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The newest AHA and ACC guidelines for treating dyslipidemia are here — and according to Dr. Kim Williams, they mark a powerful shift toward prevention, earlier testing, and whole-food, plant-based nutrition as the foundation of cardiovascular care.Rip welcomes back Dr. Kim Williams, past president of the American College of Cardiology, for a practical and deeply encouraging breakdown of what these updated cholesterol guidelines mean for everyday people.Dr. Williams explains why cardiovascular risk is no longer just about one cholesterol number. Instead, clinicians are being encouraged to look at the whole picture: LDL cholesterol, ApoB, Lp(a), inflammation, blood pressure, blood sugar, kidney function, family history, lifestyle, and coronary artery calcium when appropriate.The most exciting part for the PlantStrong community? Lifestyle optimization is now treated as the clinical foundation — and Dr. Williams is clear about what that means: a whole-food, plant-based diet built around beans, grains, nuts, seeds, fruits, vegetables, and mushrooms, along with exercise, sleep, mindfulness, strong social connections, and avoidance of tobacco, alcohol, and other harmful substances.This conversation also tackles statins, PCSK9 inhibitors, Lp(a), coronary calcium scoring, and the new philosophy of treating risk lower, earlier, and longer — always with food first, and medication when needed.Key TakeawaysThe new cholesterol guidelines emphasize lifestyle first, not lifestyle as an afterthought.Dr. Williams says a whole-food, plant-based diet should be built around beans, grains, nuts, seeds, fruits, vegetables, and mushrooms.LDL cholesterol is still important, but it is no longer the only number that matters.ApoB may give a clearer picture of risk in some people, especially those with diabetes, high triglycerides, or central obesity.Lp(a) is largely genetic and should be measured at least once in adulthood; the 2026 guideline includes updated recommendations for elevated Lp(a).Coronary artery calcium scoring can help personalize risk and guide LDL targets.Dr. Williams emphasizes that the goal is not “plants versus statins.” It is whole plant foods first, medications when needed.The overall prevention philosophy is: lower, earlier, longer.Watch the Episode on YouTube: https://youtu.be/6cD8tGpsAggLearn More About our 2026 Live PLANTSTRONG Events: https://plantstrongevents.com/ Let Us Help Your PLANTSTRONG JourneyLearn More About Our Corporate Wellness Program: https://liveplantstrong.com/corporate-wellness/ COMPLEMENT: Use code PLANTSTRONG for 30% off at https://lovecomplement.com/pages/plantstrong-special-offer Follow PLANTSTRONG and Rip Esselstynhttps://plantstrong.com/ https://www.facebook.com/GoPlantstrong https://www.instagram.com/goplantstrong/https://www.instagram.com/ripesselstyn/ Follow the PLANTSTRONG Podcast and Give the Show a 5-star RatingApple PodcastsSpotify

All Home Care Matters and our host, Lance A. Slatton were honored to welcome the team from Rock Steady Boxing as guests to the show.   About Ryan Cotton, President/CEO:   Ryan Cotton currently serves as President & CEO for Rock Steady Boxing. His involvement with the organization started in 2009 when he served on the Board of Directors for a decade. Although he serves all RSB boxers around the world, his favorite RSB boxer was his father who was a Parkinson's fighter until his last days.   Ryan's education is in physical therapy where he had a 22-year clinical career before moving into his role at RSB. He holds a Masters in Physical Therapy from the University of Evansville, and a Doctorate in Health Science from the University of Indianapolis.   About Chris Timberlake, Director of Education & Training Rock Steady Boxing:   Chris has been with Rock Steady since 2006 and currently serves as the Director of Training and Education at RSB developing and delivering training in the RSB method to new coaches around the world. She is a caregiver to Tom, who was diagnosed with Parkinson's in 2000, and understands all too well the needs of people struggling with Parkinson's.   Having trained hundreds of people with Parkinson's as well as being immersed as a care partner has given Chris a uniquely intimate perspective on how to battle this disease. She is a Certified Personal Trainer through the American College of Sports Medicine and her personal experience is an instrumental part of Rock Steady's "Cornerman" support.   About Sandra Benton, RSB Boxer, Retired business owner and hairstylist:   Sandra Benton was a business owner for 48 years working as a hairstylist and retiring at age 67. She was diagnosed with PD in April of 2023 and started RSB in July of that year.   About Jim Lindgren, RSB Boxer, Retired reporter and editor:   Jim Lindgren had a career as a newspaper reporter and editor for 25 years before becoming an editor for a market research company and retiring 2 years ago at age 66. He was diagnosed with PD at the age of 61.   About Rock Steady Boxing (RSB):   Rock Steady Boxing (RSB) is a nonprofit organization dedicated to improving the lives of people with Parkinson disease through a specialized, non-contact boxing-based fitness program developed to specifically address the symptoms of Parkinson disease. Founded in Indianapolis in 2006, RSB is built on the belief that individuals with Parkinson's can fight back against the progression of their disease through rigorous, targeted exercise   The RSB program is multimodal and incorporates boxing techniques, strength training, balance work, and cognitive challenges to address the motor and non-motor symptoms of Parkinson's. Backed by growing evidence that high-intensity exercise can slow symptom progression, RSB has become a leader in exercise-based approaches to managing the disease.   Today, Rock Steady Boxing supports a global network of more than 800 affiliate programs that deliver its training in local communities, including gyms, rehabilitation centers, and community organizations. Through comprehensive coach training, ongoing education, and a strong support system, RSB ensures that its programs are accessible, adaptable, and effective for individuals at all stages of Parkinson's. Beyond physical improvements, the organization fosters a powerful sense of community and empowerment among participants, helping them build confidence, connection, and resilience.   As it continues to expand its reach, Rock Steady Boxing remains committed to its mission of enabling people with Parkinson's to live healthier, more active lives.

Listen as hosts Tanner, John and Andy discuss their take on a recently published article in MedPage Today calling for the renaming of the Emergency Department and Emergency Medicine. Don't forget we are the official podcast of the American College of Osteopathic Emergency Physicians. Visit acoep.org today to learn more about an upcoming conference and how you can see your favorite EM Podcast LIVE and in person.

(0:00) Intro to this episode (2:52) About the podcast sponsor: The American College of Governance Counsel (3:39) Start of interview (4:18) Keith Giarman's origin story. About DHR Global (9:33) Tony Abate's origin story. Current boards: Wolfspeed, GTT Communications, Mitel, and Tacora Resources. (23:52) Turnaround Board Playbook. Three phases: 1) Fix the balance sheet; 2) Turnaround strategy, and time to turn to the income statement; and 3) Exit the business. (28:50) Private Equity Board Structure. It is all contextual. (33:40) Compensation in PE boards. (31:15) What Makes Boards Effective, from Tony based on his chairmanship experience. Execution vs process. *Execution: 1) Skill Set Distribution ("Three is too few, five too many."), 2) Relevance of that skill set distribution to the situation at hand, and 3) Willingness to engage with the management team between board meetings ("the most important" goes to board culture). (38:34) Building the Board Agenda, from Tony: Tight agenda in three buckets: 1) Decisions needed now, 2) input without a decision, and 3) FYI. Most boards get stuck on FYI and never reach the real decisions. Then 40 to 50% of the deck should be standardized financial and operational KPIs (flag only what's changing), one rotating deep dive, and executive sessions with and without the CEO. (42:53) LLCs and Governance Dynamics in PE. (45:52) AI and Board Talent Demand. "Matrix management" (50:36) Underestimated Governance Risks. From Keith: for board members: "Are they aligned? Are they courageous? And are they adaptive?" From Tony: "The board should talk about the what, not the how." Difference between supervising and execution. Caveat: some PE firms are very prescriptive. (56:23) Founder-Led or Board-Led companies. (1:00:16) What are the 1-3 books that have greatly influenced your life:  Tony:  Titan by Ron Chernow (1998) Theodore Rex by Edmund Morris (volume 2 of the trilogy) (2001) The Demon of Unrest by Erik Larson (2004) Keith: Mornings on Horseback, by David McCullough (1981) The Outsiders, by William N. Thorndike Jr. (2012) The Evolving Self, by Robert Kegan (1982)  (1:05:00) Who were their mentors, and what they learned from them. (1:09:07) Quotes they think of often or live their life by. Tony: The Man in the Ring by Teddy Roosevelt. Rudyard Kipling poem If. Keith: "Everybody has a plan until they get hit in the face" (1:11:17) An unusual habit or an absurd thing that they love. (1:12:21) The living person they most admire. Keith Giarman is a Managing Partner of the Private Equity Practice at DHR Global, and Tony Abate is an experienced board chair, director, investor, and operating executive. You can follow Evan on social media at:X: @evanepsteinLinkedIn: https://www.linkedin.com/in/epsteinevan/ Substack: https://evanepstein.substack.com/__To support this podcast you can join as a subscriber of the Boardroom Governance Newsletter at https://evanepstein.substack.com/__Music/Soundtrack (found via Free Music Archive): Seeing The Future by Dexter Britain is licensed under a Attribution-Noncommercial-Share Alike 3.0 United States License

More than 60% of maternal deaths occur during the postpartum period, and hypertensive disorders of pregnancy are a major, preventable driver of that statistic. For too long, the transition from labor and delivery to home has been a vulnerable blind spot—leading to high rates of avoidablereadmissions. But the landscape has shifting. In this episode, we are diving deep into why OB providers must optimize blood pressure control before and after postpartum discharge. We'll be breaking down the landmark 2025 MOPP study, which shook up our traditional targets by examining tight versus standard blood pressure control, alongside the recently released May 2026 ACC Expert ConsensusDecision Pathway.What is the actual "goal BP" for a safe postpartum discharge? When should we initiate outpatient tight control, and how do we prevent these patients from bouncing back to the ED? Grab your coffee and pull up a chair. Let's look at the evidence.20% DISCOUNT: https://strongcoffeecompany.com/discount/CHAPANOSPINOBG1.          Gibson K, Hameed A. Society for Maternal-Fetal Medicine Special Statement: Checklist forpostpartum discharge of women with hypertensive disorders. AJOG, 2020. 2.          Farahi N, Oluyadi F, Dotson AB. Hypertensive Disorders of Pregnancy. American Family Physician. 2024. 4.          Lindley KJ, Bello NA, Berlacher KL, et al. Optimization of Postpartum Care for Patients With and at Risk for Premature and Long-Term Cardiovascular Disease: 2026 ACC Expert Consensus. Journal of the American College of Cardiology. May 2026. 5.          ACOG Task Force on Hypertension in Pregnancy, 20136.          Rosenfeld EB, Sagaram D, Lee R, et al. Management of Postpartum Preeclampsia and Hypertensive Disorders (MOPP): Postpartum Tight vs Standard Blood PressureControl. JACC. Advances. 2025.

What if one of the biggest barriers to eating healthier isn't knowing what to eat but knowing how to prepare it? In this episode, I'm joined by Catherine Connally, a clinical nutritionist, culinary medicine educator, and creator of Flavour with Benefits®. Catherine shares her plant-based journey and the experiences that led her to this lifestyle. We discuss why culinary medicine is becoming an increasingly important part of healthcare, and how learning even basic kitchen skills can help people incorporate more plant foods into their daily lives. Whether you're new to plant-based eating or looking for fresh inspiration in the kitchen, this episode is packed with practical insights and encouragement. In this episode, we discuss: • Catherine's plant-based journey • What culinary medicine is and why it matters • The importance of cooking skills for long-term health • Common barriers to eating more plant-based foods • Practical ways to incorporate more plants into your diet • Adapting traditional recipes to be plant-based • Why flavour matters when helping people change their eating habits • Teaching plant-based cooking through culinary medicine programs • Creating sustainable, enjoyable dietary changes About Catherine Connally: Catherine Connally holds a Master of Science in Applied Clinical Nutrition, is DipACLM (Board Certified by the American College of Lifestyle Medicine) and Blue Zones certified. She is licensed as a dietitian/nutritionist in Connecticut and specializes in identifying root causes of health issues, including nutrient deficiencies, drug–nutrient interactions to guide personalized, evidence-based interventions. She has been an avid vegan since 2019 after receiving a certificate in Plant-Based Nutrition from eCornell. Ms. Connally is the creator of Flavour with Benefits®, a gourmet nutrition approach to better health focused on plant-based health-optimized recipes. Her work includes over 110 recipes published in two Amazon bestselling, multi-award-winning books: Flavour with Benefits: France (2021) and Flavour with Benefits: Sicily & Calabria (2023). She also delivers education on culinary nutrition via clinics, events such as the 2023 T. Colin Campbell Retreat (Rochester, NY) and delivering plant based cooking instruction in partnership with Aroga Lifestyle Medicine Clinics, Ontario & British Columbia, Canada. Connect with Catherine on her website: flavourwithbenefits.com and Instagram @flavourwithbenefits. Enjoy the episode! ____________________________________________________________________ Work With Me: If you're ready to go plant-based or already are and want to feel more confident about your nutrition, I offer private consultations with personalized, evidence-based guidance. No overwhelm, just clarity. Book your free 15-minute discovery call at synergynutrition.ca ___________________________________________________________________ Vegan Boss Resources:

Unlocking the Power of Walking: Feet, Movement, and Health.  This episode dives deep into how something as simple as walking is a foundational pillar for health, longevity, and overall well-being. Dr. Karen Litzy welcomes expert insights from Dr. Courtney Conley and Dr. Melissa McDowell, you'll learn practical strategies to optimize foot health, rethink footwear choices, and incorporate walking into everyday life for maximum benefit.  In this episode: ·       Why walking is considered a sixth vital sign and what it means for health assessment ·       The evidence-based optimal step range and busting myths around 10,000 steps ·       How foot strength and proper footwear influence pain, injury, and longevity ·       The biochemistry of walking and its effects on hormones, brain health, and disease prevention ·       Strategies clinicians and individuals can use to operationalize walking as a therapeutic and preventive tool ·       Challenging misconceptions about shoes, orthotics, and barefoot walking Timestamps: 00:00 - Introduction: Rethinking walking as a vital sign and its importance 02:15 - Walking as a necessity: Beyond exercise, a core biological requirement 03:40 - The myth of 10,000 steps: Evidence-based step targets for different health outcomes 05:04 - Micro walks and ambient activity: How small moments add up 06:31 - Meeting people where they are: Tailoring step goals and activity levels 08:32 - Debunking the 10,000 steps myth and the influence of misinformation 09:56 - The impact of walking on mental health and chronic disease management 11:44 - Foot mechanics and gait: Insights into movement patterns and predicting systemic health 13:15 - The importance of foot strength and preserving foot biomechanics over time 14:32 - Foot health's relationship to fall risk and aging 16:54 - Biological impacts of walking on hormones, brain growth factors, and cognitive function 18:14 - Walking as an intervention for menopause symptoms, depression, and anxiety 19:41 - The power of specific step targets for reducing disease risk 21:01 - How walking should be integrated into chronic pain management 23:34 - The simplicity of behavior change: Making walking accessible for everyone 26:54 - Overcoming pain and fear: Starting with micro walks and building confidence 28:01 - Footwear essentials: Respectting anatomy and choosing proper shoes 30:46 - The influence of shoes on foot health, posture, and systemic health 33:33 - Identifying inappropriate footwear and the role of orthotics 35:45 - Addressing footwear for children and the importance of fit during growth 38:31 - The impact of heel-toe drop and shoe structure on gait and health 41:35 - How indoor shoes and surface changes affect foot and overall health 43:54 - Walking and longevity: Connecting foot strength, fall risk, and lifespan 46:22 - Practical tips for strengthening feet and the dark side of cushioned shoes 50:02 - Tips for clinicians to integrate foot health and walking into practice 53:38 - Business opportunities in community health, workshops, and education 56:23 - Final advice for practitioners interested in promoting walking and foot health 57:59 - The journey of publishing a health-focused book: Tips and encouragement 58:06 - The importance of passion and ongoing learning in health professions 66:35 - Resources, social media, and where to find expert guidance Resources & Links: ·       Walk: The Surprising Science of Walking and How It Can Improve Your Health and Happiness ·       Gait Happens - Foot and gait analysis training ·       Melissa McDowell - Instagram | Website ·       Courtney Conley Website| Instagram | YouTube More About Dr. Courtney Conley: Dr. Courtney Conley is the founder of Gait Happens, where she pursues her passion for helping as many people as possible reclaim their foot function. As an internationally renowned foot and gait specialist, Dr. Conley teaches both nationally and internationally. She is a chiropractic physician with a BA in Kinesiology, a BA in Human Biology, and a Doctorate in Chiropractic Medicine. Based in Lakewood, CO, Dr. Conley owns and operates Total Health Solutions clinic and Total Health Performance gym, where she leads patient care focused on restoring gait mechanics and resolving foot problems to help people move more easily and pain-free. She is also a founding member of the Healthy Foot Alliance, an international team of practitioners dedicated to promoting the benefits of natural footwear, preventing unnecessary surgeries, and improving foot function to create a stable foundation from the ground up. More about Dr. Milica McDowell: Dr. Milica McDowell holds two Bachelor of Science degrees (Exercise Physiology and Health Promotion, (Montana State University), a master's degree (Physical Therapy, University of Colorado Health Sciences Center), and a Doctorate degree (Physical Therapy, Idaho State University). She served as a university faculty member in Human Performance for nearly a decade, has developed numerous medical education curricula and has been an invited speaker on many national stages, including the American Physical Therapy Association and American College of Sports Medicine's conventions. She has been an invited presenter for numerous professional organizations, and she has delivered over 300 educational lectures at state, regional, and national levels. Dr. McDowell founded Clearwater Physical Therapy, Bluebird Medical Supply Company, and co-founded Epic Fitness, 4C Sports Injury Analytics, and CrossFit Send It. In 2023, Dr. McDowell was recognized as one of the Top 50 Women Leaders in Healthcare by the Women We Admire organization. She has edited textbooks, written several university science courses, and developed professional continuing education courses that are sold in a global marketplace. One of her present interests is the responsible use of AI technologies to produce multimedia learning experiences in professional education. Jane Sponsorship Information: Book a one-on-one demo here Mention the code LITZY1MO for a free month   Follow Dr. Karen Litzy on Social Media: Karen's Instagram Karen's LinkedIn Subscribe to Healthy, Wealthy & Smart: YouTube Website Apple Podcast Spotify SoundCloud Stitcher iHeart Radio

Geriatrician Dr. Mark Supiano joins the podcast to discuss the connection between heart and brain health. Citing multiple clinical trials, he breaks down what these studies and their findings mean for blood pressure management's effect on cognitive decline and how they directly impact both patients and clinicians. Guest: Mark A. Supiano, MD, geriatrician, University Hospital Geriatrics Clinic, professor, Internal Medicine, Utah School of Medicine Show Notes Read about the Systolic Blood Pressure Intervention Trial (SPRINT) Study on the National Heart, Lung, and Blood Institute website. Learn about the SPRINT MIND study in the Journal of the American Medical Association.  Read Dr. Supiano's study, “Hypertension in the Oldest Old,” published by the Journal of the American College of Cardiology: Advances on their website. Learn about the HYVET, STEP, SPRINT-HEART and China Rural Hypertension Control Project studies through their articles on the National Library of Medicine website. Learn about an ancillary study to SPRINT, “Changes in arterial stiffness under blood pressure control are independently associated with cognitive impairment,” on the National Library of Medicine website. Learn about the Systolic Hypertension in the Elderly Program (SHEP) study, published by Clinical and Experimental Hypertension, on the Taylor and Francis Online website. Learn about the ESPRIT study on The Lancet website. Learn more about Dr. Supiano on the University of Utah Health website.   Connect with us Find transcripts and more at our website. Email Dementia Matters: dementiamatters@medicine.wisc.edu Follow us on Facebook and Twitter. Subscribe to the Wisconsin Alzheimer's Disease Research Center's e-newsletter. Enjoy Dementia Matters? Consider making a gift to the Dementia Matters fund through the UW Initiative to End Alzheimer's. All donations go toward outreach and production. Learn about Dr. Chin's book, When Memory Fades: What to Expect at Every Stage, from Early Signs to Full Support for Alzheimer's and Dementia.

Send us Fan MailIntroducing the first episode in a special series - Translational Conversations: From Model to Medicine. Hear from Dr. Ned Kalin, a nonhuman primate researcher, and Dr. Melissa Brotman, a clinical researcher, about how parallel and collaborative animal and human research studies help us better understand anxiety and irritability in youth and develop novel, effective, treatments. Drs. Kalin and Brotman discuss the unique contributions of their approaches, how the translational research process manifests in their own work, and ways scientists of all kinds can approach advocacy for the importance of animal-based biomedical research.We'd like to thank Dr. Ned Kalin, Hedberg Professor and Chair of the Department of Psychiatry at the University of Wisconsin-Madison, and Dr. Melissa Brotman, Chief of the Section on Neuroscience and Novel Therapeutics at the National Institute of Mental Health, for their openness and participation!Translational Conversations is made possible through support from Biomedical Research Awareness Day, a program of Americans for Medical Progress, and the American College of NeuropsychopharmacologyResources & Links: When the science alone is not enough: embracing our responsibility as science communicators ​Follow BRAD on X! Facebook! Instagram! https://x.com/amp_bradhttps://www.facebook.com/BRADGlobal/https://www.instagram.com/brad_globalSupport the showFollow Lab Rat Chat on X! Facebook! Instagram!https://twitter.com/thelabratchat https://www.facebook.com/labratchat https://www.instagram.com/thelabratchat All Lab Rat Chat episodes are edited by Audionauts: https://audionauts.pro/ 

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.

Preparing for a colonoscopy may not be anyone's favorite part of colorectal cancer screening, but proper colonoscopy prep is one of the most important factors in detecting precancerous polyps and colorectal cancer early. In this episode, Jacqueline Gaulin sits down with leading gastroenterologist Dr. Fola May to answer common questions about bowel preparation for colonoscopy. Why is colonoscopy prep necessary? What happens if the bowel isn't cleaned properly? Have preparation options improved over the years? And what can patients do to make the process easier? As a co-author of the latest U.S. Multi-Society Task Force recommendations on bowel preparation for colonoscopy, Dr. May explains how colonoscopy prep has evolved to become more effective and patient-friendly. She discusses lower-volume bowel prep options, updated dietary recommendations, and practical strategies to help patients achieve a high-quality prep and avoid repeat procedures. In this episode, you'll learn: ✅ Why bowel preparation is essential for an effective colonoscopy ✅ How poor prep can impact polyp and cancer detection ✅ Newer low-volume colonoscopy prep options ✅ Updated diet recommendations before a colonoscopy ✅ Tips for improving your colonoscopy prep experience ✅ How proper prep helps improve colorectal cancer screening outcomes Whether you're preparing for your first colonoscopy or looking for the latest guidance on bowel preparation, this episode provides expert insights to help you feel more confident and informed. This episode is brought to you in collaboration with the American College of Gastroenterology Patient Care Committee.   

Resistance training is one of the most powerful interventions for preserving muscle, supporting metabolic health, and promoting healthy aging—but many patients still find it intimidating or confusing. In this episode, Dr. Kara Fitzgerald sits down with exercise physiologist Brad Currier, PhD, to unpack the newly updated ACSM resistance training guidelines and discuss practical approaches for prescribing exercise across the spectrum, from sedentary adults to elite athletes. In partnership with Timeline, they also review the latest clinical research on Urolithin A, mitochondrial function, muscle recovery, protein, and creatine, offering actionable insights for functional medicine practitioners. Full show notes + references: https://www.drkarafitzgerald.com/fxmed-podcast/ GUEST DETAILS Dr. Brad Currier is Manager of Clinical Trials at Timeline, a Swiss biotech company at the forefront of longevity science for over 15 years. With a background in elite athletics, he went on to earn a PhD in muscle physiology, where his research focused on how exercise and nutrition influence aging and performance. Brad has led numerous clinical trials conducted around the world and published extensively in peer-reviewed journals. He is also the lead author of the American College of Sports Medicine's new position stand on resistance training prescription, helping shape global guidelines for strength training and healthy aging. THANKS TO OUR SPONSOR TIMELINE: http://Pro.timeline.com At the core of Timeline is Mitopure®, a pure and patented form of Urolithin A, shown to improve mitochondrial dysfunction. Learn more & Sign up for a Healthcare Practitioner account at http://Pro.timeline.com Email: care@timeline.com CONNECT with DrKF Want more? Join our newsletter here: https://www.drkarafitzgerald.com/newsletter/ Or take our pop quiz and test your BioAge! https://www.drkarafitzgerald.com/bioagequiz YouTube: https://tinyurl.com/hjpc8daz Instagram: https://www.instagram.com/drkarafitzgerald/ Facebook: https://www.facebook.com/DrKaraFitzgerald/ DrKF Clinic: Patient consults with DrKF physicians including Younger You Concierge: https://tinyurl.com/yx4fjhkb Younger You Practitioner Training Program: https://www.drkarafitzgerald.com/trainingyyi/ Younger You book: https://tinyurl.com/mr4d9tym Better Broths and Healing Tonics book: https://tinyurl.com/3644mrfw

Learn how estate planning attorneys can use AI for document review, trust analysis, client intake, and drafting assistance while maintaining professional judgment and confidentiality. The American College of Trust and Estate Counsel, ACTEC, is a professional society of peer-elected trust and estate lawyers in the United States and around the globe. This series offers professionals best practice advice, insights, and commentary on subjects that affect the profession and clients. Learn more in this podcast.

Prunes: Nature's Answer to Constipation Prunes, figs, and exercise are put to the test as natural home remedies for constipation. Listen to today's episode written by Dr Michael Greger at @NutritionFacts.org #vegan #plantbased #Plantbasednutrition #constipation #prunes #figs #fiber ===================== Original post: https://nutritionfacts.org/blog/prunes-natures-answer-to-constipation   New Documentary (Free): How Not To Die https://nutritionfacts.org/video/how-not-to-die-documentary/  ====================== Dr. Michael Greger is a physician, New York Times bestselling author, and internationally recognized speaker on nutrition, food safety, and public health issues. A founding member and Fellow of the American College of Lifestyle Medicine, Dr. Greger is licensed as a general practitioner specializing in clinical nutrition. He is a graduate of the Cornell University School of Agriculture and Tufts University School of Medicine. He founded NUTRITIONFACTS.ORG is a non-profit, non-commercial, science-based public service provided by Dr. Michael Greger, providing free updates on the latest in nutrition research via bite-sized videos. There are more than a thousand videos on nearly every aspect of healthy eating, with new videos and articles uploaded every day.   His latest books —How Not to Die, the How Not to Die Cookbook, and How Not to Diet — became instant New York Times Best Sellers. His two latest books, How to Survive a Pandemic and the How Not to Diet Cookbook were released in 2020.  100% of all proceeds he has ever received from his books, DVDs, and speaking engagements have always and will always be donated to charity.   FOLLOW THE SHOW ON: YouTube: https://www.youtube.com/@plantbasedbriefing     Spotify: https://open.spotify.com/show/2GONW0q2EDJMzqhuwuxdCF?si=2a20c247461d4ad7 Apple Podcasts: https://podcasts.apple.com/us/podcast/plant-based-briefing/id1562925866 Your podcast app of choice: https://pod.link/1562925866  

Are you training older adults or clients with specific needs? Wondering if your programs are too "safe" — or not effective enough? In this powerful episode of the “Master Instructor Roundtable,” Wendy Batts and Dr. Marty Miller break down the REAL differences between safe and effective training, and why you don't need to choose just one!

Is the skepticism around breast implant illness driven by science or the cosmetic surgery industry? What protocols (for keeping & removing) are working for patients? Robert Whitfield, MD is a fellow of the American College of Surgeons, a board-certified breast explant specialist who has performed over 2,000 explant procedures, published 15 peer reviewed publications & testified at the 2019 FDA hearing. He is a leading Breast Implant Illness expert who takes a functional approach to patient recovery.  In this episode, he says what your surgeon won't, you'll hear real symptoms from a listener, why removing them isn't enough & implant alternatives. If you liked this episode, you'll also like episode 290: ALLERGIES OR AEROSOLS? THE IGNORED REASON YOU'RE TIRED & SICK Guest:https://podcasts.apple.com/us/podcast/the-dr-robert-whitfield-show/id1678143554https://www.drrobertwhitfield.com/https://drrobscircle.com/ https://www.youtube.com/channel/UCD-Jlr_K8yi5GPV938Ddn9ghttps://www.instagram.com/dr.robertwhitfield/?hl=enhttps://www.facebook.com/DrRobertWhitfield/https://www.linkedin.com/in/robert-whitfield-md-50775b10/  Sponsors: https://www.jordanharbinger.com/starterpacks/ https://www.historicpensacola.org/about-us/  0:00 - Introduction1:09 - BII Symptoms Explained3:14 - BII vs. Perimenopause6:20 - Why "Toxic" Lost Its Meaning7:51 - A Listener's Symptom Story8:20 - Textured Implants and Lymphoma14:16 - The Case for Your Own Tissue18:18 - The Total Tox Burden Test22:24 - Can You Heal Without Explanting?28:37 - Botox and Filler as Alternatives29:59 - Foreign Body Reaction Explained32:12 - Medical Gaslighting or Industry Pressure?33:42 - Dr. Whitfield Responds to Makary37:09 - When Medicine Dismisses Women38:14 - How to Vet an Explant Surgeon40:03 - Pre and Post-Op Protocol49:29 - What Surgeons Should Be Telling You52:10 - Still Sick After Explant?53:52 - Mammograms and Rupture Risk55:09 - Saunas and Implant Leaching58:49 - How Urgent Is BII?1:00:36 - Censored by the Algorithm1:02:18 - Why Women Must Spread This MessageRequest to join my private Facebook Group, MFR Curious Insiders: https://www.facebook.com/share/g/1BAt3bpwJC/Follow me in all the places:https://www.meredithforreal.com/  https://www.instagram.com/the_curiousintrovert/ meredith@meredithforreal.comhttps://www.youtube.com/meredithforreal https://www.facebook.com/curiousintrovert

Dr. Centor discusses the American College of Physicians guidance on breast cancer screening with Dr. Carolyn Crandall.

(0:00) Intro *Reference to the Boardroom Governance Summit at Limerick Lane Cellars, Healdsburg, California (Aug 26-27, 2026)  (2:12) About the podcast sponsor: The American College of Governance Counsel. (2:59) Start of interview.  (4:00) Origin Story of Emily, and Stewardship  (6:15) From Engineer to CEO  (7:14) Companies that she led: Elo Touch Systems (97-00), Capstone Turbine (02-03), Apexon (04-07) and NovaTorque (09-17). (9:50) Changing geopolitics of manufacturing (10:49) First Boards and Public Company Lessons (first board experience in Japan) "The soft skills are the hard part to do." (15:48) On serving in private VC-backed boards. "If you know one board, you know one board. I mean, they are all so different." (22:43) On serving in non-profit boards. "It's one of the best possible ways to get governance experience." (26:20) CEO Mistakes (32:03) Board Succession for leadership and skills. (35:33) Board Evaluations Done Right  (37:41) What Makes Great Directors. *reference to Leading Edge Stewardship, by Linda Riefler and Mayree Clark (Stanford Women on Boards). "Asking the right question, at the right time, in the right way." (39:57) AI and the Boardroom. (46:16) Innovation Versus Oversight. "The goal is informed oversight without operational interference" (49:34) Teaching Governance to Stanford Students  (52:17) Boards need to have a long-term orientation in this short-term world. (52:34) Books that have greatly influenced her life: The Bible Why Nations Fail: The Origins of Power, Prosperity, and Poverty, by Daron Acemoglu and James A. Robinson (2012) The Count of Monte Cristo by Alexandre Dumas (1846) (54:12) Her mentors. "[T]hey told me things I needed to hear in a way that I could hear them because it's easy to get defensive." (55:38) Quotes that she thinks of often or lives her life by. "Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.' by Margaret Mead. (56:43) An unusual habit or an absurd thing that she loves.  (57:30) The living person she most admires in governance: Bob Joss. Emily Liggett serves on the boards of Ultra Clean Technology and Materion Corporation. She also serves as Lecturer at Stanford GSB, where she teaches corporate governance and board leadership. You can follow Evan on social media at:X: @evanepsteinLinkedIn: https://www.linkedin.com/in/epsteinevan/ Substack: https://evanepstein.substack.com/__To support this podcast you can join as a subscriber of the Boardroom Governance Newsletter at https://evanepstein.substack.com/__Music/Soundtrack (found via Free Music Archive): Seeing The Future by Dexter Britain is licensed under a Attribution-Noncommercial-Share Alike 3.0 United States License

Dr., Leslie McIntyre was raised in Central Oregon and always knew that she wanted to be a Veterinarian. She earned her DVM from Oregon State University in 1995, then did an equine internship followed by a residency in Equine Internal Medicine at Colorado State University, finishing in 1999. She was Board Certified by the American College of Veterinary Internal Medicine in Large Animal Medicine in 1999 and earned a Master's Degree from CSU that same year.Afterwards, she returned to Bend, Oregon to join an Equine referral clinic for the next six years. In 2005, she founded her own practice, Sage Veterinary Alternatives in Bend.Dr. McIntyre completed the Medical Acupuncture for Veterinarians course while a resident, became certified in acupuncture by IVAS, and has training in Homotoxicology, Canine Osteopathy, and Medical Laser therapy. She is certified in Animal Chiropractic by the IVCA and in Canine Rehabilitation by the Canine Rehabilitation Institute. She also has earned the Veterinary Master Homeopathy certification from the Pitcairn Institute and is certified by the Academy of Veterinary Homeopathy.Please enjoy this conversation with Dr. Leslie McIntyre as we discuss her education, work history, holistic training, and her involvement with the American Holistic Veterinary Medical Foundation.

The March 2026 ACC/AHA Guideline on the Management of Dyslipidemia made a major pivot regarding Lipoprotein(a) by establishing a formal recommendation for universal screening in adults. This 2026 guideline, published in the Journal of the American College of Cardiology, issued a Class 1 recommendation stating that every adult should have their Lp(a) measured at least once in their lifetime. Because Lp(a) levels are genetically determined and remain highly stable throughout a person's life, a single lifetime check is sufficient for the vast majority of the population to establish their baseline risk. Well, that's great for Family medicine or internal medicine, but how does that affect us in women's health? Well, it's complicated: lipoprotein(a) has been associated with an increased risk of VTE and has also been associated, in some studies, with FGR, preeclampsia, and preterm birth! So, can these patients receive oral contraceptives? What about Perioperative and postop care? Do these patients require anticoagulation? What about pregnancy- is LDA recommended here? And lastly, what about TXA use in patients with HMB? This podcast topic comes from one of our podcast family members who is an OBGYN military personnel caring for our wonderful troops overseas. Listen in for details!16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG1. Ezzat, D., Lopez, D. M., Claggett, B. L., Li, L., Mohammadnia, N., Schuermans, A., Hemeryck, J., Chang, A., Murillo, S., O'Donoghue, M. L., Bikdeli, B., Yu, Z., Natarajan, P., Patel, A. P., Pabon, M. A., & Honigberg, M. C. (2026). Lipoprotein(a) and incident venous thromboembolism in pre- and postmenopausal women, and in men. European Heart Journal, ehag252. https://doi.org/10.1093/eurheartj/ehag2522.ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Dyslipidemia Writing Committee. (2026). 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Circulation, 153, e1155–e1300. https://doi.org/10.1161/CIR.00000000000014233. CDC MEC 4. Prevention of Venous Thromboembolism in Gynecologic Surgery: ACOG Practice Bulletin, Number 232. Obstetrics and Gynecology. 2021. Committee on Practice Bulletins—Gynecology5. Sofi F, Marcucci R, Abbate R, Gensini GF, Prisco D.Lipoprotein(a) as a Risk Factor for Venous Thromboembolism: A Systematic Review and Meta-Analysis of the Literature.Seminars in Thrombosis and Hemostasis. 2017. Dentali F, Gessi V, Marcucci R, et al. Lipoprotein (A) and Venous Thromboembolism in Adults: The American Journal of Medicine. 2007.

Have you been overcomplicating strength training after 40? If you've ever wondered whether you're doing the "right" workout, lifting heavy enough, following the perfect program, or spending enough time in the gym, this episode may be exactly what you need to hear. A major new research review from the American College of Sports Medicine looked at 137 studies involving more than 30,000 people and came to a surprisingly simple conclusion: the biggest difference isn't between workout program A and workout program B. The biggest difference is between doing nothing and doing something. In this episode, I'm breaking down what the latest science says about strength training, why consistency matters more than perfection, and how strength training to lose weight can be much simpler than you've been led to believe. We'll talk about the best approach to building muscle, supporting hormones, improving metabolism, and using strength training as one of the most effective belly fat loss exercises available to women in perimenopause and menopause. Friend, your body doesn't need perfection. It needs participation.   FULL BLOG + SHOW NOTES Read the full article and grab the resources mentioned in today's episode:

I'm joined by Dr. Jeffrey Sankoff to talk about three exercise “rules” you may be allowed to break: you don't always need to spread workouts across the week, intensity doesn't have to come from a formal interval session, and most short workouts don't require a complicated hydration or fueling plan.The Exercise Rules You're Allowed to BreakHave you ever skipped a workout because you couldn't do the “right” one? Maybe you didn't have time for the gym, a long hike, or a structured bike ride. Today, we revisit Voltaire's reminder that “the great is the enemy of the good” and apply it to exercise. The evidence is reassuring: weekend workouts count, short bursts of effort during the day count, and for most workouts under an hour, hydration hype may matter far less than we've been led to believe.Dr. Jeffrey Sankoff, an ER physician, Ironman triathlete, triathlon coach, and host of the evidence-focused TriDoc Podcast, joins me for this conversation. While Jeff works with endurance athletes, today's discussion is for anyone who wants to live long and well while still managing the realities of work, family, travel, and everyday life.First, we break the calendar rule. Many people assume exercise has to be spread evenly throughout the week, but a 2024 Circulation study on “weekend warrior” physical activity found that people who concentrated their moderate-to-vigorous exercise into one or two days still had lower risk for many diseases compared with inactive people, especially cardiometabolic conditions such as hypertension, diabetes, obesity, and sleep apnea. The study was observational, so it does not prove weekend-only exercise is ideal, and injury risk still matters. But the practical message is clear: if weekdays are impossible, weekends still count. Next, we break the formal-interval rule. High intensity does not always have to mean a structured HIIT class, a bike trainer, or a carefully timed workout. A 2026 European Heart Journal study found that a higher percentage of vigorous physical activity was associated with lower risk across several chronic diseases and mortality outcomes. Even a small proportion of vigorous activity may matter, meaning short real-life bursts—taking the stairs quickly, walking briskly uphill, carrying groceries with purpose, or chasing a child or grandchild—can become meaningful movement when they raise your breathing and effort level. This study was also observational, so it cannot prove cause and effect, and anyone with medical concerns should check with their clinician before adding vigorous bursts. Finally, we break the bottle rule. For endurance races, long workouts, or hot-weather exercise, hydration, electrolytes, and carbohydrates can matter. But for many 30- to 60-minute workouts in ordinary conditions, a formal hydration or fueling plan may not be necessary. The American College of Sports Medicine's position stand emphasizes fluid replacement to support hydration during physical activity, but the need depends on duration, sweat loss, heat, and intensity. A practical “N of 1” approach is to weigh yourself before and after a typical workout to see how much fluid you actually lose. We also discuss electrolytes and carbohydrates. Electrolytes are mostly salts, and they become more relevant with long, hot, sweaty, or repeated sessions. Carbohydrate-containing drinks can help with longer endurance performance, but for a 35-minute walk or a short gym session, sugar in your bottle is usually not the bottleneck. A systematic review on carbohydrates and exercise performance found benefits in longer exercise contexts, but that does not mean every short workout needs sports drinks or gels. TakeawaysDon't let the perfect workout plan keep you from the good-enough workout you can actually do.If weekdays are packed, a weekend warrior approach may still provide meaningful health benefits.Look for small bursts of vigorous effort in daily life, and for most workouts under an hour, water when thirsty is usually enough.Send us Fan MailSupport the show

Why are more people becoming afraid of vaccines than the diseases vaccines were created to prevent? The answer is not simply a lack of information. In many ways, vaccines have become victims of their own success.For decades, widespread vaccination helped push diseases like measles, polio, pertussis, and smallpox out of everyday life. Many of us no longer live with the visible fear of these infections, their complications, or the way they can destabilize families, communities, and healthcare systems.But when the disease feels distant, the vaccine can start to feel like the bigger threat.That shift is now changing public health.Rather than assuming vaccine hesitancy is only about ignorance or defiance, we need to look more carefully at:• why people can become more suspicious of vaccines when they no longer see the diseases vaccines helped control• How misinformation, fear, personal experience, politics, history, and social media can shape health decisions• Why highly educated people can still be vulnerable to vaccine misinformation• how confusing a side effect, adverse event, or normal immune response with a true allergy can create long-term fear• Why egg allergy is no longer the vaccine barrier many people still believe it is• And how declining vaccination rates can allow diseases like measles and pertussis to reemergeVaccine education has to move beyond simply telling people what to do. We need clearer, more compassionate conversations that acknowledge fear while helping people separate facts from fiction.In this upcoming episode, I'm joined by Dr. Joyce Yu, associate professor of pediatrics and director of the Food Allergy Program at Columbia University Irving Medical Center.Together, we explore:What is driving the rise of vaccine hesitancyWhy vaccine-preventable diseases can return when communities let their guard downHow allergists help patients understand whether a vaccine reaction is truly an allergyAnd why rebuilding trust requires listening, clarity, and evidence-based conversationIf you or someone you love has ever felt uncertain, afraid, or confused about vaccines, allergic reactions, side effects, or conflicting health information, this conversation offers a grounded look at how fear spreads, how misinformation takes hold, and why protecting public health depends on rebuilding trust.Guest BioDr. Joyce Yu is an associate professor of pediatrics and director of the Food Allergy Program at Columbia University Irving Medical Center. She is an allergy and immunology specialist with clinical and scientific expertise in food allergy, immunology, vaccine-related concerns, and immune system function. Dr. Yu received her medical education at the Icahn School of Medicine at Mount Sinai, completed her residency at Northwestern/Lurie Children's Hospital, and completed her fellowship in Allergy and Immunology at Mount Sinai. Her postdoctoral work focused on toll-like receptor signaling and memory B cell development, mechanisms that are closely connected to how the immune system develops lasting protection. She is a fellow of both the American College of Allergy, Asthma & Immunology and the American Academy of Allergy, Asthma & Immunology. She is also a former president of the New York Allergy and Asthma Society and has held leadership roles within the Clinical Immunology Society. Connect with Dr. Yu on LinkedIn.About Your HostHosted by Dr. Deepa Grandon, MD, MBA, a triple board-certified physician with over 23 years of experience working as a Physician Consultant for influential organizations worldwide. Dr. Grandon is the founder of Transformational Life Consulting (TLC) and an outspoken faith-based leader in evidence-based lifestyle medicine.Disclaimer ​​TLC is presenting this podcast as a form of information sharing only. It is not medical advice or intended to replace the judgment of a licensed physician. TLC is not responsible for any claims related to procedures, professionals, products, or methods discussed in the podcast, and it does not approve or endorse any products, professionals, services, or methods that might be referenced.Work With Me Learn More About My Soon-to-Launch Telemedicine PlatformExciting news. My virtual medical platform is launching soon! If you're looking for personalized, evidence-based care in allergy, immunology, and lifestyle medicine, stay tuned.Visit drdeepa-tlc.org and click on “Learn More” to join the waitlist and be the first to receive updates about services, membership options, and launch details.Precision care. Personalized guidance. Wherever you are.DevotionalsWant to receive a devotional every week from Dr. Deepa? Devotionals are dedicated to providing you with a moment of reflection, inspiration, and spiritual growth each week, delivered right to your inbox. Visit drdeepa-tlc.org to subscribe for free.Trauma CoursesReady to deepen your understanding of trauma and kick-start your healing journey? Explore a range of online and onsite courses designed to equip you with practical and affordable tools. From counselors, ministry leaders, and educators to couples, parents, and individuals seeking help for themselves, there's a powerful course for everyone. Browse all the courses now to start your journey.

If you've tried medications, diet changes, fiber supplements, or other therapies for IBS-C and still aren't feeling better, you're not alone. Many people with irritable bowel syndrome with constipation (IBS-C) feel frustrated when symptoms persist despite treatment. But when treatments don't work, it may be time to take a closer look at what's really going on. In this episode of the Gastro Girl Podcast, Jacqueline Gaulin sits down with Dr. William D. Chey, world-renowned gastroenterologist  at the University of Michigan and President of the American College of Gastroenterology, to discuss what patients should do when IBS-C treatments fail. Dr. Chey explains why some patients continue to struggle, what conditions may be overlooked, and how to work with your healthcare provider to develop a more effective plan. In this episode, you'll learn: ✅ Why IBS-C treatments may not always work as expected ✅ When it's time to rethink your diagnosis ✅ The role of pelvic floor dysfunction and other overlooked conditions ✅ Questions to ask your healthcare provider ✅ How to take the next step toward better symptom control ✅ Why you don't have to settle for ongoing symptoms Whether you're newly diagnosed or have been living with IBS-C for years, this episode offers practical insights to help you move forward with confidence. Learn more at GastroGirl.com. This episode is sponsored by Ardelyx.  

Dr. Ami Bhatt is the Chief Innovation Officer for the American College of Cardiology and Chair of FDA's Digital Health Advisory Committee.We discuss the intersection of medicine and technology, highlighting the impact of digital health on chronic disease management, patient education, and access to care. The conversation delves into telemedicine, remote monitoring, patient empowerment, integrative care, and the future of predictive and preventative healthcare.This episode was sponsored by Ardelyx.

Learn how directed trusts divide trustee responsibilities, the role of trust protectors, and how modern trust design creates flexibility in estate planning while maintaining effective trust administration. The American College of Trust and Estate Counsel, ACTEC, is a professional society of peer-elected trust and estate lawyers in the United States and around the globe. This series offers professionals best practice advice, insights, and commentary on subjects that affect the profession and clients. Learn more in this podcast.

In this episode of the JACCP Podcast, host Rob DiDomenico is joined by JACCP Editor in Chief Stuart Haines and Senior Associate Editor Beth Phillips to offer practical guidance for authors seeking to publish in the Journal of the American College of Clinical Pharmacy. With nearly 500 annual submissions and a rejection rate approaching 90% for unsolicited manuscripts, it's important to put together a strong submission. The conversation covers the journal's scope and mission and addresses the most common reasons manuscripts are rejected, from methodological weaknesses to unsupported conclusions. Stuart and Beth also share actionable tips on following reporting guidelines, strengthening review articles, and exploring the journal's full range of manuscript types. A recurring theme: don't hesitate to pitch your idea before investing weeks in writing.

Cholesterol management, per new guidelines from the American College of Cardiology, is just one aspect of measures you can take to lower your risk for cardiovascular disease, the number one cause of death. Roger Blumenthal, a cardiologist at Johns Hopkins … What's involved in lowering your risk for cardiovascular disease? Elizabeth Tracey reports Read More »

New guidelines for managing cholesterol levels have recently been released by the American College of Cardiology. Cardiologist Roger Blumenthal at Johns Hopkins chaired the committee that wrote the guidelines, and says that in reviewing the data it became clear that … Certain groups of people seem to be missing out when it comes to optimizing cardiovascular disease prevention, Elizabeth Tracey reports Read More »

In this episode of CURiE Conversations, host Dr. Veronia Fahmy speaks with Nneoma Uzoukwu and Dr. Jeremy Price about their published work, "Definitive Radiotherapy in Serous Carcinoma of Unknown Primary: A Case Review."The discussion explores the presentation and management of serous carcinoma of unknown primary with isolated nodal disease, the rationale for definitive radiotherapy and key considerations for multidisciplinary cancer care.Contemporary Updates: Radiotherapy Innovation & Evidence (CURiE) is the official publication platform of the American College of Radiation Oncology through the Cureus Journal of Medical Science. Read the full article here: https://www.cureus.com/articles/479202-definitive-radiotherapy-in-serous-carcinoma-of-unknown-primary-with-isolated-nodal-disease-a-case-review

In this episode, we review key updates from the 2026 ACC-AHA Guidelines on the Management of Dyslipidemia. Key Concepts The PREVENT ASCVD equation is now recommended to calculate ASCVD risk, with thresholds at 3%, 5%, and 10%. The previous 7.5% threshold for statin treatment is now 5%. In addition to the 10-year ASCVD estimate, clinicians should consider the use of Lp(a), "risk enhancers", and coronary artery calcium (CAC) scans as a "tie breaker" with shared decision-making when the decision to treat is not clear. In addition to LDL goals of < 100, < 70, or < 55 (depending on risk), the new guidelines also suggest non-HDL-C and apoB goals once LDL cholesterol is at goal. Many patients will require non-statin therapies to achieve lipid goals. The recommended non-statin therapies include ezetimibe, PCSK9 mAb, PCSK9-interfering RNA, and bempedoic acid. References Writing Committee Members, Blumenthal RS, Morris PB, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(17):e1154-e1276. doi:10.1161/CIR.0000000000001423 Wiggins BS, Barac A, Benziger CP, et al. 2026 Dyslipidemia Guideline-at-a-Glance. J Am Coll Cardiol. 2026;87(19):2617-2623. doi:10.1016/j.jacc.2026.02.4872 Superko H, Garrett B. Small Dense LDL: Scientific Background, Clinical Relevance, and Recent Evidence Still a Risk Even with 'Normal' LDL-C Levels. Biomedicines. 2022;10(4):829. Published 2022 Apr 1. doi:10.3390/biomedicines10040829

Doctor Mau Informa ®️ #drmauinforma Cuando discutimos la diabetes tipo 2 y la prediabetes, nuestro enfoque se centra casi exclusivamente en restringir los carbohidratos y perder peso. Sin embargo, los datos de los ensayos clínicos más recientes revelan un punto ciego enorme en nuestros paradigmas de atención: el músculo esquelético es nuestro órgano de eliminación de glucosa más grande, e ignorarlo acelera el envejecimiento metabólico. En este episodio, desglosamos las pautas clínicas y los datos de ensayos más recientes que demuestran por qué el entrenamiento de hipertrofia mecánica funciona como una poderosa intervención no farmacológica para el control del azúcar en sangre, incluso para personas con un peso normal. En este episodio aprenderás: → Por qué la diabetes tipo 2 actúa como un factor de riesgo independiente para la sarcopenia acelerada y el declive de la función muscular. → Los datos moleculares que demuestran que el entrenamiento de resistencia mejora la HbA1c en aproximadamente un 0.57% y la glucosa en ayunas en ~7 mg/dL. → Por qué el entrenamiento de hipertrofia es significativamente superior al entrenamiento de resistencia a la fatiga para la inflamación sistémica y la retención de masa magra. → Los sorprendentes resultados del ensayo Kobayashi: por qué el entrenamiento de fuerza venció al cardio en la diabetes tipo 2 de peso normal. → Los parámetros de programación exactos de la Asociación Americana de Diabetes y el ACSM necesarios para optimizar la eliminación metabólica en la práctica.

(0:00) Intro, *Reference to the Boardroom Governance Summit (Aug 26-27, 2026)  (2:42) About the podcast sponsor: The American College of Governance Counsel. (3:28) Start of interview. *Reference to prior episode with Greg (E136) from 2024. (5:14) Market Boom and AI Supercycle (6:14) AI Is Changing Everything (9:06) How does a VC use AI (venture business: sourcing, selection, and stewardship) (12:13) Cloud and Startup Costs, rise of seed rounds and institutional angel investors (15:13) JSV Launchpad, a 10-week, in-person summer program in SF from JSV for early-stage student AI founders  (18:50) SaaSpocalypse Debate and AI Washing (reference to the Albert Saniger / Nate Inc case) (21:33) Growth Metrics Rewritten (when Anthropic has grown 80x year over year) "the best solution for high prices is high prices" (24:20) Sorting SaaS Risks (27:30) Defensibility in the AI Era: 1) Network effects, 2) Systems of record, and 3) Regulated workflow. (29:52) AI impact to companies: 1) Are the foundation models existential? 2) How much have you incorporated AI into your platform or your product? 3) How important is AI within your product? and 4) How much have you integrated AI into your operations? "In a world where building software is easy, one of the things that we're already seeing within our portfolio, and I think we'll see more of this, is... horizontal expansion (expanding to adjacent businesses)." (32:33) AI, Jobs, and Layoffs (*reference to this FT article: What if remote working, not AI, is to blame for weak junior hiring?) (38:28) Private Markets and IPOs. Liquidity in venture ecosystem (M&A and private equity). (42:02) SpaceX, Anthropic and OpenAI IPOs (45:18) Data Centers and Backlash "It's easy to demonize" (46:16) Regulation and Global Competition "AI right now has become a great bogeyman for both sides." (50:14) Board Strategy for AI (52:12) On Kirkland & Ellis' $500m bet to develop its own AI technology Greg Gretsch is a Founding Partner and Managing Director of Jackson Square Ventures, an early-stage VC firm based in San Francisco. Greg has more than two decades of experience in VC and five of his early-stage investments have gone on to exits or valuations above $1 billion. You can follow Evan on social media at:X: @evanepsteinLinkedIn: https://www.linkedin.com/in/epsteinevan/ Substack: https://evanepstein.substack.com/__To support this podcast you can join as a subscriber of the Boardroom Governance Newsletter at https://evanepstein.substack.com/__Music/Soundtrack (found via Free Music Archive): Seeing The Future by Dexter Britain is licensed under a Attribution-Noncommercial-Share Alike 3.0 United States License

Graduation season is once more upon us. The long school year has come to a close, and now, in caps and gowns, the nation's graduates gather to receive their various certifications, diplomas, and degrees, and listen to wisdom from a speaker.  However, many college graduations are not the same tranquil affairs they used to be. FIRE, the Foundation for Individual Rights and Expression, reports that attempts by students to disinvite commencement speakers over political beliefs have increased sharply over the last decade or so. To name one example, students at Morehouse School of Medicine are attempting to block the commencement speech of alumnus Congressman Rich McCormick, over his stances against DEI, abortion, and transgender surgeries among other views. Some schools, such as New York University, have switched to recorded remarks by students in lieu of an in-person speaker.  At this point, the level of intolerance and intellectual coddling taking place at American universities is not a new story. It's bad, but is there a way back? This week, the Heritage Foundation is releasing a new book: Higher Education in America: It's Worse than you Think. I sat down with Jonathan Butcher, Acting Director of Heritage's Center for Education Policy and one of the book's authors, to ask whether he believes there is hope for the American university.  --- Email us with thoughts, questions, or suggestions: HeritageExplains@heritage.org  ---Jonathan Butcher on X: https://x.com/JM_Butcher?lang=enHigher Education in America: It's Worse Than You Think: https://a.co/d/0aMuIWzN

Graduation season is once more upon us. The long school year has come to a close, and now, in caps and gowns, the nation's graduates gather to receive their various certifications, diplomas, and degrees and listen to wisdom from a speaker. However, many college graduations are not the same tranquil affairs they used to be. […]

We're checking in with the FPIES community to hear what's new, what's changing, and what families need to know right now. Joining us is Fallon Schultz, CEO of the International FPIES Association, who's here to share exciting updates, recent advances, and the incredible work happening behind the scenes. We'll also take a closer look at their robust resource library—packed with practical tools for patients, caregivers, and healthcare professionals alike.Resources to keep you in the know:International FPIES AssociationFAACT's Roundtable Podcast can be found on Apple Podcast, Pandora, Spotify, Podbay, iHeart Radio or wherever you listen to your podcasts.Follow us on Facebook, Instagram, Threads, BlueSky, LinkedIn, Pinterest, TikTok, and YouTube. Sponsored by: American College of Allergy Asthma and ImmunologyThanks for listening! FAACT invites you to discover more exciting food allergy resources at FoodAllergyAwareness.org!

Click to Text Thoughts on Today's EpisodeDoes your sleep tracker know you better than you know yourself — or is it just stressing you out? If you've ever woken up more anxious about your sleep score than actually rested, this episode is for you. We're cutting through the noise, the supplements, and the sleep-maxing culture to get back to what actually works — a common-sense, no-fuss approach to sleeping better in midlife. Because you're not broken. You're just navigating a body that's changing, and there's a lot you can do about it.In this episode we cover:Why your sleep target might not actually be 8 hours — and what the research really saysMorning light exposure and why it's one of the most powerful (and free) sleep tools availableThe concept of "orthosomnia" — sleep anxiety caused by your wearable data — and when to just take it offHow the narrative in your head affects your sleep (and a simple CBT-I reframe to try tonight)Caffeine's half-life and why that afternoon coffee may still be in your system at midnightAlcohol's impact on REM sleep and a simple habit to reduce the damageBlood sugar balance and how overnight crashes could be waking you up at 3 AMMagnesium — what the research supports, which forms to look for, and how to get more through foodBlue light, screens, and practical ways to protect your melatonin production at nightPre-sleep nutrition: why going to bed hungry is just as disruptive as eating a heavy mealHormone therapy as a legitimate sleep tool — and why it's worth a conversation with your doctorBreathing techniques (4-7-8 and box breathing) for falling back asleep in the middle of the nightThe eye movement trick that works for falling back asleepTemperature regulation and the ideal bedroom temp for quality sleepConsistent sleep and wake schedules — and why weekends matter more than you thinkExercise timing and why a late intense workout might be costing you sleepThe truth about melatonin dosing — why less is almost always moreCBT-I as a first-line clinical recommendation and the free app that can help you implement itSource Links1. Seven hours optimal in midlife Cambridge/Fudan University study, Nature Aging (2022): https://www.cam.ac.uk/research/news/seven-hours-of-sleep-is-optimal-in-middle-and-old-age-say-researchersAASM/Sleep Research Society joint consensus (seven or more hours): https://aasm.org/seven-or-more-hours-of-sleep-per-night-a-health-necessity-for-adults/2. Morning light / suprachiasmatic nucleus Frontiers in Neural Circuits (2024) — SCN as master circadian pacemaker: https://www.frontiersin.org/journals/neural-circuits/articles/10.3389/fncir.2024.1385908/full3. Magnesium L-threonate for sleep 2024 randomized controlled trial, Sleep Medicine X (ScienceDirect): https://www.sciencedirect.com/science/article/pii/S25901427240001934. Melatonin dosing Sleep Foundation — melatonin dosage guide (reviewed by board-certified sleep physician): https://www.sleepfoundation.org/melatonin/melatonin-dosage-how-much-should-you-takeMelatonin content variability in supplements (the 83–478% finding): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053496/5. CBT-i as first-line treatment American College of Physicians recommendation: https://www.acponline.org/acp-newsroom/acp-recommends-cognitive-behavioral-therapy-as-initial-treatment-for-chronic-insomnia6. The Atlantic article "American Insomnia" by Jennifer Senior, The Atlantic, August 2025: https://www.theatlantic.com — search "American Insomnia Jennifer Senior" (may be behind paywall; Apple News+ has audio version)My latest recommended ways to nourish and move your body, mind and spirit: Nourished Notes Bi-Weekly Newsletter30+ Non-Gym Ways to Improve Your Health (free download)Connect with Amy: GracedHealth.com Instagram: @GracedHealthYouTube: @AmyConnell

Save 20% on all Nuzest Products WORLDWIDE with the code MIKKIPEDIA at www.nuzest.co.nz, www.nuzest.com.au or www.nuzest.comThis week on the podcast, Mikki speaks to Brad Currier, Science Lead at Timeline Nutrition and lead author of the recent American College of Sports Medicine position stand on resistance training.In this episode, the conversation begins with Urolithin A and Mitopure, exploring what it is, what it does in the body, and why it has become an area of interest for mitochondrial health and muscle function. Brad explains the proposed mechanisms, the current human evidence, and what outcomes have actually been shown to improve, from cellular-level changes through to potential real-world benefits.Mikki and Brad also discuss who may be the best fit for a supplement like this, including older adults, athletes, and those already doing the fundamentals well, while also addressing the limitations of the current research and how to think about bias when science and industry intersect.The conversation then shifts to resistance training, where Brad shares key takeaways from the ACSM position stand he led, including what matters most for strength, hypertrophy, and health, and what people can probably stop overthinking.It's a balanced, evidence-informed conversation about mitochondrial health, supplementation, strength training, and the practical foundations that still matter most.Brad Currier is the Science Lead at Timeline Nutrition, where his work focuses on translating emerging research on mitochondrial health into practical, evidence-based applications. In particular, he has been closely involved in the science and communication around Urolithin A, the active ingredient in Mitopure, and its potential role in supporting muscle function, cellular energy, and healthy ageing.With a background in exercise science and resistance training research, Brad brings a dual lens to his work—combining performance-focused insights with a broader interest in longevity and metabolic health. He has contributed to large-scale evidence syntheses in resistance training, helping clarify what actually matters for strength, hypertrophy, and overall health, and where the field may have overcomplicated things.At Timeline, his role sits at the intersection of research, education, and application, helping bridge the gap between mechanistic science, clinical relevance, and real-world use—particularly as interest grows in interventions that support muscle and mitochondrial function across the lifespan.Brad Currier https://www.instagram.com/bradcurrier.phd/• ACSM Position Stand on Resistance Training (2026) - https://journals.lww.com/acsm-msse/fulltext/2026/04000/american_college_of_sports_medicine_position.21.aspx• Timeline Nutrition - https://www.timeline.com• Curranz Supplement: Use code MIKKIPEDIA to get 20% off your first order - go to www.curranz.co.nz  or www.curranz.co.uk to order yours NZ listeners - save 10% off Calocurb by using the code Mikkipedia10 at www.calocurb.co.nzContact Mikki:https://mikkiwilliden.com/https://www.facebook.com/mikkiwillidennutritionhttps://www.instagram.com/mikkiwilliden/https://linktr.ee/mikkiwilliden

Learn how modern single-family offices are structured, including classic and profits interest models, tax efficiency, governance, and investment management. The American College of Trust and Estate Counsel, ACTEC, is a professional society of peer-elected trust and estate lawyers in the United States and around the globe. This series offers professionals best practice advice, insights, and commentary on subjects that affect the profession and clients. Learn more in this podcast.

Contributor: Aaron Lessen, MD Educational Pearls:  Back pain is a common presenting complaint in the emergency department. Challenges arise when tailoring care to elderly populations using standard medical therapy: Muscle relaxants carry the risk of CNS depression or anticholinergic effects such as urinary retention and confusion. Pain medications such as opiates have side effects including constipation, respiratory depression, and hypotension. NSAIDs carry a risk of GI bleeding and worsening kidney function with chronic use. A randomized clinical trial assessing the effects of acupuncture on low back pain took 800 adults aged 65 and older with chronic low back pain and placed them into one of three treatment arms: Usual medical care Standard acupuncture consisting of 8–15 treatment sessions over 12 weeks, plus usual medical care Standard acupuncture consisting of 8–15 treatment sessions over 12 weeks, plus 4-6 maintenance sessions during the next 12 weeks, plus usual medical care Using the Roland-Morris Disability Questionnaire (RMDQ) score, they assessed disability at 6 months and 12 months. The study found that those who had undergone treatment with acupuncture had significantly greater improvements in disability related to low back pain compared to the group that was only treated with usual medical care. Acupuncture is not used in the ER, but could represent a relatively safe adjunctive therapy for patients who are not responding to standard medical therapy alone.   References:  American College of Surgeons Committee on Trauma. Best practices guidelines: geriatric trauma management. American College of Surgeons; 2023. Accessed May 27, 2026. https://www.facs.org/media/ubyj2ubl/best-practices-guidelines-geriatric-trauma.pdf DeBar LL, Wellman RD, Justice M, et al. Acupuncture for chronic low back pain in older adults: a randomized clinical trial. JAMA Netw Open. 2025;8(9):e2531348. doi:10.1001/jamanetworkopen.2025.31348 Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P

Dr. Centor discusses the American College of Physicians' recommendations for respiratory syncytial virus vaccination with Dr. Rachael Lee.

In this episode of the Neuroveda Podcast for Complex Health, Gillian Ehrlich sits down with returning guest Dr. Dawn Ibsen, compounding pharmacist and passionate advocate for personalized medicine. Together they unpack the science, history, and growing interest around methylene blue — from its origins as a treatment for malaria to its modern use in brain health, mitochondrial support, longevity, and biohacking.They also dive into the rapidly changing world of compounding pharmacies, including concerns surrounding compounded thyroid medications, the evolving landscape of peptide access, and the balance between innovation, safety, and patient care. This conversation explores what happens when cutting-edge medicine meets regulation and why personalized treatment still matters.Topics include:• Methylene blue safety, dosing, and mechanisms• Mitochondrial health and energy production• Compounding pharmacy quality and patient advocacy• Thyroid medication changes• Peptide regulation and current challenges• The future of personalized medicineBio: Dr. Dawn Ipsen, PharmD, FAPC, FACVP, FACA is a compounding pharmacist with more than 25-years of experience serving human and veterinary patients. She is the owner of two community-based compounding pharmacies in Washington state and is recognized for her expertise in personalized medication therapy, quality compounding practices, and patient-centered care.Dr. Ipsen holds an APC Fellowship and is also a Fellow of the American College of Veterinary Pharmacists and American College of Apothecaries, reflecting her advanced training and leadership in both human and veterinary compounding. In addition, she is a clinical instructor for the University of Washington School of Pharmacy and an affiliate faculty member for Bastyr University. Her professional focus includes women's health, hormone therapy, low-dose naltrexone, dermatology compounding, and complex veterinary medication solutions for small animals, exotic pets, and large animal patients.Dr. Ipsen is deeply engaged in pharmacy advocacy, education, and legislative efforts to protect patient access to compounded medications. She currently holds an APC Board of Directors position and is the founding chair for the WA State Pharmacy Association (WSPA) - Compounding Special Interest Group. The WSPA awarded her with the Distinguished Leadership Award in 2023 and the UW School of Pharmacy Distinguished Alumni Award in 2021. Dr. Ipsen regularly collaborates with prescribers, healthcare professionals, and educators to improve the therapeutic outcomes, health, education and vitality of the communities we serve.

The American College of Obstetricians and Gynecologists (ACOG) does not recommend routine ultrasound measurement of the lower uterine segment (LUS) thickness as part of the evaluation for trial of labor after cesarean delivery (TOLAC). ACOG Practice Bulletin No. 205 (2019) on Vaginal Birth After Cesarean Delivery does not include LUS measurement among its recommendations for TOLAC candidacy assessment. The guideline focuses on clinical factors such as type of prior uterine incision, number of prior cesarean deliveries, and other obstetric history to determine TOLAC candidacy, and emphasizes that most women with one previous low-transverse cesarean delivery should be counseled about and offered TOLAC. But what if you find a likely uterine window at the LUS? Does that mandate a repeat C-section? This topic comes from Serena, one of our podcast family members. Listen in for details. 1. Dr. Chapa's Clinical Pearls, Dec 31., 2023: LUST FOR TOLAC; and follow up episode Jan 15, 20242. ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Committee on Practice Bulletins—Obstetrics Obstetrics and Gynecology. 2019;133(2):e110-e127. doi:10.1097/AOG.0000000000003078.3. Rozenberg P, Sénat MV, Deruelle P, et al. Evaluation of the Usefulness of Ultrasound Measurement of the Lower Uterine Segment Before Delivery of Women With a Prior Cesarean Delivery: A Randomized Trial. American Journal of Obstetrics and Gynecology. 2022. 4. Swift BE, Shah PS, Farine D. Sonographic Lower Uterine Segment Thickness After Prior Cesarean Section to Predict Uterine Rupture: A Systematic Review and Meta-Analysis. Acta Obstetricia Et Gynecologica Scandinavica. 2019. 5. McLeish SF, Murchison AB, Smith DM, et al. Predicting Uterine Rupture Risk Using Lower Uterine Segment Measurement During Pregnancy With Cesarean History: How Reliable Is It? A Review. Obstetrical & Gynecological Survey. 2023. 6. Jastrow N, Demers S, Chaillet N, et al. Lower Uterine Segment Thickness to Prevent Uterine Rupture and Adverse Perinatal Outcomes: A Multicenter Prospective study.7. American Journal of Obstetrics and Gynecology. 2016. 8. Guerby P, Bujold E, Chaillet N. Impact of Third-Trimester Measurement of Low Uterine Segment Thickness and Estimated Fetal Weight on Perinatal Morbidity in Women With Prior Cesarean Delivery. Journal of Obstetrics and Gynaecology Canada. JOGC. 2022.

Drs. McMahon and Kalunian discuss how the latest lupus nephritis guidelines from the American College of Rheumatology and European Alliance of Associations for Rheumatology are shifting care from short-term, reactive treatment to longer-term, continuous maintenance—often 3 to 5 years or more—to better prevent kidney flares and preserve renal function. They highlight emerging data on biologic-based triple therapy (including belimumab); the importance of biomarkers and repeat biopsies; and the growing push toward personalized, sometimes indefinite, therapy for high‑risk patients.

CardioNerds Dr. Joseph Kassab, Dr. Mariana Garcia-Arango, and Dr. Christopher Mason explore the technological revolution of Coronary CT Angiography (CCTA) with expert faculty Dr. Michael Gallagher. The discussion details how CCTA has evolved into a frontline diagnostic and preventive tool, moving beyond simple anatomy to incorporate physiology via CT-FFR and biology through AI-driven plaque quantification. The episode reviews landmark evidence like the SCOT-HEART and PROMISE trials, the nuances of CAD-RADS 2.0 reporting, and the emerging role of AI in monitoring treatment response and personalizing cardiovascular care. Critically, they also discuss some of the assumptions and limitations of these techniques. Stay tuned for a matching review article to be submitted to US Cardiology Review, the official Journal of CardioNerds. This episode was supported by an independent medical education grant from HeartFlow. All CardioNerds education is planned, produced, and reviewed solely by CardioNerds.  Enjoy this Circulation Paths to Discovery article to learn more about the CardioNerds mission and journey. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscripts here. CardioNerds Multimodality Cardiovascular Imaging PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll Pearls Shift in Paradigm: CCTA is no longer just an anatomic test; with some key limitations, it can provide anatomy, physiology (CT-FFR), and plaque biology (AI-CPA) in a single non-invasive scan. The “Power of Zero” vs. Plaque: While a normal CCTA has a >95% negative predictive value, future MIs often arise from non-obstructive plaque that traditional stress tests might miss. CAD-RADS 2.0 Utility: The addition of plaque burden modifiers (P1–P4) is a “game changer,” allowing clinicians to identify high-risk patients who need aggressive lipid-lowering despite having only mild stenosis. CT-FFR as a Virtual Stress Test: CT-FFR uses computational fluid dynamics to simulate blood flow, potentially reducing unnecessary invasive catheterizations by approximately 61% without sacrificing safety. Seeing the Invisible: AI-based quantitative plaque analysis (QCPA) can identify “subvisual” plaque and low-attenuation (lipid-rich) components that are the primary drivers of acute coronary syndromes. Show Notes How has the role of CCTA changed compared to traditional functional testing? Historically, stress testing answered “is there ischemia today?”, which often reflects late-stage disease. CCTA identifies disease across the entire spectrum, asking “is there atherosclerosis and how much plaque is present?”. Landmark evidence: SCOT-HEART showed a 41% relative risk reduction in MI at 5 years attributed to intensified preventive therapies, and PROMISE showed CCTA was better at selecting patients who truly needed invasive angiography. Diagnostic CCTA imaging depends on the protocol, contrast timing, heart rate, heart rhythm, breathholding, scanner quality, and several patient factors (obesity, prior stents, heavy calcification, complex bypass anatomy, and motion artifact all may limit imaging). “CCTA is exceptional for the right patient, with the right scanner, and the right team.” What are the key modifiers introduced in CAD-RADS 2.0, and why do they matter? CAD-RADS 2.0 moved beyond stenosis severity to include plaque burden (P0 to P4), high-risk plaque (HRP) features, and the presence of ischemia based on CT-FFR. It serves as a clinical decision support tool: a patient with mild (25-49%) stenosis but “extensive” (P4) plaque burden is considered high risk and warrants aggressive risk factor modification. How is CT-FFR calculated, and when is it most useful in clinical practice? CT-FFR uses resting CCTA data and computational fluid dynamics to create a 3D model of coronary flow during simulated maximal hyperemia. It is often used for intermediate lesions (40–90% stenosis) to predict if they are  ischemia-producing, guiding the decision whether to proceed with invasive angiography.  The assumptions necessary for this computational modeling may not apply well to patients with microvascular dysfunction, significant myocardial scar or prior infarction, or ventricular hypertrophy. Still, data indicate that CT-FFR performs similarly to PET in predicting hemodynamically significant lesions.  CT-FFR performs well at the extremes (either clearly normal or clearly abnormal). Accuracy dips, however, in the intermediate range (~0.75-0.80), where decision-making is most critical. In this grey zone, additional factors can help guide the approach, including the amount of myocardium supplied, translesional gradient, and plaque features.   CT-FFR has not been validated in distal segments, stented segments, heavily calcified coronary arteries, or in patients with severe aortic stenosis. Caution with CT-FFR should be utilized in very calcified coronary segments.  What is AI-based quantitative plaque analysis (QCPA), and what metrics are ready for clinical use? This is potentially a paradigm shift, moving away from stenosis-centric thinking to a more disease burden and plaque biology focus. QCPA uses deep learning algorithms to automatically segment the vessel wall and quantify plaque volume in mm³. Ready for “prime time” metrics include: Total Plaque Volume (TPV), non-calcified plaque volume, and Low-Attenuation Plaque (LAP) burden. Can serial CCTA be used to monitor the effectiveness of medical therapies like statins? While not yet a routine guideline-driven practice, trials like PARADIGM and EVAPORATE show that therapies can stabilize plaque; notably, CCTA is better for monitoring than CAC scores, which can be misleading as statins often increase plaque calcification as part of the stabilization process. There are no randomized trials that serial CCTAs improve outcomes. Cost and radiation exposure will be notable limitations. Serial scan timing, scan acquisition and interpretation standardization would be key. Dr. Gallagher notes that we are moving toward a world in which plaque burden may become a “treatment biomarker,” similar to tumor burden in oncology.  References 1. Coronary Computed Tomography Angiography From Clinical Uses to Emerging Technologies: JACC State-of-the-Art Review. Abdelrahman KM, Chen MY, Dey AK, et al. Journal of the American College of Cardiology. 2020;76(10):1226-1243. doi:10.1016/j.jacc.2020.06.076. 2. Non-Invasive Imaging in Coronary Syndromes: Recommendations of the European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration With the American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. Edvardsen T, Asch FM, Davidson B, et al. Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. 2022;35(4):329-354. doi:10.1016/j.echo.2021.12.012. 3. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Gulati M, Levy PD, Mukherjee D, et al. Journal of the American College of Cardiology. 2021;78(22):e187-e285. doi:10.1016/j.jacc.2021.07.053. 4. Contemporary, Non-Invasive Imaging Diagnosis of Chronic Coronary Artery Disease. van der Bijl P, Gulati M, Saraste A, et al. Lancet (London, England). 2025;406(10519):2577-2587. doi:10.1016/S0140-6736(25)01586-7. 5. State of the Art: Evaluation and Medical Management of Nonobstructive Coronary Artery Disease in Patients With Chest Pain: A Scientific Statement From the American Heart Association. Slipczuk L, Blankstein R, Bucciarelli-Ducci C, et al. Circulation. 2025;152(23):e443-e466. doi:10.1161/CIR.0000000000001394. 6. Diagnostic Performance of Fractional Flow Reserve Derived From Coronary CT Angiography: The ACCURATE-CT Study. Li C, Hu Y, Jiang J, et al. JACC. Cardiovascular Interventions. 2024;17(17):1980-1992. doi:10.1016/j.jcin.2024.06.027. 7. Clinical Outcomes Based on Coronary Computed Tomography-Derived Fractional Flow Reserve and Plaque Characterization. Sato Y, Motoyama S, Miyajima K, et al. JACC. Cardiovascular Imaging. 2024;17(3):284-297. doi:10.1016/j.jcmg.2023.07.013. 8. Clinical Use of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve: Expert Consensus by an International Working Group. Tang CX, Leipsic JA, Nørgaard BL, et al. European Radiology. 2026;:10.1007/s00330-025-12313-6. doi:10.1007/s00330-025-12313-6. 9. Diagnostic accuracy of computed tomography–derived fractional flow reserve: a systematic review. Cook CM, Petraco R, Shun-Shin MJ, et al. JAMA Cardiol. 2017;2(7):803-810. Doi:10.1001/jamacardio.2017.1314 10. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). Nørgaard BL, Leipsic J, Gaur S, et al. J Am Coll Cardiol. 2014;63(12):1145-1155. Doi:10.1016/j.jacc.2013.11.043 11. Comparison of coronary computed tomography angiography, fractional flow reserve, and perfusion imaging for ischemia diagnosis. Driessen RS, Danad I, Stuijfzand WJ, et al. J Am Coll Cardiol. 2019;73(2):161-173. Doi:10.1016/j.jacc.2018.10.056. 12. 1-year outcomes of FFRCT-guided care in patients with suspected coronary disease: the PLATFORM study. Douglas PS, De Bruyne B, Pontone G, et al. J Am Coll Cardiol. 2016;68(5):435-445. Doi:10.1016/j.jacc.2016.05.057. 13. Comparison of an initial risk-based testing strategy vs usual testing in stable symptomatic patients with suspected coronary artery disease: the PRECISE randomized clinical trial. Douglas PS, Nanna MG, Kelsey MD, et al; PRECISE Investigators. JAMA Cardiol. 2023;8(10):904-914. Doi:10.1001/jamacardio.2023.2595. 14. Diagnostic and clinical value of FFRCT in stable chest pain patients with extensive coronary calcification: the FACC study. Mickley H, Veien KT, Gerke O, et al. JACC Cardiovasc Imaging. 2022;15(6):1046-1058. doi:10.1016/j.jcmg.2021.12.010. 15. Low-Attenuation Noncalcified Plaque on Coronary Computed Tomography Angiography Predicts Myocardial Infarction: Results From the Multicenter SCOT-HEART Trial (Scottish Computed Tomography of the HEART). Williams MC, Kwiecinski J, Doris M, et al. Circulation. 2020;141(18):1452-1462. doi:10.1161/CIRCULATIONAHA.119.044720. 16. AI-Guided Quantitative Plaque Staging Predicts Long-Term Cardiovascular Outcomes in Patients at Risk for Atherosclerotic CVD. Nurmohamed NS, Bom MJ, Jukema RA, et al. JACC. Cardiovascular Imaging. 2024;17(3):269-280. doi:10.1016/j.jcmg.2023.05.020. 17. Interaction of AI-Enabled Quantitative Coronary Plaque Volumes on Coronary CT Angiography, FFRCT, and Clinical Outcomes: A Retrospective Analysis of the ADVANCE Registry. Dundas J, Leipsic J, Fairbairn T, et al. Circulation. Cardiovascular Imaging. 2024;17(3):e016143. doi:10.1161/CIRCIMAGING.123.016143. 18. Prognostic Value of AI-Based Quantitative Coronary CTA vs Human Reader-Based Visual Assessment: Results From the CONFIRM2 Registry. van Rosendael A, Nakanishi R, Bax JJ, et al. JACC. Cardiovascular Imaging. 2026;19(3):345-359. doi:10.1016/j.jcmg.2025.09.021.13. Pericoronary Adipose Tissue as a Marker of Cardiovascular Risk: JACC Review Topic of the Week. Tan N, Dey D, Marwick TH, Nerlekar N. Journal of the American College of Cardiology. 2023;81(9):913-923. doi:10.1016/j.jacc.2022.12.021. 19. Effect of Icosapent Ethyl on Progression of Coronary Atherosclerosis in Patients With Elevated Triglycerides on Statin Therapy: Final Results of the EVAPORATE Trial. Budoff MJ, Bhatt DL, Kinninger A, et al. European Heart Journal. 2020;41(40):3925-3932. doi:10.1093/eurheartj/ehaa652. 20. Coronary CT Angiography Evaluation With Artificial Intelligence for Individualized Medical Treatment of Atherosclerosis: A Consensus Statement From the QCI Study Group. Schulze K, Stantien AM, Williams MC, et al. Nature Reviews. Cardiology. 2026;23(2):100-115. doi:10.1038/s41569-025-01191-6.

Col Valerie Sams, MD is an Air Force trauma surgeon, surgical critical care expert, and the Director of the Center for Sustainment of Trauma and Readiness Skills (C-STARS) at the University of Cincinnati. Her path to the operating room was anything but ordinary.   Before medical school, she served as an Air Force line officer in logistics and fuels, learning how the operational side of the service actually works at the flight line. That bilingual fluency in operations and medicine now shapes how she advocates for resources, leads hospitals, and prepares the military health system for the next fight.    In this conversation, she walks through her two tours as the trauma czar at the Bagram role three hospital straight out of fellowship, where she was responsible not only for clinical excellence but for leading every nurse, emergency medicine physician, and surgeon doing trauma care across the theater. She talks honestly about the weight of that role, especially during her second deployment with junior surgeons on their first downrange experience, the rise in U.S. casualties, the green-on-blue threat, and her work standing up Medic-X as a force multiplier for limited deployed medical crews.     Col Sams makes a powerful case for the strategic importance of military-civilian partnerships like C-STARS, the only Air Force critical care air transport advanced training course, and explains how the Air Force, Army, and Navy are converging through the Joint Trauma System, the Mission Zero Act, and the American College of Surgeons Blue Book to professionalize military-civilian integration. She is direct about the skill sustainment crisis inside military treatment facilities, the shift from 65 percent beneficiary care to 20 percent, the urgency of the Military Unique Curriculum, and the need to train outside-the-tent skills deliberately rather than by accident.   Dr. Sams lays out a clear-eyed vision for large-scale combat operations: faster trauma registry feedback loops, autonomous and decision support tools, closed-loop control ventilation, ECMO projected forward, and a hard end to the wax pencil and TCCC card as battlefield documentation. She closes with what should remain the center of gravity for every military medicine decision — the warfighter — and the conviction that they deserve the best clinical care available anywhere in the country.     Chapters (00:47-05:47) From Fuels Officer to Trauma Surgeon (05:47-12:49) Two Tours as Trauma Czar at Bagram (12:49-24:46) ECMO Forward, C-STARS, and the Skill Sustainment Crisis (24:46-35:42) Joint Military-Civilian Integration and the Military Unique Curriculum (35:42-49:26) LSCO Readiness, Force Multiplication, and Battlefield Technology (49:26-58:30) Female Leadership, Clinical Excellence, and Legacy     Chapter Summaries (00:47-05:47) From Fuels Officer to Trauma Surgeon Col Sams describes her unconventional path from Air Force line officer in logistics and fuels to general surgery and trauma fellowship. She credits her operational background with giving her a bilingual fluency between line and medical worlds that strengthens how she advocates for resources, leads hospital operations, and earns credibility with non-medical commanders.   (05:47-12:49) Two Tours as Trauma Czar at Bagram She unpacks the weight of deploying as the trauma czar at the Bagram Role 3 immediately after her fellowship and the lessons that came from leading mass casualty events, debriefing young teams, and dealing with the green-on-blue threat. She explains the stand-up of Medic-X under Lt Gen Hogg as a deliberate force multiplier for limited deployed medical crews.   (12:49-24:46) ECMO Forward, C-STARS, and the Skill Sustainment Crisis Col Sams details her work projecting ECMO capability into austere environments and around the globe, then explains the mission, history, and structure of the three original C-STARS programs. She is direct about the skill sustainment crisis, with beneficiary care in military treatment facilities dropping from roughly 65 percent to 20 percent over two decades.   (24:46-35:42) Joint Military-Civilian Integration and the Military Unique Curriculum She describes the progress driven by the Mission Zero Act, the Joint Trauma System military-civilian work group, and the American College of Surgeons Blue Book. She makes the case for a robust Military Unique Curriculum that develops both surgical fundamentals and the outside-the-tent skills that today's young military surgeons need before they take their first leadership role downrange.   (35:42-49:26) LSCO Readiness, Force Multiplication, and Battlefield Technology Col Sams turns to large-scale combat operations and the blind spots that the counterinsurgency generation may carry into the next fight. She calls for faster trauma registry feedback, autonomous decision support tools, closed-loop ventilation, ECMO projected forward, and a hard end to the TCCC wax pencil as the primary battlefield documentation tool.   (49:26-58:30) Female Leadership, Clinical Excellence, and Legacy She offers candid advice to young female military surgeons on imposter syndrome, unconscious bias, and the discipline of staying clinically excellent. She closes with the conviction that patient-centered leadership, lifelong learning, and protecting clinical talent are the foundations of how military medicine should remember her work.     Take Home Messages Operational Fluency Strengthens Medical Leadership: Time spent on the line side of the military — understanding logistics, fuels, and how the operational force actually fights — builds credibility with non-medical commanders and sharpens advocacy for resources. Surgeons who speak the operational language sit at the right tables and make better decisions for their teams and their patients.   The Trauma Czar Role Demands Leadership Before Stride: Being responsible for an entire theater of combat casualty care immediately after fellowship is a heavy and unforgiving assignment. Clinical excellence is the floor; the real work is leading nurses, emergency medicine physicians, and surgeons through mass casualty events, debriefs, and the green-on-blue threat with junior teammates who have never deployed before.   Skill Sustainment Requires Military-Civilian Partnership: Military treatment facilities now deliver only a fraction of the beneficiary care they once did, and that volume cannot sustain combat-ready trauma teams. Embedded military-civilian partnerships like C-STARS, supported by the Mission Zero Act and the American College of Surgeons Blue Book, are the realistic path to keep wartime skills sharp.   Outside-the-Tent Skills Must Be Deliberately Trained: Today's young military surgeons need more than technical readiness. They need a deliberate Military Unique Curriculum that develops the non-clinical leadership skills required to run a theater trauma system, manage resources, and lead teams under pressure. Picking those skills up on the fly is no longer good enough.   LSCO Will Not Wait on the Wax Pencil: The next fight will not give the medical force three years to figure out what changed or seven years to update clinical practice guidelines. Force multiplication through MedicX, autonomous decision support tools, closed-loop ventilation, ECMO projected forward, and modern battlefield documentation are non-negotiable investments now, before large-scale combat operations force the lesson.   Col Valerie Sams, MD Biography    Colonel Valerie Sams is the Director of the Center for Sustainment of Trauma and Readiness Skills (CSTARS) Cincinnati and serves as Critical Care Air Transport Team (CCAT) Training cadre. Originally from Georgetown, KY, she was commissioned into the Air Force in 2000, initially serving as a supply and logistics officer, which included a deployment supporting Stabilization Forces in the Balkans.    Transitioning to medicine, she earned her medical degree from St. George's University in 2008. Col Sams completed her General Surgery Residency at the University of Tennessee Medical Center (2013) and a Trauma Critical Care fellowship at Brooke Army Medical Center (2015).    As a trauma surgeon and ECMO physician, Col Sams deployed twice as the Trauma Czar for Bagram Airfield, Afghanistan. Her extensive leadership roles include Trauma Medical Director, Assistant Chief of Trauma and Surgical Critical Care, Ground Surgical Team Pilot Unit Leader, and director of various military trauma research programs.   Episode Keywords WarDocs, military medicine, military trauma surgery, combat casualty care, trauma czar, Bagram role three, Air Force trauma surgeon, C-STARS Cincinnati, critical care air transport, CCATT, Joint Trauma System, military civilian partnership, Mission Zero Act, military unique curriculum, large scale combat operations, LSCO, prolonged casualty care, MedicX, ECMO in combat, battlefield documentation, TCCC card, closed loop ventilation, military medical leadership   Hashtags #MilitaryMedicine, #WarDocs, #CombatCasualtyCare, #TraumaSurgery, #JointTraumaSystem, #LSCOReadiness, #CSTARS, #MilCivPartnership   Honoring the Legacy and Preserving the History of Military Medicine    WarDocs exists to honor the legacy of Military Medicine, preserve its history, and inspire every generation — across all Services, Corps, and Ranks — to serve with excellence and pride. Through mentorship, coaching, and education, we equip those considering, entering, and serving in military medicine with the knowledge, connections, and community they need to thrive. We celebrate Who we are, What we do, and, most importantly, How we serve Our Patients, the DoW, and Our Nation. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms.   Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast  

Dr. Howard Schubiner is an internist and pediatrician, who attained the rank of full Professor at Wayne State University School of Medicine in 1999. He is an internist and the director of the Mind Body Medicine Center at Ascension Providence Hospital in Southfield, Michigan. Dr. Schubiner is a Clinical Professor at the Michigan State University College of Human Medicine and is a fellow in the American College of Physicians, and the American Academy of Pediatrics. He has authored more than 100 publications in scientific journals and books, and lectures regionally, nationally, and internationally. Dr. Schubiner is the author of three books: Unlearn Your Pain, Unlearn Your Anxiety and Depression, and Hidden From View, written with Allan Abbass, MD, a Professor of Psychiatry at Dalhousie University in Halifax, Nova Scotia. Today, we have a fascinating conversation on Mind Body Syndrome a condition where the brain generates very real physical pain or symptoms in response to unresolved emotional stress, trauma, or repressed feelings like anger and anxiety. Learn more about your ad choices. Visit megaphone.fm/adchoices

Are your workouts actually building strength or just burning time? Amy Hudson and Dr. James Fisher break down the latest 2026 guidelines from the American College of Sports Medicine on how you should be training today. They unpack why consistency beats perfection, how minimal training can still deliver real results, and where most people waste time and effort. Tune in to simplify your approach and start training in a way that actually works.Dr. Fisher explains what the American College of Sports Medicine (ACSM) actually does. It's one of the main bodies shaping exercise science, from research journals to certifications that guide the industry.Dr. Fisher shares why resistance training is still massively underused. Around 60% of adults aren't doing any strength work, and only a small percentage hit the basic guideline of twice per week.Learn why consistency will always beat the “perfect program.” You don't need the smartest plan on paper if you're not showing up for it. What actually moves the needle is turning up regularly and putting in some effort, even on the days it feels basic.Amy covers how to choose a program you'll actually stick with. There's no shortage of “best” routines out there, but most of them fail because people don't follow through. The real win is picking something that fits your life so well that skipping it starts to feel uncomfortable.Dr. Fisher explains how to progress your training without overthinking it. If the weight, reps, or sets aren't gradually increasing, your body has no reason to adapt. Progress doesn't have to be dramatic, but it does need to be intentional.Amy covers why a personal trainer can quietly make all the difference. Most people fall into the habit of repeating the same weights and routines because it feels comfortable. A good personal trainer steps in to push progression just enough to keep you improving without burning out.Learn how working with a personal trainer improves more than just your results. You're not just getting guidance, you're also getting accountability, structure, and a reason to show up. That consistency alone is often what separates people who see change from those who stay stuck.Dr. Fisher explains why resistance training feels complicated (but isn't). Many people avoid it because they're unsure where to start or think it takes too much time. In reality, even two short 20-minute sessions a week can deliver meaningful results if done properly.Amy covers how to keep strength training simple and effective. Building strength is naturally repetitive. You don't need constant variety; you need consistency in doing what already works.Amy and Dr. Fisher agree that the basics will always outperform every “new hack.” Sleep well, eat decently, and challenge your muscles regularly is the foundation. Amy adds that it's easy to chase complexity, but most results come from doing simple things well over time.Dr. Fisher explains how eccentric overload can unlock more strength. Traditional weights give you the same resistance up and down, which limits how much you can challenge the muscle. With advanced tech like exerbotics devices, the lowering phase can match your strength more closely, creating a stronger stimulus and better results. Mentioned in This Episode:The Exercise Coach - Get 2 Free Sessions!Submit your questions at StrengthChangesEverything.com This podcast and blog are provided to you for entertainment and informational purposes only. By accessing either, you agree that neither constitute medical advice nor should they be substituted for professional medical advice or care. Use of this podcast or blog to treat any medical condition is strictly prohibited. Consult your physician for any medical condition you may be having. In no event will any podcast or blog hosts, guests, or contributors, Exercise Coach USA, LLC, Gymbot LLC, any subsidiaries or affiliates of same, or any of their respective directors, officers, employees, or agents, be responsible for any injury, loss, or damage to you or others due to any podcast or blog content.

My talk with Skye begins at 26 mins Subscribe and Watch Interviews LIVE : On YOUTUBE.com/StandUpWithPete ON SubstackStandUpWithPete Stand Up is a daily podcast. I book,host,edit, post and promote new episodes with brilliant guests every day. This show is Ad free and fully supported by listeners like you! Please subscribe now for as little as 5$ and gain access to a community of over 750 awesome, curious, kind, funny, brilliant, generous souls Skye L. Perryman is the President and CEO of Democracy Forward, a nonpartisan, national legal organization that promotes democracy and progress through litigation, regulatory engagement, communications, policy education, and research. Named as one of the 2025 100 Most Influential People In The World by TIME Magazine, Ms. Perryman took the helm at Democracy Forward a few months after January 6, 2021, in the midst of rising extremism in communities and courts across the country. She has built a visionary team of legal, policy, and communications experts to confront anti-democratic extremism head-on while also using the law to advance progress and a bold vision for the future. Under Ms. Perryman's leadership, Democracy Forward has expanded the scope and reach of its work, emerging as a nationally recognized institution that is taking on the most significant issues affecting people, families, and communities– from defending civil rights and fair wages to seeking to expand access to reproductive health care post-Dobbs to confronting attacks on education to addressing the climate crisis and much more. Since January 2025, Democracy Forward has played a leading role in inspiring courage and in protecting the American people from harmful and unlawful federal executive action. The organization has filed hundreds of legal actions, launched hundreds of investigations, and, through its Democracy 2025 initiative, has organized the largest, most successful affirmative litigation effort against executive branch excesses in United States history. Learn more about our work here. Known for her strategic insight and impact-oriented leadership, Ms. Perryman has a track record of winning tough legal and policy battles, uniting diverse coalitions, inspiring the American public, and elevating voices that represent the fabric of our country to deliver results that improve the lives of millions. Over the course of her nearly two decade legal career, Ms. Perryman has served in executive positions and has provided legal and strategic counsel for a broad range of clients and institutions. She previously served as Chief Legal Officer and General Counsel of the American College of Obstetricians and Gynecologists. There, she oversaw legal and policy strategies that resulted in historic advancements in access to health care for women, including developing strategies to support the extension of postpartum Medicaid coverage for more than 500,000 people, overseeing litigation that enabled the distribution of mifepristone by mail for the first time in US history, launching an industry-wide effort to address racism and promote racial equity in medicine, and leading comprehensive legal and policy responses to the COVID-19 pandemic. Ms. Perryman was previously a member of Democracy Forward's founding legal team and began her legal career in litigation roles at WilmerHale and Covington & Burling, where she gained the trust of clients in the health care, financial services, education, and consumer products industries while simultaneously maintaining an active pro bono practice, receiving numerous commendations and awards for her work. Ms. Perryman's work has been recognized widely for its positive impact on people and communities. She has received numerous awards and recognitions for her commitment to public service and her professional work, including receiving a Lifetime Award Award for the Pursuit of Justice from the Georgetown University Law Center's O'Neill Institute, being named one of the 500 Most Influential People Shaping Policy by Washingtonian Magazine for consecutive years, one of The NonProfit Times's Power & Influence Top 50 and their 2025 Influencer of the Year, the 2025 Resister in Law by the Feminist Majority Foundation, a Woman to Watch by the New Republic, a Chuck F C Ruff Pro Bono Lawyer of the Year recipient, a Sissy Farenthold Social Justice Award recipient, a Harry S. Truman Scholar (2002), a Baylor Line Foundation Outstanding Young Alumni (2018), and a four-time Rising Star in Litigation in Washington, DC, among other awards. Ms. Perryman is a frequent guest lecturer and keynote speaker on matters at the intersection of law and policy. She has testified before the U.S. Congress and other expert bodies and her legal work has been cited by the U.S. Supreme Court as well as state supreme courts. Ms. Perryman appears on both network and cable television and her work and commentary is routinely covered in outlets such as The New York Times, NPR, NBC News, The Washington Post, Texas Monthly, The Houston Chronicle, Teen Vogue, MSNBC and CNN. Ms. Perryman grew up in Waco, Texas and is a proud product of K-12 public education. She holds a Bachelor of Arts in Economics and Philosophy magna cum laude from Baylor University where she was elected to Phi Beta Kappa and a Juris Doctor with honors from the Georgetown University Law Center where she served as an Editor for the American Criminal Law Review and was an Editor in Chief for the ACLR's Annual Survey on White Collar Crime. Ms. Perryman serves on the boards of the Interfaith Alliance, the Atlas Performing Arts Center, the Texas Observer, the Baylor Line Foundation, and the Rise Up: Federal Workers Legal Defense Network. Alongside both progressive and conservative legal scholars, she co-chairs We Hold These Truths, Democracy Forward's initiative to provide accessible civic education to the American public. Listen rate and review on Apple Podcasts Listen rate and review on Spotify Pete On Instagram Pete on Blue Sky Pete on Threads Pete on Tik Tok Pete on Twitter Pete Personal FB page Stand Up with Pete FB page Gift a Subscription https://www.patreon.com/PeteDominick/gift Send Pete $ Directly on Venmo All things Jon Carroll  Buy Ava's Art  Subscribe to Piano Tuner Paul Paul Wesley on Substack Listen to Barry and Abigail Hummel Podcast Listen to Matty C Podcast and Substack Follow and Support Pete Coe Hire DJ Monzyk to build your website or help you with Marketing

In this episode, CardioNerds Dr. Colin Blumenthal, Dr. Kelly Arps, and Dr. Yong Hao Yeo are joined by electrophysiology expert Dr. Bradley Knight to discuss atrial fibrillation (AF) management in challenging clinical scenarios. We explore arrhythmias in patients with pre-excitation syndromes, particularly Wolff-Parkinson-White (WPW) syndrome, and strategies for rhythm control. We also discuss AF management in pregnancy, adult congenital heart disease, and patients with tachycardia-bradycardia (tach-brady) syndrome. This episode provides essential insights into nuanced decision-making for the care of patients with complex arrhythmia profiles. Audio editing by CardioNerds academy intern, Grace Qiu. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! PEARLS AF in WPW is a true emergency—AV nodal blocking agents can be deadly. In patients with WPW syndrome, AF can rapidly conduct through the accessory pathway, risking ventricular fibrillation and sudden death. Avoid AV nodal blockers like beta-blockers and calcium channel blockers. Catheter ablation is the first-line rhythm control strategy in WPW. Catheter ablation carries a Class I recommendation and offers >90% success. If antiarrhythmic drugs are needed, sodium channel blockers like flecainide or propafenone are preferred in patients without structural heart disease. In pregnancy, protecting the mother is protecting the fetus. An unstable mother means an unstable fetus. Rate control is the first step in AF with rapid ventricular responses and electrical cardioversion is safe when needed. Multidisciplinary care is essential. AF in congenital heart disease is often outside the pulmonary veins. Surgical scars and chamber remodeling in ACHD patients often lead to AF from non-pulmonary vein foci. Electrogram-based mapping and targeted ablation strategies are essential to increase success rate of durable rhythm control. Tachy-brady syndrome may require pacing to unlock therapy. AF may cause atrial myopathy and sinus node dysfunction. These patients often require permanent pacing to allow safe use of rate-controlling medications like beta-blockers and to prevent syncope or chronotropic incompetence. Notes: Notes drafted by Dr. Yong Hao Yeo Why is atrial tachycardia in patients with WPW syndrome dangerous? Patients with WPW commonly present with supraventricular tachycardia (SVT) due to atrioventricular reentrant circuits, either orthodromic or antidromic. This SVT can degenerate into AF. In the absence of AV nodal as the governor between the atrium and ventricles, the accessory pathway may conduct impulses rapidly and frequently. This can lead to dangerously high ventricular rates, predisposing patients to ventricular fibrillation and sudden cardiac arrest. What are some strategies for rhythm control in patients with WPW and atrial tachycardia? Catheter ablation is the first-line therapy (Class I recommendation), with a success rate of over 90%. Ablation reduces the risk of sudden cardiac arrest, though some patients may remain prone to AF. If ablation is not feasible/ contraindicated, sodium channel blockers such as flecainide and propafenone are good options in patients without ischemia or structural heart disease (Class IIa recommendation). Amiodarone should be avoided because it has a long half-life, can accumulate in the system, and may delay definitive treatment with catheter ablation. AV nodal blocking agents like beta blockers and calcium channel blockers should be avoided, as they are less effective at controlling ventricular rate in WPW and can increase conduction over the accessory pathway. These agents can also exacerbate the risk of rapid ventricular rates during AF and worsen left ventricular function. What are some special considerations in managing AF in pregnant patients? The primary goal in managing cardiovascular disease during pregnancy is to protect the mother, as fetal outcomes depend on maternal well-being. Therefore, while caution is necessary, we should avoid undertreating pregnant patients with AF. In cases of AF with rapid ventricular response (RVR), rate control is usually the first-line strategy, with beta blockers preferred over digoxin or non-dihydropyridine calcium channel blockers. It is then reasonable to initially observe for spontaneous conversion in stable patients. Antiarrhythmic drugs (AADs) are generally avoided during the first trimester, but clinical judgment on a case-by-case basis is essential. Evidence for the safety of AADs in pregnancy is limited, often derived from their use in other conditions such as fetal SVT. Flecainide and sotalol are reasonable options for rhythm control (Class IIa recommendation). Electrical cardioversion is considered safe in pregnancy and should be utilized when indicated (Do not forget!). There is no pregnancy-specific thromboembolic risk stratification tool. CHA₂DS₂-VASc scoring and the presence of risk factors like mitral stenosis can help guide anticoagulation decisions, though the magnitude of thromboembolic risk during pregnancy remains unclear. Rate control agents are typically continued during delivery due to the increased physiologic stress of labor and delivery. Multidisciplinary care is crucial and should involve obstetrics, maternal-fetal medicine, cardiology, and electrophysiology specialists. What are some key considerations for AF management in patients with adult congenital heart disease (ACHD)? Patients with repaired congenital heart disease are at increased risk for arrhythmias due to two main factors: surgical scars that create arrhythmogenic foci and mechanical remodeling of the atria or ventricles resulting from the underlying disease. In these patients with structural heart disease, sodium channel blockers may not be ideal antiarrhythmic options. When selecting an antiarrhythmic drug, clinicians must consider the nature of structural or surgical impairments, such as right bundle branch block or prolonged QT interval. It is also essential to assess renal and hepatic function (often impaired in patients with ACHD) to ensure appropriate metabolism and clearance of antiarrhythmic medications. Electrogram-based ablation strategies (those leveraging artificial intelligence are developing!) may help identify effective ablation targets, which are often outside the pulmonary veins in patients with ACHD. These individualized approaches can improve ablation success rates in this complex patient population. What makes tachycardia-bradycardia (tach-brady) syndrome a unique challenge in arrhythmia management? Patients who present with both AF and bradycardia, especially with syncope, require a thoughtful diagnostic approach to identify the underlying rhythm disturbance. Extended cardiac monitoring, including event monitors or implantable loop recorders, can help capture intermittent arrhythmias and correlate them with symptoms. AF may lead to atrial myopathy, and since the sinus node resides within the atrium, this can result in sinus node dysfunction—a hallmark of tachy-brady syndrome. Following spontaneous conversion from AF to sinus rhythm, sinus node dysfunction may persist, leading to prolonged pauses or chronotropic incompetence. Management becomes more complex when beta-blockers are needed for AF with RVR, as they can exacerbate bradycardia. Permanent pacemaker implantation is often the next step to consider. Permanent pacemaker implantation is often considered to facilitate safe rate control in these cases. In younger patients, aggressive AF burden reduction may prevent atrial remodeling and the development of true atrial myopathy, potentially avoiding pacemaker implantation. References Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2023;149(1). doi:https://doi.org/10.1161/CIR.0000000000001193 ‌ Van IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2024;45(36). doi:https://doi.org/10.1093/eurheartj/ehae176 ‌ Joglar JA, Kapa S, Saarel EV, et al. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm. Published online May 1, 2023. doi:https://doi.org/10.1016/j.hrthm.2023.05.017 ‌ Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary. Journal of the American College of Cardiology. 2019;73(12):1494-1563. doi:https://doi.org/10.1016/j.jacc.2018.08.1028 ‌