds of blood work, EKG, CT w contrast for blood clots and all came up clear. They seemed to think it was from excessive caffeine use (300-500mg daily) and bad sleep but weren't really sure on the peptide as there's not enough research. Seems to me that's what triggered it. I stopped caffeine&peptides immediately and have really been trying to dial in my sleep for the past two weeks. Could this be a one off thing or am I more likely to have it happen again?     - - - Show Notes and Resources: StephenCabral.com/3775 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

Can topical B12 help relieve itching?The types of doctors to avoidGetting back to basicsA case study of lavender oil helping to relieve itchingYou say you're dairy sensitive but you use whey protein. Please explain.What are your thoughts on a lactose relief patch that is on offer?

What happens when you stop building your life around your work and start building your work around your life? Jason sits down with Ryan Hanley for a wide-ranging conversation covering ITC Agents, the philosophy behind his upcoming book Easy Mode, and why autonomous AI agents may already be the biggest unlock independent agents aren't using. Key Topics: How Drake and Ryan grew ITC Agents into a premier event for independent agents Why ITC Agents and IndieTech offer an unbiased, association-free tech experience The Download Day and BrainShare format, and how IndieTech adapted it Ryan's AFib diagnosis and the life reset that followed Easy Mode: his upcoming book through a Simon & Schuster imprint The human-optimized business model behind Rogue Risk Finding employees' easy mode: the Sam the contractor case study Why LinkedIn's AI conversation is dangerously behind X The AI slop-shaming trend and why it's the wrong advice How an autonomous AI agent landed Ryan a book deal in roughly 30 minutes of actual work Reach out to: Ryan Hanley Jason Cass Visit Website: Agency Intelligence Produced by PodSquad.fm

Lisa Salberg and Dr. Michael Ayers explore the rapidly evolving world of HCM treatment, from myosin inhibitors and clinical trials to AFib management and patient-centered care. The episode also dives into advocacy, drug safety concerns, and why personalized treatment strategies matter more than ever for people living with hypertrophic cardiomyopathy. This conversation was recorded May 15, 2026.

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On this week's episode of The MacRumors Show, we discuss Google's latest wave of announcements for Android and Gemini, the newly announced Fitbit Air, and Apple Watch Series 12 rumors.The centerpiece of Google's announcements this week was Gemini Intelligence, Google's new umbrella platform for AI across phones, watches, cars, and laptops. Its headline capability is cross-app automation: users can photograph an event flyer and ask Gemini to find tickets on Expedia, or pull up a grocery list and have it build a cart in a shopping app. A companion feature called Create My Widget lets users describe a home screen widget in natural language and have Gemini generate it, drawing from Gmail and Calendar to build a personalized dashboard.Google also unveiled the Googlebook, a new laptop category designed from the ground up around Gemini with partners including Acer, Asus, Dell, HP, and Lenovo arriving this fall. Gemini in Chrome for Android gained an agentic browsing layer rolling out end of June, and Android Auto received AI-generated contextual replies and DoorDash voice ordering. A Meta partnership brings Ultra HDR, native stabilization, and night mode to Instagram on Android flagship devices.In January, Apple and Google announced a partnership under which Gemini would power the next generation of Apple Foundation Models, including a more personalized Siri expected this year. Apple's equivalent cross-app ‌Siri‌ actions were announced at WWDC 2024 but have not yet shipped; Gemini Intelligence is rolling out this summer using the same underlying technology.Google also unveiled the Fitbit Air this week, a screenless fitness tracker priced at $99 that ships on May 26. The device weighs just 12 grams with the band and tracks heart rate, AFib, HRV, SpO2, and sleep stages in a pill-shaped pebble with no display, no buttons, and no notifications. Battery life lasts for seven days, with a five-minute fast charge delivering a full day of use. A Stephen Curry Special Edition is priced at $129, with core tracking free and Google Health Premium adding an AI Coach for $9.99 per month after a three-month trial.The launch accompanies a broader rebrand. The Fitbit app becomes Google Health on May 19, with Google Fit folded in, Apple Health data supported on iOS, and APIs for Garmin, Whoop, and Oura. Bloomberg's Mark Gurman reported earlier this year that Apple has scaled back a comparable Health+ coaching service, with the feature now unlikely to launch. The Apple Watch SE starts at $249 and requires daily charging, and the Fitbit Air's $99 price with no mandatory subscription addresses a segment Apple does not cover.We also discuss the Apple Watch Series 12, which is shaping up to be an incremental upgrade. Bloomberg's Mark Gurmansaid in March that he does not expect any major design changes, and a significant redesign is now not expected until 2028.The leaker known as Instant Digital said this week that Touch ID, which appeared in leaked Apple code last year, has been deprioritized in favor of battery life improvements. DigiTimes previously reported an eight-sensor array on the back of at least one 2026 model, though blood pressure monitoring is said to be further out. A new chip is expected, with leaked code indicating a meaningful upgrade from the S10 used across the last three series, and watchOS 27 will be previewed at WWDC on June 8. Start your business with Shopify and get everything you need to sell online and in person. Start today at https://www.shopify.com/mac

SEASON 4 EPISODE 84: COUNTDOWN WITH KEITH OLBERMANN A-Block (3:00) SPECIAL COMMENT: Back from a week off just in time to put the podcast on health hiatus...details within today's supersized edition. Plus, befitting the time off, some meta pictures on how Democrats should plan for what they want this country to look like on its 300th anniversary, if it lasts that long. Will we have jailed Trump and gotten back the money he took? Undone his damage? Eliminated the anachronistic idea that Wyoming should have as many senators as California? Let the Supreme Court continue to lie, cheat and steal the democracy from under us? As John Candy said in "Splash": Think big, be big, my friend. MORE IMMEDIATELY: Whaddya mean the Governor of Virginia hasn't been BRIEFED on the way to overturn her state's Supreme Court's usurpation of redistricting? Why the hell not Hakeem Jeffries? Anybody notice Trump is simply rotating the same three lies about Iran? Why are only independent journalists like Garrett Graff still covering the WHCD non-shooting when the New York Times is doing 31 paragraphs on the future of the dinner like anybody gave a crap? AND MOST IMPORTANTLY: stop saying Trump is painting everything GOLD. That color is not GOLD. It is the color of WEE WEE. Say it. Use the clinical terms, use the gutter terms. The gutter terms define this idiot president. Stop saying gold when you mean whizzzzzzzzzzzzzz. B-Block (56:00) ON THE PASSING OF TED TURNER: Hard to believe few of the obituaries mentioned how he also invented 7-day-a-week sports on national television. Or how Jane Fonda kept him from destroying himself in, like, 1982. One particularly harrowing saga had him telling the lowest ranking staffer at CNN's Washington Bureau which way, when he finally decided he'd do it, he'd do it. And this is said with admiration and affection for the man who created the place where I and so many of the figures of the last 45 years began our TV careers. C-Block (1:30:00) ALL TED ALL THE TIME: I was holding back until I was certain I wouldn't jinx him. My beloved first rescue dog, Ted, was up against it last fall. I took him to the University of Florida for life-saving open heart surgery and boy, did they! Eight hours on the table, eight hours of SICU, all for an eight pound dog and now - he's not even on any medications! It's a long story and I would insist it's worth hearing it. And if you have a dog (or know of one) moving from Mitral Valve Disease to Heart Failure, maybe this will provide you with hope - and an option.See omnystudio.com/listener for privacy information.

Explore the launch of the Google Fitbit Air, the evolution of distraction‑free health tracking, upcoming AI and Android developments from Google I/O 2026, and how Lutron is making homes smarter with intelligent lighting and accessible automated blinds. Steven Scott and Shaun Preece dive into a wide‑ranging discussion on mainstream tech. They begin with the Google Fitbit Air, a screenless fitness tracker focused on comfort and core health features like 24/7 heart rate monitoring, AFib alerts, SpO2, and sleep tracking. The hosts examine its real‑world benefits, from week‑long battery life to fast charging and the promise of a distraction‑free experience. They also consider the new Google Health app and how AI health coaching may create meaningful insights. The conversation moves to Google I/O 2026 and the Android Show, previewing big updates to Gemini AI, Android 17, Android XR, and the potential debut of Aluminium OS for AI‑driven laptops. They also discuss the growing momentum of smart glasses and the importance of agentic AI for hands‑free productivity. In the second half, Marc Aflalo interviews Melissa Andresko from Lutron, exploring how automated blinds, intelligent lighting, and natural light optimisation are redefining home comfort, wellness, and accessibility. The episode closes with a look at AI‑powered robotic companions coming soon from Roomba and the US military's latest UFO video releases. Relevant Links Google Fitbit Air: https://store.google.com/gb/product/google_fitbit_air Lutron Caséta: https://www.casetawireless.com ----Follow on:YouTube: https://www.doubletaponair.com/youtubeX (formerly Twitter): https://www.doubletaponair.com/xInstagram: https://www.doubletaponair.com/instagramTikTok: https://www.doubletaponair.com/tiktokThreads: https://www.doubletaponair.com/threadsFacebook: https://www.doubletaponair.com/facebookLinkedIn: https://www.doubletaponair.com/linkedinSubscribe to the Podcast:Apple: https://www.doubletaponair.com/appleSpotify: https://www.doubletaponair.com/spotifyRSS: https://www.doubletaponair.com/podcastiHeadRadio: https://www.doubletaponair.com/iheartAbout Double TapHosted by the insightful duo, Steven Scott and Shaun Preece, Double Tap is a treasure trove of information for anyone who's blind or partially sighted and has a passion for tech. Steven and Shaun not only demystify tech, but they also regularly feature interviews and welcome guests from the community, fostering an interactive and engaging environment. Tune in every day of the week, and you'll discover how technology can seamlessly integrate into your life, enhancing daily tasks and experiences, even if your sight is limited."Double Tap" is a registered trademark of Double Tap Productions Inc. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

How many miles is too many miles on a race shoe? How do you stop panicking about getting injured again when you're coming back to running? Should you keep strength training during a taper? And what should you focus on before running a new distance?In this Q&A episode, I answer listener-submitted questions on some of the biggest topics that come up in ultramarathon training: race-day shoes, Cocodona race options, re-injury anxiety, setting race goals, strength training in the taper, dealing with AFib as an endurance athlete, and how to prepare for racing a new distance you never have.In this episode, I cover:How to know when your shoes are too worn out to race inWhy I prefer racing in newer shoes for major ultrasWhich Cocodona race might be best for youHow to rebuild confidence after injuryHow to balance big race goals with the fear of not finishingWhat to do with strength training during a taperHow my AFib incident has changed — and not changed — my trainingThe biggest mistakes runners make before their first time racing a new distnceHow to trust your training when race day is getting closeThis one is packed with practical advice for ultrarunners who want to train smarter, race better, and make better decisions going into their next big goal.SHOW LINKS:Want to be coached by me and my team to crush your next ultramarathon in our 1:1 coaching program?⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠Book a free call here⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ with one of our coaches to see if we are a good fit!Want to work with me to crush your next ultramarathon in our group coaching program? Sign up for our group coaching program here:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠https://www.theeverydayultra.com/group-coaching⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow Joe on IG:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/joecorcione/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Everyday Ultra YouTube Channel:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠https://www.youtube.com/channel/UCUelKGeptWZivD6yRIDiupg⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Try Mount to Coast shoes, designed specifically for ultramarathons, and get 10% off your order with code EVERYDAYULTRA by ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠going to the link here⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠.Try HYPERLYTE Liquid Performance running nutrition and get 15% off your order when you use code EVERYDAYULTRA at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.hyperlyteliquidperformance.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Try PlayOn Pain Relief Spray and get 20% off with code EVERYDAYULTRA at⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠playonrelief.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Try Bear Butt Wipes and get 10% off your order with code EVERYDAYULTRA at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠bearbuttwipes.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Try Janji apparel at janji.com/everydayultraCreate running routes easily with Footpath, the app designed to help you manage routes simply. Download for free and get a free trial at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠footpathapp.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠/everydayultraTry CurraNZ to boost recovery and performance and get 15% off your first order with code EVERYDAYULTRAPOD at ⁠⁠⁠⁠⁠www.curranzusa.com⁠⁠⁠⁠

The BOB & TOM Show — April 30, 2026 6:00 Hour 6:00 – King of England (Tim Wilson) 6:04 – Kentucky Derby talk 6:07 – China making see-through chicken 6:12 – Letter to Josh: joke at work 6:25 – Letter: Chick's Carson impression 6:26 – Doc Severinsen declining Carson's invite 6:30 – Ace joke about himself (Chick) 6:31 – Tom too busy to take his ring off 6:32 – Slump-busting gold thong discussion 6:33 – Tom watching a movie during a song 6:34 – Letter: were you weird before radio? 6:36 – “I'm more unique” (Ace) 6:38 – Spin and Marty show (Tom) 6:51 – “Cut My Life Into 2 Pieces” song 6:52 – Letter: Heaven Can Wait stars 6:53 – Letter: armored truck robbery 6:54 – Letter: milking a cobra with tweezers 7:00 Hour 7:05 – Weather radar wars (Tom) 7:06 – Kentucky Derby horse names for everyone 7:08 – Letter: Chick and Josh as old-style playboy bunnies 7:09 – Letter: woman gives birth on airplane 7:24 – Werther's candy in the green room 7:27 – Kentucky Derby horse odds (Chick) 7:28 – Josh joke about derby horse name 7:33 – World record: two people keep five balloons in the air for 15 minutes 7:37 – New Werther's ad campaign ideas 7:51 – “She Has a Shatner Bed” (Pat, song) 8:00 Hour 8:05 – Routine rectal exam helps return heartbeat to normal (Kristi, AFib discussion) 8:08 – Less AFib in men's prisons? (Tom) 8:14 – Kristi's pit stop story 8:30 – Hippo song (Pat) 8:32 – Stripper uses 7-foot pole as a weapon 8:46 – “My Mother” (Chick clip) 8:00–8:59 – Today in History segment 8:52 – Love for Mr. Potato Head (Tom) 8:55 – “Brick House” and copyright discussion 9:00 Hour 9:05 – Interview: Al Jackson (Zoom) 9:11 – Word of the day: alpine divorce (Al) 9:17 – Al on being over yoga pants 9:28 – Petroleum shipment for condoms stuck in Strait of Hormuz 9:29 – Top condom makers (Chick) 9:33 – Man arrested for selling marijuana in vending machine 9:35 – Would you be a good travel roommate? (Kristi) 9:50 – Monks arrested for marijuana 9:51 – “Smells Like Weed” (Pat, song) Learn more about your ad choices. Visit podcastchoices.com/adchoices

Join us as we review recent practice-changing articles on left atrial appendage closure vs AC for AFib, apixaban vs rivaroxaban for VTE, intensive LDL targeting, GLP1s and substance use disorders, and more! Fill your brain hole with a delicious stack of hotcakes! Featuring Paul Williams (@PaulNWilliamz), Shani Herzig (@ShaniHerzig) Rahul Ganatra (@rbganatra), and Matt Watto (@doctorwatto).Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMECredits Written and Hosted by: Rahul Ganatra MD, MPH; Shani Herzig, MD, MPH; Paul Williams, MD, FACP, Matthew Watto MD, FACP Cover Art: Rahul Ganatra MD, MPH Reviewer: Emi Okamoto, MD Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Intro, disclaimer Left atrial appendage closure vs anticoagulation in AF Apixaban vs rivaroxaban for VTE Intensive LDL targeting in ASCVD GLP1s and substance use disorders FDA approves Orforglipron E-cigarettes and cancer Early AM blood draws and sleep quality Outro Sponsor: FIGSGo to wearfigs.com to get 20% off during Nurses WeekSponsor: Panacea Financial If you're about to make the leap into  residency and feeling the financial pressure of that transition, visit PanaceaFinancial.com/curbsiders todaySponsor: MasterClass Right now, as a listener of this show, you get at least 15% off any annual membership at MASTERCLASS.com/CURB.

We are in the second week of a 4-part series on the 4th-largest killer in America.  In this episode, you'll learn:—Why Dr. Prather says that Disease Care is best for crisis care and that the Emergency Room is the place to go when you have a Stroke.  And the crucial role of pharmaceuticals to help prevent Strokes by keeping Hypertension under control.—The importance of the Heart Rate Variability diagnostic that Holistic Integration does on every patient that measures your body's ability to bring you into Homeostasis and shows if you have chronic diseases.—What role Structure-Function Care should play in treating and preventing Strokes.  And how Holistic Integration helps to heal the body so that patients can eventually reduce their Blood Pressure medications because the underlying problem has been corrected.—Dr. Prather's own story of the "life-changing" External CounterPulsation Therapy at Holistic Integration that helps Cardiovascular Disease by replicating aerobic exercise. —How Atherosclerosis is helped by the combination of ECP Therapy and proper supplementation.  And how patients with 90% blockage in their arteries were completely cleared of those blockages after ECP Therapy. —Why "the safest place you can be" if you are at risk of a Stroke or Cardiovascular problems is on ECP Therapy. —How ECP Therapy helps Hypertension.   And how ECP reverses Kidney Disease, which is an underlying cause of most Hypertension cases. —The regenerative ability of the heart and how Dr. Prather has seen Congestive Heart Disease patients with hearts twice their normal size be completely normalized.  And how ECP Therapy helps with Afib and abnormal heart rhythm. —The stories of patients with Stroke damage, Dementia, and Alzheimer's finding improved cognition  because ECP Therapy improves blood flow and healing to the brain.   —How Holistic Integration does Micronutrient Testing to know exactly what nutritional supplementation a patient needs to prevent the Free Radical damage that is the root cause of Strokes and Cardiovascular Disease.  And how Cholesterol actually ABSORBS Free Radicals in the body and heals the brain. http://www.TheVoiceOfHealthRadio.com*Receive exclusive bonus content as a member of our Voice Of Health Patreon Community:https://www.patreon.com/cw/VoiceofHealthPodcast

Registered dietitian nutritionist Leyla Muedin discusses a New England Journal of Medicine paper (July 2024, cited via Holistic Primary Care) warning about drug-induced magnesium depletion, especially from diuretics, proton pump inhibitors (e.g., Nexium, Prilosec), and certain antibiotics. She notes magnesium is often not routinely measured despite links between deficiency and cardiovascular, metabolic, and neurological problems, including arrhythmias (AFib, long QT, torsades), endothelial dysfunction, and longer ICU stays. Prevalence estimates range from 7–11% (up to 20%) in hospitalized patients and 2–4% among outpatients, with higher rates among long-term PPI and diuretic users. She reviews symptoms and causes, explains limits of serum magnesium testing, highlights associations with diabetes, alcohol use, low potassium and calcium, and outlines evaluation options and oral repletion approaches, favoring better-absorbed forms like magnesium glycinate over oxide due to diarrhea risk.

🧭 REBEL Rundown 🔑Key Points Try the coffee nap! Where you combine caffeine and a 30-minute nap to then have that boost energy and alertness by the time it kicks in.💤 Sleep isn’t optional—it’s crucial for memory, mood regulation, and physical recovery. It is fundamentally different from rest❌ Replacing sleep with caffeine isn’t effective and can have negative health impacts. Make getting enough sleep a priority🌞 Sunlight exposure is important for maintaining circadian rhythms and sleep quality. This applies even if you work as a nocturnist💡 Creating a personalized sleep system enhances quality and consistency. It gives you back control of a schedule that you may feel like is out of your hands.🧩 If you’ve tried these strategies and you’re still struggling, consider true sleep pathology (insomnia, shift work disorder, sleep apnea) and get help—this is not a “be tougher” problem.🩺 Better sleep isn’t just about feeling good; it’s directly tied to error reduction, patient safety, and longevity in EM/ICU careers. Click here for Direct Download of the Podcast. 👀Previously Covered and Related Content: REBEL Core Cast: Sleep HygieneREBEL MIND: Rest Is Not Sleep: The Seven Dimensions of True RecoveryRebellion in EM: Care For Yourself – Sleep HygieneFirst10EM: Some Evidence For Working Night ShiftsREBEL MIND: Dunning Kruger Effect 📝 Introduction Welcome to this episode of REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. Today we are exploring the imperative topic of rest and why it’s not just about sleeping. The second of a two part series, hosted by Dr. Mark Ramzy with guests Dr. Maureen Aiad and Dr. Amil Badoolah, continue our discussion but this time on the multifaceted nature of sleep, how it serves as medicine and how we can use our tools deliberately to get more of it! Cognitive Question How would your clinical performance, patience with families, and long-term career sustainability change if you treated sleep as a non-negotiable clinical intervention rather than a flexible “nice-to-have”? 💤How is Sleep Different From Rest? 1. Rest reduces load; sleep repairs systemsWe previously talked about the 7 types of rest and you can check that out hereExamples of physical rest include: pausing tasks, stepping away from the monitor, taking a walk, stretching, breathing, journaling, connecting with a colleague. This lightens your cognitive/emotional burden.Sleep is fundamentally different in that it’s an active biologic process that helps:Consolidates memory and learning (yes, including the tough cases from last night).Regulates mood, impulse control, and emotional reactivity.Supports immunity, metabolic health, and cardiovascular function.Repairs tissue, replenishes neurotransmitters, and fine-tunes neural networks.You can have “rested but underslept” days (you took breaks but got 4 hours in bed), and “slept but unrested” days (you got hours, but all junk sleep). Both matter, but they are not interchangeable.2. Sleep architecture vs. “knocking out”True restorative sleep cycles through NREM and REM in predictable patterns.Alcohol, late caffeine, and fragmented nights may help you fall asleep faster but:Suppress REM.Shorten deep sleep.Increase awakenings and light sleep.The result: you technically slept, but your brain didn’t get the “software updates” it needed.Biology isn’t built for your scheduleCircadian rhythms were designed for light-day / dark-night cycles, not:10 pm–7 am ED shifts.24-hour calls.6 nights in a row followed by days.Your body can adapt partially, but not instantly and not perfectly. That’s why:You can feel “jet-lagged” even when you haven’t traveled.Sleep before and after nights feels odd and fragile.Recognizing that “this is biologically unnatural” is key: you’re not weak; you’re fighting physiology. 🏥How This Applies to the Emergency Department or ICU? Performance & safetySleep deprivation:Slows reaction time and increases error rate.Impairs risk assessment and complex decision-making.Drops your frustration tolerance with consultants, families, and staff.In both emergency medicine and critical care, that translates into:Anchoring on the wrong diagnosis.Missing subtle clinical changes.Snapping at a tech, nurse or resident and damaging team culture. Chronic health for chronic shift workLong-term sleep disruption is associated with:Hypertension, diabetes, obesity.Depression, anxiety, burnout.Arrhythmias (e.g., AFib) and increased stroke risk.Possibly increased all-cause mortality.You’re already in a high-stress, high-exposure specialty. Chronically poor sleep amplifies that risk profile and can end a career early—or make you miserable while you’re still in it.Culture of “heroics” vs. healthSkipping sleep to pick up extra shifts, late meetings, or “just one more note” is often praised.We rarely celebrate:The attending who says “no” to a 2 pm meeting post-nights.The resident who defends their blackout-curtains-and-earplugs routine. 🛏️Different Ways to Improve Your Sleep Clarify your “sleep non-negotiables”Decide how many hours you realistically need to function (e.g., 7–9 on off days, realistic blocks on nights).Treat those hours as you would a procedure time—blocked, protected, and respected.Use caffeine like a drug, not a reflexAim for ≤ 2 cups equivalent on most days.Avoid caffeine within 4–6 hours of your planned sleep time (remember: it can hang around up to 12 hours).Consider scheduling caffeine for:Early in the shift for alertness.Strategic “coffee naps” (see below), not late-night chugging.Respect alcohol’s impact on sleepRecognize that even small to moderate doses degrade sleep architecture.Avoid using alcohol as a “sleep aid”—you’ll fall asleep faster but sleep worse.If you do drink, separate it from bedtime and keep it modest.Optimize food and fluid timingHydrate consistently on shift, but taper fluids ~4 hours before bed to reduce nocturnal bathroom trips.Avoid heavy, spicy, or large meals within 2–3 hours of sleep to decrease reflux and discomfort.Plan a light, balanced “pre-sleep” snack if going to bed hungry keeps you awake.Move your body (but not right before bed)Regular exercise improves sleep depth and latency.Try to avoid intense workouts within 2 hours of bedtime.On shift: micro-movement (stairs, brisk walks between pods, quick stretch sessions) can help alertness without wrecking sleep later.Control light exposureMaximize sunlight or bright light after waking (even if that’s 3–4 pm after a night).Minimize bright light and screens before sleep:Dim lights.Use night mode/blue-light filters if you must scroll.For daytime sleep:Use blackout curtains, tinfoil, cardboard, or sleep masks.Yes seriously use tinfoil if you have to, we talk about it on the podcast episode!Aim for “I might be blind” darkness—so dark you can’t see your hand in front of your face.Dial in your sleep environmentCool room temperature (fan or AC if possible).White noise or sound machine to mask household/traffic noise.Earplugs and eye masks as needed.Bed used primarily for sleep (and sex)—not for charting, doom scrolling, or email.Strategic power napsKeep naps ≤ 20–30 minutes to avoid sleep inertia.Prefer early-afternoon or pre-night-shift naps.Coffee nap strategy:Drink a small coffee.Immediately lie down for a 20–30 min nap.Wake up as the caffeine kicks in, combining nap benefit + stimulant.Thoughtful melatonin useRemember melatonin is a hormone, not a vitamin gummy.Lower doses often work as well as (or better than) large OTC doses.Use it intentionally and intermittently, not as a crutch every night.Over-reliance may reduce your own natural production and its effectiveness over time.Build pre-sleep ritualsRepeated, calming habits signal your body it’s time to downshift:Warm shower, gentle stretching, or yoga.Guided breathing or body scan.Brief journaling or “brain dump” of tasks to get them out of your head and onto paper.Protect from pathologic patternsIf despite consistent effort you:Snore heavily, stop breathing, or gasp in sleep.Feel excessively sleepy driving home or at work.Cannot fall asleep or stay asleep for weeks to months.Consider evaluation for sleep apnea, insomnia, or shift-work sleep disorder with your physician or sleep specialist. ⏩Immediate Action Steps for Before/During/After Your Next Shift 1. **Before the Shift**: Plan a 20–90 minute nap before your first night shift (many clinicians find 3–5 hours earlier in the day is ideal).I treat ED and ICU shifts very differently. I always sleep 3-5 hours before my night shifts aiming for the full 5 (sometimes 6 or more) hours for my ED shifts because you always have to be “on”. Depending on the ICU I’m working in, I may have a bit more downtime so 3 to 5 hours is plenty.Set a caffeine plan: decide in advance when your last dose will be (e.g., none after 2–3 am if sleeping at 8–9 am).Tell your household, “This is my sleep block” and agree on a plan for kids, pets, deliveries, etc.On my calendar, I completely block off time called “Pre-call sleep” so no meetings can be scheduled and then put my phone in airplane mode2. **During the Shift** Hydrate early; taper fluids in the last 3–4 hours of your shift Eat something light but adequate; avoid “last-minute” heavy meals right before sign-out.Build in micro-breaks and movement: one or two short walks, a few stretches, even a quick stair run if safe.Get outside or near a window for a few minutes of light exposure if possible.3. **After the Shift**On the way home:Use sunglasses to reduce bright morning light if you’re aiming for sleep soon.Avoid “just checking” email or messages; shift into wind-down mode.At home:Do a brief, calming decompression (shower, light snack, 10–15 minutes of low-stimulation TV or reading).Make your room cold, quiet, and dark (blackout curtains, tinfoil/cardboard, white noise, fan).Put your phone on Do Not Disturb and physically place it away from the bed.On my calendar, I completely block off time called “Post-call sleep” so again no meetings can be scheduled and then I personally don’t just put my phone on Do Not Disturb but rather in airplane mode and WIFI OFF If you can’t sleep after ~20–30 minutes:Get out of bed, do something calming in dim light (breathing, gentle stretching, journaling).Return to bed when sleepy—this trains your brain to associate bed with sleep, not frustration. Conclusion Rest and sleep are both critical—but they’re not interchangeable. Rest helps you step out of the constant “on” of our jobs, while sleep is the biological intervention that restores your ability to show up safely and sustainably. Rest ≠ sleep. Rest reduces load; sleep repairs your brain and body. You need both, on purpose.As EM and ICU clinicians, we’re trying to perform formula-one-level medicine with engines that often only see half their maintenance. You won’t fix shift work. You can build a sleep system that respects your biology, your schedule, and your life at home.That system starts with valuing sleep, then prioritizing it, personalizing it, trusting the process when it’s imperfect, and actively protecting both your routine and your mindset. 🚨 Clinical Bottom Line Sleep is medicine. Shift work is biologically unnatural. Struggling does not mean you’re weak; it means you’re human fighting physiology. Use your tools deliberately. Caffeine, naps, light, food, movement, melatonin, and environment can be leveraged—or can quietly sabotage you. Build and defend a personalized sleep routine. Communicate it, normalize it, and protect it from casual encroachment. You can’t control every trauma, code, or admission—but you can control how seriously you take your own recovery. Your patients, your team, and your future self all benefit when you do. Further Reading Espie CA. The ‘5 principles’ of good sleep health. J Sleep Res. 2022 Jun; PMID: 34676592Solodar, J“Sleep hygiene: Simple practices for better rest.” Harvard Health, 31 January 2025 Link is HereSuni, E.“Mastering Sleep Hygiene: Your Path to Quality Sleep.” Sleep Foundation, 7 July 2025, Link is Here Meet the Authors Mark Ramzy, DO Co-Editor-in-Chief Cardiothoracic Intensivist and EM Attending RWJBH / Rutgers Health, Newark, NJ Maureen Aiad, DO Assistant Professor of Emergency Medicine NYU Grossman Long Island School of Medicine, New York Amil Badoolah, DO Assistant Professor of Emergency Medicine NYU Grossman Long Island School of Medicine, New York REBEL Core Cast 119.0 – Sleep Hygiene REBEL Core Cast 119.0 – Sleep Hygiene Click here for Direct Download of ... Read More The post REBEL MIND – How to Sleep When the World Says You Can't appeared first on REBEL EM - Emergency Medicine Blog.

Join us as we review and appraise recent practice-changing articles on oral semaglutide for obesity, fish oil in ESRD, IV iron during infection, the new US Dietary Guidelines, & anticoagulation after ablation in AFib. Fill your brain hole with a delicious stack of hotcakes! Featuring Paul Williams (@PaulNWilliamz), Rahul Ganatra (@rbganatra), Josh Gilman, & Matt Watto (@doctorwatto).Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMECredits Written and Hosted by: Rahul Ganatra MD, MPH; Paul Williams, MD, FACP, Joshua Gilman, MD, & Matthew Watto MD, FACP Cover Art: Rahul Ganatra, MD MPH Reviewer: Emi Okamoto, MD Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Intro, disclaimer Oral Semaglutide for obesity Fish Oil for CV risk reduction in hemodialysis patients IV Iron for iron deficiency anemia during infection New USA Dietary Guidelines Anticoagulation after catheter ablation for AF Outro Sponsor: FIGSCheck out the limited-edition Team USA collection, and get 15 percent off your first order at Wearfigs.com with code FIGSRX. Sponsor: Continuing Education CompanyVisit CMEmeeting.org/curbsiders and use promo code Curb30 for 30% off all online courses and webcasts.  Sponsor: GustoTry Gusto today at gusto.com/CURB, and get three months free when you run your first payroll.Sponsor: MDProgress For our listeners, enjoy your first month free at mdprogress.ca/promo/curbsiders

This week, Dr. Kahn breaks down a new paper examining the risks and reported side effects of statins—including the surprising finding that placebo alone is linked to many of the same symptoms. He also covers an oral PCSK9 inhibitor currently under study and what it could mean for cholesterol management. The episode then dives into the latest research on emerging therapies designed to lower lipoprotein(a), including a real-world case study that highlights where this rapidly evolving field is headed.  Shorter discussions include heart disease at a young age, why so many patients fail to reach blood pressure treatment goals, aspirin use one year after AFib ablation, skeletal muscle as an endothelial stabilizer, and why exercise variety may be one of the most powerful risk reducers we have.  Thanks to WellBean for sponsoring the show. Save on their delicious bean-based products at wellbean.life with code DrKahn15.  Dr. Kahn will also be leading a free online seminar on cholesterol on February 17, 2026 at 7 PM EST with Forks Over Knives. Register HERE.

A study shows how effective the Apple Watch is at detecting AFib in adults over 65, and Tesla now has at least a couple of unsupervised autonomous robotaxis giving rides in Austin.Starring Jason Howell and Sarah Lane.Show notes can be found here. Hosted on Acast. See acast.com/privacy for more information.