Podcasts about avms

Pulmonary AVM may be rare, but missing them can lead to lifelong complications, especially in patients with hereditary hemorrhagic telangiectasia (HHT). How do you choose the right device and strategy to ensure long-term success with embolization? In this episode of the BackTable Podcast, host Dr. Kavi Krishnasamy is joined by Dr. Brian Funaki and Dr. Nima Kokabi to unpack the evolving treatment landscape for pulmonary arteriovenous malformations (PAVM). Through imaging breakdown, review of challenging real-world cases, and a discussion on advanced treatment strategies, the conversation tackles a key debate in pulmonary embolization: are plugs replacing coils as the new standard? --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Okamihttps://okamimedical.com/ --- Timestamps 00:00 - Introduction01:43 - Defining HHT and PAVM05:53 - Democratizing Interventions for HHT Patients08:83 - Recommendations to Embolize PAVM13:19 - Imaging Specificity and Procedural Preferences23:29 - Persistence Rates with Plugs and Coils25:59 - Lag in Utilization of Plugs29:18 - Comparison of LOBO to Alternative Vascular Plugs34:26 - Post Embolization Symptoms and Troubleshooting Methods39:04 - PAVM Cases and Treatments54:26 - Wrap Up and Credits --- More about this episode The discussion begins by defining HHT and PAVM, highlighting the risks associated with untreated PAVM and the critical need for genetic screening and multi-organ evaluation. Drs. Funaki and Kokabi review current treatment recommendations, surveillance imaging, and follow-up protocols, with special considerations for pediatric and high-risk patients. They explore practical tips for optimizing embolization performance, focusing on device selection and the evolving role of vascular plugs. By comparing different plug designs, such as wire count and pore size, and sharing lessons from challenging cases, including persistent lesions, tortuous anatomy, and pseudoaneurysm management, they provide advanced troubleshooting and decision-making strategies to achieve more durable, successful PAVM treatments. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

AVM Burst in the Brain: A Recovery Story of Patience, Aphasia, and Finding Your Way Back Jennifer Tomscha was 39, driving her three-and-a-half-year-old daughter home from preschool, when an AVM burst in her brain. She felt a wash of dizziness first. Then her vision started collapsing on the right side. She pulled onto a narrow verge on the highway between Greytown and Carterton in New Zealand, tried to reach her husband, got no answer, and dialled 111 instead. When the dispatcher asked what was wrong, she said something she still can’t fully explain: “I think I’m having a stroke.” She didn’t know yet that she had two arteriovenous malformations in her left frontal lobe — one discrete, one diffuse. She didn’t know that within hours she’d be helicoptered to Wellington Hospital for an emergency craniotomy, or that the following Monday a neurosurgeon named Dr. Woon would spend thirty hours trying to remove both malformations from her brain. She just knew something was wrong, and that her daughter was in the back seat, and that she couldn’t keep driving. That moment — pulling over, self-diagnosing, refusing the urge to simply lie down and rest — may be the reason she’s alive. What happens when an AVM bursts in the brain An arteriovenous malformation is a tangle of abnormal blood vessels that connects arteries directly to veins, bypassing the capillary network that normally regulates blood flow. Most people with an AVM never know they have one. But when an AVM bursts in the brain, blood floods into surrounding tissue at high pressure, and the consequences are almost always severe: haemorrhagic stroke, seizures, sudden neurological deficits, and in many cases, death. Jennifer’s first surgery controlled the bleeding. The second, five days later, was supposed to remove both malformations. It didn’t go as planned. The surgical team discovered that blood flow to the first AVM was feeding the second one, causing the brain around it to swell. Dr. Woon had to make an impossible decision in the middle of the operation: let her die, or remove a portion of healthy brain tissue along with the malformation. He chose to keep her alive. The surgery took thirty hours. When it was finally over, he called her husband and said, “Well, you’ll be lucky if she talks.” The six weeks she can’t remember Jennifer has no memories of the first six weeks after her AVM burst. She was in a medically induced coma for the surgery, then in intensive care, then transferred to rehabilitation. Everything she knows about that period has been told to her by other people. When her memory started returning, she found herself in a rehabilitation ward in Masterton, using adult nappies, unable to sit up in bed. The front of her skull had been removed and wouldn’t be replaced for months. She wore a protective helmet whenever she walked. And yet — she insists — she felt fine. [Quote block — mid-article] “I kept saying, ‘I’m okay, I’m fine. You guys should just take it easy around me.’ But of course, I wasn’t really fine.” — Jennifer Tomscha The honest recognition of what had happened to her didn’t come for almost two years. It took that long for her brain to have enough capacity to think about her brain. The myth of the one-year recovery window Most stroke survivors are told, either directly or by implication, that the first year matters most. That after twelve months, improvements slow. That after two years, you’ve plateaued. Jennifer’s experience — and the experience of nearly every long-term survivor interviewed on this podcast — contradicts that narrative. Four years after her AVM burst, she is still discovering what recovery means. Her academic writing, once her profession as the Director of the Writing Program at NYU Shanghai, doesn’t flow the way it used to. She can’t recall songs from memory anymore, or sing the ones she used to sing. Her aphasia shows up most at night, when she’s tired. She still takes an afternoon nap most days. But she’s also finishing a PhD. She can read as well as she ever could. She’s speaking, articulately, in a podcast interview eighty minutes long. And the parts of recovery she thought had stopped improving are, quietly, still improving. What Jennifer wants other survivors to know Her advice, offered near the end of the conversation, is short and unsparing: “You can rest, and that’s okay. You can be as slow as you want to be, and that’s also okay. But don’t give up. Just keep going — at whatever pace feels right.” It’s a rejection of both the productivity culture that tells survivors to push harder and the clinical culture that tells them to accept their limits. Recovery, for Jennifer, isn’t a race against a deadline. It’s a long, patient process of finding out what comes back and learning to live fully with whatever doesn’t. Bill’s book and community If Jennifer’s story resonates with you, Bill Gasiamis’s book — The Unexpected Way That A Stroke Became The Best Thing That Happened To — explores the same territory: the slow, unexpected, sometimes beautiful work of rebuilding a life after a brain event. Get the book here Readers who want to support the podcast and connect with the community of survivors it serves can do so at Patreon. Support on Patreon This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. Jennifer Tomscha: An AVM Burst in Her Brain at 39, and the Four-Year Climb Back to Herself She self-diagnosed her own stroke while driving with her daughter. Four years on, she’s still discovering what recovery really means. Highlights: 00:00 Introduction and Background 10:00 Reflections on the Experience 18:00 Long-term Effects and Adaptations 26:45 Identity and Self-Perception Post-Stroke 38:48 The Long Game of Recovery 51:07 The Journey of Recovery 01:03:42 The Evolution of the Podcast Transcript: Introduction and Background: AVM Burst in the Brain Jennifer Tomscha (00:00) Dr. Woon was my neurosurgeon. And he just said, I’ll never do another surgery like that ever again. it was really long. And I think he definitely had made me worse. Like they had taken out. too much of my normal brain. when he called my husband after the surgery was over, Dr. Woon said like, well, you’ll be lucky if she talks. he was just so discouraged from how the AVM surgery went. when I finally talked to him on Zoom. was so you And I was like, yeah, yeah, yeah, of course I can. He was like, will you show me? and I walked up and down the room and he was like laughing so hard at my being able to walk. He was like so enthusiastic about it. Bill Gasiamis (00:44) Welcome back everybody. I am Bill Gassiomas and my guest today is Jennifer Tomche. In March, 2022, Jennifer was 39 years old living in New Zealand, finishing the first year of a PhD program when something happened to her brain that changed everything. What followed was a medical emergency unlike anything I’ve heard described on this podcast and a recovery story that quietly dismantles one of the most damaging myths in stroke survivor community. That after a certain point, the window for improvement closes. Jennifer is four years out from what happened to her. She still takes an afternoon nap every day. She still notices the edges of what her brain can and can’t do. And she is also finishing a PhD, raising two children and speaking with a clarity and warmth that will stop you in your tracks. This is a conversation about what it actually means to play the long game and why might be the most important thing any survivor can do. Before we get into it, if this podcast has been part of your recovery journey, I’d love for you to check out my book, The Unexpected Way That a Stroke Became the Best Thing That Happened, at recoveryafterstroke.com/book. And a genuine thank you to everyone supporting this work on Patreon. If you wanted to support the show, you can go to patreon.com/recoveryafterstroke. really helps me keep the conversation going. Let’s get into it. Bill Gasiamis (02:12) Jennifer Tomscha welcome to the podcast. Jennifer Tomscha (02:14) Thank you. I’m glad to be here. Bill Gasiamis (02:17) It’s lovely to have a local with me. Usually all my guests are from the United States or Canada or the United Kingdom. You’re just a hop, skip and a jump away in New Zealand. Jennifer Tomscha (02:20) Yeah. Mm hmm. Yep. Yep. I’m American originally, but we moved here in 2020. So ⁓ we I’m grew up in Iowa. And then and then I after but we were living in Shanghai for us for almost seven years, my husband and I were living in Shanghai and I was teaching at New York University, Shanghai and then when COVID happened in China. Bill Gasiamis (02:35) Where are we from in America? Jennifer Tomscha (02:54) they told us to leave the country because it was where it started. So, and we had two kids, so my husband didn’t want to go back to the United States. And so my sister lives in New Zealand. So we moved here and then we just stayed here. mm-hmm. So, yeah. Bill Gasiamis (03:11) So in China, was it just a request? Was it a directive? What was the situation? Jennifer Tomscha (03:18) From New York University, they said if you weren’t a Chinese national citizen, they strongly urged us to leave because they just didn’t know how they were gonna manage it. everyone, mean, in China, they had had SARS in the early 2000s, so they had already had it. And so right away, everyone had their masks on. They were ready to… go and I was like, I want to get out of here. So we went to New Zealand and they also had a lockdown, but it was just for a month and then everyone could wander around because the virus was not here. we just stayed and I got into this PhD program. So that’s why we’re still in New Zealand. Bill Gasiamis (04:00) Wow. That kind of brings us to the first question I ask most people these days is what was life like before stroke? So there was a little bit of stuff going on. was, work in China. There was a bit of, ⁓ travel from the United States to China. was children, but daily life. What, what was that like before the stroke? Jennifer Tomscha (04:21) When I saw my stroke happened in March of 2022 and at that time I had been in my PhD program for about a year. And I was just finishing up my research proposal. And so I was doing that during the day and my kids were both at, I have an older son who was in second grade year two. And then I have a daughter who was in preschool. And so my days were I dropped them off at their schools and then I would work for a little while. And then I would. go and get them. So, and then they would come home and we would do all the other stuff in parenting. And my husband at that time was working at the library. So he had, he was at the libraries from nine to five every day. So he was at work. And that’s what, that’s what we were doing. Yeah. When I had my stroke. I was busy trying to finish up this research proposal. And then, yeah. Bill Gasiamis (05:14) 39 years old at the time as well. Jennifer Tomscha (05:16) Yes, was 39. Bill Gasiamis (05:18) any signs, any kind of inkling that something was not right. Jennifer Tomscha (05:23) I didn’t, weirdly, so I’m trying to think about, my whole life I’ve had this thing where if, especially at just certain points if I hit my, this is maybe nothing to do with anything, but if I hit my elbow or my wrist, then I would pass out. And sometimes I would have like a little seizure while I was passing out. So wasn’t just like a regular fainting, it was like a seizure. And I had some of those in high school and I actually went to the, hospital for those at one point and I think they didn’t know what that was and they just did an EEG. I don’t even think we had an MRI where I lived. So I didn’t really know and then that sort of passed. But I was feeling when I have a daily journal that I was writing and when I go back and read that daily journal, the whole, for a couple months ahead of time, I was like, I just feel kind of weird. I don’t feel great. I feel like a little bit sick and I don’t know what’s wrong with me. And at that time they were allowing COVID to enter New Zealand. They were putting it in. So I was like, I think I might have COVID, but I took a bunch of tests. They were all negative. And then my stroke happened on Tuesday, but the Friday before I was so sick. And then that weekend I was really sick too. And then I got, like, I kind of felt like I woke up, I felt really nauseous. And then I felt better on Monday and Tuesday. And Tuesday was when my stroke happened. So I think that was all, it was all, think, my body reacting to, I was probably bleeding in my head at that time or something. mm-hmm. Bill Gasiamis (06:57) I got it. And we’re to have to go back and talk about how it was that when you got hit on your, on your wrist and your elbow, how hard was the hit? Jennifer Tomscha (07:05) I don’t know. Not super hard, I just, I don’t know what, I actually don’t know, and maybe it’s nothing to do with it. You know, maybe it’s something else in my body that I am prone to fainting. But I don’t know, I don’t really know why that, and maybe it wasn’t anything like that. But I had one day when I was 16 and I passed out three times and that did seem kind of funny. And I went to the doctor and I passed out while I was at the doctor’s office. So they were like, there’s nothing wrong with you. So they put me to the hospital. They did the EG. stayed the night. And then they were like, there’s nothing wrong with you. So that was it. But I think if nowadays they probably would have done an MRI, maybe, and they would have seen that I had my AVM and my whole life would have been different because I wouldn’t have done all the stuff that I’ve done now. Like my mom was like, if we had known you had had an AVM, you would have gone to school. in Sioux City, you know, or we would have done something to keep you nearby because we would be worried about you. Instead, I was just like, doing whatever I wanted to, which is good. Bill Gasiamis (08:14) Laze, but that’s kind of good. But also I get the preventative thing. One of the, my former guests had a daughter who had an AVM and I think she was five when she passed away from a bleed in the brain because of an AVM. That’s horrific. And one of the, it’s actually worth listening to that episode and it’s worth me interrupting this right now to jump on and find that episode so that I can share it with people. And this particular lady has made it her life’s mission to raise money, get an MRI machine and do preventative scans for people in case they have an AVM or some other undiagnosed neurological condition. I think it’s Gina. Gina Keely. OK, it’s. And her ⁓ foundation is now called the Paige Keeley Foundation, it’s the most heartbreaking story. It’s episode 141 and I’ll have the link in the show notes and I’ll have it in the YouTube description. So for anyone listening, jump back and have a look at that. And also maybe even consider supporting the foundation because the story is heartbreaking and the efforts that this lady is going to ensure that this doesn’t happen to other people is just amazing. So. I wanted to, I raised that because I had a, in 2011, no, no, in 2010, about 18 months before my actual AVM bled, I had a really terrible negative episode, nauseous, room spinning, like all the signs of stroke, but completely missed the, completely missed Jennifer Tomscha (09:47) Mm. Bill Gasiamis (09:55) the AVM when I went and actually had an MRI. So yeah, I went to the hospital, gave them my, rundown of what was happening to me and they were so switched on and they got me in and they did all the tests, but they didn’t find anything because they didn’t know what they were looking for. And there was no obvious sign of bleeding. So they didn’t dig deeper. And I have a friend of mine who is a radiographer who actually did my MRIs Jennifer Tomscha (09:58) ⁓ really? Mm. Reflections on the Experience Bill Gasiamis (10:22) when I was in hospital being treated after my AVM burst in 2012. And he said to me, the preventative stuff is very difficult because if you don’t specifically know what you’re testing for, you don’t know how to set up the machine and how many slices that it needs to take and at what resolution. So that when you deliver that to the radiologist and they’re looking at it, can they see an AVM and then pass that on? Jennifer Tomscha (10:37) Mmm Bill Gasiamis (10:49) that information onto the neurologist. They might even miss it, even though they’re doing MRI. But what Jena is doing, it sounds like they’re specifically going after aneurysms, AVMs, other malformations, and therefore they have kind of this better opportunity to find it. So if somebody is considering getting a preventative scan of their brain, you have to be very specific. Jennifer Tomscha (10:53) Bye. Bill Gasiamis (11:14) with the team of doctors, radiographers, neurologists, as to what you want them to look for and make sure that they adjust the scan so that it’s fit for purpose. Jennifer Tomscha (11:25) That’s interesting. That’s really interesting. Bill Gasiamis (11:26) Yeah. So what was the day of the stroke like? Was it, you said you’re feeling better on that Tuesday. Jennifer Tomscha (11:34) Mm-hmm. I had a good day. I have like lots of notes from my research proposal and I went to pick up. I don’t know why I did it this way actually. I went, my daughter’s preschool is in our town, Greytown, and I went and picked up her first and then I went to get my son. His school is a Montessori school. It’s in one town north. And so I went and got her and we were driving in the car and when I turned onto the highway that connects Greytown and Carterton, I just felt like a wash of dizziness and I started losing sight, I think, in my right eye. And it’s seven kilometers from Graytown to Carterton. And right before we got into Carterton, I pulled over onto the side of the highway. I tried, so by that time I think I had lost most of the sight in my one, my right eye. And so it wasn’t very long actually. And so I tried to call my husband, he didn’t answer. And then I just called 111 and I was like, I don’t know why I was like, I think I’m having a stroke, but I don’t know why I even thought that actually. Do know what I mean? I just, was like, something is wrong with me. And so my daughter was fussing in the back and, I don’t really remember anything after that. I don’t remember the paramedics coming. I don’t remember talking to anyone. but so when they, I think the police came first and then Then the paramedics came and they said I was nauseous, but talking a little bit. But then they moved me into the ambulance and, I started, choking and, or something, and they had to intubate me in the ambulance. And then they took me in. I was helicoptered off to Wellington hospital. So. Bill Gasiamis (13:12) How did you feel about it? I know you did the right things. You nailed it. But how did you feel? What were you thinking? I was completely oblivious to the risk I was at or in. Jennifer Tomscha (13:14) Yeah. Mm-hmm. Mm-hmm. I don’t know. just, let’s see, I think… I think when I was losing my vision, that was hard. I mean, I’m really lucky. There was a little ⁓ path on the side of the road right before you enter Carterton. So I pulled over there so I could still control the car. You know what I mean? I wasn’t so bad. And I could dial 111 on my phone. I could still think about those things. But it wasn’t very long after I dialed 111 and talked to those people that I’d that my memory is gone. So I think, I mean, I have spent a lot of time trying to like go back and figure out like, what was it? What could I have done early? know, like I was really lucky I was in the car, because honestly, because if I was at home, I might’ve like laid down and taken a nap and not called anybody actually, or called Dan and half have not answered. So then I could just see myself. Bill Gasiamis (14:14) you Jennifer Tomscha (14:22) It was actually really lucky that I was in the car with my daughter because it made me, I mean, I couldn’t keep driving very well. And so it made me pull over and it made me, I’d have to do something because I wasn’t in town. So I had to like figure out how I was going to manage the situation. And so I was really lucky actually that I was in the car and that I was in a public space where I was easy to find and like I could, so I felt like really lucky that all that happened. in that time period, but also that soul that my daughter was with me because it made me, I had this like parental responsibility that I had to, I couldn’t keep driving with her in the car. Like I just, I knew I had to do something and quickly. I feel like, I feel really lucky that that was the situation that I was in because I could see a different day where I didn’t go get the kids at that time. And I maybe would have tried to take a nap and it would have been totally different. So you know what I mean. Bill Gasiamis (15:19) It’s such a common thing for people to go, oh, I’m not feeling well. I think I’ll just go lay down and have a rest and see if I can just get over it, sleep through it or whatever. yeah. And then it just leads to even more and more trouble or problems. The fact that you said, I think I’m having a stroke, right? That is so cool and bizarre and amazing. Jennifer Tomscha (15:29) Mm-hmm. Mm-hmm. The guy was like, why? And I was like, well, I’m losing my sight. I was like, I mean, I don’t know how it was. I was like, why do you think you’re having a stroke? I was like, I don’t know. But there was something wrong. You know what I mean. Bill Gasiamis (15:52) Yeah, that’s such a good question for me. Why do you think I’m going to strike? I don’t know, but I just came up with it. What? That was enough though. Like that was such a response from you to say, I think I’m having a stroke. It’s very, very rare that people get there, but the fact that you got there kind of gave, gave them also like an understanding of how to attend the site and what to do. Jennifer Tomscha (16:01) Mm. Bill Gasiamis (16:18) And that saves time as well. That saves a ton of time. Jennifer Tomscha (16:21) Right. Mm-hmm. Mm-hmm. Bill Gasiamis (16:23) and gets them, even though you may have been wrong, right? Gets them looking in the direction because they’re already got that in their mind. And then, well, let’s look at that first and then let’s suss it out. She might be completely wrong. But I walked into the hospital after my, while I was having the third blade and said, I’m having a brain hemorrhage or something like that. And I was in the hospital upright, standing, looking normal and Jennifer Tomscha (16:27) Yeah. Yeah, yeah, yeah, that’s true. That’s ⁓ Mm-hmm. Bill Gasiamis (16:51) They were looking at me like, okay, what are you on? This guy, this guy must be on something because it doesn’t look like he’s having a stroke. And then I had to try and convince them, but I wasn’t giving them my contact details. So they weren’t able to bring up my record. And all they were saying was just give us your name, give us your name. We’ll put it in the system. We’ll have a look. And eventually they got it out of me and, ⁓ and I was right. But yeah, such a good thing. Jennifer Tomscha (16:54) Oh, yeah, yeah, yeah, uh-huh. no. Hmm. you Bill Gasiamis (17:21) I love those little bits and pieces that go well together because you often hear I often hear the bits and pieces that didn’t go well and and it turned out differently and how old was your daughter at the time? Yeah, wow. Jennifer Tomscha (17:30) Mm-hmm. She was three and a half. And so she was still in the backseat, know, backwards in her car seat. And then we stopped and she was like, why are we stopping or whatever in her three and a half year old voice? And I was like, I just had to make a couple of phone, you know, I don’t know what I said to her. And then I think when the police came, she was asleep. Like she fell asleep back in the car. then, and then. It’s just, I, I’ll, so then for the next six weeks I don’t have any memories of anything. So all, all of the information has been given to me by other people. But, so, yeah. Long-term Effects and Adaptations Bill Gasiamis (18:04) So was quite a large blade after all of that. Jennifer Tomscha (18:06) Yeah, it was large. They took me, so I flew in the helicopter from Masterton to Wellington and I think they, by then my sister had gotten to the hospital and they, yeah, I think they said, yeah, they did an emergency, is it craniac? Or what’s the? Bill Gasiamis (18:25) Craniotomy, Jennifer Tomscha (18:26) Yeah, they did an emergency cradionomy and they saw that I was bleeding. And then they saw that I had this large left frontal or frontal lobe AVM. So, and then they said that at that moment they couldn’t tackle that AVM. So they, controlled the bleeding and then they, and they left my skull out and then, yeah. And then, then they, they talked to the neurosurgeon and He, that was a Tuesday and he said, why don’t you, I was in a coma, just keep her in a medical coma. And then Monday they would do the, the, the surgery to get rid of the AVM. Bill Gasiamis (19:05) And then that surgery happened. Jennifer Tomscha (19:07) That happened and it was, had my, actually had two AVMs. One was really discreet and they could see all the endings of it. And the other one was diffuse. I don’t really understand it, but, the neurosurgeon said there was like parts of regular brain in and around the AVM. I don’t really understand how that happens, but, ⁓ so they started in the morning and they did, they got rid of the one AVM. They were taking it out. And then something about the blood vessels that had some of they had been putting blood into that AVM. They then started feeding into the other AVM. So then that AVM made my brain sort of swell where that AVM was. And so the neurosurgeons had to decide if, mean, basically it was like, let me die. because they couldn’t do anything about it, or they would get rid of that AVM and they would just take out the brain that was, the normal brain that was in the regular AVM. So they took, they decided not to let me die, thank goodness, and they decided to do that. so, but it was really long surgery, it was 30 hours, I think they just didn’t, yeah, it was really long. And… And I think Dr. Woon was my neurosurgeon. And he just said, when he went and sewed my head back together, he didn’t think I was listening, but I was in the other room and I could hear him after I had my skull put back in. And he was like, I’ll never do another surgery like that ever again. it was too, it was really long. And I think he definitely thought that he had made me worse. Like they had taken out. too much of my normal brain. when he called my husband after the surgery was over, like they didn’t call him. Dan, my husband was waiting for the whole 30 hours and they only called him one time at like 11 o’clock that night. And they were like, we’re finishing up. But then they had all this other stuff happen. So they didn’t actually call him again until noon the next day. And Dr. Woon said like, well, you’ll be lucky if she talks. Because we had to take out. he was just so discouraged from how the AVM surgery went. And so, yeah. Bill Gasiamis (21:24) Dr. Woon needs to give himself way more credit. Jennifer Tomscha (21:27) I know, I know, I also think that. I also think that, I mean, it’s, I mean, neurosurgeons, they’re, it’s amazing that you could, I’ve just, it’d be so weird if your job was to cut people up and go into their brains and try and fix something in that organ, which is so mysterious, do you know? Like, yeah, so. Bill Gasiamis (21:48) Wow. 30 hours. So he also is thinking in his career, he’s probably never going to come across another 30 hour surgery. Yeah. Well, only if it’s necessary to make somebody better, but yeah, we definitely want to avoid that if we can for every human on the planet and for Dr. Woon, but I just, I’m just completely in awe of these people. I bumped into my surgeon last year. Jennifer Tomscha (21:57) I hope not. mean, I hope, you know, yeah, I don’t think, yeah. Right. Mm-hmm. Bill Gasiamis (22:15) because I had another MRI, because I had another bout of headaches and all that kind of stuff. still, you know, it hasn’t ended. I still go through all these things. And I mean, I mean kind of, I get emotional when I’m around her and when I’m in the room with her. If she told me to jump off a cliff because there is something positive down there and I would do it. If she said, if she said punch a hole through that wall, I would do it. Like I would do whatever she said because Jennifer Tomscha (22:20) no. Yes. Yeah. Bill Gasiamis (22:44) I just cannot get over the, know, when, you know, when you make a decision, some people, my phone is weird. I’ve never done this before, but you have a piece of fabric and it’s got some lines on it. And you know, if you cut it wrong, that you can’t use that piece of fabric for that pair of trousers anymore. You’ve got to use it for something else. Like that’s a pretty mild problem to happen. Like you cut wrong, you go in the wrong place. You pop that aside and. You’re useful. If you do that to a human, there’s no going back. And you’ve got to make that decision every single time you walk into the operating theater. And imagine his family. Like, I feel like we need to reach out to his family and say, is there anything we need to make up for? I know we had your husband for 30 hours, but like, how can we support your family now that he’s done that for my family? Jennifer Tomscha (23:40) Yeah, yeah, yeah. Bill Gasiamis (23:40) Do you know, like it’s so interesting that these people have been able to get to that level of capability. Jennifer Tomscha (23:49) Yes. Bill Gasiamis (23:50) with humans and helping people stay alive and be here with their family, be a mom, be a wife, be a daughter, be a member of the community. Jennifer Tomscha (23:51) Mm-hmm. Yep. Yep, exactly. It’s just, it’s amazing. It’s just so, and I’m so grateful to him and he had another neurosurgeon working with him and yeah, it did, I mean, yeah, it’s amazing. I always think though, I’m trying to think about like, did, why, if he cut out those parts of my brain, why weren’t they, why? I mean, I have some things I can’t do that I could do before. Like I can’t, this is so weird. I can’t recall songs very well and I can’t sing songs from memory, like at all. Like that part of my brain is done, which is fine, but I used to sing a lot. but I think because if the AVM is there when you’re in your, if it’s there when you’re in your mom’s womb, like if you’re, when you’re developing. It’s probable that my brain was like, there’s a little issue here in this brain. We’ll move some of the stuff away from, don’t you think that would be, yeah, because I just think like, I think where my AVMs were, my brain was like, we’re gonna move, we’re not gonna put stuff by those AVMs because yeah, because your brain is really adaptable. Like that’s one of the things that I’ve been reading since I had my stroke. Bill Gasiamis (24:59) Wow. Yeah, I’ve never thought about that. Why not? That makes sense, Jennifer. Because it’s… Yeah. Jennifer Tomscha (25:18) My mom’s like, your brain is so adaptable and flexible and it can do different things. You just have to try doing things, you know, and failing. Bill Gasiamis (25:26) And the blood flow is not right. So you imagine with blood flow not being right, then the brain’s not developing correctly in that spot anyway. And it’s just developing where there is blood flow. Jennifer Tomscha (25:37) Yes, exactly. Exactly. I just I feel like that makes sense to me. And that’s why if you’re the neurosurgeon, I mean, you really don’t know. Like Dr. Woon didn’t know what was there. But I just feel like maybe my brain when it was developing was like, well, this isn’t a good spot and this other spot isn’t a good spot. So we’ll just do everything in a different place. And the brain is really you can really do that. I think your brains are really plastic in the way that they can order themselves. And so I So it’s still all Dr. Woon. I’m just so grateful to him and everything that he did. Because honestly, I feel like I come from the States. I don’t know that a neurosurgeon, I just don’t know how long a neurosurgeon would have, they might be like, I’m done, I can’t do this anymore. I just don’t really know. It just all depends on the doctor and who sees you and everything. So I just felt so lucky to have been here. Bill Gasiamis (26:30) Imagine doing a 30 hour shift on any day for anything. Jennifer Tomscha (26:34) No. And the thing about neurosurgery is like you’re in, I mean you’re doing like, you’re in a microscope or whatever doing that little and you’re tying off a little blood vein and I don’t know, it’s nuts, it’s so nuts. mm-hmm. Bill Gasiamis (26:39) them. Identity and Self-Perception Post-Stroke Yeah. And they talk about, you know, how dangerous it is to drive when you’re off a take when you haven’t slept, when all those things. And these guys are going for 30 hours and they’re doing the most intricate, life altering surgery and it all goes perfectly well. So how wrapped was he when he realized how well it went. Jennifer Tomscha (27:09) I didn’t talk to him until June, so that was at the end of March. And then I was in the ICU for a while. then they moved me to Masterton and I did rehab. And then I went to this last clinic, this ABI, this brain clinic for people who had brain injuries. And that’s when I finally talked to him on Zoom. And he was like, so can you walk? And I was like, yeah, yeah, yeah, of course I can. He was like, will you show me? and I walked up and down the room and he was like laughing so hard at my being able to walk. He was like so enthusiastic about it. I was, you know, I mean, we can talk about this too. was, everyone was like, when I finally have my memory back, I was in Masterton and I was using a diaper. I couldn’t walk. I couldn’t step in bed, but I remember being, actually, ⁓ I remember being like, I’m fine. I’m fine. Everyone is just fussing over me. But of course, they were right too. Do you know what I mean? But I was like, I’m okay. Everyone needs to just like, let me just relax around me. And everyone was like, everything I did, they would be like, you know, I couldn’t feed myself. And then, you know, there’s all this stuff. And I was like, I’m really okay. You guys should just. take, like, I’m fine. I kept saying that, like, I’m okay, I’m fine. You guys are all. But of course, I wasn’t really fine, but I felt like, Bill Gasiamis (28:36) It sounds like you weren’t physically there yet, but you were emotionally and mentally fine. Like it sounds like you were on the, you kind of knew that things were going to turn out or. Jennifer Tomscha (28:48) I think so. I think, or maybe, I always think like maybe you can only manage so much. like at that time I had my front part of my skull was gone because it had been taken out when they did both my surgeries. And so I had to wear like a rugby helmet or whatever when I walked. But otherwise I would sit in my room and it looked terrible. It’s just so terrible. but I just didn’t really recognize that. Like I didn’t, wasn’t, I couldn’t do all the things at once. So I think I was just thinking about like, and finally at the middle of May, my mom and sister, I still had my like long hair in the back and short in the front. So my sister was gonna cut the long hair in the back. And I saw myself in a mirror and I was like, that doesn’t look very good. You know, like I wasn’t, I don’t feel like I was totally aware. I wasn’t, my brain wasn’t. totally back in it. It’s a long time to recover and I feel like my brain only gave me, I don’t know, I felt like I couldn’t think about my own brain, maybe for like a year or something, really think about it in a second order way. Bill Gasiamis (29:59) allow yourself to kind of observe your state, your brain condition. Jennifer Tomscha (30:02) Yes. Yes, I think I was like, it was like that my it was like maybe in October of the next year, October of 2023, where I was like, Oh, I can think about my brain and what it is in a way that I couldn’t. Because I don’t know, you have to go through, you just have to relearn a lot of stuff. But I didn’t like I’m lucky, like, it didn’t affect my reading, so I could read right away. I’m not a very good writer, like, I don’t have good handwriting anyway, and my handwriting still maybe isn’t as good as it was before I had my stroke, but, yeah. I feel like, felt like, the actual healing was a longer process than I thought it was going to be, especially right when I first woke up, because I was like, I’m fine, but I wasn’t really fine, actually. Do you know what I mean? Bill Gasiamis (30:55) 100%, they can make doctors and neurosurgeons do a 30 hour surgery, find that part, fix it, ta-da-da-da-da, do all those things, but they can’t make a helmet for God’s sake look half decent after they’ve taken your skull out. Like as if it’s bad enough, have skull missing and then they put this terrible looking thing over your head. Jennifer Tomscha (31:11) No. It’s true. It’s true. It’s true. Yeah. Yeah. So, yeah. Bill Gasiamis (31:22) And I know for women like hair is a big deal and become. Jennifer Tomscha (31:27) It was really, I have always liked my hair and it was, I had short hair for about a year and a half maybe, you know, and I started growing out more and that was a little bit hard. I felt like that’s really vain, but I was like, man, I just did not like that short hair. Cause it’s not very, I don’t know. I just, wanted my old hair back. So I was lucky that it came back though. You know, everything, it’s not cancer. It’s a different thing. So you have a different, you know. Bill Gasiamis (31:51) I never would have told you that your hair didn’t look good, but my favorite hair is brunette curly hair. Yeah. My wife is a brunette naturally and she has curls in her hair and she straightens it all the time. I haven’t seen her brunette curly hair for 30 years. Jennifer Tomscha (31:57) Thank you. ⁓ yeah. no. Bill Gasiamis (32:13) I’m like, woman, that’s what I like. Like that’s my thing. you stop straightening your hair, but I can’t get it to stop. ⁓ Jennifer Tomscha (32:20) Yeah, that’s fine. Everyone has to do what they want with their hair and everything. you know, that’s something that one thing I think about my stroke is you just got to go live your life. Like you can’t and you’ve done that beautifully. You know what I mean? Like this podcast is amazing. it’s just like, you just got to go do what feels good for you at the time and what you want to do and just do it. and stop saying no, or you know what I mean. Bill Gasiamis (32:49) I’m trying. am. know exactly what you mean. One of the biggest things is identity is a big, big thing. And I don’t talk about me so much. I’ll talk about what happened to me, my stroke journey, but I don’t really give people a look behind the curtain. You know, sort of really understand what’s going on. This is just all a facade. And one of the challenges that I have is this painting company that I started 20 years ago was the main source of income. And it stopped abruptly seven years in when I became. Jennifer Tomscha (33:02) Hmm. Mm-hmm. Great. Bill Gasiamis (33:17) and it sort of still kept bubbling along. And then I got back to it in 2019 because my clients were still calling me and I was well enough after seven years of going through stroke and all the stuff of surgery, learning to walk again and all that. I was good enough to sort of get back into it. And of course in 2019, I only had six months and then we were in lockdown. And then in lockdown, we had two years of lockdown in Melbourne, and then I’m trying to keep that thing going again. And then there was this massive influx of work after lockdown because everyone’s going, I’ve been looking at these walls for two years. They look terrible. Let’s get them painted. They had spare money because they hadn’t spent anything for two years. And that was like, let’s do this and let’s do that. And there was this massive amount of work for about 18 months. And then that was done. It was gone. And it’s been a steady decline since as soon as Trump opened his mouth and did something in Iran and said what he said, and he plummeted like we’ve got no work. And I’m okay to have no work because I’ve been there before and we’ve managed our affairs so that we’re okay. But I can’t employ people right now at all. That’s gone. And getting people back and starting that again is going to be extremely difficult because the curve Jennifer Tomscha (34:27) Yeah. Mmm. Hmm. Bill Gasiamis (34:36) is not it’s not going to be a sharp dip and then it’s going to be a big spike of work and demand and all that kind of stuff. this podcast has been my saving grace every time I’ve needed to occupy myself with a project and make it so that I’m not thinking about me. The podcast was there. I did. I did an interview. It got me over the line. But now the biggest void that’s going to occur is not that I’m going to Jennifer Tomscha (34:47) Mm-hmm. Bill Gasiamis (35:05) potentially not have work in this field and after shut it down, which is gonna be fine if I do that, I’m okay with that. I’ll kind of pass it on to my younger son who’s looking to do some work in a similar space. I’ll give him the phone number and he’ll be able to take those types of inquiries and then he’ll do it on his own, like very small, the way I started at the beginning. And is that I’m gonna have all the time in the world. Jennifer Tomscha (35:23) Mm. Bill Gasiamis (35:29) on my hands to do the thing that I’ve been avoiding doing because I had this business that relied on me and the thing was to do public speaking. Right. And to actually do it the way that I’ve wanted to do it for more than a decade, which was to talk about the topics that I want to talk about, which no one’s talking about post-traumatic growth, overcoming trauma, how that’s applicable in organizations. Jennifer Tomscha (35:38) yeah, yeah, Mmm. Bill Gasiamis (35:56) how to treat people better in an organization so they have less mental health issues, so they have less physical issues, so they’re sick less, so they enjoy their work, so they’re not hating their life. And now I’m going to have all the time in the world to do it. And I’m shitting myself. That’s the biggest issue, right? So that’s a little bit of a look behind the curtain. I am loving this. This is an amazing thing. And I do remember when I first started it, I was concerned about what people would say about me. You’re going to sound dumb, Bill. You you’re not going to, you know, what authority do you have? All those kinds of things, they were coming up in my head. And then when I wrote the book, the same thing, I wrote my first book, The Unexpected Way That a Strike Became the Best Thing That Happened to Me. Everyone has said, don’t write that book. Don’t write that. Jennifer Tomscha (36:27) Mm. Bill Gasiamis (36:39) Don’t let that be your title. It’s bizarre, it’s weird, like it’s strange, it’s too long and all these things. So I did it. And of course, the first time I spoke about it on YouTube, one of the first comments was a negative comment on my YouTube channel. It’s like, ⁓ okay. My God, that’s a kick in the guts. Jennifer Tomscha (36:44) really? ⁓ yeah. Bill Gasiamis (37:03) So those little kicks in the guts that I’ve had along the way have been few and far between, but they’re the ones that seem to persist the most. And they stay in that part of your head, which says, you know, that public speaking gig, you’re probably going to do the first one and they’re going to say you were terrible. And then you’re to feel all sad at 52 about, you know, yourself and all these things. Jennifer Tomscha (37:15) Yeah. you Bill Gasiamis (37:29) how you’re going to overcome that emotionally and mentally and all this kind of stuff. It’s like, Bill, relax. You’re gonna have time to build your new career at 52. You’re gonna have time to do it. So that’s like, all right. I find myself getting pushed into a corner and only then responding with, all right, all right, I better step up again. I better do this again. Jennifer Tomscha (37:33) Mm-hmm. Yeah. Mm-hmm. Mm-hmm. Mm-hmm. Yeah. Bill Gasiamis (37:58) Very strange, re-imagining yourself and recreating yourself after stroke is a huge thing because you’re also doing it with a stroke brain. Whereas before I had no excuses, I was doing it still. Like the pattern is the same. The stroke brain part of it is an obstacle that I wish I didn’t have, but somehow this stroke brain part has made me do things I’ve never done before. Jennifer Tomscha (38:14) You The Long Game of Recovery Bill Gasiamis (38:27) a podcast, a book. You know, I was a tradie. I was like, I didn’t study. didn’t read. In my, by the time I got to the age of 37, honestly, Jennifer, I reckon I’d read maybe seven books. And they were about this criminal underworld figure in Melbourne who had this, who had this career and of being like really terrible and somehow. He was the thing that I was interested in reading about. Like that’s the only thing that captured my imagination. Everything else, everything else I picked up from listening to podcasts or watching shows on TV and that kind of stuff. So I wanna just, I wanna make people understand that the battles that you’re fighting, I’m fighting, it’s real. Like you’re not doing it alone. Everyone’s fighting this. How do I reimagine myself? Jennifer Tomscha (38:56) Bye! Bill Gasiamis (39:20) after stroke, you know, I don’t tell people I’m an author. Still, this book has been out for three years. I’ve had amazing reviews. I’ve had a couple of, you know, negative reviews and that’s okay. I’m not, I’m not an intellectual. I haven’t, I’ve never studied how to write literature, any of that stuff. And it’s sold about seven or 800 copies just through the podcast. Jennifer Tomscha (39:21) Mm-hmm. Mm-hmm. Mm-hmm. That’s pretty good. That’s actually quite a bit, I feel like. It’s quite a bit, actually. Mm-hmm. Bill Gasiamis (39:47) I feel like to like I don’t promote it. I don’t tell anyone about it just in the podcast. And it’s like, I still don’t say I’ve authored a book. Nobody knows. Jennifer Tomscha (39:56) You should say it. mean, I do think the what are you going to do after you have a stroke? How are you going to do it? It’s all very strange and scary, I think. And like, yeah, I, I totally get your feeling about it. And it’s just really tricky to know what is the You know, for me, I feel like I was in middle of my PhD, so I took 22 months or 20 months off of doing the PhD just to rest. And then I went back in and it was, it is still, it was really hard. I like, wasn’t very good at figuring out how to write in the academic way. Which was my position. I was director of the writing program at NYU Shanghai. So I was like, that was my thing. And it was very hard to figure out how to return to do the critical work of my thesis. was just, it’s just, I don’t know, my brain just couldn’t figure out how to do it right. It was really interesting. was like, the sentences I was writing weren’t as good. They probably still aren’t as good. You know, like when I look at what I was writing before I had my stroke, which is part of my thesis, and then the stuff I wrote after my stroke, I feel like I can tell a little bit of a difference in the fluency of my writing, for sure. So, yeah. And I just, so… Yeah, I don’t know. It’s tricky. It’s tricky to figure out. But I was really lucky, actually. I think the PhD was helpful because… I could just go at it on my own time and I could just take however much time I needed. And I, I had a deadline. but it was good to just, it was actually like a really good place to start to work my brain again, to be like, okay, I have to, I’m going to write on this author and what she thinks about character. And I’m just going to, and I have these other texts that I’m interested in and I have to figure out how I’m going to. Represent them in my own work. And so it was really good to do all that. It was a good stepping stone for me I think actually to get back into it and to see What I could and couldn’t do very well, like I feel like I’m a really good reader. I’m a really good Critic and I’m not so good at ⁓ writing down what I think anymore as well So I’m just I really have to work on and I don’t know how you get it back like Bill Gasiamis (42:26) articulating Jennifer Tomscha (42:28) Yeah, articulating what I mean and yeah, I feel like I can’t, I can’t say things as artfully or as proficiently as I used to. So I don’t know, this woman who is getting her PhD at Vic too, she’s like, she studies how people learn to read. And she was like, if you’re having problems with academic writing, you should get a, and I still haven’t done this, you should get an academic book and you should listen to it because a lot of learning to read is listening to how sentences sound. She was like, so you should listen to an academic book and that will help you think about how those sentences work and how they’re maybe different from like, I write fiction. So fiction is one thing and then this is a different way of writing. So she said that was one thing that she thought I should do to help. develop my proficiency in academic writing, which was really interesting. So. Bill Gasiamis (43:25) Yeah, it’s a different approach. You know, it’s coming from the auditory, you know, system and therefore the auditory digital system. Therefore you go in and you you, you pick up nuances that you wouldn’t have known were there if you’ve never heard an academic speak or if you’ve never read an academic document in that way. So you might read it. Jennifer Tomscha (43:28) Mm-hmm. Yeah. Bill Gasiamis (43:51) to get something out of it. Like, okay, what is this academic saying about this topic? But that’s not paying attention to the structure of how it’s written. That’s a different filter. Jennifer Tomscha (43:55) Mm-hmm. No, exactly. Mm-hmm. Mm-hmm. Exactly. So I thought that was an interesting way to think about, like, how I could get better at that thing. That was, like, a really important thing for me. That, for some reason, it did just get a little bit, I don’t know, stunted? Or I don’t know what happened, you know? Or I just haven’t been in academia as much. So you know what I mean? So, yeah. Bill Gasiamis (44:17) Yeah. Yeah, 100%. The skill is not as refined or, or practiced as your other skills. So it’s not the thing that you’re the best at. and you’re getting better at it. The thing about it is also, may I add you’re only four years out from all the drama that you had with your brain. So there’s a lot of healing to happen that is going to improve. That’s going to get better and better. And in four or five years from now, you will have Jennifer Tomscha (44:29) Mm-hmm. Bill Gasiamis (44:49) turn the corner again, you’ll see that there’s more and more improvement. It’s really important for people to hear this, who are three, two, one, five, six years in, there’s still heaps of healing and recovery to come. So it’ll happen. Jennifer Tomscha (45:07) Yeah, that was something that my husband and I, in my first year after my stroke, he would be like, go to the gym. And he did. He, I went to the gym and I, had me lift weights and he wanted me to like exercise. And he was like, what are you doing to improve your mind and your body over this first year? And I was like, I’m, I’m again, I was like, I’m fine. I’m really fine. And, and, ⁓ he thought I wasn’t doing enough. Like he wanted me to just go at it with this intensity. I don’t know. was an, cause I was like, I am going at it with my own sort of intensity, but he wanted me to be more aggressive than I wanted to or something. You know what I mean? He wanted me to be like, he wanted to see me really working at it and like sweating or doing, you know what I mean? And I was like, I don’t wanna, I don’t know. Bill Gasiamis (45:59) He wanted it to be more masculine. Jennifer Tomscha (46:01) Yeah, I guess. And he’s not very masculine guy. I mean, he’s a masculine guy, but he’s like, he was just he just wanted to see me sweating it out or doing the really see my focus. And I just yeah. And that has been an issue because he’s like, yeah, he’s just like, are you going to work again? I was like, yes, I’ll work. I just don’t know what I’ll do. And I don’t know if I could do a full eight hour day right now. I still take a nap every day in the afternoon. So But yeah, it’s just, don’t, yeah, so. Bill Gasiamis (46:34) It’s easy for a caregiver to say that because they haven’t had a stroke. Thank God. Thank God. ⁓ Jennifer Tomscha (46:40) No, I know. Thank goodness. Yeah, yeah, yeah. Actually, I mean, I feel really bad for Dan and my mom and my sister. Like, it’s actually worse to be the caregiver in some ways because you just, you don’t go through it. So you, you don’t really know what it’s like. Bill Gasiamis (46:55) I and you, and if you’ve got an imagination, a wild imagination, you could turn it into something completely way worse than what it is. And if you’re ignorant, which most family members and caregivers are, let’s face it. And that’s okay. Then you do the other thing. You play it down and you assume she should be going harder than that or Jennifer Tomscha (47:11) Yeah. Mm-hmm. Bill Gasiamis (47:19) If I was, if it was me, I’d be doing that. But your brain has actually been injured and in that space, perhaps where motivation is for some people. And there is no way that you can make that person more motivated by willing them on or telling them to go to the gym or whatever. That could actually be missing the motivation part. So there’s a whole bunch of things that caregivers and family members miss. And it’s for me, it’s when I’m surrounded, when, when the people that are around me are Jennifer Tomscha (47:33) Mm-hmm. Bill Gasiamis (47:46) ⁓ people who don’t want to engage deeply in those types of troubles, life and all that kind of stuff. they’re great people. They’re just like, emotionally they don’t go deep, right? They love it that there’s ambiguity around like what’s wrong with me. Cause they look at me, I look right. And then they just go, everything’s fine. He looks amazing. I feel better now. And when I’m around him, I can just talk about dumb stuff. Jennifer Tomscha (48:07) Mmm, yeah, yeah. Bill Gasiamis (48:14) And we can talk about things that are not important and everything’s fine. And it’s kind of like head in the sand. It’s a, you know, one step, one emotional step removed from the actual goings on. And it kind of also helps me strangely enough, because then I don’t have to deal with their inability to handle actual life and the real things that are going on. Jennifer Tomscha (48:39) Mm. Yeah. Bill Gasiamis (48:43) that can just be living in La La Land and I don’t have to deal with that level of complexity. So it’s kind of, they’re both situations are helping me in a way. Whereas at the beginning I was taking that negatively. The thing I do, the thing I would like to do is challenge caregivers to listen to the podcast, especially of the spouse who I’ve interviewed. Jennifer Tomscha (48:50) Yeah. Yeah, that’s true. Bill Gasiamis (49:09) You know, and then a couple more after that to get an insight so that they’re not guessing or second guessing or think they know better, et cetera. No doubt about it. they, know, they know some things about us that they can see that we’re not doing a pattern in behavior that we’re avoiding. Perhaps they know that part and all that type of thing. But we’ll say, we’re also dealing with a messed up brain. So have a bit of a kind of a Q Jennifer Tomscha (49:13) Hmm. Right, right. Bill Gasiamis (49:36) be curious about where that person’s coming from, not how you’re feeling about where they’re coming from. And that’s what family members and caregivers do. They make it about them. And I had to say a few times to people in my circles, like, it’s not about you. Jennifer Tomscha (49:43) Right. Ha Tomscha Tomscha! Yeah, yeah, yeah, yeah, yeah. Bill Gasiamis (49:56) It’s actually really about me. cannot walk and I can’t use my left hand. It’s not about you. Like I know you woke up with a numb leg one day because you slept on it wrong, but it’s not the same. Jennifer Tomscha (50:05) Yeah, yeah, yeah. Yeah, yeah, yeah. That’s funny. Yeah. Bill Gasiamis (50:14) My wife was dragging my foot in the wheelchair. It had fallen off the, you know, the rest where your leg, your feet sit. It had fallen off and I hadn’t noticed. This is like day three or day four after brain surgery. And it was dragging underneath the footrest. And she noticed that the wheelchair wasn’t moving and she was shoving it until we realized. Jennifer Tomscha (50:22) higher. Bill Gasiamis (50:40) My foot was stuck underneath the rest and we had a laugh. that kind of like, that’s one of those, if those people were there and they saw that, they would realize like, it’s not about your numb leg when you slept on it weird one night. take your stuff and just, you know, park it for now. So it’s interesting. That’s kind of why I think I do this podcast. I think it’s for those Jennifer Tomscha (50:44) Yeah, yeah, Mm-hmm. Mm-hmm. The Journey of Recovery Bill Gasiamis (51:08) people if they, I’ve never told them that they should jump on, but if they, for example, get curious one day and they want to know what it’s like to be in Bill’s head, pick one of the 400 episodes. Just have a listen. Jennifer Tomscha (51:09) Mmm. I have a question for you. you, this is something that, so you think you could just, you can keep improving from your stroke. There’s not like a deadline. There’s not like a couple of years or any. Bill Gasiamis (51:36) One of the things I learned from my wife and my brother, my brother is my biggest nemesis. You he’s older and he’s the most loving guy. He’s the most supportive guy, but he has a weird way of doing it. Just, you know, we’re different characters, right? So he just is a bit different in the way. one, one of the things my brother said was that I picked up, I reckon it was five, six years ago is he’s in it for the long game. Jennifer Tomscha (52:03) Hmm. Bill Gasiamis (52:04) When I was young, I had 20 jobs in 10 years. He said two jobs in 40 years or 30 in 30 years. So he just chips away, works away, works away, works away. This is an analogy, right? But also a true story. My wife started her, her, her master’s in psychology. She only started that a few years ago, but the whole. Jennifer Tomscha (52:08) Hmm. Hmm. Bill Gasiamis (52:28) journey to get to the Masters of Psych started in I think late 2011 or early 2011, about a year before I ended up in hospital. She is just now finishing the last part of her Masters degree and she found a job literally a week ago in her field two days a week. Jennifer Tomscha (52:35) Mm. Mmm. ⁓ Bill Gasiamis (52:56) to work as a provisional psychologist so that she can get the 1500 hours of work in the field before she actually gets her actual full psychology license. And I’m like, dude, I get it. So what you’re telling me is that if you just start and never stop, you’re gonna see some kind of progress. And I apply that to… Jennifer Tomscha (53:08) Right. That’s amazing. Mmm. Mm-hmm. Bill Gasiamis (53:27) stroke recovery. I know that people are dealing with far more deficits that perhaps you and I show visibly and that their hand may not specifically work the way that it always that they wanted it to work or that the way that it worked before. But that doesn’t mean the brain’s not continuously continuously healing that part of the brain might be gone. But as far as healing the parts around the brain that are still there, that’s continuing. Jennifer Tomscha (53:28) Uh-huh. Mm-hmm. Mm-hmm. Bill Gasiamis (53:58) And if, and, and one of the questions that I have for people is like, is what I’m doing supporting my recovery or is it hindering my recovery? Because I’ve met stroke survivors who have gone back to the smokes, who have gone back to alcohol. And if you’re doing things that are getting in the way of recovery, then you’re not allowing the brain to continuously do what it does best, which is overcome challenges, rewire. Jennifer Tomscha (54:05) Mmm. Bill Gasiamis (54:25) find new ways around, know, develop new neural pathways and adapt. And that’s kind of where I think it’s at adaption, right? And the great thing about understanding these days about neurodiversity and understanding what somebody with ADHD goes through is the one skill they’re really, really good at is adaption. Jennifer Tomscha (54:31) Mm-hmm. Mm, that’s interesting. Yeah, yeah. Mm-hmm. Bill Gasiamis (54:49) because and people with dyslexia. my God, like some of the biggest, most wealthy billionaires on the planet had dyslexia. Richard Branson is a classic example of that. Yeah. And they adapt. They find a way to somehow overcome the normal world and be weird in the way that they see letters and what letters do and how they move on a page and all that kind of stuff because their brain adapts and they can just continuously improve their adaption strategy. Jennifer Tomscha (54:57) really? didn’t know that. Mm-hmm. Bill Gasiamis (55:17) to get to a point where no one knows that they have this condition. So that’s what I’m really passionate about. That’s why the podcast exists. I’ve interviewed in my 400 episodes, I’ve certainly interviewed stroke survivors who I’ve had improvement 10, 11, 12, 13 years post stroke, got a finger movement back. Yeah, got sensation back, something rewired. So yeah. Jennifer Tomscha (55:19) Right. Mm-hmm. really? That’s amazing. Yeah, becau

SEO Summary: Scientific Comparable Sales Selection Using Z-Scores and Similarity Scoring Choosing comparable sales in real estate appraisal does not have to rely on judgment or guesswork. This podcast introduces a data-driven, scientific approach to comp selection using Z-scores, standardization, and similarity scoring. A Z-score measures how far a property feature—like square footage, age, lot size, or condition—is from the market average. This allows appraisers to compare different property characteristics on the same scale, eliminating bias caused by large numbers dominating smaller ones. Once the appraiser standardizes the features, the spreadsheet calculates a similarity score, a Z-Score. This combines all differences into a single number that shows how close each sale is to the subject property. The lower the distance, the better the comparable. This process is known as statistical distance analysis and replaces traditional methods like bracketing and subjective comparison. Such an approach also helps identify bad comps instantly. If any feature has a Z-score above ±2 or ±3, it signals a potential outlier that may distort value conclusions. By using standard deviation, regression analysis, and clustering, appraisers can improve accuracy, consistency, and defensibility. Key benefits include: Improved valuation accuracy Reduced selection bias Stronger USPAP compliance and defensibility Clear, repeatable methodology This modern appraisal technique aligns with data analytics, machine learning principles, and statistical modeling, making it essential for appraisers adapting to AI, AVMs, and evolving industry standards.  

Amazon verkauft im Rahmen der Frühlingsangebote das Fritz!Fon X6 Black für nur rund 66 Euro. Wir haben alle Infos zum AVM-Telefon für euch.

In this conversation, Kenon Chen, Executive Vice President of Strategy and Growth at Clear Capital, shares insights from his extensive career in the real estate and technology sectors. He discusses his career highlights, the evolution of Clear Capital, and the lessons learned in leadership. Kenon emphasizes the importance of authenticity, curiosity, and understanding market needs. He also outlines Clear Capital's innovative solutions and the technical challenges faced in the real estate market. Additionally, Kenon offers advice for aspiring PropTech founders and shares insights into his professional life and industry networking.   Takeaways   Survived the dot com boom and crash. Proud of the growth at Clear Capital. Authenticity is key in leadership. Focus on understanding customer problems. Curiosity drives better decision-making. Managing without authority is crucial. Clear Capital offers comprehensive property data solutions. Technical compliance is a major challenge. Networking is essential in PropTech. Removing friction in the loan process is vital.   Chapters   00:00 Career Highlights and Early Experiences 01:58 Evolution of Clear Capital 04:05 Lessons Learned from Failures 06:18 Guidelines for Aspiring Leaders 07:38 Clear Capital's Offerings 11:11 Technical Challenges in Real Estate 14:29 Advice for PropTech Founders 15:53 A Week in the Life of a Leader 17:22 Conferences and Networking in PropTech 18:44 Identifying Market Gaps 21:00 Rapid Fire Questions  

Mastering the Tape: Strategies for High-Volume Note InvestingWelcome to a special edition of Note Night in America! It is hard to believe that 2026 is already nearly a sixth of the way through. Time flies when deals are crossing your plate, and tonight we are diving deep into a massive new "tape" of 1,317 owner-financed notes that just hit the market. Whether you are a seasoned pro or just getting your feet wet, the sheer volume of opportunities available right now—especially across states like Texas, Florida, and Arizona—is staggering. We are breaking down how to stop "falling in love" with a single deal and instead start bidding at scale to ensure you actually get assets under contract.Five Key Takeaways from the 1,300+ Note TapeDon't Over-Analyze the Front End: Many investors waste hours on bid work; if you spend more than 30 minutes on a tape like this, you are over-thinking it.Bidding Without Addresses: High-level sellers often "mask" addresses to protect the privacy of their portfolios; you must learn to bid based on provided AVMs and ZIP codes, with the understanding that bids can "fade" once full due diligence begins.Targeting Double-Digit Yields: For performing notes, the goal is often a 16% yield on cash flow, allowing you to pay your investors a solid 7–9% while keeping the spread.Geographic Opportunities: While Texas leads the current tape with 425 notes, surprising opportunities are popping up in places like Alaska, which has 17 notes available—the most we've ever seen there.The Power of Volume: Instead of bidding on two notes, bid on twenty; increasing your volume significantly raises your chances of successful acquisitions in a competitive market.As we prepare for our upcoming three-day workshop in Austin, the focus remains on real-world application. From leveraging AI to finding deals and raising capital, the landscape of note buying is shifting. The world has changed quite a bit in the last year, and staying updated with new marketing tactics and vendor networks for BPOs and title work is essential for success.The window to act on this current tape is small, with bids due in just 48 hours. Success in this industry isn't about finding the "perfect" note; it's about understanding the numbers, staying disciplined with your yields, and having the courage to submit offers across multiple states. If you're ready to take your portfolio to the next level, it's time to dive into the spreadsheets and start bidding. We'll see you at the top! Watch the Original VIDEO HERE!Book a Call With Scott HERE!Sign up for the next FREE One-Day Note Class HERE!Sign up for the WCN Membership HERE!Sign up for the next Note Buying For Dummies Workshop HERE!Love the show? Subscribe, rate, review, and share!Here's How »Join the Note Closers Show community today:WeCloseNotes.comThe Note Closers Show FacebookThe Note Closers Show TwitterScott Carson LinkedInThe Note Closers Show YouTubeThe Note Closers Show VimeoThe Note Closers Show InstagramWe Close Notes Pinterest

Mastering the Tape: Strategies for High-Volume Note InvestingWelcome to a special edition of Note Night in America! It is hard to believe that 2026 is already nearly a sixth of the way through. Time flies when deals are crossing your plate, and tonight we are diving deep into a massive new "tape" of 1,317 owner-financed notes that just hit the market. Whether you are a seasoned pro or just getting your feet wet, the sheer volume of opportunities available right now—especially across states like Texas, Florida, and Arizona—is staggering. We are breaking down how to stop "falling in love" with a single deal and instead start bidding at scale to ensure you actually get assets under contract.Five Key Takeaways from the 1,300+ Note TapeDon't Over-Analyze the Front End: Many investors waste hours on bid work; if you spend more than 30 minutes on a tape like this, you are over-thinking it.Bidding Without Addresses: High-level sellers often "mask" addresses to protect the privacy of their portfolios; you must learn to bid based on provided AVMs and ZIP codes, with the understanding that bids can "fade" once full due diligence begins.Targeting Double-Digit Yields: For performing notes, the goal is often a 16% yield on cash flow, allowing you to pay your investors a solid 7–9% while keeping the spread.Geographic Opportunities: While Texas leads the current tape with 425 notes, surprising opportunities are popping up in places like Alaska, which has 17 notes available—the most we've ever seen there.The Power of Volume: Instead of bidding on two notes, bid on twenty; increasing your volume significantly raises your chances of successful acquisitions in a competitive market.As we prepare for our upcoming three-day workshop in Austin, the focus remains on real-world application. From leveraging AI to finding deals and raising capital, the landscape of note buying is shifting. The world has changed quite a bit in the last year, and staying updated with new marketing tactics and vendor networks for BPOs and title work is essential for success.The window to act on this current tape is small, with bids due in just 48 hours. Success in this industry isn't about finding the "perfect" note; it's about understanding the numbers, staying disciplined with your yields, and having the courage to submit offers across multiple states. If you're ready to take your portfolio to the next level, it's time to dive into the spreadsheets and start bidding. We'll see you at the top!Watch the Original VIDEO HERE!Love the show? Subscribe, rate, review, and share!Here's How »Join Note Night in America community today:WeCloseNotes.comScott Carson FacebookScott Carson TwitterScott Carson LinkedInNote Night in America YouTubeNote Night in America VimeoScott Carson InstagramWe Close Notes Pinterest

Dural arteriovenous fistula (DAVF) is a rare vascular condition where abnormal connections (fistulas) form between branches of arteries and veins in the dura mater, the brain's covering. The dural arteries deliver high-pressure, oxygen-rich blood to the brain, while the dural veins return deoxygenated, low-pressure blood to the heart. DAVF causes high-pressure arterial blood to flow into veins or sinuses meant for low-pressure blood, which can lead to ruptures, brain hemorrhages, and other neurological issues.Meet Dr. Aditya (Adi) Iyer, a board-certified, fellowship-trained neurosurgeon specializing in vascular diseases of the brain and spine at Pacific Neuroscience Institute®. As one of California's few dual-trained neurosurgeons, Dr. Iyer offers both minimally invasive open surgical techniques and incisionless catheter-based procedures to treat strokes, aneurysms, AVMs, tumors, and pain.

On this week’s episode, we’re continuing our Guidelines Series exploring the 2022 ESC/ERS Guidelines for the diagnosis and treatment of Pulmonary Hypertension. If you missed our first episode in the series, give it a listen to hear about the most recent recommendations regarding Pulmonary Hypertension definitions, screening, and diagnostics. Today, we’re talking about the next steps after diagnosis. Specifically, we’ll be discussing risk stratification, establishing treatment goals, and metrics for re-evaluation. We’ll additionally introduce the mainstays of pharmacologic therapy for Pulmonary Hypertension. Meet Our Co-Hosts Rupali Sood  grew up in Las Vegas, Nevada and made her way over to Baltimore for medical school at Johns Hopkins. She then completed her internal medicine residency training at Massachusetts General Hospital before returning back to Johns Hopkins, where she is currently a pulmonary and critical care medicine fellow. Rupali’s interests include interstitial lung disease, particularly as related to oncologic drugs, and bedside medical education. Tom Di Vitantonio  is originally from New Jersey and attended medical school at Rutgers, New Jersey Medical School in Newark. He then completed his internal medicine residency at Weill Cornell, where he also served as a chief resident. He currently is a pulmonary and critical care medicine fellow at Johns Hopkins, and he’s passionate about caring for critically ill patients, how we approach the management of pulmonary embolism, and also about medical education of trainees to help them be more confident and patient centered. Key Learning Points 1) Episode Roadmap How to set treatment goals, assess symptom burden, and risk-stratify patients with suspected/confirmed pulmonary arterial hypertension (PAH). What tools to use to re-evaluate patients on treatment Intro to major PAH medication classes and how they map to pathways. 2) Case-based diagnostic reasoning Patient: 37-year-old woman with exertional dyspnea, mild edema, abnormal echo, telangiectasias + epistaxis → raises suspicion for HHT (hereditary hemorrhagic telangiectasia) and/or early connective tissue disease. Key reasoning move: start broad (Groups 2–5) and narrow using history/exam/testing. In a young patient without obvious left heart or lung disease, think more about Group 1 PAH (idiopathic/heritable/associated). HHT teaching point: HHT can cause PH in more than one way: More common: high-output PH from AVMs (often hepatic/pulmonary) Rare (1–2% mentioned): true PAH phenotype (vascular remodeling; associated with ALK1 in some patients), behaving like Group 1 PAH. 3) Functional class assessment WHO Functional Class: Class I: no symptoms with ordinary activity, only with exertion Class II: symptoms with ordinary activity Class III: symptoms with less-than-ordinary activity (can't do usual chores/shopping without dyspnea) Class IV: symptoms at rest Practical bedside tip they give: Ask if the patient can walk at their own pace or keep up with a similar-age peer/partner. If not, think Class II (or worse). 4) Risk stratification at diagnosis: why, how, and which tools Big principle: treatment choices are driven by risk, and the goal is to move patients to low-risk quickly. ESC/ERS approach at diagnosis (as described): Use a 3-strata model predicting 1-year mortality: Low: 20% ESC/ERS risk assessment variables (10 domains discussed): Clinical progression, signs of right heart failure, syncope WHO FC Biomarkers (NT-proBNP) Exercise capacity (6MWD) Hemodynamics Imaging (echo; sometimes cardiac MRI) CPET (peak VO₂; VE/VCO₂ slope) They note: even if you don't have everything, the calculator can still be useful with ≥3 variables. REVEAL 2.0: Builds on similar core variables but adds further patient context (demographics, renal function, BP, DLCO, etc.) Case result: both tools put her in intermediate risk (ESC/ERS ~1.6; REVEAL 2.0 score 8), underscoring that mild symptoms can still equal meaningful mortality risk. 5) Treatment goals and follow-up philosophy What they explicitly prioritize: Help patients feel better, live longer, and stay out of the hospital Use risk tools to communicate prognosis and to track improvement Reassess frequently (they mention ~every 3 months early on) until low risk is achieved “Time-to-low-risk” is an important treatment goal Also emphasized: The diagnosis is psychologically heavy; patients need clear counseling, reassurance about the plan, and connection to support groups. 6) Medication classes for the treatment of PAH Nitric oxide–cGMP pathway PDE5 inhibitors: sildenafil, tadalafil Soluble guanylate cyclase stimulator: riociguat Important safety point: don't combine PDE5 inhibitors with riociguat (risk of significant hypotension/hemodynamic effects) Endothelin receptor antagonists (ERAs) “-sentan” drugs: bosentan (less used due to side effects/interactions), ambrisentan, macitentan Teratogenicity emphasized Hepatotoxicity that requires LFT monitoring Can cause fluid retention and peripheral edema Prostacyclin pathway Prostacyclin analogs/agonists: Epoprostenol (potent; short half-life; IV administration) Treprostinil (IV/SubQ/oral/inhaled options) Selexipag (oral prostacyclin receptor agonist) 7) Sotatercept (post-guidelines) They note sotatercept wasn't in 2022 ESC/ERS but is now “a game changer” in practice: Mechanism: ligand trap affecting TGF-β signaling / remodeling biology Positioned as potentially more disease-modifying than pure vasodilators Still evolving: where to place it earlier vs later in regimens is an active question in the field 8) How risk category maps to initial treatment intensity General approach they outline: High risk at diagnosis: parenteral prostacyclin (IV/SubQ) strongly favored, often aggressive early Intermediate risk: at least dual oral therapy (typically PDE5i + ERA); escalate if not achieving low risk Low risk: at least one oral agent; many still use dual oral depending on etiology/trajectory For the case: intermediate-risk → start dual oral therapy (they mention tadalafil + ambrisentan as a typical choice), reassess in ~3 months; add a third agent (e.g., selexipag/prostacyclin pathway) if not low risk.  References and Further Reading Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Rådegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S; ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022 Oct 11;43(38):3618-3731. doi: 10.1093/eurheartj/ehac237. Erratum in: Eur Heart J. 2023 Apr 17;44(15):1312. doi: 10.1093/eurheartj/ehad005. PMID: 36017548. Condon DF, Nickel NP, Anderson R, Mirza S, de Jesus Perez VA. The 6th World Symposium on Pulmonary Hypertension: what’s old is new. F1000Res. 2019 Jun 19;8:F1000 Faculty Rev-888. doi: 10.12688/f1000research.18811.1. PMID: 31249672; PMCID: PMC6584967. Maron BA. Revised Definition of Pulmonary Hypertension and Approach to Management: A Clinical Primer. J Am Heart Assoc. 2023 Apr 18;12(8):e029024. doi: 10.1161/JAHA.122.029024. Epub 2023 Apr 7. PMID: 37026538; PMCID: PMC10227272. Hoeper MM, Badesch DB, Ghofrani HA, Gibbs JSR, Gomberg-Maitland M, McLaughlin VV, Preston IR, Souza R, Waxman AB, Grünig E, Kopeć G, Meyer G, Olsson KM, Rosenkranz S, Xu Y, Miller B, Fowler M, Butler J, Koglin J, de Oliveira Pena J, Humbert M; STELLAR Trial Investigators. Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension. N Engl J Med. 2023 Apr 20;388(16):1478-1490. doi: 10.1056/NEJMoa2213558. Epub 2023 Mar 6. PMID: 36877098. Ruopp NF, Cockrill BA. Diagnosis and Treatment of Pulmonary Arterial Hypertension: A Review. JAMA. 2022 Apr 12;327(14):1379-1391. doi: 10.1001/jama.2022.4402. Erratum in: JAMA. 2022 Sep 6;328(9):892. doi: 10.1001/jama.2022.13696. PMID: 35412560.

Ethics Is Not Just Compliance: What USPAP Is Really Asking of Appraisers In this episode, we take a clear-eyed, plain-language look at professional ethics in real estate appraisal.  And why ethics is far more than rule-following or box-checking. Too often, ethics is treated as compliance: follow USPAP, disclose conflicts, don't lie, don't cheat. All of that matters, true.  But it's not the whole story. This episode explores what USPAP is actually designed to do.  It differentiates between honest mistakes, professional carelessness, and intentional bias.  And it makes clear why those distinctions matter for public trust, credibility, and the future of the appraisal profession. We walk through three fundamentally different kinds of ethical failure that appraisers face in the real world: • Carelessness and negligence.  This is when assumptions go untested or data goes unchecked• Knowing misrepresentation.  When an appraiser recognizes a problem but proceeds anyway• Systemic pressure.  Those times when speed, volume, or client influence quietly undermine independence Using USPAP SR 1-3 and SR 2-3, this episode explains why intent matters just as much as accuracy, and why a report can be “technically correct” yet ethically indefensible. We unpack why USPAP places responsibility squarely on the appraiser, even when the system makes ethical practice uncomfortable. This is not a scolding and not a lecture. It's a professional conversation about judgment, responsibility, and what it actually means to sign your name to an appraisal certification. If you're an appraiser, reviewer, regulator, attorney, or lender who wants to understand why USPAP is written the way it is, how ethics differs from mere compliance, and why professional judgment cannot be delegated to forms, templates, AVMs, or clients, then this episode of the Appraiser’s Advocate is for you. Because USPAP isn't asking for perfection.

Jamie Pritchard is the Sales Director at MS Lending Group, a specialist lender in Manchester founded in 2021 by Michael Stratton, which has grown into a key player in short term bridging finance for residential and commercial properties.Bringing over 20 years of experience, Jamie joins us to discuss the real limits of artificial intelligence in short term lending. He explains why his team relies on AVMs and desktop valuations to deliver 70+ deals monthly, yet draws a firm line at full AI underwriting.

This Listing Bits episode is now available on your favorite podcast player! Overview Greg Robertson sits down with industry veteran Amy Gorce of REdistribute to clarify what REdistribute actually does, how it differs from display-focused data platforms, and why MLSs should care about the exploding gray-market use of MLS data. Amy breaks down the institutional-buyer use cases, explains how gray-market pipelines emerged, and outlines why MLS participation directly impacts valuation accuracy, AVMs, risk modeling, and overall market health. Key Takeaways  • REdistribute is not a display vendor. Their data is used solely for institutional-grade analytics, AVMs, risk modeling, and portfolio management—never for consumer-facing listing display.    • Owned by MLSs, built for MLSs. The operating agreement limits eligible purchasers and prevents MLSs or brokers from using the data for competitive display products.    • The gray market is real and accelerating. Companies scrape, partner with brokers, or purchase unclear data sources to fuel AVMs and risk tools—often without MLS compensation. REdistribute is actively converting gray-market users.    • AI is making the problem bigger. Scraping tools, automated ingestion, and LLM training pipelines are proliferating. REdistribute is building an MCP server to support AI-specific use cases in a controlled and compliant way.    • Coverage, not demand, is the bottleneck. Institutional buyers are ready, but MLS participation is still below critical mass (~55–60% coverage). More MLSs joining closes the gap and increases revenue potential.    • Economics vary by use case. AVM licensing generates significantly higher value than simple match-and-append use cases—creating real opportunities for meaningful revenue distribution back to MLSs and brokers.    • Joining is simple. MLSs sign a license agreement and can be onboarded in roughly two weeks, with quarterly revenue distributions.   Links  • The Market Value of Listing Data—and the Cost of the Grey Market - White Paper Contact Amy Gorce Allison Duggins Sponsors Trackxi - Real Estate's #1 Deal Tracking Software Giant Steps Job Board – Where ORE gets hired Production and editing services by: Sunbound Studios  

This week's episode is a masterclass on vascular anomaly treatment. Brush up on your malformations with Dr. Cliff Weiss, the Director of the Vascular Anomaly Center at Johns Hopkins. He shares next-level techniques, precision diagnostics, and his 'gold standard' approach to alcohol sclerotherapy.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/---SYNPOSISThe episode begins with the most vital component of patient care: establishing a correct diagnosis through proper classification. Dr. Weiss shares his philosophy that “MRI is a conversation” - not just an image, detailing the specific MRI protocols to confidently make a diagnosis over 90% of the time. He then shares an overview of the classification system, differentiating vascular tumors like hemangiomas from high-flow and low-flow vascular malformations.Dr. Weiss explores a wide array of treatment strategies tailored to each diagnosis. He walks through his techniques for treating low-flow malformations with sclerotherapy—using agents like alcohol, doxycycline, and bleomycin based on a lesion's location and characteristics—and his use of cryoablation for vascular tumors. He then dives into the creative and high-stakes approaches for treating AVMs, comparing transvenous and transarterial embolization with agents like Onyx and coils, before concluding with his predictions on the future of IR in the field.---TIMESTAMPS00:00 - Introduction 02:36 - Vascular Anomaly Center at Johns Hopkins06:33 - Vascular Anomaly & Malformation Diagnosis with Imaging09:04 - Classifying Vascular Anomalies15:55 - Vascular Tumors18:46 - Low-Flow Malformations27:58 - Needle Placement29:56 - Retro-orbital & ENT Malformations32:44 - AVM Treatment Strategy40:41 - Following up with Patients

1. Getting Leads from AIAI can help you find and qualify homeowners who may be interested in a second mortgage (home equity loan or HELOC). Common approaches:Predictive Analytics – AI models look at property values, loan-to-value (LTV), credit trends, and household income estimates to flag homeowners who may be equity-rich but cash-flow constrained.Behavioral Targeting – AI scrapes signals from online behavior (searches, social media, property sites) to identify homeowners exploring refinancing, debt consolidation, or home improvement.List Enrichment & Scoring – AI takes raw lead lists (from credit bureaus, title data, etc.) and ranks prospects by likelihood of conversion.Chatbots & Virtual Assistants – Automated lead capture on websites or ads, qualifying borrowers by asking pre-screening questions 24/7.2. Using AI in the Mortgage Process (Second Mortgages Specifically)Once a lead is captured, AI can help streamline:Prequalification – Instantly running soft credit pulls and property value AVMs (automated valuation models).Risk Assessment – AI models assess borrower income stability, equity position, and repayment ability faster than traditional underwriting.Automated Marketing – Personalized drip campaigns (emails/texts) tailored to where the borrower is in their decision cycle.Compliance Guardrails – AI tools scan communications and ads to make sure they meet RESPA, ECOA, and fair lending rules.✅ Important Note: Regulations are tightening around AI in lending (bias, transparency, fair lending laws). Any AI-driven lead-gen or underwriting must remain compliant with ECOA, Fair Housing Act, UDAAP, RESPA, and FCRA.Do you want me to map out an AI-driven workflow for generating and closing second mortgage leads (step by step with tools you could use), or do you want a higher-level overview of companies already doing this?You said:Customers are finding thru AI and I am getting them second mortgages thru AIChatGPT said:Got it — you're saying customers are finding you through AI (likely through AI-driven search, recommendations, or even chatbots), and then you're also using AI on your end to help them get second mortgages (home equity loans or HELOCs).Here's how that usually plays out, and how you can structure it:

Was haben automatisierte Bewertungsmodelle mit Grillen zu tun? Eine ganze Menge – denn wie beim Grillen geht es auch bei Automated Valuation Models (AVMs) um das richtige Zusammenspiel vieler Zutaten, das perfekte Timing und am Ende um ein Ergebnis, das überzeugen muss. Doch während beim Grillabend der Geschmack entscheidet, braucht es in der Immobilienbewertung belastbare Daten, transparente Methoden – und ein gutes Maß an Verständnis für komplexe Modelle. In dieser Folge von IMMOblick tauchen Peter Ache und Robert Krägenbring gemeinsam mit Prof. Dr. Christian Müller-Kett tief ein in die Welt der datengetriebenen Wertermittlung. Christian, der als Data Scientist und Geoinformatiker nicht nur fachlich sattelfest ist, sondern auch komplexe Sachverhalte verständlich erklären kann, macht klar: AVMs sind keine einfache Rechenmaschine. Sie bestehen aus aufeinander aufbauenden Prozessen, in denen Algorithmen, Frameworks, Methoden und sogenannte Hyperparameter zusammenspielen – oft in einer für Außenstehende kaum nachvollziehbaren »Blackbox«. Wie man ein Modell von einem einfachen Workflow abgrenzt, worauf es beim sogenannten „Feature Engineering“ ankommt, und welche Rolle Transparenz und Unsicherheiten spielen – all das wird praxisnah diskutiert. Besonders spannend: die internationale Perspektive, etwa durch den Austausch beim AVM-Workshop auf Zypern. Dort wurde deutlich, dass andere Disziplinen wie die Rechtswissenschaft eigene, teils kritische Anforderungen an die Nachvollziehbarkeit von Modellen stellen – und dass es in Deutschland Nachholbedarf gibt. Christian zeigt auf, wie erklärbare künstliche Intelligenz (XAI) helfen kann, selbst komplexe Verfahren wie Random Forests nachvollziehbar zu machen – etwa mit Hilfe von Shapley-Werten oder Modell-Dokumentation. Gleichzeitig bleibt eines klar: Kein Modell ist perfekt. Und gerade in der Immobilienbewertung braucht es neben Statistikkenntnissen vor allem eins – Urteilsvermögen und kommunikative Stärke, um Ergebnisse einordnen und erklären zu können. Peter und Robert fragen gewohnt kritisch nach, bringen Beispiele aus der Praxis ein und nehmen auch die Perspektive der Sachverständigen in den Blick. Und ja – gegrillt wird auch: nicht nur der AVM-Prozess, sondern auch Christian, der charmant und fundiert Rede und Antwort steht. Eine Folge mit fachlicher Tiefe, einer Prise Humor und jeder Menge Erkenntnisse für alle, die sich für die Zukunft der Immobilienbewertung interessieren. Reinhören lohnt sich – nicht nur zur Grillsaison. Weitere Informationen findest du hier: Webseite: https://dvw.de/publikationen/immoblick Social Media: LinkedIn | Instagram | Facebook

Here's a simple and clear breakdown of how AI is making second mortgages easier for homeowners and lenders alike:

Was ist eigentlich eine Versicherung? Wie funktioniert unsere OKP? Was ändert sich mit EFAS? Und warum keine Einheitskasse?Diese und viele weitere Fragen klären wir mit Otti Bitterli (ehem. CEO der Sanitas). Er erklärt uns Begriffe wie Risikoausgleich, Vertragszwang, Umlageverfahren, AVMs und noch viel mehr. Eine mega spannende Folge mit einem echten Kenner - merci tuusig Otti für deine Zeit!Lieblingsgegenstand:Sessel und Buch in Reichweite

In this episode, we sit down with Paul Chandler, a leading voice in the appraisal industry. As President of the Northern California Chapter of the Appraisal Institute and Chair of the Industry Advisory Council for the Appraisal Foundation, Paul is at the forefront of key industry discussions. We dive into the future of appraisal modernization, the evolving role of AVMs, and the growing influence of artificial intelligence in valuations. Paul also shares insights from his work on the Appraisal Foundation's AVM Task Force and breaks down what's behind the "AI Hype" and the industry's "Need for Speed."Tune in to hear why keeping human expertise in the process is more important than ever.At The Appraisal Buzzcast, we host weekly episodes with leaders and experts in the appraisal industry about current events and relevant topics in our field. Subscribe and turn on notifications to catch our episode premieres every Wednesday!

Targeted, image-guided interventions can make a big difference for patients with hereditary hemorrhagic telangiectasia (HHT). Learn how in this week's BackTable episode featuring Dr. Clifford R. Weiss (Director of the Johns Hopkins Vascular Anomalies Center and HHT Center of Excellence) and host Dr. Michael Barraza. --- SYNPOSIS Dr. Weiss delves into the complexities and multisystem nature of HHT, emphasizing the significance of early diagnosis and multidisciplinary care. He goes on to explain the clinical criteria for diagnosing HHT, the role of genetic and imaging screenings, and the evolving approaches to treating pulmonary arteriovenous malformations (AVMs) in adults and children. The doctors discuss the potential impact of anti-angiogenic medications on the future management of HHT. The episode closes with a nod to the pivotal role that HHT Centers of Excellence play, and the ongoing dedication to improving patient outcomes through collaborative care and innovative research. --- TIMESTAMPS 00:00 - Introduction 03:57 - Diagnosing and Screening for Hereditary Hemorrhagic Telangiectasia (HHT) 07:37 - Treatment Approaches for HHT 12:12 - Embolization Techniques and Safety Measures 19:02 - Future of HHT Treatment and Research 22:30 - Conclusion and Final Thoughts --- RESOURCES The Johns Hopkins Hereditary Hemorrhagic Telangiectasia (HHT) Center of Excellence: https://www.hopkinsmedicine.org/interventional-radiology/hht

Companion Episode: Cerebral Aneurysms, AVMs, and Intracranial Hemorrhage Companion Episode: Cerebral Aneurysms, AVMs, and Intracranial Hemorrhage Differentiation Cerebral Aneurysms vs. Arteriovenous Malformations (AVMs) Cause of Hemorrhage: Cerebral Aneurysm: Weakening and bulging of an arterial wall. AVM: Abnormal connection between arteries and veins without capillaries. Location: Cerebral Aneurysms: Frequently at arterial bifurcations in the Circle of […] The post 125b Retention Practice & PANCE Questions for Cerebrovascular disorders appeared first on Physician Assistant Exam Review.

This week on the Power House Podcast, HousingWire CEO Clayton Collins sat down with loan originator turned software executive: Jeff Bell, President at Uplist. Jeff joins us to talk about four really pertinent topics in today's market: leadership, learning, loan monitoring, and recapture. Uplist just launched what it says is a killer new tool that will help loan officers automatically generate refinance options for their clients. The technology, called “Recapture,” is integrated with the leading pricing engines, and it provides LOs with timely, accurate data that identifies multiple refi opportunities for clients. Unlike rate alert tools, Uplist's product fully automates the refinance analysis process. This includes property ownership checks, automated valuation models (AVMs), loan amount amortization and financial benefit calculations. Those four topics (leadership, learning, loan monitoring, and recapture) discussed in this episode are going to be hotly discussed at this year's MBA Annual in Denver. Listen in for insightful discussion about streamlining the loan monitoring process, competing in a refinance mortgage market, coaching and more! HousingWire will be hosting a happy hour on Monday night at this year's MBA Annual. You can register here. Here's what you'll learn: Coaching can significantly impact personal and professional growth. Knowing how to use the right technology correctly is more important than just having technology. Prioritize proactive communication with clients instead of reactive. Understanding the nuances of a competitive landscape is key for originators. Leadership development should always be ongoing. Related to this episode: Uplist launches automated refi analysis tool | HousingWire MBA Annual 2024 HousingWire Cocktail Party Jeff Bell | LinkedIn Uplist | LinkedIn HousingWire IMB Summit On-Demand Enjoy the episode! The Power House podcast is a show about leadership, markets and entrepreneurship in the housing industry. Each Thursday, Clayton Collins speaks with CEOs and founders from the mortgage and real estate sector to reveal how housing executives think about business growth, operational strategy, and leadership. The Power House podcast reveals the full picture through the stories of the industry's most impactful leaders. Clayton Collins is the CEO of HousingWire, and the Power House podcast is produced by HousingWire's Content Studio. Initially launched in 2019 as the Housing News podcast, the show was relaunched as Power House in 2024. Learn more about your ad choices. Visit megaphone.fm/adchoices

UCSF neurosurgeon Ethan Winkler, MD, PhD, summarizes the surgical treatment options for patients with arteriovenous malformations (AVMs) and describes the decision-making process for choosing the best treatment for each individual. Series: "UC San Francisco News" [Health and Medicine] [Show ID: 40237]

UCSF neurosurgeon Ethan Winkler, MD, PhD, summarizes the surgical treatment options for patients with arteriovenous malformations (AVMs) and describes the decision-making process for choosing the best treatment for each individual. Series: "UC San Francisco News" [Health and Medicine] [Show ID: 40237]

UCSF neurosurgeon Ethan Winkler, MD, PhD, summarizes the surgical treatment options for patients with arteriovenous malformations (AVMs) and describes the decision-making process for choosing the best treatment for each individual. Series: "UC San Francisco News" [Health and Medicine] [Show ID: 40237]

UCSF neurosurgeon Ethan Winkler, MD, PhD, summarizes the surgical treatment options for patients with arteriovenous malformations (AVMs) and describes the decision-making process for choosing the best treatment for each individual. Series: "UC San Francisco News" [Health and Medicine] [Show ID: 40237]

We've been hearing the rumblings: Some appraisers believe the end is near for the appraisal profession. Listen in as Bryan and his guest Simon Blackburn discredit that notion. Blackburn is founder and CEO of MtgeFi, a company that forecasts mortgage trends. In the episode, he discusses his recent article, "Top 10 Reasons Appraisals Are Here to Stay and Critical to U.S. and Global Markets."

In this episode of "Real Estate Success: The Whissel Way," hosts Kyle Whissel and Bryan Koci delve into the crucial aspects of real estate valuation. They discuss the importance of setting the right price for homes, understanding market conditions, and effectively communicating these factors to sellers. The episode covers key strategies for assessing property value, including analyzing market trends, bracketing neighborhoods, and using comparable sales. The hosts also highlight common pitfalls agents encounter and provide tips on overcoming challenges posed by automated valuation models (AVMs). This episode offers valuable insights for agents aiming to refine their pricing strategies and enhance their real estate expertise. YouTube Chapters 00:00 - Introduction and Episode Overview 00:34 - Importance of Real Estate Valuation 02:17 - Factors in Pricing a Home 03:18 - Understanding Market Conditions 06:02 - Comping Properties: Key Criteria 10:30 - Common Pricing Mistakes to Avoid 13:07 - Unique Property Features and Valuation 14:05 - Impact of Automated Valuation Models (AVMs) 16:09 - The Future of Real Estate Pricing Technology 17:47 - Whissel Widget of the Week

We welcome Dr. David Penn of Nuvance Health. Dr. Penn is a neurosurgeon with areas of expertise including treatment of complex brain tumors, such as acoustic neuromas and meningiomas, vascular malformations, such as aneurysms and AVMs and cerebral bypass. Ray Graf hosts.

Feeling isolated after your diagnosis? Finding your tribe is life altering and tremendously helpful in facilitating your treatment and recovery from brain surgery and bleeds. TAAF is The Aneurysm and AVM Foundation, a foundation focused on supporting brain bleed survivors, grieving families, caregivers, and research. In this episode, Eryn interviews Dina Chon, the executive director of TAAF. The two discuss the mission and work of TAAF which supports individuals who have experienced brain bleeds and provide resources and information to the community. SummaryDina shares the history of the TAAF Foundation and how it has grown over the years. They also talk about the importance of acknowledging and embracing all emotions, not just happiness, in the healing process. In this conversation, Dina Chon discusses her personal experience with her mother's brain aneurysm and how it led her to leading The Aneurysm and AVM Foundation. She shares the importance of support groups and the impact they can have on survivors and their families. Dina also highlights the various programs and resources offered by TAAF, including brain buddies, fundraising events, and research grants. She emphasizes the power of community and the role of TAAF in providing support, education, and advocacy for those affected by brain aneurysms and AVMs. Keywordsbrain bleeds, Aneurysm and AVM Foundation, TAAF, support, resources, emotions, healing, brain aneurysm, AVM, support groups, TAAF, The Aneurysm and AVM Foundation, brain buddies, fundraising events, research grants, community, support, education, advocacyTakeawaysThe Aneurysm and AVM Foundation (TAAF) is an organization that supports individuals who have experienced brain bleeds and provides resources and information to the community.TAAF was founded by a neurosurgeon and his nurse who wanted to do more for patients beyond medical treatment.TAAF offers support groups and resources for individuals and families affected by brain bleeds.It is important to acknowledge and embrace all emotions, not just happiness, in the healing process. Support groups can provide a sense of community and understanding for survivors and their families.The Aneurysm and AVM Foundation (TAAF) offers various programs and resources, including brain buddies, fundraising events, and research grants.TAAF focuses on research, programming, and providing support to survivors and their families.Fundraising is essential for TAAF to continue its work in supporting and advocating for those affected by brain aneurysms and AVMs.Getting involved with TAAF, whether through fundraising or participating in support groups, allows individuals to give back and help others in the community.Sound Bites"If it bleeds, TAAF leads.""I would literally program myself to work all day and help people 24 hours.""I am non-robot for sure.""My mom was lying in the bathroom. She'd gotten up to use the restroom, I'm assuming, and she'd ruptured.""She opens her eyes and she looks at me and she tells me she loves me. And she passes out and she dies.""We're going to be like you."Chapters00:00Introduction and Starting the Conversation03:19The History and Growth of TAF08:03Dina's Journey to TAF12:16The Role of TAF in Serving the Community14:24Embracing All Emotions in the Healing Process18:04Supporting Individuals at Every Stage22:54Personal Experience with Brain Aneurysm28:44The Importance of Support Groups32:40Programs and Resources Offered by TAF36:53Fundraising for Research and Support45:17Getting Connected with TAFReach out toEryn on

Dural arteriovenous fistula (DAVF) is a rare vascular condition where abnormal connections (fistulas) form between branches of arteries and veins in the dura mater, the brain's covering. The dural arteries deliver high-pressure, oxygen-rich blood to the brain, while the dural veins return deoxygenated, low-pressure blood to the heart. DAVF causes high-pressure arterial blood to flow into veins or sinuses meant for low-pressure blood, which can lead to ruptures, brain hemorrhages, and other neurological issues.Meet Dr. Aditya (Adi) Iyer, a board-certified, fellowship-trained neurosurgeon specializing in vascular diseases of the brain and spine at Pacific Neuroscience Institute®. As one of California's few dual-trained neurosurgeons, Dr. Iyer offers both minimally invasive open surgical techniques and incisionless catheter-based procedures to treat strokes, aneurysms, AVMs, tumors, and pain.Discover expert care and advanced treatment options with Dr. Iyer, dedicated to ensuring the best outcomes for your vascular health.

The trigeminal autonomic cephalalgias are a group of headache disorders that appear similar to each other and other headache disorders but have important differences. Proper diagnosis is crucial for proper treatment.  In this episode, Gordon Smith, MD, FAAN, speaks with Mark Burish, MD, PhD author of the article “Cluster Headache, SUNCT, and SUNA,” in the Continuum April 2024 Headache issue. Dr. Smith is a Continuum Audio interviewer and professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Burish is an associate professor at UT Health Houston in Houston, Texas. Additional Resources Read the article: Cluster Headache, SUNCT, and SUNA Subscribe to Continuum: continpub.com/Spring024 Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Transcript Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the Show Notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the Show Notes. AAN members: stay tuned after the episode to hear how you can get CME for listening.   Dr Smith: This is Dr Gordon Smith. Today, I'm interviewing Dr. Mark Burish on cluster headache, which is part of the April 2024 Continuum issue on headache. Dr Burish is an Associate Professor of Neurology at the University of Texas Health Science Center at Houston, which is located in Houston, Texas. Mark, thanks so much for joining me today on Continuum Audio. I was really excited to be asked to talk with you about this article. When I recertified from my boards the last time (and actually, it will be the last time I have to take the exam), I did the AAN course on all of neurology. And I'm a neuromuscular guy, right, and so I was actually kind of worried about the headache part because I thought, “How interesting could that be?” And I was blown away at how fascinating headache has become, and in particular, your topic (cluster, SUNCT, SUNA, the trigeminal autonomic cephalalgias) - such a great topic. But before we start talking about them, I'd love to just hear more about how you got interested in this area - both headache, this topic in particular. What's your story, Mark? Dr Burish: Well, thank you very much for having me. I'm honored to be part of this. I got into headache probably the way many people do; is, in residency, you figure out what you like, and your residency clinic tends to start collecting patients that you like (not that you're trading them with other residents, but you see certain patients). And mine (by the end of residency) had a lot of headache and pain patients into it. Then, I was very fortunate and had the opportunity to do some research as part of my career. I'm an MD-PhD, and I spend about half my time now doing research on cluster headaches, so I'm very fascinated by these types of diseases. Dr Smith: Can you tell us really briefly what you're working on in your research? Dr Burish: Cluster headache is such a poorly researched area. There's not a lot of people in it, so we do a little bit of everything: we have a clinical trial going; we do some basic science on the circadian mechanisms (cluster gets this very weird timing to it, where the headaches happen same time every day); and we do a little bit of starting to wade into the genetics. Dr Smith: Well, super exciting. I was actually blown away by the statistics on cluster (as common as multiple sclerosis), and the severity of pain I was amazed to learn is above that of childbirth (it was, like, between nine and ten out of ten, which is really crazy). And I'm worried that I missed these patients in my neuromuscular clinic. So, maybe we can begin by - just tell us what you think our listeners need to know. If they have to drop off right now, what message do they need to remember from our conversation? Dr Burish: I think there's two things. First of all, the first-line treatments for these headaches have not changed recently. For cluster headache, you still treat it with oxygen, the triptans (the faster triptans; not the oral ones, but the injectables and nasals), and you prevent them with verapamil. For SUNCT and SUNA, you use lamotrigine. So, those have not changed over time. There are some new treatments, which we'll talk about later. Then the second point is, there are four different types of headaches in this family and they all look very, very similar (one-sided pain, autonomic features, ipsilateral lacrimation, rhinorrhea - that type of thing). They differ in the treatments and how long they last. If you get them wrong (if you misdiagnose them), you're probably not going to give them correct treatment. Indomethacin works very well for two of them (the ones with hemicrania in the name, so not the ones we're going to discuss today). And then SUNCT, SUNA, and cluster headache - indomethacin does not work very well. So, it's important to distinguish them and get them right. Dr Smith: Maybe we can start there, Mark. I mean, I was kind of appalled to learn that the average delay in diagnosis is four to nine years in your article, and given the severity of pain and the impact it has on these patients, that's clearly a challenge. What's so hard about this? And do you have pearls on how we can recognize these patients? And how do you sort this out practically in clinic? Dr Burish: For cluster headache patients especially, it is a lot more common than we would think it is, but it still goes misdiagnosed, partly because most cluster headache patients are episodic. So, there's an episodic version where you get them every day for a few weeks and then they might go away for a year. So, I think what happens is that patients start to get into a cycle and they either get confused for sinusitis (because it happens in the spring), or they schedule a visit with a neurologist or somebody else, but the headaches are over by the time they see them, and they cancel the visit. So, I think they get misdiagnosed partly because it's either confused or they don't see doctors fast enough. I think a little bit more awareness of what this disease is and then, somehow, a mechanism to get these patients in a little bit more urgently is probably what's necessary. Dr Smith: Well, Mark, access is a real issue in neurology more broadly, and I'd love to talk to you about that in a moment, but I wonder if we could go back. You talked about how similar these are to one another, yet the treatments are different. How do you sort out the diagnosis when you're seeing a patient? Let's say you have someone who comes in who has episodic, unilateral, very severe pain and some of these autonomic features. What are the pearls for differentiating cluster, SUNCT, and SUNA from each other? Dr Burish: The big difference between all these different headaches is the timing. As a general rule, SUNCT and SUNA attacks last seconds (they're very similar to trigeminal neuralgia); paroxysmal hemicrania (that's one of the hemicrania ones, where indomethacin helps) - those attacks last minutes; cluster headache attacks last about an hour; and the hemicrania continua is constant (that's the other hemicrania one where indomethacin works). The other part is how often they happen. Again, SUNCT and SUNA - very similar to trigeminal neuralgia, may happen hundreds of times a day; paroxysmal hemicrania - dozens of times a day; cluster headache - maybe a handful of times; and then, hemicrania is constant. Based on how long the attacks are and how frequent the attacks are, you can generally separate them out. And if you're not sure, just try indomethacin. And then if it doesn't work, you're trying to distinguish between SUNCT and SUNA, which lasts seconds, and cluster headache, which lasts an hour, so fairly easy to distinguish those. Dr Smith: How long does it take to medicine to work in a patient with hemicrania continua or paroxysmal hemicrania? I'll remind our listeners - there's a separate article in the same issue of Continuum on that topic - but for our purposes, let's say you try that; how long do you need to try it? Dr Burish: Yeah, there's a great, another article about how much to give and how it works. It is generally pretty quick. I have noticed with most patients that the onset is twenty-four to forty-eight hours. And then, if you stop the medicine, the same thing - offset is kind of twenty-four to forty-eight hours. So, patients know pretty quick whether it's going to work. Dr Smith: Wow - that's awesome. One of the things I was interested in was so-called “secondary cluster.” So, you've seen your patient and let's say you've diagnosed them with cluster (primary cluster). Do you do additional testing? Do they need imaging or other laboratory workup? Dr Burish: Yeah. The differential for cluster (and cluster is the one that we know the most about; it is the most common of all the trigeminal autonomic cephalalgias) - it's a fascinating differential. If you don't know much about them, migraine is probably the most common. If you do know a lot about them, hemicrania continua and paroxysmal hemicrania are very common. But there's all these secondary headaches that can look identical to cluster headache; these pituitary hormone-secreting tumors (prolactinomas) - things like that. So, because all these other secondary causes can happen, they generally recommend everybody gets an MRI of the brain, with or without contrast. If that is normal and the patients continue to not respond to the medicines like you expect them to (verapamil doesn't work, oxygen doesn't work, and so forth), then you might do some additional testing for pituitary bloodwork. So, just kind of a panel of hormones, looking at blood vessels (because there are some cases that dissections or AVMs can cause cluster headaches). And then sometimes get imaging of the apex of the lung because there's some data that - with the Horner syndrome - that that might be relevant. Dr Smith: I'll refer our listeners to your article, just in general, because they really need to read it. It's fantastic. But your discussion about the neuroanatomy is really cool, and probably more than we want to get into right now, but the intersection of the neuroanatomy with therapeutics, and some of these other potential etiologies. So, one thing I was really amazed by (or appalled by, frankly) was the frequency with which these patients have suicidal ideation, given the severity of the pain and, I assume, the long time it often takes to get this sorted out. How do you handle that in clinic? Do you have conversations with people about this? How often do you appreciate it? And any words of wisdom for those of us who might encounter these patients? Dr Burish: Yeah. It's not hard to imagine why patients would be suicidal with this. When you have pain that is a ten out of ten - and patients who have also had childbirth and cluster, they consider childbirth more around a seven - so you can imagine how painful this is and what thoughts might be going through people's heads. It tends to be (in my personal experience and some emerging data) that they are suicidal during a cycle. So, for these episodic patients (most patients are episodic with cluster headache for a few weeks), they are suicidal during those weeks. And when the headaches go away, much less risk of suicide. So, during the cycle, I try to get my patients in as fast as possible, get the medications in as fast as possible, but basically just be there to let them know that we have options, and so that they consider me as their first option, rather than something darker. Dr Smith: How successful is first-line therapy in these patients and what's your success rate with your initial attempt at treatment? Dr Burish: On the acute side, the as-needed medicines (sumatriptan, oxygen) - if you give an injection (not the oral; that takes too long) - incredibly effective; for most patients, one or both of those will work. We usually prescribe both because the injections - usually you can't get that many (they can be quite expensive, realistically speaking). But also, just practically speaking, patients can have headaches up to eight times a day and you're not really supposed to be taking sumatriptan eight times a day, so we also give oxygen (but then again, oxygen is not very portable, so that's where the sumatriptan comes in). On the preventive side - not great. There's been some studies suggest maybe fifty percent is as good as any preventive is going to work for you, and that's not considering side effects and other things that patients might stop them. So, we do need to have a few different preventive options and you may have to go through a few different things. Chronic cluster headache (which is the more rare version, where patients have them year-round) is anecdotally much more refractory to treatment. Dr Smith: Can you talk a little bit about bridge therapy? You differentiate bridge from prophylactic therapy in your article. Dr Burish: Yeah. When you're approaching one of these patients - let's say they're completely naive to any medications - usually we will give them a couple of as-needed, acute medications (sumatriptan injections and oxygen). We'll give them a preventive like verapamil, but the verapamil takes a few weeks to kick in. So, the obvious question is, “What am I supposed to do in the meantime, while you're ramping it up and it's kicking in?” So, we use these short-term preventives, which we call bridge therapies or transitional therapies. These are short-acting preventives; they kick in quick, but you can't take them for very long. The most common by far is prednisone. Or an occipital nerve block with some sort of steroid (so, steroids in some sort of fashion). We will usually give them right at the beginning of a cycle (right at the beginning of a flare for chronic cluster headache patients) while we are uptitrating something like verapamil. Dr Smith: This may be a really silly question, but the next time I see one of these folks and I want to start oxygen, how do I do it? What are the logistics of giving someone oxygen for this, and how do patients navigate that, right? If you're having eight attacks a day during a cluster and you work as a nurse in the headache clinic, you probably have oxygen there. But you get where I'm going, right? - it's logistically challenging. How do you order it, and do you have words of wisdom to make it easier for patients to use? Dr Burish: There's a whole kind of system of oxygen, durable medical equipment - stuff that I've had to learn. To boil it down, there are basically two types of oxygen. There's a concentrator - kind of just a machine that takes room air and turns it into about ten percent oxygen - that is sometimes effective for patients. But sometimes ten liters per minute (which is the highest that can give) is not enough and you need fifteen liters per minute. In that case, you need an oxygen tank (the big metal cylinders that you see with a extra device on top called a regulator, that can crank it up to fifteen liters a minute. For both of these - fifteen liters a minute - you're going to need a mask. The nasal canula is just - it doesn't get up to fifteen; it's not going to be enough, so we give you this bag mask (the non-rebreather mask, or the bag hanging out below it). You really need high dose, pure oxygen for these things to work, so you have to write orders that say, “fifteen liters a minute, with regulator and non-rebreather mask.” Dr Smith: I'll refer our listeners to your Continuum article. I know a lot of our listeners use Continuum at point of care. And, of course, you can access it electronically, so there's really great pearls there. Another question for you: CGRP agents have really transformed migraine; what role do they play, if any, in management of these headaches (cluster, SUNCT, and SUNA)? Dr Burish: I think this is a fascinating emerging area of cluster headache research. One of the studies in the last three years came out that it was successful for episodic cluster headache, called galcanezumab, and it did not work for chronic cluster headache. Meanwhile, a couple other CGRP companies have tried them and they were unsuccessful, at least according to the data on ClinicalTrials.gov. And some other CGRP studies are still emerging. We know that both migraine and cluster headache work on the trigeminal system (I mean, this is a trigeminal autonomic cephalalgia - it's in the name) and CGRP is involved in the trigeminal system. That's probably where the commonality between migraine and cluster headache come from - they both work on the same pain system. But why all of them seem to work for migraine and only some of them – you know, some of these medicines work for cluster headache - is a fascinating thing. Does that mean that we don't have the dose right? Does that mean that we don't have the timing of these clinical trials right? Does that mean it's just not as effective? And there's other things that are involved in cluster headache - it's an interesting mechanism that we can start to explore. Dr Smith: I wanted to learn more about the circadian aspects of this - I found that really interesting, and you commented that you're interested in that in a research perspective. Can you describe that phenomena a little bit and just tell us what your thoughts are? Dr Burish: The interesting thing about cluster headaches, specifically, is that the headaches happen, for most patients, the exact same time every day – so, within an hour each day. So, my patient usually will say, “They're at two AM.” Across different time zones, every study that's been done - well, not every study, but many studies have been done - two AM is the most common time of day. But if you ask an individual patient, patient number one will say, “They happen every day at two AM; patient number two will say, “They happen every day at three in the afternoon.” I had a patient who was, I think, kind of getting fed up with all the questions I was asking about his headaches, and he said, “Dr Burish, it's three o'clock; if you want to wait until three fifteen, I'm going to get a headache - you can see what it's like.” That's how sure he was about when the headaches were going to happen. And other than maybe hypnic headache, there are a few other headaches that have that level of circadian predictability. So, it's just an odd, curious, unique thing to these headaches and we don't quite understand why yet. Dr Smith: So, I'm curious if the time of day patients get their headaches is in any way correlated with other aspects of sleep phenotype, right? There's broad variability in your sleep phase - the length of it, when it starts and ends. Is there any relationship, in your experience, between the time of day (two AM, ten PM) and other aspects of their sleep? Dr Burish: We haven't seen that, to my knowledge. People have looked, for example, at sleep studies while patients are having attacks. These attacks occur out of REM sleep, non-REM sleep - it doesn't seem to matter. Anecdotally, patients will say, “My cycle last year - I had headaches every day at two AM. But my cycle this year - I have headaches every day at five in the afternoon.” So, even a same patient who, theoretically, is not having big sleep changes over different years, has different timing of attacks. Dr Smith: Mark, what's the latest thing? What's most exciting in the field that you can tell our listeners about? Dr Burish: There are a lot of new treatments for cluster headache. There's the galcanezumab, which we discussed a little bit. There is a new dose for prednisone. We weren't sure how effective it was; now we're using kind of neuroimmunology-level doses of prednisone (100 milligrams daily; kind of titrating down from there). And then there's an occipital nerve stimulator for the chronic cluster headache patients. Since the last Continuum review on this topic, these three trials have been successful, and I think what gets lost is how impressive each one of these is in different ways. The prednisone study is impressive because you had to study that medicine (which we thought worked but didn't have a good clinical trial), and it's really hard to enroll patients in a placebo-controlled study where you already think it works. Another was done by a large pharmaceutical company. This is not an advertisement for or against, but these companies have rarely ventured into studying cluster headache until recently. The third study, the stimulator study, was a ten-year, multisite study involving surgeons and neurologists - just a monumental effort. It's because of these impressive studies that we now have data on how to treat the patient. Dr Smith: Just so interesting. I tell you what - I mean, if you told me twenty years ago I would be this interested in headache, I would have said, “You're crazy.” But now I see why our residents are so interested in it and why you are. This is fascinating. I could keep going for another hour or two asking you questions, Mark, but maybe we can pivot back to where we began. You told us your story about enriching your resident clinic - and for those residents listening, those are words of wisdom right there, my friend. But here's my question for you: we've already talked about access to care and how you manage access for these patients, but we have a huge access issue in neurology broadly and we desperately need more neurologists. As you're probably aware, there are some of our colleagues that don't think pain is neurology (I'm not one of them, but I know some of them and respect them otherwise). If there's an access issue for neurology, there's a access crisis for pain neurologists. And you don't just see headache, as I understand it; you see other patients with pain. So, I want to give you the last few minutes of our Continuum Audio episode to do your pitch, right? What do you have to say to the residents that are listening to us (or students) about why you find managing pain so rewarding and why they should consider this as a field? Dr Burish: Yes - I also did a fellowship in pain medicine, in addition to my headache research, so I see a little bit of both. For me, the patients are very appreciative because you are talking with them about what they are interested in. They are not interested in the change in the MRI between last time - I mean, they are interested in it, but not as much as, “I hurt today.” So, patients are more than happy - they're very grateful that you are addressing their primary concern, the thing that they're going home with that day that they're worried about. For me, seeing these patients has been very rewarding. From the research side. I think it's fascinating that there's just not enough research in this area - you can create your own niche; you can look into your own mechanisms - there's just not a lot of people in this field. And then, I think from a clinical side, other than the rewarding nature of it, there's a lot of options that we have. There's all of these neuropathic medications; there's all these different headache medications. If you want to wade into the procedural side of things (which I did with pain management), you can get into fluoro-guided procedures and spinal cord stimulators and all these different options that we have for these patients that help them, in addition to whatever they're going through. I have patients that then come back and say, “Well, by the way, I have these seizures; do you mind helping me kind of just go through my antiepileptics.” And they're generally well controlled and they consider me kind of a general neurologist for them. So, I've found it extremely rewarding and I wouldn't do anything different. Dr Smith: Well, that's really great information and I hope our resident listeners will take that to heart. Your article is truly amazing, Mark. I can't tell you how much I was impressed with it, and for our listeners - you gotta check it out. I've got a list of ten other things on my piece of paper here I could ask Mark about, but I think we're probably at time. So, Mark, thank you so much. Congratulations on an amazing article and really fascinating and exciting area of neurology. Dr Burish: Thank you. Thank you very much for having me. Dr Smith: Again, today we've been interviewing Dr Mark Burish whose article on cluster headache - appears in the most recent issue of Continuum, which is on headache. Be sure to check out Continuum audio podcasts from this and other issues, and thank you very much to our listeners for joining us 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 practice. Right now, during our Spring Special, all subscriptions are 15% off. Go to Continpub.com/Spring2024 or use the link in the episode notes to learn more and take advantage of this great discount. This offer ends June 30, 2024. AAN members: go to the link in the episode notes and complete the evaluation to get CME. Thank you for listening to Continuum Audio.

Ready to dive into the nitty-gritty of property valuation in Brisbane? Join hosts Melinda and Scott Jennison in the latest episode of the Brisbane Property Podcast as they unveil insights from their team's in-house research on Automatic Valuation Reports (AVMs). In this episode, Melinda and Scott discuss the accuracy of AVMs in evaluating property values, based on their team's analysis of real-life case studies. They delve into a selection of properties from their study, revealing statistics on how many properties sold within the projected range of AVMs compared to those that didn't. The discussion goes deeper into understanding the reasons behind the significant differences found in these valuation tools. From market fluctuations to property uniqueness, they explore the various factors influencing AVM accuracy and their implications for property investors and homeowners. Whether you're an experienced investor, a potential buyer, or simply curious about property valuation complexities, this episode offers valuable insights and revelations. Hit play now and gain the knowledge to navigate the Brisbane property market with confidence!   Connect with Us: Subscribe on Youtube https://www.youtube.com/channel/UCW30uBCnHQ2YllnwGKHNfxg Listen on Spotify https://open.spotify.com/show/5tODCtY54iQrxadNqqmevs Streamline Property Buyers Website https://streamlineproperty.com.au/ Ready to work with us directly? https://streamlineproperty.com.au/contact/   If you liked this episode, please don't forget to subscribe, tune in, and share this podcast with others you know will benefit from the information we share!

Welcome to the "Loan Officer Training" podcast series, your go-to resource for mastering the intricacies of the lending world. In this episode, we embark on a journey through the realm of Automated Valuation Models (AVMs), Collateral Data Aggregation (CDAs), Desktop Appraisals, and Alternative Valuations. Join us as we decode these essential tools and techniques that are revolutionizing the appraisal process for loan officers. From understanding the accuracy and limitations of AVMs to harnessing the efficiency of Desktop Appraisals, we cover everything you need to know to streamline your appraisal workflow and expedite loan processing. Additionally, we'll explore the emerging trend of Alternative Valuations, offering innovative solutions to traditional appraisal challenges. Whether you're a seasoned pro or new to the field, this episode equips you with the knowledge and strategies to leverage AVMs, CDAs, Desktop Appraisals, and Alternative Valuations effectively in your lending practices. Tune in now and elevate your expertise in appraisal management!Join The Mortgage Calculator at https://themortgagecalculator.com/joinAbout The Mortgage Calculator:The Mortgage Calculator is a licensed Mortgage Lender (NMLS #2377459) that specializes in using technology to enable borrowers to access Conventional, FHA, VA, and USDA Programs, as well as over 5,000 Non-QM mortgage loan programs using alternative income documentation! Using The Mortgage Calculator proprietary technology, borrowers can instantly price and quote thousands of mortgage loan programs in just a few clicks. The Mortgage Calculator technology also enables borrowers to instantly complete a full loan application and upload documents to our AI powered software to get qualified in just minutes!Our team of over 350 licensed Mortgage Loan Originators can assist our customers with Conventional, FHA, VA and USDA mortgagCatch all the episodes of the Loan Officer Training Podcast at https://themortgagecalculator.com/Page/Loan-Officer-Training-Series-Podcast Catch all the episodes of the Loan Officer Training Podcast at https://themortgagecalculator.com/Page/Loan-Officer-Training-Series-PodcastLoan Officers for Unlimited Free Non-QM Leads & Trainings Join The Mortgage Calculator at https://themortgagecalculator.com/joinThe Mortgage Calculator is a licensed Mortgage Lender (NMLS #2377459) that specializes in using technology to enable borrowers to access Conventional, FHA, VA, and USDA Programs, as well as over 5,000 Non-QM mortgage loan programs using alternative income documentation! Using The Mortgage Calculator proprietary technology, borrowers can instantly price and quote thousands of mortgage loan programs in just a few clicks. The Mortgage Calculator technology also enables borrowers to instantly complete a full loan application and upload documents to our AI powered software to get qualified in just minutes! Our team of over 350 licensed Mortgage Loan Originators can assist our customers with Conventional, FHA, VA and USDA mortgages as well as access...

Automated Valuation Models, or AVMs, are computer algorithms that use various data points and statistical models to estimate the value of a property. These models consider factors such as property characteristics, location, historical sales data, market trends, and other relevant information. The result is an automated property valuation report, providing an estimated property value without the need for a human appraiser. Today, We have Allan Weiss, Co-Founder of Case-Schiller index share how they created AVM in property valuation.

Moyamoya disease is a rare neurovascular condition that can affect both children and adults and is caused by progressive narrowing or blockage of the major blood vessels supplying the brain.The result is a lack of necessary blood flow to the brain, which can cause stroke, mini-stroke (TIA – transient ischemic attack) or bleeding into the brain. Numerous tiny vessels develop around the blockage in an attempt to compensate for the lowered blood flow, leading to a smoky appearance of these vessels on imaging. This smoky appearance is what gives the disease its name, as “moyamoya” means puff of smoke in Japanese.Aditya (Adi) Iyer MD, MS, is a fellowship-trained neurosurgeon with a focus on vascular diseases of the brain and spine at Pacific Neuroscience Institute. As one of California's few dual-trained neurosurgeons, Dr. Iyer is able to offer both minimally invasive open surgical techniques as well as incisionless catheter based procedures to treat patients with strokes, aneurysms, AVMs, tumors and pain.

To have a podcast on The Cost Approach and USPAP.  How exciting (not)!  You're right.  This is not exactly the conversation you'll have when you get together with friends.  Even if those friends are other appraisers!  But the point is the cost approach is an untapped resource.  It is the sunshine to which appraisers typically do not expose their analytics.  This is a shame, really, since this approach can tell us so much about the quality of our analytics via the other approaches.  How so? We all know that in older neighborhoods, there are likely to be few vacant site sales.  This is where we appraisers can put the cost approach and USPAP to good use.  This absence of data makes adjusting for site differences such as size, view, access, shape, etc. difficult to extract from the market. But you can use improved sales data to extract comparable site values.  That takes a little practice and training, true, but once you master that protocol, life as an appraiser becomes easier.  And, reports go out the door a little faster.  Who doesn't want to produce more reports, thus greater cash-flow, right? And what are the advantages to appraisers who understand the cost approach and USPAP?  More than you think, frankly!  But the eye-opener is that as we come to understand the cost approach, then begin to use it properly, our clients are less motivated to hire AVMs and BPOs.  Therefore, they are more prone to hire us, since we provide services and insights that the other tools simply cannot.  So mastering the cost approach should not be a chore.  Instead, let's look at it as the opportunity to become even more indispensable.  Let's seize the opportunity to become even more professional than we are today!    

Our last Podcast before Christmas A real light-hearted start to the Podcast this week as we discuss Christmas preparations, family, and favorite Christmas television.Our guest this week is Shirley Willsher, Shirley has had two major health events in her life, the first being Arteriovenous malformation (AVM's)  and a few years later a Heart attack.Shirley openly and honestly tells us how the onset of ATV put her in a six-day Coma, had major surgery, and dealt with recovery. An unexpected turn of events that all came early one normal morning while at the gym. Following her recovery, a few years later Shirley suffered a heart attack one morning family gathered around to help, and was again rushed into hospital for surgery the very same day. Arteriovenous malformations (AVMs) happen when a group of blood vessels in your body forms incorrectly. In these malformations, arteries and veins are unusually tangled and form direct connections, bypassing normal tissues. This usually happens during development before birth or shortly after.During a heart attack, a lack of blood flow causes the tissue in the heart muscle to die. A heart attack is also called a myocardial infarction. Prompt treatment is needed for a heart attack to prevent death.We of course cannot finish our Podcast this week without "Martin's Joke of the Week"In closing, we discuss our next show and what we have lined up and of course wish everyone a happy Christmas.#HeartTransplant#EbsteinsAnomaly#RareCondition#HealthJourney#LifeChangingDiagnosis#MentalHealth#Vulnerability#SelfCompassion#PostTraumaticGrowth#MedicalMiracle#BBCSports#Inspiration#Cardiology#Surgery#Podcast#Healthcare#HeartHealth#MedicalBreakthrough#EmotionalJourney#SupportSystem#HealthcareHeroes#PatientStories#CardiologyCare#MedicalJourney#LifeLessons#MentalWellness#HealthAwareness#InspirationalTalk#LivingWithIllness#RareDiseaseAwareness#SharingIsCaring#MedicalSupport#BBCReporter#HeartDisease#PodcastInterview#HealthTalk#Empowerment#Wellbeing#HealthPodcast#ChronicIllnessCheck out our new website at www.whostomanddick.com

On today's episode, Editor in Chief Sarah Wheeler talks with Brandon Lwowski, senior director of research at House Canary, about potential new rules for automated valuation models (AVMs) and his vision for using AI to battle appraisal bias.Related to this episode:Connect with Brandon on LinkedInTrade groups warn of “unintended consequences” from proposed AVM rulesHousingWire's YouTube ChannelEnjoy the episode!The HousingWire Daily podcast examines the most compelling articles reported across HW Media. Each morning, we provide our listeners with a deeper look into the stories coming across our newsrooms that are helping Move Markets Forward. Hosted and produced by the HW Media team.

Today's episode covers cranial complications such as cerebral aneurysms, vasospasms, AVMs, and traumatic brain injuries. We take a brief look at these various disease processes and then discuss how we can manage them from an anesthesia standpoint. There is much to unpack here, we hope you enjoy following along!Support the showTo access all of our content, download the CORE Anesthesia App available here on the App Store and here on Google Play. Want to connect? Check out our instagram or email us at info@coreanesthesia.com

Dr. Benjamin Hechler returns for another engaging episode of Everyday Oral Surgery, an accomplished OMS practitioner based in North Carolina. We're excited to welcome him back as we delve into today's topic, benign aggressive lesions. In our discussion today, Dr. Hechler speaks to what sets an aggressive lesion apart and the different categories of lesions, both official and unofficial. He proceeds to highlight crucial principles in managing aggressive lesions, such as the importance of obtaining a comprehensive patient history, essential imaging considerations, and the most important principle to remember when obtaining a biopsy. We also look at four key radiographic features to be aware and Dr. Hechlers takes us through an overview of Ameloblastoma; what it is, the treatment, and the management. Furthermore, he discusses vascular anomalies, how he differentiates treatment for venous malformations versus AVMs, and shares insights on different lesions including those seen in the TMJ and benign fibro-osseous lesions. Be sure not to miss out on this episode if you are interested in hearing more about how Dr. Hechler approaches the diagnosis, treatment, and management of benign aggressive lesions as an OMS. Key Points From This Episode:An introduction to our guest and today's topic of conversation: benign aggressive lesions.Dr. Hechler speaks to what sets an “aggressive” lesion apart.An instance, regarding a lesion, that should “prick your ears” according to Dr. Hechler.We discuss the different categories of lesions, both official and unofficial.His thoughts on the types of aggressive lesions OMS see more regularly. Principles of aggressive lesion management: a broad overview. Why taking a complete patient (or lesion) history is essential. The most important principle to remember when obtaining a biopsy.We discuss the process of biopsying vascular lesions: aspirate. A look at four key points of radiographic features to be aware of.Dr. Hechler talks about Ameloblastoma: what it is, the treatment, and the management.Ameloblastoma demographics and whether it's commonly associated with an impacted tooth.How he treats the venous malformation differently than the AVM.The various aggressive TMJ lesions seen in OMS.He highlights some of the benign fibro-osseous lesions we may see in practice.How he approaches (sometimes multiple) recurrences of lesions. He shares thoughts on the future of benign aggressive lesion treatments.Links Mentioned in Today's Episode:Dr. Benjamin Hechler on LinkedIn — https://www.linkedin.com/in/ben-hechler/Dr. Benjamin Heckler Email — benhechler@gmail.com ISSVA classification of vascular malformations — https://www.issva.org/UserFiles/file/ISSVA-Classification-2018.pdf AAOMS Annual Meeting — https://www.aaoms.org/meetings-exhibitions/annual-meeting/105th-annual-meetingEveryday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

We welcome Dr. David Penn of Nuvance Health. Dr. Penn is a neurosurgeon with areas of expertise including treatment of complex brain tumors, such as acoustic neuromas and meningiomas, vascular malformations, such as aneurysms and AVMs and cerebral bypass. He specializes in minimally-invasive, endoscopic treatments for pituitary tumors and other types of brain tumors. Ray Graf hosts.

Communication Tips: Giving and Receiving Feedback featuring Stacey Wolfe, MD, FAANSStacey Quintero Wolfe, MD is a neurosurgeon with Wake Forest Baptist Health in Winston-Salem, North Carolina.She is a board-certified neurosurgeon, specializing in disorders of blood vessels, brain trauma and spine. She completed fellowships in endovascular and cerebrovascular/skull base neurosurgery at the University of Miami.  As a 21-year US Navy veteran, she earned the Meritorious Service Medal and developed the Stroke and Neurotrauma Programs at Tripler Army Medical Center. She joined Wake Forest Baptist Health in 2013 as Director of Neurointerventional Surgery and Residency Program Director. She built a hemorrhagic stroke research program and am co-Principal Investigator of National Institute of Health (NIH) StrokeNet at Wake Forest Baptist Health. She leads multiple NIH and national clinical trials in stroke and brain hemorrhage, and is studying neuroinflammation, genetic risk factors, and genetic mutations in the development of cerebral Arteriovenous malformations (AVMs) in her research lab. She has served on the American Association of Neurological Surgeons Board of Directors, Executive Committee of the Congress of Neurological Surgery and Society of Neurological Surgeons, American Heart Association Mission Stroke Task Force, and as Chair of Women in Neurosurgery. She has published over 100 peer-reviewed articles and review for five journals. She was awarded the national 2021 ACGME Courage to Teach Award for innovation and mentorship in education, and am dedicated to providing cutting edge care for patients with neurologic disease.She lives in Winston-Salem with her husband and two children. In her free time, she volunteers at a local school and in the community.  

One of the most important aspects of being a medical professional is reviewing your past cases (especially those involving complications) and studying public records of complications so that you are constantly improving the quality of care that you provide to your patients. To help us further explore this topic, we are joined once again by the Medical Director of Blue Cross, North Carolina, Dr. Ben Hechler. Our first case is about a middle-aged male who experienced laryngospasms after receiving anaesthesia and ultimately, passed away. Dr. Ben hones in on the main learning points from this case including the safety of sedation, common ailments that are often overlooked, and how he would treat laryngospasms. After briefly touching on the importance of being aware of EMS response times in your area, we get into our second case regarding a patient who received a $2.7 million settlement after being negligently operated on for an arterio-venous malformation (AVM). Dr. Ben describes the clinical findings that are common to AVM and how he would treat it, what you can do when you have a clash of professional opinions with your colleague, other AVM scenarios to consider, and reiterating why you should always document your rationale and perform reviews of your own cases. Plus, if you are a new OMS graduate, be sure to speak to your KLS Martin representative for some amazing once-off specials! Key Points From This Episode:A warm welcome back to Dr. Ben Hechler as Dr. Stucki explains the importance of case reviews. Diving straight into the first case study of a middle-aged male who spasmed after induction.The main learning points (and medical reminders) from our first case, according to Dr. Ben. Discussing issues of safety regarding sedation, anesthesia, and general drug administration. Our guest explains what can be done to mitigate safety concerns before surgery.  Why obstructive sleep apnea (OSA) and hypertension are often overlooked.How Dr. Ben treats laryngospasms, and what to keep in mind when dealing with the issue.Why it's always good to know the average EMS response time in your area. Our second case is about an AVM patient who was negligently operated on.Dr. Ben explains what went wrong with the patient who eventually received a $2.7 million settlement. Clinical findings that you can expect from arterio-venous malformations (AVM).How he treats AVMs, and what you can do when there's a clash of professional opinions. The difference between confirmed and suspected AVMs, and other scenarios to consider.Reiterating the importance of documenting your rationale and performing case reviews. If you are a fresh OMS graduate, speak to your KLS Martin rep for incredible once-off specials. Links Mentioned in Today's Episode:Dr. Ben Hechler on LinkedIn — https://www.linkedin.com/in/ben-hechler/ KLS Martin — https://www.klsmartin.com/en/ Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

In this special episode, Leigh Brown delves into the world of real estate property data collectors, discussing their role, potential risks, and implications for consumers and professionals in the industry. The episode highlights the rise of appraisal management companies (AMCs) and automated valuation models (AVMs) and how they came into effect after the housing crisis. Learn the concerns about the new program introduced by Fannie Mae and Freddie Mac, which involves sending unlicensed and unregulated data collectors into homes to gather information for the banks. The lack of oversight and potential biases are problematic, as they could lead to inaccurate valuations and manipulation of property values. The episode emphasizes the importance of certified appraisers and the need for regulatory oversight in professional services.    To learn more about this complex and crucial topic, listen to this episode and then jump to last week's interview with Peter Gallo, Owner/Chief Appraiser at HOMESIGHT APPRAISAL, as he shared his personal encounter when he questioned a tech company representative regarding regulatory compliance.   Key takeaways to listen for Understanding the role of AMCs and AVMs The risks of allowing unlicensed data collectors into your home The potential impact on the real estate market The importance of advocating for the role of certified appraisers   Resources mentioned in this episode 411 - What Makes Appraisers an Irreplaceable Role in Real Estate with Peter Gallo   Connect with Leigh Please subscribe to this podcast on iTunes or the Podcasts App on your phone, and never miss a beat from Leigh by visiting https://leighbrown.com. DM Leigh Brown on Instagram @ LeighThomasBrown. Subscribe to Leigh's other podcast Real Estate From The Rooftops   Sponsors Leigh Brown University – New On-Demand Training How to Dominate During This Recession! Enroll Now to get ahead of the curve and learn how to manage changing markets, the action steps for what to do, and most importantly, what to say so that you can secure listings, assist more buyers, and grow your business no matter what the market is doing. Link: http://dominatethisrecession.com

In 2020, William Kyler Lewis, 15, was riding in the car with his mom in College Station, Texas, when he suddenly turned to her confused. His head hurt, he was sick to his stomach and his vision was blurred. Soon, he couldn't remember anything for more than a few seconds. After his mom rushed him to the pediatrician, he got a shot and was told to go home. Instead, his mom drove 1½ hours to a children's hospital in Houston. Nurses there thought Kyler had taken drugs, but his mom insisted no, he was not that type of kid, and something was very wrong. A CT scan revealed Kyler had an acute spontaneous intracranial hemorrhage from a brain arteriovenous malformation (AVM) that he unknowingly had when he was born. A brain AVM is a condition that is not inherited. AVMs are a random occurrence due to a gene malfunction in utero where a mass of arteries connect directly to veins. Kyler received lifesaving external ventricular drain (EVD) surgery to control the fluid build-up in his brain. After the stroke, memory and neuro fatigue became a big problem. Kyler has undergone radiation and chemotherapy and takes medication for epilepsy, headaches, dizziness, weakness and tremors. Yet, Kyler is inspiring many. He uses local news, community functions and social media to educate the public that a child can have a stroke, too. He also organizes walks to highlight the importance of recognizing the symptoms of a pediatric stroke. Kyler's Facebook group, “A Cure for Kyler,” his CaringBridge page and YouTube channel educate and inspire pediatric stroke survivors by documenting his recovery. His video, “Being You after an Aneurysm/AVM Rupture,” and his family's Facebook page, “AVM Alliance: A Cure for Kyler and Friends,” share stories of other hemorrhagic stroke survivors and educate people about symptoms and conditions. Links: Cxnadvisory.com https://www.f3metro.com/ Freed to Lead   CONTACT INFO: https://www.linkedin.com/in/tim-whitmire-7955145/ Twitter: @trwhitmire_OBT Show Credits: Music intro credit to Jake Dansereau, connect at JAKEEZo on Soundcloud @user-257386777. Our intro welcome is the voice of Caroline Goggin, a stroke survivor and our first podcast guest! Please listen to her inspiring story on Episode 2 of the podcast. Thank you Caroline! Until next time, be sure to give the show a like and share, +follow and connect with us on social or contact us to support us as a show sponsor or become a guest on the Know Stroke Podcast. Visit our new website to apply here: https://www.knowstrokepod.com/ Connect with Us and Share our Show on Social: Website | Linkedin | Twitter | YouTube Watch this episode on YouTube: https://youtu.be/pSYVCzUGZXs

A key component of your head-to-toe and focused assessments is the vascular assessment. In this episode I'm sharing tips and real-world examples to help you feel more confident at the bedside. * What type of clinical situations warrant a vascular assessment * Tips for taking a proper blood pressure measurement * Pulse assessment, including a key tip on using the Doppler * General vascular assessment techniques including capillary refill, edema and pain * Neurovascular assessment * The 6 P's of Ischemia * What the Allen test is and how to perform one * Bruits and thrills demystified! Did you enjoy the PodQuiz at the end of the episode? Sign up for Study Sesh and change the way you study! Are you looking for an easier way to learn Med Surg? Enroll in Med Surg Solution and get lessons on 57 key topics as well as out-of-this-world study guides! Want a sneak peek into nursing school so you can be prepared and ready? Crucial Concepts Bootcamp teaches you core foundation concepts, medication math, organizational strategies, study tips and so much more. Get ready for nursing school and enroll in Crucial Concepts Bootcamp today! Learn more about cardiac assessment in Performing A Cardiac Assessment: Episode 250 Learn more about AVMs in AVMs A to Z: Episode 241 Read the article about performing a vascular assessment and view references here. __________  The information, including but not limited to, audio, video, text, and graphics contained on this podcast are for educational purposes only. No content on this podcast is intended to guide nursing practice and does not supersede any individual healthcare provider's scope of practice or any nursing school curriculum. Additionally, no content on this podcast is intended to be a substitute for professional medical advice, diagnosis or treatment. Straight a Nursing is a proud member of the Airwave Media Network. Learn more about your ad choices. Visit megaphone.fm/adchoices

All episodes are available at https://TheNeuroNerds.com. Follow @TheNeuroNerds on Twitter/Instagram and Like us at Facebook.com/TheNeuroNerds. Summary Joe is speaking at the TAAF Walk on September 18, 2022. On this episode, to celebrate this amazing event supporting aneurysm and AVM survivors, Joe is speaking with TAAF's community engagement manager, Dina Chon. They talk about how important it is to connect survivors and those who support organizations like TAAF at fundraising events like this walk to spread awareness and encourage more people to support the brain injury survivor community. Spread the word about this event by tweeting the registration link for this event and tagging @TAAF, @TheNeuroNerds and #TAAFWalk. Links Mentioned Register here: https://www.classy.org/event/taafwalk-2022-17th-annual-aneurysm-and-avm-awareness-walk/e409424   Credits New to our show? Take our episode tour to get started! https://newsletter.theneuronerds.com/tour Find tools for recovery in Joe's FREE guide, 9 Must-Have Tools for Stroke & Brain Injury Recovery! This guide includes some essential tools for your recovery journey including tips for occupational and physical therapy, mindset, overstimulation, and more. Get your copy here → https://www.yousorock.coach/guide If you're a brain injury survivor who would like to learn how to shift your mindset, create a routine, and get more support during recovery, book a call with Joe at https://newsletter.yousorock.coach/checkin-call Support The NeuroNerds podcast on Patreon and join our NeuroJedi High Council at www.Patreon.com/TheNeuroNerds Check out The NeuroNerds Amazon Shop at amazon.com/shop/theneuronerds Plus get a free Audible trial at http://www.audibletrial.com/theneuronerds! Co-hosted by Joe Borges and Lauren Manzano Find Joe at http://joesorocks.com and @joesorocks on Twitter/Instagram Submit your stroke/brain injury recovery story at https://www.joesorocks.com/submit-your-story Find Lauren at @laurenlmanzano on Instagram, @tankbbg on Twitter Produced by Joe Borges and Felice LaZae, http://felicelazae.com, @felicelazae on Twitter/Instagram Edited by Marcellus Wesley - https://www.soundsignature.productions Sponsored by Motus Nova, Avid Technology, and our Patreon Supporters

An arteriovenous malformation (AVM) is an abnormal cluster of blood vessels that lack a capillary network, which results in both disrupted blood flow and disrupted oxygen delivery. In this episode I'm talking you through AVMs step-by-step so you can (finally) understand them! Want to get a study guide that goes with this lesson? Check out Power Guides here. Learn more about neurological assessment here. Want to maximize your learning by reading this information, too? Check out the article and references here.   RATE, REVIEW AND FOLLOW! If this episode helped you, please take a moment to rate and review the show! This helps others find the podcast, which helps me help even more people :-) Click here, scroll to the bottom, then simply tap to rate with 5 stars and select, "write a review." I'd love to hear how the podcast has helped you! If you're not following yet, what are you waiting for? It takes just a quick moment and the episodes show up like magic every Thursday. And, when I release a bonus episode, those show up, too! You'll never miss a thing! In Apple Podcasts, just click on the three little dots in the upper right corner here. Know someone who would also love to study with me? Share the show or share specific episodes with your classmates...when we all work together, we all succeed! On Apple Podcasts, the SHARE link is in the same drop-down as the follow link. Spread the love! Thanks for studying with me! Nurse Mo

Depression sucks, and it lies. It's a life threatening condition that affects a lot of stroke survivors and can block their recoveries. In 2010, business owner Keith Taylor survived a stroke. A rare genetic condition meant that the arteries and veins in his body don't always connect the way they're supposed. It's called Hereditary hemorrhagic telangiectasia (HHT). One day, that flawed connection leaked and began killing brain cell. Keith began his journey through the stroke care system of the time, into the depths of depression, leaving the business he planned his life around  and to the life he lives today helping stroke survivors in Central Oregon and around the world live their best lives. He shares his journey in today's episode. If you don't see the audio player below, visit http://Strokecast.com/MSN/Keith   Click here for a machine-generated transcript Who is Keith Taylor? Keith Taylor runs Strength After Stroke Keith Taylor is a deeply passionate, and dedicated leader in the stroke community. He is dedicated to helping stroke survivors regain their own power and strength to live a full and productive life. While owning and being the sales manager of a large manufacturing business in Oregon, he had a stroke at the age of 48. After looking for, and not finding, anyone to help with the depression and lack of confidence after his stroke, he decided to create that for other stroke survivors. He is President of the Board of Directors with Stroke Awareness Oregon and is the owner of Strength after Stroke; a company dedicated to providing resources for stroke survivors to re-ignite their desires and regain their confidence. What is HHT? HHT stands for Hereditary hemorrhagic telangiectasia. That tells most of us…absolutely nothing. The condition impacts the way the blood vessels in our body connect. When the circulatory system works properly, blood flows from the heart under high pressure through the arteries to deliver oxygen and nutrients to the organs throughout the body. One big artery (the aorta) comes off the heart and splits into smaller and smaller arteries that carry blood to the kidneys, the toes, the brain, and every other part. The arteries are built to withstand the blood pressure. Veins take blood from the organs and bring it back to the heart. Along the way, the deliver carbon dioxide to the lungs and waste material to the kidneys, liver, and other disposal sites. The blood is no longer under such high pressure at this point. In between, there are capillaries. These are the tiny, thin blood vessels that allow oxygen and nutrients to pass from the blood to the organs and for carbon dioxide to pass back. Arteries branch smaller and smaller and thinner and thinner to become this huge network of capillaries, which the consolidate and get bigger and bigger until they become veins. Meanwhile, that branching down and consolidating up reduces the pressure on the blood in the system In a patient with HHT, those capillaries don't always form where they are supposed to. Instead, the arteries will connect directly to the veins. These malformations are weak spots since the veins may not be able to handle the pressure of the blood coming into them. These AVMs, or arterial-venous malformations can then rupture or leak resulting in a hemorrhagic stroke. You can learn more about HHT at the CDC's website here: https://www.cdc.gov/ncbddd/hht/index.html#:~:text=HHT%20is%20a%20disorder%20in,present%20between%20arteries%20and%20veins. HHT is not the only cause of AVMs but it is an important one. Nosebleeds Nosebleeds are an important signal that something may be wrong. Frequent or regular nosebleeds are something to discuss with your doctor. Nosebleeds are a common indicator of HHT. Someone who has HHT will need to keep on top of their monitoring to reduce the chances of a dangerous stroke or other conditions. HHT by itself doesn't have many visible symptoms so nosebleeds can be a good flag. In my case, it was nosebleeds that revealed my high blood pressure, which remains one of the top causes of stroke. The problem, of course, with high blood pressure is that it doesn't hurt. Unless you're checking it, you won't know you have it. Nosebleeds, however, are one powerful indicator. If you or someone you care about has frequent nosebleeds, discuss it with your doctor. There can be lots of different causes, but often the nosebleed is the least severe consequence of that cause. Depression Lies I talk about depression a lot on the show because it is a big deal and stroke has been shown to cause depression. Depression can be a deadly disease. It can also tell us not to get out of bed. Or to skip our exercises. Or to question if we should even be here. Or try to convince us we are a burden to the people who love us. Depression interferes with our recovery, our energy, our relationships, and our view of the future. But always remember the biggest fact about depression: Depression lies. All the time. I first encountered this concept while reading a blog post from writer, actor, and professional geek Wil Wheaton. You can see that post at http://Strokecast.com/DepressionLies When depression says we shouldn't get out of bed or off the couch, depression lies. When depression tells us our friends and families wish we weren't there, depression lies. When depression tells us to skip therapy because it doesn't matter, depression lies. Don't listen to the liar that is depression. Help is available. Your doctor therapist will be happy to point you in the right direction. Hack of the Week When you forget a name or word, channel your inner Elsa, and let it go. Just relax. It's okay to struggle with names and words. People you deal with will be okay with it. The more you stress about it, the harder it will be to remember and the more likely you are to struggle with other words, too. Often we worry about what strangers will think about us when we are out and about, but the thing is they don't really care. Everyone we see is caught up in their own fear that everyone is judging them that they don't have the attention or energy to actually judge others. If you think someone does give you a dirty look or something like that, remind yourself that their probably thinking about that cringey thing they said at their 8th grade dance. Somehow it just smacks them at random from the depths of their memory. But the key is that's it's not about you. So relax. And let it go. Links Where do we go from here? Check out Keith's work at http://StrengthAfterStroke.org Share this episode with someone you know by giving them the link http://Strokecast.com/Keith Subscribe to the free Strokecast newsletter at http://Strokecast.com/News Don't get best…get better.