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Episode 194: Acute low back pain. Future Dr. Ibrahim presents a clinical case to explain the essential points in the evaluation of back pain. Future Dr. Redden adds information about differentiating between a back strain and more serious diseases such as cancer, and Dr. Arreaza shares information about returning to work after back strain.Written by Michael Ibrahim, MSIV. Editing and comments by Jordan Redden, MSIV, and Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Dr. Arreaza:Welcome back, everyone. Today's topic is one that every primary care provider, emergency doctor, and even specialist sees routinely: low back pain. It's so common that studies estimate up to 80% of adults will experience it at some point in their lives. But despite how frequent it is, the challenge is to identify which cases are benign and which demand urgent attention.Jordan:Exactly. Low back pain is usually self-limiting and mechanical in nature, but we always need to keep an eye out for the rare but serious causes: things like infection, malignancy, or neurological compromise. That's why a good history and physical exam are our best tools right out of the gate.Michael:And to ground this in a real example, let me introduce a patient we saw recently. John is a 45-year-old warehouse worker who came in with two weeks of lower back pain that started after lifting a 50-lb box. He describes it as a dull, aching pain that radiates from his lower back down the posterior left thigh into the calf. He says it gets worse with bending or coughing, but he feels better when lying flat. He also mentioned some numbness in his left foot, but he denies any bowel or bladder issues. His vitals are completely normal. On exam, he had lumbar paraspinal tenderness, a positive straight leg-raise at 40 degrees on the left and decreased sensation in the L5 dermatome, though reflexes were still intact.Dr. Arreaza:That's a great case. Let's take a minute and talk about the straight leg raise test. This is a bedside tool we use to assess for lumbar nerve root irritation often caused by a herniated disc. ***Here's how it works: the patient lies supine, and you slowly raise their straight leg. If pain radiates below the knee between 30° and 70°, that suggests radiculopathy, especially involving the L5 or S1 nerve roots. Pain at higher angles is more likely due to hamstring tightness or mechanical strain.Michael:Right. So, stepping back: what do we mean by "low back pain"? Broadly, it's any pain localized to the lumbar spine, but it's often classified by type or cause:Mechanical (like muscle strain or degenerative disc disease), Radicular (nerve root involvement), Referred pain (like from pelvic or abdominal organs), Inflammatory (AS), and Systemic or serious causes like infection or malignancy. Jordan:In John's case, we're thinking radicular pain, most likely from a herniated disc compressing the L5 nerve root. That's supported by the dermatomal numbness, the leg pain, and that positive straight leg test.Dr. Arreaza:Good reasoning. Now, anytime we see back pain, our brains should run a checklist for red flags. These help us pick up more serious causes that require urgent attention. Let's run through the red flags.Michael:Sure. For fracture, we think about major trauma or even minor trauma in the elderly, especially those with osteoporosis or on chronic steroids. Also, anyone over 70 years old.Jordan:Then we have infections, which could include things like discitis, vertebral osteomyelitis, or epidural abscess. Red flags include fever, IV drug use, recent surgery, or immunosuppression.Michael:Malignancy is another critical one, especially if there's a history of breast, prostate, lung, kidney, or thyroid cancer. Clues include unexplained weight loss, night pain, or constant pain not relieved by rest.Jordan:And don't forget about inflammatory back pain, like ankylosing spondylitis, which is often seen in younger patients with morning stiffness that lasts more than 30 minutes and improves with activity.Dr. Arreaza:And of course, we always rule out cauda equina syndrome: a surgical emergency. That's urinary retention or incontinence, saddle anesthesia, bilateral leg weakness, or fecal incontinence. Missing this diagnosis can be catastrophic.Michael:Thankfully, in John's case, we don't see any red flags. His presentation is classic for uncomplicated lumbar radiculopathy. But we must stay vigilant, because sometimes patients don't offer up key symptoms unless we ask directly.Jordan:And that's where associated symptoms help guide us. For example:Radicular symptoms like numbness or weakness follow dermatomal patterns. Constitutional symptoms like fever or weight loss raise red flags. Bladder/bowel changes or saddle anesthesia raise alarms for cauda equina. Pain that wakes patients up at night might point to malignancy. Dr. Arreaza:So when do we order labs or imaging?Michael:Not right away. For most patients with acute low back pain, imaging is not needed unless they have red flags. If infection is suspected, we'd get CBC, ESR, and CRP. For cancer, maybe PSA or serum protein electrophoresis. And if inflammatory back disease is suspected, HLA-B27 can be helpful.Jordan:Yes, imaging should be delayed for at least six weeks unless red flags or significant neurologic deficits are present. When we do image, MRI is our go-to especially for suspected radiculopathy or cauda equina. X-rays can help if we're thinking about fractures, but they won't show soft tissue or nerve root issues.Michael:In the example from our case, since the patient doesn't have red flags, we'd go with conservative management: start NSAIDs and recommend activity modification. As this is the acute setting, physical therapy would not be recommended.Jordan:For the acute phase, research shows no serious difference between those with PT and those without in the long term. However, physical therapy is really the cornerstone of management for chronic back pain. It's not just movement: it's education, body mechanics, and teaching patients how to move safely. And PT can actually reduce opioid use, imaging, and injections down the line for patient struggling with long term back pain.Dr. Arreaza:Yes, and PT is not one-size-fits-all. PT might include McKenzie exercises, manual therapy, postural retraining, or even neuromuscular re-education. The goal is always to build core stability, promote healthy movement patterns, and reduce fear of motion.Jordan:Let's take a minute to talk about the McKenzie Method, a physical therapy approach used to treat lumbar disc herniation by identifying a specific movement, (often spinal extension) that reduces or centralizes pain. A common exercise is the prone press-up, (cobra pose for yoga fans) where the patient lies face down and pushes the upper body upward while keeping the hips on the floor to relieve pressure on the disc. These exercises should be done carefully, ideally under professional guidance, and discontinued if symptoms worsen.Michael:For our case patient, our working diagnosis is mechanical low back pain with L5 radiculopathy. No imaging needed now, no red flags. We'll treat conservatively and educate him about proper lifting, staying active, and recovery expectations.Jordan:We also emphasized to him that bed rest isn't helpful. In fact, bed rest can make things worse. Keeping active while avoiding heavy lifting for now is key.Dr. Arreaza:Return-to-work recommendations should be individualized. For example, an office worker, positioning while working, or work hours may be able to return to work promptly. However, those with physically demanding jobs may need light duty or be off work.Ice: no evidence of benefit. Heat: may reduce pain and disability in pain of less than 3 months, although the benefit was small and short.And we should always teach safe lifting techniques: bend at the knees, keep the load close, avoid twisting. It's basic knowledge, but it is very effective in preventing recurrence.Jordan:Now, if a patient fails to improve after 6 weeks of conservative therapy, or if they develop new neurologic deficits, that's when we think about referral to spine specialists or surgical consultation.Michael:And as previously mentioned: in cases where back pain becomes chronic (lasting more than 12 weeks) a multidisciplinary approach works best. That can include:Physical therapy, Cognitive behavioral therapy (CBT) And sometimes pain management interventions. Jordan:We can't forget the psychological toll either. Chronic back pain is associated with depression, anxiety, and opioid dependence. Increased risk factors include obesity, smoking, sedentary lifestyle, and previous back injuries.Dr. Arreaza:Well said. So, let's summarize. Michael?Michael:Sure! Low back pain is common, and most cases are benign. But we have to know the red flags that point to serious pathology. A focused history and physical exam are more powerful than many people realize. And the first step in treatment is almost always conservative, with a strong emphasis on maintaining physical activity.Jordan:And don't underestimate the value of patient education. Helping patients understand their pain, set realistic expectations, and stay active is often just as important as the medications or therapies we offer.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478–491. https://doi.org/10.7326/0003-4819-147-7-200710020-00006Deyo, R. A., Mirza, S. K., Turner, J. A., & Martin, B. I. (2009). Overtreating chronic back pain: Time to back off? Journal of the American Board of Family Medicine, 22(1), 62–68. https://doi.org/10.3122/jabfm.2009.01.080102National Institute for Health and Care Excellence. (2020). Low back pain and sciatica in over 16s: Assessment and management (NICE Guideline No. NG59). https://www.nice.org.uk/guidance/ng59Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367UpToDate. (n.d.). Evaluation and treatment of low back pain in adults. Wolters Kluwer. https://www.uptodate.com (Access requires subscription)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.
Today's top stories:Federal appeals court rules Trump can keep control of National Guard in CaliforniaKern County firefighters control trailer fire on Downing Avenue in NW BakersfieldPetition to ban unsupervised minors at Valley Plaza Mall gains steamPresident Trump will decide 'within 2 weeks' to strike Iran3 members of Bakersfield family are in Israel as attacks continueAuditions set for 'Nutcracker' performances later this yearKern River Valley residents face repeated public safety power shutoffsBakersfield Commons construction is well underway, but it's not what was once envisionedFor more local news, visit KGET.com.
If You Missed Romeo In The Morning We Talked About: The phrase “It's cheaper to keep her”, Micheal Bean and relationships and the dumbest reason you broke up with someone.
Today's top stories:Israel, Iran continue trading attacks as US weighs interventionSpaceX rocket explodes during test in TexasMan sentenced in death of 10-year-old Arvin girlFirst responders mural vandalized at corner of 21st Street and Chester AvenueSupervisor raises concerns to state regulators over Kern River Valley power shutoffsCounty considering alternatives to fund new animal shelterKern County Fair announces 2 more music acts for 2025For more local news, visit KGET.com.
Kaitlin Mamie is here on this week’s Steph Infection! Steph and Kaitlin reminisce about old stories from their early days in LA together, some crazy experiences from the Bonnaroo, and Kaitlin walks Steph through the very unique story of giving birth to her daughter. Steph’s new special, FILTH QUEEN, will be releasing on Netflix on JUNE 24! Make sure to save the date!! Follow @Steph_Tolev and @Steph_Infection_Podcast on Instagram. Send in your body stories to be featured on the pod! See Steph Live!! KEEPIN EM HARD 2025 Tour US Dates June 6-7 Raleigh, NCJune 28 Bakersfield, CAAugust 29 La Brea, CA Get tickets at https://punchup.live/stephtolev Be sure to follow @kaitlinmamie on Instagram! Steph Tolev caught fire on the BILL BURR PRESENTS: FRIENDS WHO KILL, Netflix special. She was named a COMEDIAN YOU SHOULD AND WILL KNOW by Vulture, which recognized her as one of Canada’s funniest exports. She was featured on Comedy Central’s THE RINGERS stand up series, and season two of UNPROTECTED SETS. Steph has appeared in Comedy Central’s CORPORATE and starred in an episode of the Sarah Silverman-produced PLEASE UNDERSTAND ME. Steph has been well received at festivals all over the world and headlines clubs across the country. She also has a hit podcast on ALL THINGS COMEDY called “STEPH INFECTION” and appears in the feature OLD DADS starring and written by Bill Burr on Netflix. Check out her tour dates to see her live!
The new Rumps & Bumps jersey just dropped! Check out afterpartyinc.com. Peep the brand new episode featuring the one and only El Paso Foos! As he comes on reveals the face behind the instagram account and we chop it up and get to know him. He tells us about his early success in the music scene and his transition to talent management plus he names some of the best artists in the Sun City. Follow us on social media @AaronScenesAfterParty
Today's top stories:Lawmakers debate whether the US should become involved in Israel-Iran conflictSen. Alex Padilla speaks out on his removal from DHS press conferenceKeep Kern County Cool fan drive for seniors taking place todayThree more Rite Aid stores in Bakersfield set to closeCounty approves Uber service availablity at Meadows Field AirportCostco to open standalone gas station in Southern CaliforniaSome Kern River Valley residents question recent fire safety power shutoffsTeen accused of shooting California City officer found competent to stand trialSeven Southern California men arrested for massive Lebec rest stop jewelry heistFor more local news, visit KGET.com.
Send Robert a Text! In April 1979, 14-year-old Dana Butler left her Bakersfield home to visit her grandparents—but never arrived. Two and a half days later, her body was discovered near Alfred Harrell Highway, launching a homicide investigation that would haun Bakersfield to this day. The case, tangled in allegations of drugs, power, and corruption, would eventually point to a well-connected former law enforcement official—whose shocking death only deepened the mystery.***SUBSCRIBE HERE***For only $4 per month, you can subscribe to Notorious Bakersfield to get access to the entire back catalog of episodes. Subscribe here:https://www.buzzsprout.com/1784628/subscribe Purchase Notorious Bakersfield: The Book Volume II here: https://a.co/d/2XONnB1 ***SUBSCRIBE HERE*** For only $4 per month, you can Subscribe to Notorious Bakersfield to get access to the entire back catalog of episodes. Subscribe here: https://www.buzzsprout.com/1784628/subscribe
In this episode of the Uplevel Dairy Podcast, Peggy sits down with Adam Westenbroek of Westwind Farms in Bakersfield, California. Adam shares how cutting-edge technology is empowering him to be both the dairyman and the dad he wants to be.He emphasizes the importance of implementing technological advancements, such as activity monitoring and sort gates, to improve cow comfort and efficiency, which in turn has allowed him to spend more time with his family. Adam also talks about the personal and professional growth he's experienced and his ongoing commitment to constantly improve his dairy operations. This episode highlights the intersection of traditional hard work with modern innovations to achieve sustainable and successful dairy farming.The High-Performance Mindset Series is powered by Nedap. Nedap is future-proofing dairy farms by revolutionizing cow-side care through technologies in activity monitoring, cow locating, milk metering and identification. Listen for more episodes in this series throughout 202500:00 Introduction to Adam Westenbroek and Westwind Farms01:03 Adam's Journey into Dairy Farming03:21 Challenges and Innovations in Dairy Farming08:48 Family Life and Work Balance13:32 Embracing Technology for Better Dairy Management16:38 Letting Go of the Old Ways17:06 Embracing Technology in Dairy Farming17:40 Impact of Technology on Daily Operations18:38 Improving Cow Handling and Health20:26 Reproductive Goals and Challenges21:36 Breeding Program Strategies22:40 Future Plans for Dairy Optimization24:18 Personal Growth and Leadership25:28 Uplevel 5: Getting to Know Adam29:09 Final Thoughts and ReflectionsAbout Nedap
Today's top stories:Trump leaves G7 summit early amid Irael-Iran conflictGov. Newsom says he'll fight back after Trump annouces escalation of ICE deportationsKCSO releases video of Water Street shooting where deputy and suspect were woundedArvin man arrested, accused of sexual abuse of childThieves take car charger cables from Brundage Lane businessKCSO warns of text scams demanding paymentYosemite National Park to open all campgrounds for this summerAmazon announces Prime DaysFor more local news, visit KGET.com.
Today's top stories:Man suspected in shooting 2 Minnesota lawmakers is capturedTrump calls for ICE to expand deportation raids in Los Angeles, Chicago, New YorkThousands turn out for "No Kings" protest in Bakersfield2 people struck by pursuit suspect in Oildale: Kern County Sheriff's OfficeSuspected DUI driver in deadly Union Ave crash is booked into jailFifth suspect in deadly dispensary shooting due in court TuesdayKern County Public Health: West Nile virus found in mosquito sample for first time this year2025 Beautiful Bakersfield Awards honor community changemakersFor more local news, visit KGET.com.
The Moneywise Radio Show and Podcast Friday, June 13th BE MONEYWISE. Moneywise Wealth Management I "The Moneywise Guys" podcast call: 661-847-1000 text in anytime: 661-396-1000 website: www.MoneywiseGuys.com facebook: Moneywise_Wealth_Management Guest: Matt Conners, Owner of FuelRunner website: https://myfuelrunner.com/ phone: 661-525-3835 instagram: myfuelrunner
Tyler Grey grew up struggling in the rough town of Bakersfield, California. The military seemed like the perfect answer...a way out of his difficult situation, and an outlet to help him protect others. The chance to be one of the good guys. After serving with the Army Rangers and the elite Delta Force, a battlefield injury resulted in his exit from the front and a new beginning as an actor, director, producer and writer, having appeared in films such as DC's Suicide Squad for director David Ayer, and as a recurring star on CBS' hit action series Seal Team. He joins the program to discuss his new book, Forged in Chaos: A Warrior's Origin Story, and shares his observations on his own past and those he met along his journey.
Today's top stories:Israel launches military strikes against Iran nuclear sitesOne passenger survived Air India crashSanta Ana man arrested on suspicion of kidnapping Bakersfield teen girl he met through video gameFederal appeals court ruling allows National Guard to remain in CaliforniaAnti-ICE protests continue in Southern CaliforniaCalifornia Sen. Alex Padilla forcibly removed from DHS Secretary Noem press conferenceKernville park reopens after repairs from river floodingTwo items added to "Dirty Dozen" list from watchdog groupFor more local news, visit KGET.com.
Get the inside scoop on how the OPC tours came to life, including the key role Balanced Body played in making them happen. Lesley and Brad share what it's like to be on the road, how they stay grounded during tour season, and why reflecting after each stop matters. This episode is packed with community, purpose, and behind-the-scenes fun. Whether you've joined a tour before or are curious about what it's like, you'll love hearing what's in store for this year.If you have any questions about this episode or want to get some of the resources we mentioned, head over to LesleyLogan.co/podcast https://lesleylogan.co/podcast/. If you have any comments or questions about the Be It pod shoot us a message at beit@lesleylogan.co mailto:beit@lesleylogan.co. And as always, if you're enjoying the show please share it with someone who you think would enjoy it as well. It is your continued support that will help us continue to help others. Thank you so much! Never miss another show by subscribing at LesleyLogan.co/subscribe https://lesleylogan.co/podcast/#follow-subscribe-free.In this episode you will learn about:How the Balanced Body partnership made the OPC tours possible.Highlights from past tours and how they've evolved.Navigating unexpected changes and pivots while on the road.The small routines that keep Lesley grounded during tour season.Why reflecting after each tour helps improve the next one.The real impact of showing up in person and building community.A behind-the-scenes look at this year's OPC tour plans.Episode References/Links:Balanced Body - https://www.pilates.comContrology Reformer - https://beitpod.com/reformerContrology Spine Corrector - https://beitpod.com/spinecorrectorContrology Folding Mat - https://beitpod.com/foldingmatOPC Tours - https://opc.me/tourOPC Host - https://opc.me/host If you enjoyed this episode, make sure and give us a five star rating and leave us a review on iTunes, Podcast Addict, Podchaser or Castbox. https://lovethepodcast.com/BITYSIDEALS! DEALS! DEALS! DEALS! https://onlinepilatesclasses.com/memberships/perks/#equipmentCheck out all our Preferred Vendors & Special Deals from Clair Sparrow, Sensate, Lyfefuel BeeKeeper's Naturals, Sauna Space, HigherDose, AG1 and ToeSox https://onlinepilatesclasses.com/memberships/perks/#equipmentBe in the know with all the workshops at OPC https://workshops.onlinepilatesclasses.com/lp-workshop-waitlistBe It Till You See It Podcast Survey https://pod.lesleylogan.co/be-it-podcasts-surveyBe a part of Lesley's Pilates Mentorship https://lesleylogan.co/elevate/FREE Ditching Busy Webinar https://ditchingbusy.com/ Resources:Watch the Be It Till You See It podcast on YouTube! https://www.youtube.com/channel/UCq08HES7xLMvVa3Fy5DR8-gLesley Logan website https://lesleylogan.co/Be It Till You See It Podcast https://lesleylogan.co/podcast/Online Pilates Classes by Lesley Logan https://onlinepilatesclasses.com/Online Pilates Classes by Lesley Logan on YouTube https://www.youtube.com/channel/UCjogqXLnfyhS5VlU4rdzlnQProfitable Pilates https://profitablepilates.com/about/ Follow Us on Social Media:Instagram https://www.instagram.com/lesley.logan/The Be It Till You See It Podcast YouTube channel https://www.youtube.com/channel/UCq08HES7xLMvVa3Fy5DR8-gFacebook https://www.facebook.com/llogan.pilatesLinkedIn https://www.linkedin.com/in/lesley-logan/The OPC YouTube Channel https://www.youtube.com/@OnlinePilatesClasses Episode Transcript:Brad Crowell 0:00 You have to be able to be fluid enough to make changes in the moment when something isn't working or isn't making sense, or not necessarily in the moment you have to catch it, you can assess it after the fact and do the post mortem.Lesley Logan 0:15 Welcome to the Be It Till You See It podcast where we talk about taking messy action, knowing that perfect is boring. I'm Lesley Logan, Pilates instructor and fitness business coach. I've trained thousands of people around the world and the number one thing I see stopping people from achieving anything is self-doubt. My friends, action brings clarity and it's the antidote to fear. Each week, my guest will bring bold, executable, intrinsic and targeted steps that you can use to put yourself first and Be It Till You See It. It's a practice, not a perfect. Let's get started. Lesley Logan 0:58 Welcome back to the Be It Till You See It second half of the how did these tours come to be? And Brad is back as my guest. So this is a different kind of cadence, I guess you'd say. Brad Crowell 1:10 Yeah, you know, we're shaking things up a little bit. Lesley Logan 1:11 So we're not answering any of your questions. We're not going to talk about the Be It Action Items we shared with you. Brad Crowell 1:16 But we are going to talk about that amazing guest you had on this week's episode. Lesley Logan 1:20 Oh yeah, yeah. We're talking about you, Brad. Brad Crowell 1:22 It was me. Lesley Logan 1:23 And also, if you want to come to the tours, opc.me/tour, no matter when you hear this, you will always be able to see what upcoming tour there is or you'll get on a waitlist for the next one to come out. But basically, we do two tours a year. So we left off with how we started talking with Balanced Body about our tours.Brad Crowell 1:42 Yeah. So I remember we were at a POT, I think. Lesley Logan 1:46 In Monterey in 2020. Brad Crowell 1:48 No, I think it was before that. I think it was in Chicago, even before that. Lesley Logan 1:51 Well, there was a Chicago one that I talked to them and I planted the seed, that was in 2019. Brad Crowell 1:54 Yeah, but that's the one I was talking about. So we started talking to Balanced Body years prior to their participation, and I remember the conversation with their team. I just remember looking at their operation and literally watching them back a tractor trailer up to the convention center and commenting and going, Wow, you guys have tractor trailers. And the response was, we have three. I was like, you have three tractor trailers? They're like, yeah, look where do you think all these Reformers are gonna go? And they were loading case after case after case of things into the thing. And I was like, wow, it's so much work for you guys to go on the road. And they said, yeah, for us to put on these POTs, it is a massive enterprise to do. Many, many, many people, lots and lots of money. It's so much coordination, so much effort, you know. And I jokingly said, well, you know, I think we can help you guys out with that. And that didn't really come to anything, but I, in my mind, I was like, we could do it for half, you know. And then we got the van, and then we were talking with Ken.Lesley Logan 2:56 What happened is they changed, on the Contrology, they changed how you can do the wheels, the side wheels, how you can tighten them or not tighten them, and they change it to make it easier for people. And so I said, we're all, we're driving to the POT Monterey anyways, because we're gonna have a booth there as well because we had a booth in the October one which was when you kind of planted that seed. Brad Crowell 3:15 Yeah, and for us it was only what eight hours, at this point we've driven across the country multiple times. They're like, yeah, we'll just drive. Lesley Logan 3:20 I said, oh, I'll bring my Reformer. And we weren't even staying at the hotel where the event was. We were just down the street, just because of, like, I needed a really big room. Brad Crowell 3:27 Yeah, you had to do a weekend workshop thing. Lesley Logan 3:29 Yeah, I had to, like, host a weekend event and so we needed a big room. And so I had my assistant at the time, like, literally scoping pictures of rooms and we're like, there's no way we can make this room work, because the beds right there. So we had to stay about a mile a half away from the venue. And so Ken Ubered over. Brad Crowell 3:45 Ken is the owner of Balanced Body. Lesley Logan 3:47 Yeah, so get this, Ken Ubered over to our hotel, during setup of his humongous convention, to change the little silver situation that goes on the back of my carriage, to change the wheels out. Brad Crowell 4:01 Yeah, he brought us wrenches.Lesley Logan 4:02 He just brought a wrench, brought a credit card, so we had also brought our Nespresso machine. Brad made him a cup of Nespresso and so he fixed he like, this is, this is what.Brad Crowell 4:11 We're just chilling out, you know, and he's working on this Reformer, we're just chit-chatting. Lesley Logan 4:16 And then Brad's like, oh, man, I'll take you back to the venue. Brad Crowell 4:18 Yeah. He's like, oh, I'll grab an Uber. I was like, no, you will not grab an Uber. I will drive you, you know. And of course, I wanted him to see the van. Lesley Logan 4:26 Yeah. So he got in the van. He had to see how big the van was. He had just seen that we brought the Reformer. Brad Crowell 4:31 Yeah, yeah. Obviously, we brought the Reformer. But he said to me, oh my gosh, I always wanted one of these when I was in my 20s. I always just wanted to drive around the country. And it's so cool that you guys are doing this, and that's when I got a chance to say, well, this is, you know, we do go on tour, and we are taking, we're already taking a Reformer with us, so that we can show off the Contrology Reformer, right? And he was like, wow. And so, you know, I didn't like full blown pitch him in that moment, but it was like one major seed planted, because he could see it, feel it, touch it, understand it, in a way that wasn't us trying to pitch the vision. He could be in the vision.Lesley Logan 5:09 Yeah. So they actually signed on with us for our first ever summer tour. And so we got to do the west coast because we'd only ever done the East Coast and the middle we'd never done the west coast before we'd pulled them. We want to do a West Coast tour. So we actually did our first West Coast tour. It wasn't very long. It was kind of like a short and sweet thing. I know. We did Las Vegas. We did Los Angeles. Brad Crowell 5:31 Well, somewhere in there, we missed the 2022 winter tour. But we, 2020. Lesley Logan 5:36 Oh, yeah, we did a '22 we did a 22, you're right, we did do a 2022 winter tour. And that got bigger, got back up to the size. Brad Crowell 5:41 Yeah, that was like eight or nine. So we have Cleveland, St Louis, Dallas, Houston, Nashville, Atlanta, Greensboro. Yeah. So. Lesley Logan 5:48 Yeah, yeah, yeah, yeah. That one, that one was really great, actually, because we got back up to our 2019 numbers and so we were able to say, okay, so we've had four tours, and so we're able to show them like, look now that COVID allows us to do this. Look at these nine cities. What if we, so we did our biggest tour ever, which was the West Coast tour. We didn't do Los Angeles. We started at Las Vegas. Did we even do Las Vegas? I know we did Riverside. Brad Crowell 6:10 For the summer tour? Lesley Logan 6:11 Yeah. We did Redlands. Brad Crowell 6:13 Redlands, Long Beach. Lesley Logan 6:14 Long Beach. Brad Crowell 6:14 Bakersfield. Lesley Logan 6:15 Bakersfield. Brad Crowell 6:16 Central Valley, Hanford, Fresno. Lesley Logan 6:18 Yeah it was near Fresno. Brad Crowell 6:19 Modesto. Lesley Logan 6:20 Modesto. You guys were hitting some of those great I-5 cities. Brad Crowell 6:23 So that's five. Yeah, we did Fairfield. Lesley Logan 6:25 Yes. And we did Sacramento. Brad Crowell 6:27 Sac. Lesley Logan 6:27 And then we did a tour of Balanced Body, even though we've done it before with Ken, we did a tour so that our OPC members could see how it's all done. It was so fun. They do amazing work at Balanced Body, just being great on the environment. Then we did. Brad Crowell 6:40 Bend. Lesley Logan 6:40 Bend, Oregon. Brad Crowell 6:42 Portland. Lesley Logan 6:42 Portland. That was so fun, too, Seattle, and then. Brad Crowell 6:46 Spokane. Lesley Logan 6:47 Spokane and then we dropped down, had a couple days off in Idaho. And then we got all around St George, Utah. Brad Crowell 6:54 So we did 11 stops. Lesley Logan 6:55 11 stops, it was our biggest one, and it was so fun. And we got to see how hot it could get. So then the van got a fan. Brad Crowell 7:05 We also did that whole tour in two weeks. Lesley Logan 7:07 In two weeks. Brad Crowell 7:07 It was like 16 days. Lesley Logan 7:09 It was really. Brad Crowell 7:10 It was zipped through 11 stops in 16 days. Lesley Logan 7:13 It was, yeah, there's a heat wave. So I was not, I was okay with zipping through. Then, because of that went so well and Balanced Body was so great with that that they joined us for our winter tour in 2023 and then we really able to like. Brad Crowell 7:26 But that's when I think things really blew up. Lesley Logan 7:27 Yeah, I don't think it was our, it was our biggest tour, for sure. It beat the 11 cities, but it wasn't our biggest, biggest. Then, last year, you want to go through them? Brad Crowell 7:36 Sure. We did Vegas, St George, Denver, Lawrence, Kansas, St Louis, Missouri, Cleveland, Ohio, Saratoga Springs. That was a private event. Boston, t hen Providence, private event. Brooklyn. We had to cancel New York City because nobody was in town. Hershey, Pennsylvania, Greensboro, North Carolina, Charleston, South Carolina, Miami, Sarasota, that's the first time we did the inside of Florida. Then Austin, Dallas, Albuquerque, Sedona. So by far, this was the largest one of the 19 cities. Lesley Logan 8:10 Yeah, then we did a summer tour with the Midwest. Because if you've noticed, we've been skipping Chicago for a while. So we have been alternating the West Coast, with the Midwest, and so this is how we decided, like, okay, so you need to know, after every single one of these tours, we reflect about, like, what went well, what cities went well? Will we go back, how the people like it, how much effort was it, how great was the host? You know, if we love the host, obviously it's amazing for us to want to go there. If the host works really, really hard, then, of course, we want to continue to work with them and support them. But we also discovered that my voice, as I get older, my voice can only do. Brad Crowell 8:47 I don't think it's just because you're getting older. We had you working nine days in a row, literally teaching class nine days in a row. By the ninth day you were fried. Lesley Logan 8:56 And some of these studios, they're acoustic. Brad Crowell 8:58 You're not a day older than 29, love. Lesley Logan 8:59 Thanks, baby. Some of these students, the acoustics are not awesome for that, because you have to get your voice to carry and all these things. And so, at any rate, you'd think, well, Lesley, don't you teach all day? No. No, I don't. No, I don't. In fact, when I. Brad Crowell 9:14 Come on, you do talk, you do talk most of the time, but like this is different than trying to yell in a warehouse, you know, like. Lesley Logan 9:20 Yeah, and get people's attention in a warehouse, for sure, some of them have music going on, the whole thing. So, at any rate, we've made changes to the tour. So you'll notice with tour schedules since summer of the Midwest. Brad Crowell 9:31 Well, that, so the Summer Tour was only 13 stops, but we did it in 16 days. Yes, we were flying through. Lesley Logan 9:36 We made changes that we can only do max six days in a row before a day off, five is more ideal. Brad Crowell 9:42 But this was a major change for us, where, whereas, like, all right, we have to be very intentional about the breaks that we're putting in. Because one, things Lesley mentioned at the beginning was, how does she maintain her consistency? How does she maintain her you know, how do you do that stuff? Lesley Logan 9:57 So these tours, because I don't want to do them, because it's a job. We actually truly enjoy doing the tours. We have so much fun. I mean, I get to hug hundreds of people. It's so great. And it really, actually makes me go, oh, I wanna teach all the time. And then I'm actually like, no, actually, I really love my life, but I love that I get to see so many of you that I only see on like, I only get to read words on the internet. I get to see you in person. I could touch you and like you're three dimensional and all the things. We really love doing it, we also want to be able to be as present as possible. And so after every tour, we always reflect back, do we have enough time in that city? Do we have enough time to do this? You guys, I must work out so I do not teach all these people Pilates, and I don't get workouts in. And so every schedule we have to make sure that five days a week, I have time at a gym. I have time to move before I'm teaching giving me space to go the gym at 11pm at night is not space to work out. Also, I have to make sure that I get to have seven hours of sleep, very important. So all the things that I preach about prioritizing myself first, those things happen on tour. Brad Crowell 10:57 People always ask us how do you maintain your routine when you're completely jacking up your routine?Lesley Logan 11:02 Yeah? Well, you can speak to this. You guys use a really cool app that plans out everything, because he'll kind of drive late at night while I'm sleeping, so I can go to bed early, and I'll wake up and it will say like you're working out from this time to this time. Then you're driving here to get coffee, and then you're driving here to do this thing, and so that I have time to do my thing for myself while you're sleeping.Brad Crowell 11:22 Yeah, so we take shifts, because just the nature of our brains and our bodies, I usually stay up late. Lesley usually gets up early, especially when, when it was the COVID trip that was crazy, like the van almost never turned off. We just kept going. Lesley Logan 11:36 We were so nervous about touching anything. Brad Crowell 11:37 I sleep, you drive, and while you were sleeping, I would drive, and we'd just go, go, go. Lesley Logan 11:42 That was very different. That was also just like a very different time in the world. We were, like, afraid. We still wondered if you got COVID from gas station handles and we were going to see people at Christmas, and we had to do like, a three-day hangout at your parents' house.Brad Crowell 11:55 But the point is that we were overlapping on purpose while one was sleeping, the other was driving. Now it's a little less. The maximum amount of driving that we're trying to do in a day is, like, no more than eight hours. And that's still a lot, you know, so we've started to slow it down, which has since then made the tour longer, but it makes it a lot more enjoyable so.Lesley Logan 12:17 We also get to like, see places now, because and we have the dogs, well, now we just have one dog. We should tell them funny stories about the dogs before we wrap this episode up. But we like make sure that they get walks, and we take it through really beautiful habitat preservations that allow for dog walking. We get to see some really cool thing.Brad Crowell 12:33 We stopped in Kansas by, like, one of those big tank memorials and threw the ball. I mean, you know, like this, all these things that we do. Then the Winter Tour 2024 with the support of Balanced Body. And we had some other sponsors, too. Yeah, we had 21 locations, 21 stops. But in order to meet these new requirements of no more than six days in a row of teaching, how do we drive eight hours or less a day? How do we make sure that we've got time to do some workouts. By the way, we're interested in seeing White Sands National Park on this trip. Can we do that, you know, like stuff like that. How do we work all that in? Well, it ended up making, making the trip 34, 35 days. But we actually went the longest. We drove 80, over 8000 miles. Lesley Logan 13:17 Yeah, we got to go to some great places. And also, if you're like, this sounds so amazing, guys, everything works out for you. Just so you know, pretty much every tour there was a dud city.Brad Crowell 13:24 Oh yeah, we had to cancel. It would have been 22 cities on the Winter Tour, and we, unfortunately, had to pull one because we just had no one participate.Lesley Logan 13:33 And we and talk about like the last time was that perseverance, we paid people to scour emails and Instagram handles for three hour drive away to be like, okay, well, what if we get these people from this state to come in? What if this people from this state come in? They could do with this. Brad Crowell 13:47 I mean, I would drive and just call, literally, I would call studio after studio after studio. Lesley Logan 13:51 And we had people say, and it was a lovely house. And she's like, no, people are just last minute. We're like, girl, it's 48 hours before. This is as last minute as we, no, we're not driving up there. So again, we don't take it personally. It sucks. We always do reflect, like, what could we have done better? Was it the time of day? You know, we've had cities that have done really, really well two years in a row, and then have a dud year, and we're like, oh, what happened there? And it's like, oh. So this next Winter Tour, we're flipping two cities because we're like, oh, you know, we did them before Christmas and then after Christmas. And this year we switched that, and that didn't go well for either one of them. So you start to learn the seasons of things, and you have to know that it's not personal, but the reflecting after every tour really helps us make each tour even better. And we're six weeks, five weeks away from our eighth tour, and it's gonna be epic. It's gonna be amazing. It almost feels like a vacation.Brad Crowell 14:38 A little bit more time-condensed, so we're a little over three weeks, but we're at doing almost 19 stops. So that's, that's intense. Lesley Logan 14:46 Three of them include Canada.Brad Crowell 14:48 Yeah. So we're, we're doing our best here to get to do our first international tour. I mean, we are going, so. Lesley Logan 14:55 We're going. Just so you know, these tours also are a huge investment. There's a reason why we have a sponsor with Balanced Body. They really help us actually be on the road for that long because when you're on the road for that many weeks, you're having three plus meals a day on the road. All that adds up money, the gas, depending on what state you're in, is insane, right? So there's that we do. We try not to use a hotel at this point because we have the van, the investment we've made in the van, you know, to make it so we can live in all of that kind of costs money. And so there are things that have failed on tours where, like, like, those stops that haven't made money or haven't, haven't, had been canceled, but having a sponsor that allows us to, like, really be on the road for that long, so that we can do these stops and we can see all of you, but to get to Canada, we're investing thousands of dollars to make it happen.Brad Crowell 15:41 Yeah, had to pay an attorney to help us with paperwork and it was like. Lesley Logan 15:44 Because you can't just work wherever you want to work. You can't just do that. So we're super, super excited to be one of the first people that actually do a big Pilates event. There have been other Pilates events in Canada. I don't want to discount those ones that are happening in Balanced Bodies in Montreal.Brad Crowell 15:59 It's like, it's the thing that's exciting about this is it'll be our first international tour. Lesley Logan 16:03 Yes, yes. I know people are like, when are you going to do a European tour? So I used to think it was like two years away after what we're doing for Canada. You guys, I gonna tell you right now, that's a five year plan. Because, like. Brad Crowell 16:13 Yeah, we so we're thinking about, how could we do this, you know, in Europe and Australia. Because, like, eventually for us, that's the vision. We want to go see those places. We want to spend the time, I think, for us to drive around Australia, to do it right, it's going to take us five to six weeks of driving, like, that's a lot. Lesley Logan 16:28 And we're going to have to rent a van there. We're certainly not going to take one. I was thinking about put some magnets on it. But also, there are actual laws about what we can do, and we don't do these things quietly. So, so if you live in Australia or Europe, and you want us to do tours there, you should definitely reach out. We keep a list of people who love to host. And we do need hosts. These tours, they happen when there's hosts. But also, and that goes for anyone in the States as well. You can actually put your place on there. But also, we're gonna need legal help, because, like we're talking immigration attorney help, which is not cheap, by the way, very expensive, so that we can actually do these things. So what we thought would be like in two years, I'm realizing, is probably a few years in the making. But we want to make this happen. We want to be part of it. That's why we're actually telling you the behind the scenes on how these tours work. So opc.me/tour is where you go for tickets, but opc.me/host is where you go to apply to be a host. Okay, so funny stories about the dogs. First of all, we used to do these tours with three dogs. Brad Crowell 17:29 Three. Lesley Logan 17:30 And then Gaia's last tour was Summer Tour 2024. Brad Crowell 17:33 Well, her first last tour. Lesley Logan 17:35 Her first last tour was Winter 2022. Brad Crowell 17:38 So, was it winter? Lesley Logan 17:40 Oh, yeah, Winter Tour 2022. Brad Crowell 17:42 It was Winter Tour, you're right.Lesley Logan 17:43 And then it was, her first last tour was Summer 2023 then her second last tour was, was winter 2023 and then. Brad Crowell 17:52 Her actual last tour was Summer '24. Lesley Logan 17:53 You guys, before we started, she, you guys, she did not want to go. We were, the van was loaded up, the boys were in it. The boys, because the boys, once we start loading the, putting stuff up to load in. They are like, in the van. Brad Crowell 18:03 Yeah, they do not want to be left behind, so they're sitting in the van watching us. Lesley Logan 18:07 It is hot as fuck outside. And they're like, no, I need to be in the van. I'm like, okay, but the doors are wide open. I can't be in the van. And they're freaking out. They're, they're just, you know, very nervous. And she, so we have the whole van loaded up. The boys are in the van. We go Gaia, and she comes and looks at the door.Brad Crowell 18:22 She comes out onto the front porch, stares at us. Lesley Logan 18:26 And she goes back inside. Brad Crowell 18:27 Turns around and goes back in the house. She's like nuh-uh.Lesley Logan 18:30 And we forced her, we forced her to go on this tour. And she was at this point, sleeping 20 hours a day, just anyways, she was having a hard time with her back legs. We're carrying her everywhere, which we've been doing the last two tours. Brad Crowell 18:41 And we had to lift her in and out of the van. Lesley Logan 18:42 Lift her in the van, and then, okay, so on this her on her final, final, last tour, she had an accident in the bed, and that was really unfortunate, because we're on the road now. We've got a dog, but that has to get washed. We don't always have time for a, like, a wash and, like, I don't know what you call this, like a fluff and fold. So I'm in Kansas City teaching a class, and while I'm teaching, Brad leaves to go bathe her. So he finds a place that he can bathe her, and he has to leave because it's hot out. He has to leave.Brad Crowell 19:12 So the timing of things, we have a very tight timeline. Lesley Logan 19:16 He leaves the car running with the dogs in the van and the boys. Brad Crowell 19:20 Wait. So, hold on. You're teaching the class. You're teaching the workshop. I have, literally, I have 90 minutes to get up and out, find a place, turn it around, wash the dog, get back. Right?Lesley Logan 19:34 Yeah. So he pulls up to this dog place. Brad Crowell 19:37 Well, the first one I pulled up to, it says on Google Maps that they have a thing in there to wash them. They don't. And I was like, are you, are you kidding? I just wasted 10 minutes coming all the way over here, and you don't have what I need. Lesley Logan 19:49 Yeah, so, so then he now has to go the next one, right? So he goes to the next one. He leaves the car running because it's hot out. It's like 90 something degrees. He leaves it running. And the boys are in the passenger seat, watching Brad take Gaia into the van. They're not okay with this. The pack is not together, somehow, though, while he's washing Gaia, so she's in this tub. Brad Crowell 20:10 So they're in the van, I'm in the store. But the the van's running so that the AC could be blasting. And August. Lesley Logan 20:18 Pressed the window button. Brad Crowell 20:19 He goes to the driver's seat, and shoves his nose, but he touches, he steps on the window button, and the window goes down, and sure enough. Lesley Logan 20:27 Jumps out. Brad Crowell 20:28 Two dogs jump out of the van. Lesley Logan 20:29 And they go up to the store, which has those doors that open by themselves. Brad Crowell 20:32 So before that happened, I'm in the back of the store, and I'm washing Gaia, right? She's covered in shit. All of a sudden, up at the front of the store, I hear, oh no, oh no, right, and this now there's multiple people yelling oh no. And then this lady's running down the store, and she's yelling, hey, sir, sir, I think your dogs just got out of the van. I'm like, holding the hose, and it's one of those timer things. So, like, I'm like, all right, I guess I'm gonna have to get more of that once I figure this other thing out. So I throw the water that's already it's still coming out. I just throw it and like, I'm like, Gaia, you stay. And she's looking at me, like, how could I possibly go anywhere? Right? And so I'm running out towards the van right at the same exact time the double doors of this big dog store open, and both August and Bayon come running into the store.Lesley Logan 21:21 Yeah, they ran into the store. So thankfully, they ran into the store and not, like, down the street. I don't even know what we would have done. At any rate.Brad Crowell 21:28 Yeah, I was, like, I was, because there was a parking lot. Like, there was hundreds of cars. It would have been terrible. Lesley Logan 21:33 Yeah. So they ran into the store, so Brad has to get them. Brad Crowell 21:36 So now I got all three dogs in the back, in the dog washing area, because I'm like, screw it. You guys are with me now. We're just gonna all hang out here. Finish washing Gaia. I blow dry Gaia down. And they were like, hey, can we get you a leash? Because the leashes were in the van. It wasn't like that, you know, so, and I was like, that would be so helpful. So they helped me, like, get the dogs on a leash. And, you know, we troop out of it, and everyone's happy because, you know, the dogs came to be with the pack. Lesley Logan 22:04 Yeah, so. Brad Crowell 22:06 Oh, and then I had to zip back just in time for the end of the workshop so that I could do the raffle. Lesley Logan 22:10 And I'm like, wrapping up this workshop, and he's not there. And I'm like, where the fuck is he? Because I can't, I don't know what I'm raffling off like I had to check people into this next thing. I had no idea this was going on. Anyways, oh my God. So this tour we. Brad Crowell 22:24 Chaos. Lesley Logan 22:25 This tour will be not chaotic. Future tours will not be chaotic because we have one dog. Brad Crowell 22:30 Yes, he's very chill. He just wants to lay next to you.Lesley Logan 22:33 He's very chill. Just wants to lay down. He wants to just be there. So I think it was so this is where we're at. No more shenanigans. Real easy. Roll in, roll out. You guys. We have two tours this year. We have a summer tour in the West Coast, into Canada. Please tell your friends, come make a trip out of it. We're doing some really cool cities. We're going to places you're going to want to travel to, and obviously, East Coast, the South check our Winter Tour list. And if you are living anywhere in the world and you want a tour stop, feel free to go to opc.me/host but opc.me/tour get tickets for you and your friends.Brad Crowell 23:06 If you want a tour stop, meaning you would like to host us, go to opc.me/host. If you would like information about the tour itself, go to opc.me/tour.Lesley Logan 23:16 And all of the classes and workshops are for all levels, so your friends and your family can come. These are not made to be only for teachers. There are CECs for the teachers. And again, our headlining sponsor for these next two tours is Balanced Body and Contrology. Oh, and now we have a contour kit, because we're bringing a Reformer, a mat and a Spine Corrector, so you guys can try those things out.Brad Crowell 23:40 Not a chair? Lesley Logan 23:41 No, we didn't buy the chair. Brad Crowell 23:42 Oh, I thought we did.Lesley Logan 23:44 No, we talked about that. Brad Crowell 23:44 All right, failed. Well, that's fine.Lesley Logan 23:47 I would love another chair. But we discussed that. Brad Crowell 23:50 It is big. It's just a lot.Lesley Logan 23:53 We discussed it. It was not the right thing to buy it until the van's more set up,Brad Crowell 23:58 Yeah. So anyway, come try out all that fun stuff. So what would you say would be a Be It Action Item for this episode? Lesley Logan 24:06 Oh, just go buy a ticket to our upcoming tour, because you're gonna have the best time. You're gonna be in community. If you feel lonely, or if you feel burnt out, or if you feel exhausted, then you come on this tour and you, I fill your cup. I prioritize you, I answer your questions. You get to see people you pass as two ships. You get to maybe meet up with people you had no idea love Pilates the same way you do. These literally bring people together. And it doesn't matter how you started Pilates, how many years been doing Pilates, if you teach who trained you. I don't give a fuck. Being in community is the be it action item. It's important.Brad Crowell 24:45 Cool. So my Be It Action Item is when it comes to projects like this, don't be afraid to make changes after you've decided this is how it should work, right, because, for example, if we didn't sell tickets to a spot why are we driving there, right? And that's a bummer, and that's frustrating, but you have to be able to be fluid enough to make changes in the moment when something isn't working or isn't making sense, or not necessarily in the moment, you have to catch it, you can assess it after the fact and do the post mortem, right? For example, from the Summer Tour '24 to the Winter Tour '24 we decided you clearly shouldn't be teaching nine days in a row. That is not healthy, right? So therefore we put a hard stop six days maximum on the way out to Philadelphia. We only taught one stint of six days. Everything else was five, four days in a row before we took a day off on the way back from Philadelphia, same thing, we only had one stint of six days because we were making adjustments and making changes. So, yeah, but I still agree with you that you should come join us because of community. It is so important, especially now with our virtual world, with loneliness being higher than it's ever been, with social media not helping any of us actually function in our own lives. Even though we've been sold this story that somehow it's gonna connect us better, it fucking doesn't, and it's just making us lonelier. So what we're trying to do is actually bring together people in real life, so that we can support each other and be around each other, because we need it. So we would love to meet you, come join us on these tours. Brad Crowell 26:22 Yes, all right, loves, until next time, Be It Till You See It. Brad Crowell 26:25 Bye for now. Lesley Logan 26:27 That's all I got for this episode of the Be It Till You See It Podcast. One thing that would help both myself and future listeners is for you to rate the show and leave a review and follow or subscribe for free wherever you listen to your podcast. Also, make sure to introduce yourself over at the Be It Pod on Instagram. I would love to know more about you. Share this episode with whoever you think needs to hear it. Help us and others Be It Till You See It. Have an awesome day. Be It Till You See It is a production of The Bloom Podcast Network. If you want to leave us a message or a question that we might read on another episode, you can text us at +1-310-905-5534 or send a DM on Instagram @BeItPod. Brad Crowell 27:10 It's written, filmed, and recorded by your host, Lesley Logan, and me, Brad Crowell. Lesley Logan 27:15 It is transcribed, produced and edited by the epic team at Disenyo.co. Brad Crowell 27:19 Our theme music is by Ali at Apex Production Music and our branding by designer and artist, Gianfranco Cioffi. Lesley Logan 27:26 Special thanks to Melissa Solomon for creating our visuals. Brad Crowell 27:30 Also to Angelina Herico for adding all of our content to our website. And finally to Meridith Root for keeping us all on point and on time.Transcribed by https://otter.aiSupport this podcast at — https://redcircle.com/be-it-till-you-see-it/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy
On the 151st Episode of "Keep Grinding The Podcast", I am joined by Arnold Cueto with our wrestling special "Doing The Job: Pro Wrestling Talk w/ Arnold Cueto"We're discussing Smackdown in Bakersfield, Money In The Bank and Raw from this past week. We're putting over the wrestling that we love here at DOING THE JOB! Follow on Instagram: instagram.com/keepgrindingpodcastApple Podcasts: https://podcasts.apple.com/us/podcast/keep-grinding-the-podcast/id1454842213Spotify: https://open.spotify.com/show/1oEJKJbSSRpbo7XQhyOF9X?si=d6PNHQLBRNSMyYNWZWy96QWebsite: https://www.bookec3.com/keepgrindingthepodcast
Today's top stories:Air India jet crashes moments after takeoffCity of Bakersfield approves water usage rate hike for some residentsBakersfield City Council approves additional funds for police officer body-worn camerasCalifornia Living Museum mourns deaths of 2 animalsDriver in deadly suspected DUI crash in SE Bakersfield is 19Standard School District superintendent resignsFederal court to hear case over Trump's order to send National Guard to Los AngelesHarvey Weinstein convicted of sexual assault, acquitted of another chargeYoung Marines gather US flags ready to be properly retiredFor more local news, visit KGET.com.
Brittany Brave is here on this week’s Steph Infection! Steph and Brittany chat about comedy and dating in NYC, LA, and Miami, finding the perfect partner, Brittany brings stories about her allergy to red ants, and much much more! Get 60% off the Magic Mind offer with our link and code https://www.magicmind.com/sinfection60 & SINFECTION60 #magicmind #mentalwealth #mentalperformance Steph’s new special, FILTH QUEEN, will be releasing on Netflix on JUNE 24! Make sure to save the date!! Follow @Steph_Tolev and @Steph_Infection_Podcast on Instagram. Send in your body stories to be featured on the pod! See Steph Live!! KEEPIN EM HARD 2025 Tour US DatesJune 6-7 Raleigh, NCJune 28 Bakersfield, CAAugust 29 La Brea, CA Get tickets at https://punchup.live/stephtolev Be sure to follow @brittanybrave on Instagram! Steph Tolev caught fire on the BILL BURR PRESENTS: FRIENDS WHO KILL, Netflix special. She was named a COMEDIAN YOU SHOULD AND WILL KNOW by Vulture, which recognized her as one of Canada’s funniest exports. She was featured on Comedy Central’s THE RINGERS stand up series, and season two of UNPROTECTED SETS. Steph has appeared in Comedy Central’s CORPORATE and starred in an episode of the Sarah Silverman-produced PLEASE UNDERSTAND ME. Steph has been well received at festivals all over the world and headlines clubs across the country. She also has a hit podcast on ALL THINGS COMEDY called “STEPH INFECTION” and appears in the feature OLD DADS starring and written by Bill Burr on Netflix. Check out her tour dates to see her live!
Today's top stories: 1 person dead in fiery crash in SE BakersfieldTrump defends move to send National Guard, military to Los Angeles amid ICE protestsProtesters in Bakersfield show solidarity for Los Angeles amid ICE raidsQuestions remain 7 months after Marketplace shootingMeet Lauren Holcomb, the newest member of the 17 News at SunriseBakersfield City Council to discuss water rate hikeKGET collecting US flags ready for retirement through FridayCA Republicans call out Newsom over Prop 36 fundingFor more local news, visit KGET.com.
If You Missed Romeo In The Morning We Talked About: My trip to Mississippi, the craziness of travel and are there more great dads then great moms?
Today's Top Stories: Marines sent to Los Angeles following ICE raids County and state leaders react to ICE raids Kern County reaches agreement with SEIU Bakersfield water rates to increase by 56% over the next 5 years Investiagtion underway after inmate is stabbed at Kern Valley State PrisonEx- Board of Trustee member found not guilty on charges related to fraud Bakersfield man accused of impregnating teen girl takes plea deal For more local stories, visit KGET.com.
Episode 193: Gestational Diabetes IntroJesica Mendoza (OMSIII) describes the pathophysiology of gestational diabetes and the right timing and method of screening for it. Dr. Arreaza adds insight into the need for culturally-appropriate foods, such as vegetables in Mexican cuisine. Written by Jesica Mendoza, OMSIII, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.DefinitionGestational diabetes mellitus (GDM) is a condition that occurs to previously non-diabetic pregnant women, caused by glucose intolerance at around the 24th week of gestation. PathophysiologyGDM arises due to an underlying pancreatic beta cell dysfunction in the mother which leads to a decrease in the amount of insulin produced and thus leads to higher blood sugar levels during pregnancy. The placenta of the fetus will produce hPL (human placental lactogen) to ensure a steady supply of sugars to the fetus, creating an anti-insulin effect. However, hPL readily crosses the placental barrier causing the mothers insulin requirement to increase, when the mother's pancreas cannot increase production of insulin to that level needed to counter the effect of hPL they become diabetic, and this leads to gestational diabetes. So, basically the placenta is asking for more glucose for the baby and the mother's pancreas struggles to keep the glucose level within normal limits in the body of the mother. If left untreated, high levels of glucose in the mother can cause glucotoxicity in the mother.“Glucotoxicity” refers to the toxic effect of glucose. Glucose is the main fuel for cell functions, but when it is high in the bloodstream, it causes toxicity to organs. Prevalence of GDM.The CDC reports mean prevenance of GDM is 6.9%. In U.S. mothers the prevenance increased from 6.0% in 2016 to 8.3% in 2021. Many different factors have played a role in increasing gestational diabetes in American mothers, some of those being the ongoing obesity epidemic with excess body weight being a known risk factor for insulin resistance. Another being advanced maternal age (AMA) as more American women have children later in life their body becomes less sensitive to insulin and requires a higher insulin output on top of the insulin that is required for the fetus. The “American diet” is also something that has a big effect in diabetes development. With the increase of high-carb foods that are readily available, the diet of Americans has declined and is affecting the metabolic health of mothers as they carry and deliver their children. Despite ongoing awareness of GDM, 6% to 9% of pregnant women in the United States are diagnosed with gestational diabetes, and the prevalence continues to increase worldwide. It is estimated that in 2017 18.4 million pregnancies were affected by GDM in the world, which then continued to increase to 1 in 6 births to women with GDM in 2019. It was also found that women living in low-income communities were disproportionately affected due to limited healthcare access. Additionally, women with GDM had a 1.4-fold increase in likelihood of undergoing a c-section, with 15% increase in risk of requiring blood transfusion. Screening for GDMGestational diabetes is screened between the 24th to 28th week of gestation in all women without known pregestational diabetes. In women who have high-risk for GDM the screening occurs during the first trimester, these women usually have at least one of the following: BMI > 30, prior history of GDM, known impaired glucose metabolism, and/or a strong family history of diabetes. The screening during the first trimester is to detect “pregestational diabetes” because we have to keep a good glycemic control to improve outcomes of pregnancy. So, if it's positive, you start treatment immediately. If these women are found to have a normal glucose, they repeat the testing again as done normally, at 24-28 weeks of gestation. How do we screen?The screening itself consists of two types of approaches. The two-step approach includes a 50-gram oral glucose tolerance test (OGTT), where blood glucose is measured in an hour and if it is below 140 they are considered to not have GDM, however if the reading is greater than 140 they must then do a 3-hour, 100g oral glucose tolerance test. The 3-hour OGTT includes measuring the blood sugars at Fasting which should be less than 95, at 1 hour at less than 180, at 2 hours at less than 155, and at 3 hours at less than 140. If 2 or more of these values exceed the threshold the patient is diagnosed with gestational diabetes mellitus. The one-step approach includes 75g after an overnight fast. Blood glucose is measured while fasting which should be less than 92, at 1 hour less than 180 and at 2 hours less than 153. If any one of these values is exceeded, the patient is diagnosed with GDM.If the mother is found to be GDM positive during pregnancy she will also need continued screening post-partum to monitor for any development of overt diabetes. The testing is usually 75g 2-hour OGTT at 6-12 weeks postpartum. If this testing is normal, then they are tested using HbA1c every 3 years. If the post-partum testing shows pre-diabetes, annual testing is recommended using HbA1c measurements. Maternal complications Women with GDM are at an increased risk for future cardiovascular disease, T2DM, and chronic kidney disease. GDM is also associated with increased likelihood of developing pre-eclampsia following delivery. Pre-eclampsia is a complication seen in pregnancy characterized by high blood pressure, proteinuria, vision changes, and liver involvement (high LFTs). Pre-eclampsia can then progress to eclampsia or HELLP syndrome, both of which can include end organ damage. Additionally, she can develop polyhydramnios which leads to overstretching of the uterus and can induce pre-term labor, placental abruption, and or uterine atony, all of which additionally put the mother at increased risk for c-section. All of these maternal complications that stem from GDM lead to complications and extended hospitalization. Child's complications Although there is an increased set of risks for the mother, the neonate can also develop a variety of risks due to the increased glucose while in utero. While the fetus is growing, the placenta is the source of nutrition for the fetus. As the levels of glucose in the mother increase so does the amount of glucose filtered through the placenta and into the fetal circulation. Over time the glucose leads to oxidative stress and inflammation with activation of TGF-b which leads to fibroblast activation and fibrosis of the placenta. This fibrosis decreases the nutrient and oxygen exchange for the fetus. As the fetus attempts to grow in this restrictive environment its development is affected. The fetus can develop IUGR (intrauterine growth restriction) leading to a small for gestation age newborn which can then lead to another set of complications. The low oxygen environment can lead to increased EPO production and polycythemia at birth which can then lead to increased clotting that can travel to the newborn brain. Newborns can also be born with fetal acidosis due to the anerobic metabolism and lactic acid buildup in fetal tissues which can cause fetal encephalopathy leading to cerebral palsy and developmental delay. And the most severe of newborn complications to gestational diabetes can lead to fetal demise. Furthermore, the increase of glucose can also lead to macrosomia in the infant which can often lead to a traumatic delivery and delivery complications such as shoulder dystocia and brachial plexus injury. Brachial plexus injury sometimes resolves without sequela, but other times can lead to permanent weakness or paralysis of the affected arm. The baby can be born too small or too big.Additionally, once the fetus is born the cutting of the umbilical cord leads to a rapid deceleration in blood glucose in the fetal circulation and hypoglycemic episodes can occur, that often lead to NICU admission. The insulin that is created by the fetus in utero to accommodate the large quantities of glucose is known to affect lung maturation as well. The insulin produced inhibits surfactant production in the fetus. Upon birth some of the newborns also have to be placed on PEEP for ventilation and some children require treatment with surfactant to prevent alveolar collapse and/or progression to NRDS created by the low surfactant levels. Additionally, neonates who are macrosomic, which is usually seen in GDM mothers, are larger and stronger and when put on PEEP to help increase ventilation the newborn's stronger respiratory effort can lead to higher pulmonary pressures and barotrauma such as neonatal pneumothorax.Long term complications to the child of a mother with GDM also occur. As the child grows, they are also at an increased risk for developing early onset obesity because of the increased adipose storage triggered by the increase in insulin in response to the high glucose in utero. This then can lead to a higher chance of developing type 2 diabetes mellitus in the child. With diabetes, also comes an increase in cardiovascular risk as the child ages and becomes an adult. The effects of GDM go beyond the fetal life but continue through adulthood.What can be done?Gestational Diabetes Mellitus has many severe and lifelong consequences for both the mother and the child and prevention of GDM would help enhance the quality of life of both. Many of the ways to prevent GDM complications include patient education and dietary modifications with a diet rich in whole grains, fruits, vegetables and lean proteins. Benefits of some vegetables in the Mexican cuisine that may be beneficial: Nopales, Chayote, and Jicama. Those are good alternatives for highly processed carbs.Mothers are usually offered nutritional counseling to help them develop a tailored eating plan. This and 30 minutes of moderate exercise daily is recommended to increase insulin sensitivity and lower the post-prandial glucose levels. If within 2 weeks of implementing lifestyle changes alone the glucose measurements remain high, then medications like insulin can be put onboard to manage the GDM. If they require insulin, I think it is time to refer to a higher level of care, if available, high risk OB clinic.Conclusion: Now we conclude episode number ###, “[TITLE].” [summary here]. _____________________References:Eades CE, Burrows KA, Andreeva R, Stansfield DR, Evans JM. Prevalence of gestational diabetes in the United States and Canada: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2024 Mar 15;24(1):204. doi: 10.1186/s12884-024-06378-2. PMID: 38491497; PMCID: PMC10941381. https://pubmed.ncbi.nlm.nih.gov/38491497/QuickStats: Percentage of Mothers with Gestational Diabetes,* by Maternal Age — National Vital Statistics System, United States, 2016 and 2021. Weekly / January 6, 2023 / 72(1);16. https://www.cdc.gov/mmwr/volumes/72/wr/mm7201a4.htm?utmAkinyemi OA, Weldeslase TA, Odusanya E, Akueme NT, Omokhodion OV, Fasokun ME, Makanjuola D, Fakorede M, Ogundipe T. Profiles and Outcomes of Women with Gestational Diabetes Mellitus in the United States. Cureus. 2023 Jul 4;15(7):e41360. doi: 10.7759/cureus.41360. PMID: 37546039; PMCID: PMC10399637. https://pmc.ncbi.nlm.nih.gov/articles/PMC10399637/?utmPerlman, J. M. (2006). Summary proceedings from the neurology group on hypoxic-ischemic encephalopathy. Pediatrics, 117(3), S28–S33.DOI: 10.1542/peds.2005-0620C.Low, J. A. (1997). Intrapartum fetal asphyxia: definition, diagnosis, and classification. American Journal of Obstetrics and Gynecology, 176(5), 957–959.DOI: 10.1016/S0002-9378(97)70609-0.Hallman, M., Gluck, L., & Liggins, G. (1985). Role of insulin in delaying surfactant production in the fetal lung. Journal of Pediatrics, 106(5), 786–790.DOI: 10.1016/S0022-3476(85)80227-0.Sweet, D. G., Carnielli, V., Greisen, G., et al. (2019). European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update. Neonatology, 115(4), 432–450.DOI: 10.1159/000499361.Raju, T. N. K., et al. (1999). Respiratory distress in term infants: when to suspect surfactant deficiency. Pediatrics, 103(5), 903–909.DOI: 10.1542/peds.103.5.903.Burns, C. M., Rutherford, M. A., Boardman, J. P., & Cowan, F. M. (2008). Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycemia. Pediatrics, 122(1), 65–74.DOI: 10.1542/peds.2007-2822.Dabelea, D., et al. (2000). Long-term impact of maternal diabetes on obesity in childhood. Diabetes Care, 23(10), 1534–1540.DOI: 10.2337/diacare.23.10.1534.Dashe, J. S., et al. (2002). "Hydramnios: Etiology and outcome." Obstetrics & Gynecology, 100(5 Pt 1), 957–962.DOI: 10.1016/S0029-7844(02)02279-6.Long-term cost-effectiveness of implementing a lifestyle intervention during pregnancy to prevent gestational diabetes mellitus: a decision-analytic modelling study. Diabetologia.American College of Obstetricians and Gynecologists. (2018). Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstetrics & Gynecology, 131(2), e49–e64. https://doi.org/10.1097/AOG.0000000000002501Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.
Today's Top Stories:Fort Fire evacuations liftedKernville man in custody after officer-involved-shootingMan accused of stabbing estranged wife still a no-show in courtKCSO lieutenant charged with 9 felonies SNIP bus helps spay and neuter furry friends ahead of Fourth of July Patrick's Pantry gathers over 20,000 food items in food driveFirst Fridays art walk begins tonight For more local stories, visit KGET.com.
Today's top stories:Fort Fire prompts evacuation warning for areas near Interstate 5 south of GrapevineFamily member of person accused of starting deadly State Rd fire speaks with 17 NewsTeen who saved family dog from house fire in central Bakersfield meets with dog's ownerCandidates for California governor speak a year ahead of primaryTrump administration threatens to cut federal funding for California High Speed Rail projectPresident Trump signs travel ban for 12 countriesKern County Public Health alerts residents mosquito season is onPatrick's Pantry collecting food items outside KGET today'Wicked: For Good' trailer releasedFor more local news and updates, visit KGET.com.
Elton Castee (TFIL, OVERNIGHT, HAUNTED HOMIES) is here on this week’s Steph Infection! Elton chats with Steph about his craziest paranormal interactions, exploring the Paris catacombs, what actually makes him scared, and much much more! Steph’s new special, FILTH QUEEN, will be releasing on Netflix on JUNE 24! Make sure to save the date!! Follow @Steph_Tolev and @Steph_Infection_Podcast on Instagram. Send in your body stories to be featured on the pod! See Steph Live!! KEEPIN EM HARD 2025 Tour US DatesJune 6-7 Raleigh, NCJune 28 Bakersfield, CAAugust 29 La Brea, CA Get tickets at https://punchup.live/stephtolev Be sure to follow @eltoncastee on Instagram! Steph Tolev caught fire on the BILL BURR PRESENTS: FRIENDS WHO KILL, Netflix special. She was named a COMEDIAN YOU SHOULD AND WILL KNOW by Vulture, which recognized her as one of Canada’s funniest exports. She was featured on Comedy Central’s THE RINGERS stand up series, and season two of UNPROTECTED SETS. Steph has appeared in Comedy Central’s CORPORATE and starred in an episode of the Sarah Silverman-produced PLEASE UNDERSTAND ME. Steph has been well received at festivals all over the world and headlines clubs across the country. She also has a hit podcast on ALL THINGS COMEDY called “STEPH INFECTION” and appears in the feature OLD DADS starring and written by Bill Burr on Netflix. Check out her tour dates to see her live!
A Bakersfield girl, whose family said she faced deportation while battling a life-threatening medical condition can stay in the U.S. for now. The $600 million dollar plan to rebuild schools damaged in the Palisades Fire and hopes that the feds will pick up the tab. Longtime Pacific Symphony conductor Carl St. Clair prepares to step back from the podium. Plus more.Support The L.A. Report by donating at LAist.com/join and by visiting https://laist.comVisit www.preppi.com/LAist to receive a FREE Preppi Emergency Kit (with any purchase over $100) and be prepared for the next wildfire, earthquake or emergency! Support the show: https://laist.com
Today's top stories:Victims in Indiana triple homicide were from Bakersfield4-year-old living in Bakersfield with rare condition allowed to stay in USSteel, aluminum tariffs go into effectCA lawmakers react to Trump's threat of fines after transgender athlete competes in state championshipsRains expected to soak southeastern USMan accused of killing his roommate at East Bakersfield apartmentMan sentenced to 2 years in prison for EBT benefit theftKGET collecting US flags ready to be retiredRite Aid store closing in Bakersfield, part of corporate bankruptcyFor more local stories, visit KGET.com.
If You Missed Romeo In The Morning We Talked About: Summer jobs, judge people by what they are buying at the store, how every generation thinks they are the best and having game today doesn't work like it did back in the day
Romeo talks about mail order catalogs, summer vacation and not wearing your wedding ring out in public.
Today's top stories:Two people needed to be rescued from Kern River at Hart ParkArrest made in mobile home fire that killed woman in OildaleSuspect arrested for homicide after body found in East Bakersfield apartmentAmid ICE raid in San Diego, person with BCHS FFA jacket seen in videoPresident Trump to hold tariff talks with Chinese leadershipTrump threatens California with "large scale fines" after transgender athlete competes in CIF championshipsFairfax Junior Baseball Club begins its seasonStudy: Coffee can help women keep healthy3 Rite Aid stories in Bakersfield to closeFor more local news, visit KGET.com.
Bakersfield baker to take religious liberties case to U.S. Supreme Court after refusal from Calif. high court Please Subscribe + Rate & Review KMJ’s Afternoon Drive with Philip Teresi & E. Curtis Johnson wherever you listen! --- KMJ’s Afternoon Drive with Philip Teresi & E. Curtis Johnson is available on the KMJNOW app, Apple Podcasts, Spotify, Amazon Music or wherever else you listen. --- Philip Teresi & E. Curtis Johnson – KMJ’s Afternoon Drive --- Weekdays 2-6 PM Pacific on News/Talk 580 & 105.9 KMJ DriveKMJ.com | Podcast | Facebook | X | Instagram --- Everything KMJ: kmjnow.com | Streaming | Podcasts | Facebook | X | Instagram See omnystudio.com/listener for privacy information.
Coach George Eglesfield from NCAA D1 California State University at Bakersfield shares his journey from international student-athlete to recruiting coordinator and assistant coach, providing valuable insights for swimmers considering the US college route. His personal experience swimming at the University of Wyoming combined with his current coaching perspective offers a comprehensive view of collegiate swimming opportunities.In this episode, Coach George shares the things the would focus on if he was a high school aged international swimming recruit, as well as tips he has for athletes getting ready to start their swimming journey this upcoming August. The infamous online platform Swim Cloud is also discussed, where Coach George emphasises the value in utilising this website when a swimmer is starting out their US college recruitment journey.Claire asks Coach George her favourite question about red flags and green flags in college recruiting, and also delves into the prevalent priority she sees with Australian swimmers: wanting a warm climate college in Florida or California. Coach George provides his insight as to why climate considerations should be secondary to swimming program quality, academics, and scholarship opportunities.The episode ends with Coach George discussing how the modern college swimming world is increasingly intense - times from 10 years ago would not be competitive today.Enjoying what you are learning from In the Huddle? Leave us a review and message us on Instagram for more Podcast topic requests!
Bakersfield baker to take religious liberties case to U.S. Supreme Court after refusal from Calif. high court Please Subscribe + Rate & Review KMJ’s Afternoon Drive with Philip Teresi & E. Curtis Johnson wherever you listen! --- KMJ’s Afternoon Drive with Philip Teresi & E. Curtis Johnson is available on the KMJNOW app, Apple Podcasts, Spotify, Amazon Music or wherever else you listen. --- Philip Teresi & E. Curtis Johnson – KMJ’s Afternoon Drive --- Weekdays 2-6 PM Pacific on News/Talk 580 & 105.9 KMJ DriveKMJ.com | Podcast | Facebook | X | Instagram --- Everything KMJ: kmjnow.com | Streaming | Podcasts | Facebook | X | Instagram See omnystudio.com/listener for privacy information.
Today's top stories:Kern County Sheriff's Office releases video of 2 incidents where deputies shot at suspects.Pedestrian killed by vehicle in south BakersfieldMan's body located is Isabella Lake after drowningSenate takes on President Trump's 'Big, Beautiful Bill"Suspect in custody after Colorado attack against Israel supportersWalk For Kids 5K raises money for Ronald McDonald HouseCA Democrats wrap up convention in Anaheim2 Rite Aid stores in Bakersfield to closeFor more local news, visit KGET.com.
In this podcast, we talk with Cory Peebles from Toolin' Around Handyman, based in Bakersfield, California. He talks about changing from a career in the oil and gas industry, to having a thriving company generating close to $700,000 in revenue annually!Hosted by Jason Call, Founder of Handyman Marketing Pros, and Allen Lee, Founder of The Handyman JourneyGet a professional website, SEO, and advertising at https://HandymanMarketingPros.comGet handyman-specific business coaching from Allen Lee at https://HandymanJourney.comSign up for our monthly Webinars and Training (FREE!) at https://HandymanSuccess.net
Episode 192: ADHD Treatment. Jordan Redden (MSIV) explains the treatment of ADHD. Dr. Bustamante adds input about pharmacologic and non-pharmacologic treatments. Dr. Arreaza shares the how stimulants were discovered as the treatment for ADHD. Written by Jordan Redden, MSIV, Ross University School of Medicine. Comments and edits by Isabelo Bustamante, MD, and Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction.ADHD is a chronic neurodevelopmental condition characterized by inattention, impulsivity, and/or hyperactivity. While it's often diagnosed in childhood, symptoms can persist well in adulthood. The treatment for ADHD is multifaceted. It often includes medication, behavioral therapy, environmental modifications, and sometimes educational interventions which are especially effective in younger patients. Ongoing evaluation is needed during treatment. Treatment needs adjustments over time.Starting with medications: Stimulants are the most well-studied and effective pharmacologic treatment for ADHD. These include methylphenidate-based medications such as Ritalin, Concerta, and Focalin, and amphetamine-based options, like Adderall, Vyvanse, and Dexedrine. Discovery of stimulants for ADHD> Dr. Charles Bradley discovered stimulants as the treatment for ADHD around 1937. ADHD did not have a name at that time, but it was known that some children had behavioral problems related to poor attention and inability to control their impulses, but they were still intelligent. Dr. Bradley was a psychiatrist who was working in the Bradley Hospital (Rhode Island), he was studying these children and, as part of his experiments, they developed severe headaches. He gave “Benzedrine” (a decongestant) to his pediatric patients to treat severe headaches, and he discovered that Benzedrine improved academic performance and interest in school and improved disruptive behavior in some children.How do stimulants work.Stimulants work primarily by increasing dopamine and norepinephrine levels in the brain, which helps improve focus, attention span, and impulse control. They typically show a rapid onset of action and can lead to noticeable improvements within the first few days of use. Dosing is individualized and should start low with gradual titration. Side effects can include reduced appetite, insomnia, headaches, increased heart rate, and emotional lability.Types of stimulants. Stimulants come as short acting and long acting. They can come as a tablet, liquid, patch, or orally disintegrating tablet. After the discovery of Benzedrine as a possible treatment for ADHD, more research was done over the years, and Ritalin became the first FDA-approved medication for ADHD (1955). The list of medications may seem overwhelming, but there are only two types of stimulants used to treat ADHD: methylphenidate and amphetamine. Long-acting stimulant medications are often preferred for their consistent symptom control and lower potential for misuse. Vyvanse (lis-dexa-mfetamine) is a widely used long-acting amphetamine-based option. As a prodrug, it remains inactive until metabolized in the body, which results in a smoother onset and offset of action and may reduce the risk of abuse. This extended duration of effect can help patients maintain focus and regulate impulses throughout the day without the peaks and crashes sometimes seen with shorter-acting formulations. Of note, Vyvanse is also approved for Binge Eating Disorder. Many of these medications are Schedule II controlled substances, so to prescribe them you need a DEA license. Other long-acting options include Concerta, an extended-release methylphenidate, as well as extended-release versions of Adderall and Focalin. These are especially helpful for school-aged children who benefit from once-daily dosing, and for adults who need sustained attention during work or academic activities. The choice between short- and long-acting stimulants depends on individual response, side effect tolerance, and daily routine.For patients who cannot tolerate stimulants, or for those with contraindications such as a history of substance misuse or certain cardiac conditions, non-stimulant medications are an alternative. One of the most used is atomoxetine, which inhibits the presynaptic norepinephrine transporter (NET). This leads to increased levels of norepinephrine (and to a lesser extent dopamine). Guanfacine or clonidine are alpha-2A adrenergic receptor agonists that lead to reduced sympathetic outflow and enhanced prefrontal cortical function, improving attention and impulse control. These alpha agonists are particularly useful in younger children with significant hyperactivity or sleep disturbances.Non-pharmacologic treatments.Behavioral therapy before age 6 is the first choice, after that, medications are more effective than BH only, and as adults again you use CBT.Medication is often just one part of a broader treatment plan. Behavioral therapy, especially in children, plays a critical role. Parent-training programs, positive reinforcement systems, and structured routines can significantly improve functioning. And for adolescents and adults, cognitive-behavioral therapy (CBT) is particularly helpful. CBT can address issues like procrastination, time management, emotional regulation, and self-esteem which are areas that medication doesn't always touch.Using medications for ADHD can be faced with resistance by parents, and even children. There is stigma and misconceptions about mental health, there may be concerns about side effects, fear of addiction, negative past experiences, and some parents prefer to treat ADHD the “natural” way without medications or only with supplements. All those concerns are valid. Starting a medication for ADHD is the first line of treatment in children who are 6 years and older, but it requires a shared decision with parents and patients. Cardiac side effects are possible with stimulants. EKG may be needed before starting stimulants, but it is not required. Get a personal and family cardiac history, including a solid ROS. Benefits include control of current condition and treating comorbid conditions.The presentation of ADHD changes as the person goes through different stages of life. For example, you may have severe hyperactivity in your school years, but that hyperactivity improves during adolescence and impulsivity worsens. It varies among sexes too. Women tend to present as inattentive, and men tend to be more hyperactive. ADHD is often underdiagnosed in adults, yet it can significantly impact job performance, relationships, and mental health. In adults, we often use long-acting stimulants to minimize the potential for misuse. And psychotherapy, particularly CBT or executive functioning coaching, can be life-changing when combined with pharmacologic treatment. There are several populations where treatment must be tailored carefully such as pregnant patients, individuals with co-occurring anxiety or depression, and those with a history of substance use. For example, atomoxetine may be preferred in patients with a history of substance misuse. And in children with coexisting oppositional defiant disorder, combined behavioral and pharmacologic therapy is usually more effective than either approach alone.Comorbid conditions.Depression and anxiety can be comorbid, and they can also mimic ADHD. Consult your DSM-5 to clarify what you are treating, ADHD vs depression/anxiety.Treatment goes beyond the clinic. For school-aged children, we often work closely with schools to implement 504 plans or Individualized Education Programs (IEPs) that provide classroom accommodations. Adults may also benefit from workplace strategies like structured schedules, noise-reducing headphones, or even coaching support. Ongoing monitoring is absolutely essential. We assess side effects of medication, adherence, and symptom control. ***In children, we also monitor growth and sleep patterns. We often use validated rating scales, like the Vanderbilt questionnaire for children 6–12 (collect answers from two settings) or Conners questionnaires (collect from clinician, parents and teachers), to track progress. And shared decision-making with patients and families is key throughout the treatment process.To summarize, ADHD is a chronic but manageable condition. Effective treatment usually involves a combination of medication and behavioral interventions, tailored to the individual's needs. And early diagnosis and treatment can significantly improve quality of life academically, socially, and emotionally.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text rev. (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022. CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder). Understanding ADHD. Accessed May 2025. https://chadd.org National Institute for Health and Care Excellence (NICE). Attention Deficit Hyperactivity Disorder: Diagnosis and Management. NICE guideline [NG87]. Updated March 2018. Accessed May 2025. https://www.nice.org.uk/guidance/ng87 Pliszka SR; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(7):894–921. doi:10.1097/chi.0b013e318054e724 Subcommittee on Children and Adolescents with Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019;144(4):e20192528. doi:10.1542/peds.2019-2528 Texas Children's Hospital. ADHD Provider Toolkit. Baylor College of Medicine. Accessed May 2025. https://www.bcm.edu Wolraich ML, Hagan JF Jr, Allan C, et al. Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis. UpToDate. Published 2024. Accessed May 2025.https://www.uptodate.comThe History of ADHD and Its Treatments, https://www.additudemag.com/history-of-adhd/Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.
Today's top stories:Brush fire burns in Frazier Park area Group of parents hold prayer vigil for 11-year-old seriously hurt after being struck by vehicleRobert Price: Domestic violence ends life of Bakersfield woman after graduation partyPatrick's Pantry to collect items next week for people in needCOVID-19 variant making its way through US, CaliforniaFederal courts rule on Trump tariffsFrontier High School student with serious medical condition graduatesHigh school student to travel to Africa to improve healthImmigration officials say 4-year-old with severe medical condition and her family are not due to be deportedFormer BCSD Superintendent Mark Luque lands new jobFor more local news, visit KGET.com.
Born without his right leg, Conal Doyle is an accomplished athlete who refuses to let challenges get in his way. “And I've carried that through my legal career, taking really tough cases to trial.” With host Dan Ambrose, Conal shares his journey from defense attorney to a leading plaintiff's attorney in California. The founder of Doyle Law, Conal handles only 5 to 10 high-value amputation and TBI cases at a time, and his results include a record-setting $26.8 million medical malpractice verdict and a recent $100 million shareholders' rights victory. At TLU Beach (June 4-7), he'll teach a TBI masterclass, covering everything from case intake to trial strategy.Train and Connect with the Titans☑️ Conal Doyle | LinkedIn☑️ Doyle Law | Facebook | YouTube☑️ TLU Beach☑️ Trial Lawyers University☑️ TLU On Demand Instant access to live lectures, case analysis, and skills training videos☑️ TLU on X | Facebook | Instagram | LinkedIn☑️ Subscribe Apple Podcasts | Spotify | YouTubeEpisode SnapshotConal started his career at Florida's largest law firm, trying 11 to 12 jury trials in his first five years as a defense attorney representing government entities and hospitals.After six years in defense work, he moved to California in 2003, eventually starting his own firm 20 years ago.An appearance on 60 Minutes, regarding a client who died of penile cancer after government health agencies wouldn't provide a biopsy to rule out cancer, propelled his practice and led to his arguing before the US Supreme Court.He focuses on 5 to 10 high-value cases at a time, specializing in amputation injuries and traumatic brain injuries.In 2014, Conal achieved a historic $26.8 million medical malpractice verdict in conservative Bakersfield, California - the highest in county and state history at the timeHis recent shareholders' rights case victory in Delaware Chancery Court will exceed $100 million after interest, making it his first nine-figure resultConal has competed in...
California is home to a quarter of the nation's unhoused population. That's around 187,000 people. As the state grapples with homelessness, tensions are hitting a high point between Governor Gavin Newsom and local leaders when it comes to funding solutions. Reporter: Laura Fitzgerald, CapRadio A family in Bakersfield is facing deportation, despite entering the country legally to obtain care for their young daughter. Lawyers for the family say the 4-year-old girl could die if she's forced to leave the US. Reporter: Joshua Yeager, KVPR Learn more about your ad choices. Visit megaphone.fm/adchoices
Romeo talks about a Pre k graduation and stop complaining about Bakersfield heat.
Today's top stories:Brush fire slows down early morning traffic on southbound I-5Homicide investigation underway after deadly stabbing at Monterey St homeBoy on bike severely injured after being struck by vehicle in East Bakersfield4-year-old Bakersfield girl could die if she gets deported and misses life-saving treatmentsCalifornia could face annual multi-billion dollar deficits for years, report saysLawmakers weigh possibility of oil companies leaving CaliforniaMulti-sport athlete makes history for Kern Valley High SchoolFederal court strikes down most of President Trump's tariffsEx-deputy to take stand in sexual misconduct trialBakersfield College, Bakersfield CIty School District leaders unexpectedly leave rolesFor more local news, visit KGET.com.
Bryan sat down with Influencer Bob Johnson, originally from Bakersfield, who now lives in Boise, ID area. He talks about starting from scratch in a new area, but the power of grilling meat to attract men to Jesus. He talks about his challenges and missteps in trying to get The Journey started there and the blessing of learning to let the Holy Spirit lead. We are seeing the birth of Influencers Idaho through one faithful missionary.
Jetski Johnson is here this week on Steph Infection! Steph and Jetski chat about playing music on stage and it’s similarities to standup, breaking wrists ice while ice skating, the best dive bars, and much more! Steph’s new special, FILTH QUEEN, will be releasing on Netflix on JUNE 24! Make sure to save the date!! Follow @Steph_Tolev and @Steph_Infection_Podcast on Instagram. Send in your body stories to be featured on the pod! See Steph Live!! KEEPIN EM HARD 2025 Tour US DatesJune 6-7 Raleigh, NCJune 28 Bakersfield, CAAugust 29 La Brea, CA Get tickets at https://punchup.live/stephtolev Be sure to follow @jetskijohnson on Instagram! Steph Tolev caught fire on the BILL BURR PRESENTS: FRIENDS WHO KILL, Netflix special. She was named a COMEDIAN YOU SHOULD AND WILL KNOW by Vulture, which recognized her as one of Canada’s funniest exports. She was featured on Comedy Central’s THE RINGERS stand up series, and season two of UNPROTECTED SETS. Steph has appeared in Comedy Central’s CORPORATE and starred in an episode of the Sarah Silverman-produced PLEASE UNDERSTAND ME. Steph has been well received at festivals all over the world and headlines clubs across the country. She also has a hit podcast on ALL THINGS COMEDY called “STEPH INFECTION” and appears in the feature OLD DADS starring and written by Bill Burr on Netflix. Check out her tour dates to see her live!
Check out what you missed on Romeo In The Morning coming of a holiday weekend.
Today's top stories:2 people found shot to death in East BakersfieldNeighbors rattled after young couple found dead in Oildale apartmentFBI offers reward for information leading to arrest of 1999 Shafter murder suspectWind-driven fire near Meadows Field now under controlCA lawmakers call out Gov. Newsom over budget that would cut women's health servicesCity of Malibu to hire security company to patrol burn areas Bakersfield Museum of Art to debut latest exhibitionsKern High School District graduation ceremonies to beginBakersfield girl with life-threatening condition faces deportationMoving company data shows people are moving out of Bakersfield, but it's just one data pointFor more local news, visit KGET.com.
Send Robert a Text! He came to Bakersfield in 2001 as a respected dental specialist with impressive credentials. But behind the newspaper ads and TV commercials was a man with a troubling past. This is the story of Dr. Robert Tupac's dramatic rise—and devastating fall. Purchase Notorious Bakersfield: The Book Volume II here: https://a.co/d/2XONnB1 ***SUBSCRIBE HERE*** For only $4 per month, you can Subscribe to Notorious Bakersfield to get access to the entire back catalog of episodes. Subscribe here: https://www.buzzsprout.com/1784628/subscribe
A MIXED-RACE WANNABE RAPPER DIY LATINO FILMMAKER Kahlil Maskati shares growing up half Puerto Rican and half Indian in New Jersey, finding his creative voice through rapping and filmmaking, getting staffed on So Help Me Todd after the Paramount Writers Mentoring Program, and how making his indie feature Do I Shock You Like Lightning? led him to direct a new Chicano detective short set in Bakersfield. Instagram - @lalistapodcast Music: Arriba Mami - Jingle Punks
Check out the SKIMS Ultimate Bra Collection and more at https://www.skims.com/killer #skimspartner Get your summer savings and shop premium wireless plans at MINTMOBILE.com/killer In the spring of 2018, three young adults from Bakersfield, California vanished within weeks of each other. As their mothers connected the dots, they uncovered a tangled web of drugs, illegal weapons, and betrayal. Get exclusive Killer Instinct content on my patreon : https://www.patreon.com/killerinstinct If you like the show, telling a friend about it would be helpful! You can text, email, Tweet, or send this link to a friend: http://bit.ly/KillerInstinctPod Follow Savannah on IG: @savannahbrymer Follow Savannah on Twitter: @savannahbrymer Learn more about your ad choices. Visit podcastchoices.com/adchoices
Liza Treyger returns to Steph Infection this week! Steph and Liza chat all about her new special NIGHT OWL which is on Netflix now! They also chat about their shared love for Law & Order, they dive into each others instagram algorithms, crocodile incidents, and much more! Steph’s new special, FILTH QUEEN, will be releasing on Netflix on JUNE 24! Make sure to savethe date!! Follow @Steph_Tolev and @Steph_Infection_Podcast on Instagram. Send in your body stories to be featured on the pod! See Steph Live!! KEEPIN EM HARD 2025 Tour US DatesMay 22 Phoenix, AZMay 23-25 Tempe, AZJune 6-7 Raleigh, NCJune 28 Bakersfield, CAAugust 29 La Brea, CA Get tickets at https://punchup.live/stephtolev Be sure to follow @glittercheese on Instagram! Steph Tolev caught fire on the BILL BURR PRESENTS: FRIENDS WHO KILL, Netflix special. She was named a COMEDIAN YOU SHOULD AND WILL KNOW by Vulture, which recognized her as one of Canada’s funniest exports. She was featured on Comedy Central’s THE RINGERS stand up series, and season two of UNPROTECTED SETS. Steph has appeared in Comedy Central’s CORPORATE and starred in an episode of the Sarah Silverman-produced PLEASE UNDERSTAND ME. Steph has been well received at festivals all over the world and headlines clubs across the country. She also has a hit podcast on ALL THINGS COMEDY called “STEPH INFECTION” and appears in the feature OLD DADS starring and written by Bill Burr on Netflix. Check out her tour dates to see her live!
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