Podcasts about CNS

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Best podcasts about CNS

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Latest podcast episodes about CNS

TheHealthHub
Hormones, Longevity And The Path To A Happier Life With Esosa Edosomwan

TheHealthHub

Play Episode Listen Later Nov 30, 2021 50:11


In this episode we speak with Esosa Edosomwan, MS, CNS, LDN about hormone balancing, longevity and tools to achieve both. Esosa, also known as “Raw Girl” of therawgirl.com is a dynamic Certified Nutrition Specialist, Behavioral Coach, host of the Staying Ageless Podcast, founder of Staying Ageless University, and published author. Clients who have worked with Esosa in group and private coaching have: lost hundreds of pounds, healed cystic and hormonal acne, achieved hormonal balance pre and post menopause, had cancer downgraded, reversed nutritional deficiencies, prediabetes, diabetes, hypertension, reversed hair loss and more. Esosa specializes in plant-based nutrition and transitioning, women's hormonal balance, weight loss, healing acne and skin conditions, nutrition and lifestyle interventions to enhance beauty and increase longevity, candida and parasite cleansing, and detoxification. Outside of her passion for health, Esosa is an award winning, globe-trotting producer and actress who has been featured in Glamour, Vogue, The New York Times, Elle, Ebony, Black Enterprise and more. Learning Points: 1. How Esosa evolved into the health space from a successful acting and producing career. 2. What longevity means to Esosa and how she has developed that into a successful program 3. How hormonal balancing can improve many health issues including PCOS, fibroids and acne. Social Media: https://www.instagram.com/therawgirl/ https://www.therawgirl.com/

GW Integrative Medicine
Clinical Herbalism | Spices, Herbs, & Everyday Health

GW Integrative Medicine

Play Episode Listen Later Nov 30, 2021 43:54


A clinical herbalist has training that gives them a more technical and scientific approach to understanding the way herbs work, how the body responds, and what is necessary to support good health. We talk about this and more with Bevin Clare Bevin Clare, MS, RH, CNS, is a clinical herbalist, nutritionist, and Professor and Program Manager of the Master's of Science in Clinical Herbalism at the Maryland University of Integrative Health. The author of "Spice Apothecary: Blending and Using Common Spices for Everyday Health," she holds a MSc in Infectious Disease from the London School of Hygiene and Tropical Medicine and has studied herbal medicine around the world to blend her knowledge of traditional uses of plants with modern science and contemporary healthcare strategies as a consultant and educator. She serves as an adjunct Assistant Professor at the Massachusetts College of Pharmacy and is an Adjunct Associate Professor at the Northeast College of Health Sciences. Bevin is the President of the American Herbalists Guild, the largest body of professional clinical herbalists in the US and is a board member of the United Plant Savers, a group working to protect at-risk medicinal plants in North America. She travels the world with her two kids in tow, tasting spices, exploring markets and wandering the countryside. ◘ Related Content Bevin's website https://bit.ly/31inE3Z Meet the Herbalist with Bevin Clare https://bit.ly/3Dddhvz American Herbalists Guild https://bit.ly/3lmciU0 Herbal Medicine FAQs https://bit.ly/3D84SJW ◘ Transcript https://bit.ly/3xBrEJb ◘ This podcast features the song “Follow Your Dreams” (freemusicarchive.org/music/Scott_Ho…ur_Dreams_1918) by Scott Holmes, available under a Creative Commons Attribution-Noncommercial (01https://creativecommons.org/licenses/by-nc/4.0/) license. ◘ Disclaimer: The content and information shared in GW Integrative Medicine is for educational purposes only and should not be taken as medical advice. The views and opinions expressed in GW Integrative Medicine represent the opinions of the host(s) and their guest(s). For medical advice, diagnosis, and/or treatment, please consult a medical professional.

Building Abundant Success!!© with Sabrina-Marie
Episode 2222: Jonny Bowden, PhD, CNS ~ NY Times, Forbes Talks Boosting Your Nutritional Fitness!

Building Abundant Success!!© with Sabrina-Marie

Play Episode Listen Later Nov 30, 2021 43:07


Forbes, NYT, The Huffington Post, CNN, MSNBC have featured Renown Nutritionist & Fitness Expert. Best-selling author, Jonny Bowden, PhD, CNS.His first Love is MUSIC, but started out as a professional musician & played all over New York CIty, playing jazz, pop, Broadway, nightclub acts, Jonny studied with the great Herbie Hancock & was as a pianist at the Alvin Ailey Dance Studios. He has a Master's degree in psychology BUT after learning the lifestyle & physical effects that the professional music & entertainment scene can bring, He was able to beat his addiction to smoking, drugs & alcohol.Jonny got a PhD in holistic nutrition and earned board certification and the CNS (Certified Nutrition Specialist) designation from the College's Certifying Board of Nutrition Specialists.He is a frequent guest on television and radio, he has appeared on Fox News, ABC, NBC, and CBS as an expert on nutrition, weight loss, and longevity. the author of thirteen books on health, healing, food and longevity including several best-sellers, “The 150 Healthiest Foods on Earth” and “Living Low Carb” & "The Most Effective Ways To Live Longer".Dr. Jonny has contributed to articles for dozens of national publications (print and online) including The New York Times, The Wall Street Journal, Forbes, The Daily Beast, The Huffington Post, Vanity Fair Online, Time, Oxygen, Marie Claire, Diabetes Focus, GQ, US Weekly, Cosmopolitan, Self, Fitness, Family Circle, Allure, Men's Heath, Prevention, In Style, Natural Health, and many other publications. He appears regularly as an expert on ABC-TV Los Angeles. ~ JonnyBowden.com 2021 Building Abundant Success!!All Rights Reserved © 2021  Building Abundant Success!!Join Me on ~ iHeart Radio @ https://tinyurl.com/iHeartBASSpot Me on Spotify: https://tinyurl.com/yxuy23baAmazon Music ~ https://tinyurl.com/AmzBAS  

Realfoodology
67: Let's Get Back to Ancient Remedies with Dr. Josh Axe

Realfoodology

Play Episode Listen Later Nov 24, 2021 65:27


On today's episode I speak with Dr. Josh Axe, founder of Ancient Nutrition and DrAxe.com.  He is a certified doctor of natural medicine (DNM), doctor of chiropractic (DC) and clinical nutritionist (CNS) with a passion to help people get healthy by empowering them to use nutrition to fuel their health. He is the bestselling author of the KETO DIET, Eat Dirt, and COLLAGEN DIET, and author of the new, best-selling book Ancient Remedies. Dr. Axe founded the natural health website DrAxe.com, one of the top natural health website in the world today. Its main topics include nutrition, natural remedies, fitness, healthy recipes, home DIY solutions and trending health news. Dr. Axe is also the co-founder of Ancient Nutrition, which provides protein powders, holistic supplements, vitamins, essential oils and more to the modern world. Dr. Axe is an expert in functional medicine, digestive health and herbal remedies and founded one of the largest functional medicine clinics in the world, in Nashville, TN, and served as a physician for many professional athletes Dr. Axe Website Dr. Axe Facebook Ancient Nutrition Facebook Dr. Axe Instagram Ancient Nutrition Instagram Dr. Axe Pinterest Dr. Axe YouTube SPONSORED BY: Organifi Black Friday- Cyber Monday Details Nov. 26th-29th and extend through 30th. organifi.com/realfoodolgy with code: REALFOODOLOGY 25% off everything + free shipping orders over $100 Magic Mind http://www.magicmind.co  Code REALFOODOLOGY gets you 20% off 

ESPN Syracuse
Players Only 11-21

ESPN Syracuse

Play Episode Listen Later Nov 22, 2021


Matt Slocum and Ryan Story chat with CNS varsity golf coach Chuck Banks, Mexico girls swimming and diving's Alexa Von Holtz, and discuss the latest and greatest in high school sports!

The Fed and Fearless Podcast
Nutrition for Lyme Disease Recovery with Lindsay Christensen

The Fed and Fearless Podcast

Play Episode Listen Later Nov 22, 2021 56:10


About ten years ago I was diagnosed with Lyme disease. This resulted in some major changes that I made to my diet and lifestyle in order to feel better. A decade later, I no longer have symptoms of Lyme. So it is possible to overcome this chronic disease. Today's guest is full of information on how you can do the same!   About Lindsay Christensen Lindsay Christensen, MS, CNS, CKNS, has her B.S. in Biomedical Science and her M.S. in Human Nutrition. She has successfully completed a 1,000-hour supervised experience program for the Certified Nutrition Specialist (CNS) credential, an esteemed credential for healthcare professionals with an advanced level of education and experience in nutritional biochemistry and medical nutrition therapy. Lindsay enjoys working with a diverse array of clients. Areas of expertise include nutrition care for complex chronic illnesses, including Lyme disease and CIRS, food sensitivities, and gastrointestinal health issues.  Lindsay is an avid researcher and writer. When her nose isn't buried in the latest nutrition science and medical research, she can be found backpacking, skiing, and rock climbing in her beautiful home state of Colorado.   Clues That You May Have Lyme Disease While the tell-tale bullseye rash is the most obvious and well-known symptom of Lyme, it doesn't always present itself. Lindsay explains that Lyme can show up in a number of different ways. There could be other types of rashes from co-infections. Sometimes it feels like a case of the flu or fatigue. After some time, cognitive dysfunctions can crop up. There's also more information emerging around Lyme disease-related gut issues. Bloating, constipation, food sensitivities, and indigestion can all be related to Lyme disease too. Unfortunately, eradicating chronic Lyme disease is no simple matter. Lindsay describes how Lyme is a very complex bacterium that can cause all sorts of havoc.   Building a Healthy Immune System with Your Diet While medication certainly plays a role in treating it, Lindsay has seen the benefits of implementing nutrition and lifestyle protocols as well. When put into place, these support a more robust immune system and help it handle the infection. Because so much of our immune system starts with gut health, addressing your dietary needs is the most important place to start. While many other treatments will certainly help, you're just making recovery all that much more unlikely if you ignore the needs of your gut. By reducing inflammation, your immune system will be better supported in tackling this infection throughout your body. This means limiting refined sugars, flours, processed seed oils, and dairy. This all helps to create an environment in which your immune system can help do its job of keeping this infection in check. Have you experienced Lyme disease? In what ways has it impacted your health? Leave a comment on the episode page!   Got a question you'd love to hear me answer on the show? Leave me a voice message here!   In This Episode How Lindsay's own experience with Lyme disease led her to help others with it too [4:00] Common and less-understood symptoms associated with Lyme disease [11:00] Common tests to diagnose Lyme and their limitations [16:15] Deconstructing the most popular myths surrounding Lyme Disease [21:00] Using nutrition to help your body fight a Lyme infection [25:00] How nutrition acts as a foundation for rebuilding health [38:10] Integrating lifestyle changes into your daily life in order to support overall health [49:45]   Quotes “That's part of why it's so hard to diagnose. It can look like just about anything else other than a Lyme infection.” [13:45] “For somebody who's been dealing with Lyme for a long period of time, it becomes a lot more complicated to treat. It becomes more like belonging in terms of turning around somebody's health and treating that infection.” [21:46] “It's not just a matter of ‘boosting' immunity. In many ways, it's more of a balancing act that needs to happen because the bacteria that causes Lyme can do different things to the immune system.” [24:18] “I view nutrition as creating this foundation to rebuild your health after having dealt with Lyme. We need to have good gut health in place to have our immune system function properly.” [38:27]   Review Fed and Fearless on Apple Podcasts! Send a screenshot of your review to hello@lauraschoenfeldrd.com or send me a DM on Instagram and I'll send you my Overcoming Undereating eBook. If you post your favorite episode in your Insta stories and tag me @LauraShoenfeldRD, I'll also send you my 14-Day Calorie Challenge Recipe Guide!   Links Get the FREE Profit Planning Workbook Find Lindsay Christensen online Follow Lindsay on Facebook | Linkedin | Twitter | Instagram The Lyme Disease 30-Day Meal Plan Leave a review of Fed and Fearless! Sign Up For The Free Training: The 5 Secrets of Fearlessly Healthy Women of Faith Learn more about business coaching with me Got a question you'd love to hear me answer on the show? Leave me a voice message here! Join the Fed and Fearless Society on Facebook Follow me on Facebook | Instagram | Twitter | Pinterest Podcast production & marketing support by the team at Counterweight Creative

Research To Practice | Oncology Videos
Hodgkin and Non-Hodgkin Lymphomas | Meet The Professor: Optimizing the Clinical Management of Hodgkin and Non-Hodgkin Lymphomas — Part 2

Research To Practice | Oncology Videos

Play Episode Listen Later Nov 18, 2021 58:15


Featuring perspectives from Dr Brad Kahl, including the following topics: Introduction (0:00) Case: A woman in her late 50s with diffuse large B-cell lymphoma and risk of CNS recurrence — Mitchell R Smith, MD, PhD (6:16) Case: A man in his early 60s with Grade I/II follicular lymphoma — Ranju Gupta, MD (27:47) Case: A man in his early 50s with classical Hodgkin lymphoma, nodular sclerosis type — Mamta Choksi, MD (35:31) Case: A woman in her 80s with mantle cell lymphoma — Zanetta S Lamar, MD (47:21) Journal Club with Dr Kahl (56:43) CME information and select publications

IC Wellness Podcast
How Herbs Can Support Those with IC with Jillian Bar-av, MS, RHAHG), CNS, LDN

IC Wellness Podcast

Play Episode Listen Later Nov 15, 2021 51:54


Jillian Bar-av, MS, RH(AHG), CNS, LDN is a Clinical Herbalist & Licensed Nutritionist. She shares how you can utilize herbs to help reduce IC symptoms. To work with Jillian or to contact her directly, please visit www.greenspringherbs.com

Affaires étrangères
Les enjeux de la Corne de l'Afrique

Affaires étrangères

Play Episode Listen Later Nov 13, 2021 59:53


durée : 00:59:53 - Affaires étrangères - par : Christine Ockrent - Un an de conflit au Tigré, situation chaotique à Khartoum, intérêts grandissants des puissances étrangères... Quelles sont les tensions à l'œuvre dans cette région de l'Est de l'Afrique ? - invités : Roland Marchal Chercheur au CNRS et au Centre de Recherches Internationales (CERI) de Sciences Po, spécialiste des conflits armés en Afrique centrale; Stéphane Lacroix Professeur associé à l'Ecole des affaires internationales de Sciences Po, chercheur au CERI; Thierry Pairault directeur de recherche émérite au CNRS/ EHESS; Bassma Kodmani directrice du think tank Arab Reform Initiative et membre du Comité des Négociations de l'opposition syrienne (CNS)

WO Voices
Dr. Neda Gioia: Theia Award Acceptance

WO Voices

Play Episode Listen Later Nov 12, 2021 4:28


Neda Gioia, OD, CNS, FOWNS, received the Dr. Gertrude Stanton Innovation Award during the 2021 Theia Awards of Excellence ceremony. Hear her speak about her passion for including nutritional counseling as part of the eye exam experience. 

The Solarpreneur
Running a $116M Solar Company (then starting again from scratch!) - Jerry Fussell

The Solarpreneur

Play Episode Listen Later Nov 12, 2021 85:10


DOWNLOAD SOLCIETY APP NOW! Speaker 1 (00:00:03):Welcome to the Solarpreneur podcast, where we teach you to take your solar business to the next level. My name is Taylor Armstrong and I went from $50 in my bank account and struggling for groceries to closing 150 deals in a year and cracking the code on why sales reps fail. I teach you to avoid the mistakes I made and bringing the top solar dogs, the industry to let you in on the secrets of generating more leads, falling up like a pro and closing more deals. What is a Solarpreneur you might ask a Solarpreneur is a new breed of solar pro that is willing to do whatever it takes to achieve mastery and you are about to become one.Speaker 2 (00:00:41):What's going on Solarpreneurs? We have another fantastic episode and we alive here in Las Vegas, Nevada here in, uh, a man of the hour, his mansion here, just hanging out. So we've got Mr. Jerry Fussell on the show, Jerry. Thanks for coming on with us today.Speaker 3 (00:00:57):Yeah. Thanks for driving up too. I appreciate it. It's how far from San Diego? It's like five hours. Five hours. Yeah. So thanks man, for coming up and hanging out. Glad to have you here at the house. And, uh, thanks for jumping on a podcast with me, man.Speaker 2 (00:01:09):Yeah. I love it. And know Jerry has been treating me to pop tarts and a sandwich. Isn't all, all the pizza I can handle here. So, Hey man,Speaker 3 (00:01:18):It's definitely a house that we house door knockers a lot because pizza and Pop-Tarts and sandwiches that'sSpeaker 2 (00:01:26):Okay. I had more, more food than the first door knocking the house I was in. That's true. All we had was eggs. Pretty much.Speaker 3 (00:01:32):We have a lot of those too. Okay.Speaker 2 (00:01:33):So they got it all, but I know it's been an awesome time here, so yeah, we'd been able to shoot some content and just kind of hang out here with Jerry and his guys. And, um, and the other big announcement we have before we kinda jump into things here is, um, Jerry, he, with his company Pi Syndicate, they are the first ever sponsors of the Solarpreneur podcasts. So, uh we're yeah, I'm happy about it. And we're going to let Jerry talk a little bit about that and then also is partnering on it, but, um, just like the summary of it, they are a, well, I guess you can say, well, it's just a summarized version. Do you want to tell our listeners what pipes in the syndicate is real quick?Speaker 3 (00:02:12):Yeah. Yeah. So Pi Syndicate is more of a supportive kind of mastermind. Um, we didn't start a truly make money. I already have some successful solar companies. My, one of my partners, Mikey, Lucas and Austin already have successful businesses. The reason why we started it is because we realized that about 85% of the guys in the industry that are top earners. So the guy's making, you know, over $150,000 a year, ended up leaving the industry and they have no money. They don't own any real estate. They don't have any money in savings. And about half of them owe money to the IRS. So when we talk about why we work, you know, it's a fun job going door to door, selling stuff. There's a ton of reasons why we all work, but when it comes down to it, if it didn't actually pay us any money, we would all stop.Speaker 3 (00:02:57):And that's eventually what happens is guys get burnt out because the money is not, not good enough to overcome the fact that they owe money on taxes or that they haven't really accumulated any wealth. And it's just, you know, just like you and I, we both probably hopped around to different houses. You know, door-knocking across the country, it's not indicative of saving money. It means that we go buy a BMW when we get enough money or we, we go out to fancy dinners or whatever, we're going to spend the money on. Or we buy our wife a $20,000 wedding ring when we propose because we're making money and guys, uh, leave the industry. Eventually majority of people end up not door knocking forever. Some of us love it. Some of us love it for five years and it's time to move on. And the sad thing for us is when they do move on, they put a lot of sweat and work into the job and they leave the industry with nothing to show for it.Speaker 3 (00:03:47):And these are guys making the top one, 2% of income earners in the entire country, and they're not having any money in savings and investments. And so that's, our mission is to change that we want to, within five years of working in the solar industry, have a plan for retirement in place where a guy can walk away from the door to door, industry, Copia, dentist, whatever he wants to do, and still have a substantial financial portfolio with investing and savings and emergency funds and all the things you need. Also a credit score, enough income to buy your first house. You know, all the things that companies don't really educate their, uh, door knockers on and their sales guys on is really the gap that we fill within the industry. We're kind of selective, but at the end of the day, we want to hang out with cool people that are knocking doors.Speaker 3 (00:04:32):It's just the coolest, single job to meet people that live differently, right. That wake up every day, excited to go to work. Cause if you don't, you quit within three months, probably. So if you're there a couple of years and you're a top earner, you're a guy want to hang out with and be around. And so that's what the mastermind is about is hanging out and being together. The reason I'm so excited to sponsor the podcast is because we feel like you're adding value. Whether it be a new guy that's 30 days in the industry, or maybe just thinking about going into solar, I've heard guys tell me that they've listened to your podcast to make a decision, even to accept a job in the solar industry, which is really cool. But then I would say your normal audience is one of two things, either kind of new to solar.Speaker 3 (00:05:16):And they're looking to see what podcasts are out there. And then the other one, which is strange is like the really seasoned guys like me that just want to hear good conversations with guys that are still in the field door knocking. Part of the reason why I respect you so much is because not only do you do a podcast, but you're still out door knocking virtually every day. So the content is fresh. It's, it's exactly what's going on to help you make money. And when you have guests on the conversations you have with them, um, definitely flow very well because you're doing the same job as them. So it's real life questions. It's real life answers about how to make more money, how to be more consistent in solar. And that's what we really preach is consistency and hard work. And that's the same thing.Speaker 3 (00:05:56):The podcast help brings people that listen to it. So we are super pumped to be a sponsor. And we look forward to being a sponsor for years to come and all the success in the world. We know you're going to hit 500 listeners, um, uh, 500,500,000 listeners. Uh, pretty soon as our goal has a sponsor. So we're going to be boosting some of the marketing and stuff to help you get there because literally everyone in solar right now, everyone in door to door needs to be listening to a mentor, tell them how to do their job better. And we feel like you're a great guy to do that for us.Speaker 2 (00:06:26):I love that. Appreciate that, Jerry. Absolutely man. And yeah, no, it goes without saying too, it's like you were saying so many guys just get out of this and reminds me of the NFL or something. We've all heard like guys in the NFL. I think I heard a stat that like, I don't know some crazy number of them are broke within a couple of years after they can't get out of the NFL. And I feel like door to door is very similar in that guy is making insane amounts of money knocking doors, but let's be honest. We're probably not all going to be doing this stower, you know, retirement age. No. So that's, what's so cool about what you're doing with Pi Syndicate is you're teaching guys how to really hang on to that money and turn that money into future investments in keep a hold of it. Because a lot of people that aren't, you know, super smart with itSpeaker 3 (00:07:08):And, you know, to be clear, um, I wasn't super smart with it either. I started out door to door when I was 19 selling, um, cable, internet door to door and it only paid $30 a sale or something like that. But you could go out and sell 10 of them a day. It's still really good money. And then I became a regional manager and started to make even better money. And, you know, a few hundred thousand dollars was flowing in and I was making all this money. And um, then 26 years old came around. I had my first child and, uh, talking with my wife, I decided to go out and get a real job. I had been in door-to-door for about six years was killing it, making hundreds of thousands dollars a year. I had literally had about a million dollar net worth. And I thought I was doing awesome.Speaker 3 (00:07:51):Right? And then I decided, well, I really want to do something. So I got a job at a children's home. I was working on a college degree and within a year I was completely broke. Um, just completely devastatingly broke, you know, eating ramen noodles again, I'm like, dude, I have a professional college level job. And now me and my wife, uh, are back to eating beans and rice. And we're like, is this what real life is supposed to be? But this is what everyone tells you to go. Do you know what I mean? But what happened is I was living a lifestyle based on being a door to door guy and not everyone stays at door to door guy forever. And so that transition for me was extremely difficult when I realized that I, I thought I want to do something out of it. I thought I wanted a real job, um, that everyone talks about.Speaker 3 (00:08:35):And I'm so glad that I found my way back. And so the first time I engaged with a publisher to write a book, I thought, for sure, my book's title was going to be millionaire by 25 and broke by 26. Um, to really explain why to manage your money better, how to take care of your money. Cause it was a hard life lesson, but it's almost identical to the majority of guys in the door to door industry. And we're not talking about the guy that makes it 30 days and quits. We're talking about guys that are making hundreds of thousands of dollars a year, selling solar pest control roofing. Um, they're not going to last forever. They always think that they want to go do something else. And at, at that point, I don't know of a single another occupation without like being a brain surgeon that you can go and make 300 K a year.Speaker 3 (00:09:20):Like it's just not going to happen. Maybe over 30 years of building it up, even being on wall street, building up, being with a trading company or something like that, you can get there, you know, over years of dedication and working hard with your clients, maybe insurance, you know, there's some things that you can build up this business and make hundreds of thousands dollars, but there's nothing I can think of that you can leave door to door, knowing nothing about anything besides sales and make 300 K year. So there's always going to be this turmoil in your life where you decide to get out of sales. And for me it was, you know, I didn't want to work after five o'clock. I wanted to go home at five, o'clock have dinner with my family. I thought that was the American dream, you know, to have, uh, a normal job.Speaker 3 (00:10:00):I'd get off, go home, eat dinner, have a dog, walk the dog. And uh, I learned very quickly over about a year eating beans that, uh, the American dream wasn't so fun. And I decided to go back to work. But I, at the same time realized there's guys that are not going to decide to go back to work. There's going to be guys that are super happy to make 50 to a hundred thousand dollars a year, but their lifestyle is going to have to change. And just like the NFL players, it was hard for me to adapt my lifestyle to the lower income. So when my wife wanted to go out for anniversary, we still spent $250 on dinner. You know, we still bought, you know, $200 shoes instead of $50 shoes. Like all the things that we had trained ourselves to budget for were all incorrect.Speaker 3 (00:10:43):And we had never had to live on a budget being 21 years old and making 200 grand a year. You don't really have to budget. You just spend your money on whatever you want. And then you're like, oh man, I ran out of money. I need to go knock more doors. And you just can't keep the money coming in. Um, it's not a very smart way longterm to live. So my goal is to get with people that are 18, 19 25, really, you could be 35 and this is the first time you're in door to door. And you're like, this is a lot of money. Those are the guys that we want to help. And they're the same audience that you're trying to help too. So I think there's a lot of alignment there just helping guys get to that next level. So we're excited to help them for that.Speaker 2 (00:11:19):I love that. And yeah, we've had a couple of finance guys and things like that. Come on. But yeah, this is kind of the first, um, you're the first people I've seen really put together kind of mastermind style and help people at this level, which is awesome. So that's why,Speaker 3 (00:11:34):You know, yeah. And the whole thing, the whole thing about Pi Syndicate is it's sharing a lot of the resources for my company, but, you know, we made last year was 151 million. And so the revenue is very large, but then that means I spend hundreds of thousands of dollars a year on legal, on CPAs and advisors. You know, I spent $400,000 last year on mastermind groups. Um, you guys don't have the resource to do that. You're doing really good Taylor, you're killing it. You're in the top of the industry. You're still not going to go out and drop a hundred thousand dollar retainer on an attorney cause you don't need it. Right. It just doesn't make any sense. Your wife would be like, are we getting a divorce? Why do you need the a hundred thousand dollars retainer? Um, so it's just something that you don't think you need until you need it.Speaker 3 (00:12:15):Right? And so it's much better to have my legal team on standby to have our CPAs answer really hard questions to have my tax strategies that you normally only invest in. If you make, you know, $10 million in profit a year or more, uh, be available to you guys. And we do it in a mastermind setting so that we can share the knowledge, um, pretty openly, but with only guys that we want to hang out with, right? There's some guys in masterminds, I'm sure you've been to events and things. You're like, I'd rather not go hang out with a guy afterwards. So we definitely want to make it a group of guys where we stay together for a really long time. And then we want to see your businesses grow, you know? And, um, I would love to see your podcast. I was saying 500,000 listeners earlier.Speaker 3 (00:12:56):I'm not joking about that. I'd love to see your podcast expand to grow. You know, when people talk about the solar guys are listening on podcasts, that should be at my let you know, Jordan Bell Ford and Taylor Armstrong like that. I mean, that's really, when it comes to selling, how many viewers do you need to have listening? And because it's a lot of valuable things, I literally think anyone not listening to your podcast is probably selling the wrong thing. Like they're, they're probably selling cars. They're probably selling watches at a jewelry store, probably selling cell phones. And they're all listening to the wrong podcasts. They think that ed, my let's going to make him rich or grant Cardone and they're not, solar's going to make him rich and they need to be listening to the right box.Speaker 2 (00:13:33):Okay. There's no doubt about that. I mean, I always say we're the Navy seals of the sells industry. No one's selling like we are so we can learn how to sell solar. Then it's like, I mean, that's why we got so much money in this and yeah, yeah. I can translate to anything else to,Speaker 3 (00:13:46):For sure. Yeah. And we definitely have to get good. We got to hone our skills because, um, it's not about how much money even make per job. It's about how much money you make at the end of the year. And we know that this is the gold rush right now. Um, but the guys that made the most money during the gold rush, you know, you've heard the saying that they sold the shovels and they were the support guys. They built the businesses around it. And so yes, we need to be Navy seals. But the reason to hone our skills that much is because it's not going to pay this much forever five years down the road, let's say the average commission is, you know, a thousand dollars a job then instead of 2,500 or more now, um, that's going to be devastating for someone that hasn't hone their skills.Speaker 3 (00:14:26):If they're used to a 5%, 10% close rate and they think they're killing it because they live in California and they're making serious money per sale, uh, that's not going to be around forever. And so the reason why you have to hone your skills is yes, it's nice to make a million dollars a year. This year, selling solar by having a 40% close rate would be awesome. Right? But the real reason is because, um, in five years you're going to have to close at a 40% rate to make the same amount of money you're making today. So if you, this is the training time, view it as a quick start bonus viewed. As you know, the companies are encouraging you to get out there and sell. It's not going to be like this forever. The whole, the law of supply and demand means that the more people that want to sell solar, the less money the companies will pay to sell for us to sell solar.Speaker 3 (00:15:08):Now they're always going to have all commission jobs. So you're always going to be able to make serious money selling solar, you know, look at the other industries, the pest control, the roofing a thousand dollars per sale is still super competitive. And I really believe that's probably where we're going over the next five years. And so we've got to hone those skills because a lot of us that are selling four jobs a month, five jobs a month, a thousand dollars a sell is not going to cut it. We need to be selling, you know, sitting in three appointments a day and selling, you know, one of those a day. Then we start still making good money. Even with the money being turned down, we're still turning out 200,000 a year or more. Um, even when the industry changes, we also need to prep our skills because there's a few times where your skills mean more than just, um, what you can do with them.Speaker 3 (00:15:53):Navy seals end up retiring from the Navy seals. They go into contracting work and there's companies that will pay them millions of dollars to train other people how to do those skills. So when we talk about honing our skills, it's not just about what you can do with the skills, it's about how you can leverage that to help others. And when we, when we talk about even the big guys in sales grant, Cardone never made as much money as he's making until he made a decision to help other people make money. And, uh, same thing with a lot of the other trainers, right? They could go out. There's only so many hours during the day. So, um, they're only gonna make so much money guys like ed, my left that are worth hundreds of millions of dollars, did it by having thousands of people underneath of him selling stuff.Speaker 3 (00:16:35):And that's really what we have to think is I have to get my skills to a level where I can leverage that to help others and in helping others solve the problem, they're going to give me a small amount of a percentage of the problem I solved. So if you help them make a thousand dollars, maybe they're willing to give you a hundred bucks, but while you can only run five appointments a day, guys that are on your teams, running stuff for you could be running hundreds of appointments a day. So it's just the economies to scale are where it's going to be at. So I encourage the guys, listen to this podcast and, um, and really being interested in solar to hone your skills, stop thinking about even your close rate today. Think about what it'll allow you to build in a year and two years and three years, because the economy is not always going to stay the same. So your skills have to up-level. Yeah,Speaker 2 (00:17:20):No, I agree. A hundred percent. And that's why I talk about on the podcast too. I, I encourage all the people listening. I'd go out and teach your teams to sell, develop that skill, to like present to others, to teach other people, you know, they've got all sorts of things. Like you can go to the Toastmasters, the speaking trainings, things like that. I think that's a huge skill to learn because yeah, we're not always going to be, like you said, making as much as we are in solar necessarily right now. So it's important for people that develop those other skills, which are money-making skills, presenting others, training other people, and then you have a whole different set of skill set you can do when maybe solar isn't as good. So, um, yeah, that's huge, Jerry. And, um, we're going to have your partner Austin in, he's going to also talk about pipes and they get to, so we'll leave, um, some, some stuff for him to talk about that too. Um, but yeah, with you, I wanted to hear, I know you talked about a little bit about your background, how you started in selling, but I wanted to hear, how did you transition, uh, specifically into solar sales? And can you talk about how you started your first company with that? And this is obviously super.Speaker 3 (00:18:22):Yeah, so it was a, it was a rough, um, transition. I had, um, gone home and I was selling ADT as a director level. So nice house, no debt. Um, I had everything we needed was making 200,000 a year, thought it was at the top of my game. Um, and then a solar company kept stealing my top reps. So I managed a three or four state region. Um, and they kept stealing reps and it was always my best ones, always the guys that were making 30 deals a month now, all of a sudden our solar reps. So I decided to go to this company because I'm pretty mad. So I'm just going to walk in, I'm a straight forward guy and say, Hey, stop selling my people. I train these people, you know, it's unfair. And the guy said, let me vent for a little while.Speaker 3 (00:19:06):Then he goes, well, don't you ask yourself why they are selling solar? Don't you want to know how much money you could make selling solar. And so I listened to the pitch and I was like, dang, it it's a good pitch. That's way more money than security. Right. And so I was like, okay, I need to take this seriously. So I go home and I talked to my wife and say, Hey, I think we have to make this transition. I had already noticed some of the writing on the wall. ADT had actually not brought on more customers than it canceled since the time that I've been there over the few years that I've been there. And so that was worrying, you know, if we couldn't outsell the cancels, that's a bad thing. And so how ADT dealt with it as they would acquire other companies and kind of fluff their numbers because they're publicly traded.Speaker 3 (00:19:47):So it never looked like they lost subscribers. Um, but it wasn't because of sales. We could not outsell the cancels. Yeah. And so that doesn't sound sustainable to me. So I had already had some fear that no matter how good we sold, it was just a matter of time, five years, 10 years, 20 years down the road that nobody's going to want to buy security door to door for $60 a month payment. Right. So I was just a little bit worried. So I went home and I talked to my wife and we decided to go ahead and me take an offer, you know, and, and go into that. I accepted the offer within the first 30 days. Um, I thought it was going to make all kinds of money and I made one sale. And some, my wife's like, you gotta tell me what's going on here.Speaker 3 (00:20:32):This is crazy. I would also driving three and a half hours to get to the field. So I was at the time because we were trying to save money. I was like, I'm going to do this as cheap as physically possible. I'm going to drive back and forth, you know, as much as I can. And if I have to, I'll just sleep in the car, get up, knock turf in the morning and, and go at it. I had a, a nice SUV. So I lay a whole air mattress. One of those that you see on Amazon where you pump them up, you know, they cover the seats. I was like, this is going to be cool. Yeah. Just hit the doors. It's parked right there. So I was grinding, right. I was not going like 12 hours a day. And uh, my only break for air conditioning was like, maybe go watch a movie or something like that.Speaker 3 (00:21:10):Well, I was like, if you watch a movie, why can't you just go get a hotel? I'm like, well, maybe it's 12 bucks. Like I don't want to stay in a $12 hotel. That's disgusting. And, uh, but it was a grind right. For a whole month and I made one deal and I thought, this is, this has gotta be over. I think our average commission back then was $1,500. So I traded somewhere around $20,000 a month. In that first month I went down to about 1500. And of course you don't get it until they install it. So they gave me like a little bit and they were like, oh, and you'll get the rest just whenever we don't know. And I'm like, oh, I'm in trouble. ADT was like, next day, you know, somebody would be out there installing it. So I misunderstood that coming into solar.Speaker 3 (00:21:48):Where was, where were you selling that? Kansas city. Okay. Yeah, not a great market. It was only about six years ago. Okay. So, and, um, they had a huge rebate in Kansas city and the rebate had gone away the month I started. So we went from having, I think the state level was up to a $2, a watt rebate then had gone down to a dollar watt and then it kind of went away. Well, $2 watt rebate is huge. So our average sell price was like $3 a watt. And, um, between the rebate and the ITC at the time was 30%. We literally were giving away solar for free. So when I accepted the job, I thought I was going to go door to door and just give it away for free. And then like the week I started, they're like, Hey, the rebate's gone away.Speaker 3 (00:22:28):You really guys, it's not free anymore. You need like 25 to $30,000 on every deal. And I'm like, what? I thought we gave stuff away for free. Well, what's going on with this. And so it kind of changed the game really quickly on me. Uh, I adjusted though. So then, um, once I figured out how to sell, I realized that it was a lot about understanding the benefits, understanding the tax taxes, really understanding how much money they would save because I was so new. It allowed me to adjust faster than the guys that have been doing it two years with this huge rebate and everything. And so the next, uh, three months I had made about a hundred sales, I think 102 sales in the next three months. So it really kicked in and I did really, really well. What's strange is you have these self limiting beliefs though.Speaker 3 (00:23:15):I always believed in ADT that I had to sell 30 deals a month and I really peaked out around the same thing. So it's almost like this mindset that I was a 30 deal a month, a rep I carried over into solar as well. And it's just recently that I realized that mindset's completely wrong listening to some of your podcasts with guys. I think you said recently you had someone on that sold 68 deals in a month. So more than double, more than double what I was selling. So I looked back saying, man, I wonder if I totally just carried over a self-belief from selling security that had nothing to do with solar, but I consistently would put up 30 deals a month. The cool thing about solar is there's commercial too. So my last month I killed it. Um, commission wise, I probably would've made somewhere around 280 5k in 30 days.Speaker 3 (00:24:00):So it was incredible. I went home, talked to my wife, we're super excited. We're like, man, this is it. We're making, we love this company. The company's like, Hey, by the way, we can actually afford to pay you that much. And we're nine months behind on install. And I'm like, oh wow, that's crazy. Some of you listening have probably heard words similar to that before, um, from a solar company. So I decided really quickly to go out on my own. Cause I was like, how much worse can it be if they can't pay me? And it takes nine months to install, I'm sure I can do better than that. So, um, the trouble was, I had to walk away from all of that commission and then, um, didn't have a lot of money in the bank. And so cause you know how far behind commissions are.Speaker 3 (00:24:41):So really I walked away from even more than that. And um, but I had no debt on my house and everything. So we had to sell our house. We had to cash out, 401k, invest, everything we had into starting a solar company. And when you tell your wife that it's time to sell the dream house, to go door to door again and sell more solar, it was a hard conversation. I'm so thankful that she supported me through that though and made that leap. Um, it took about three more years of making really minimal amount of money. I think I pulled maybe $30,000 a year out of my company. Okay. The first six months I, uh, you couldn't hire an EPC like you can now they just really didn't exist. Right? And so I had to hire a, uh, NAVSUP trainer to come in and train me to install.Speaker 3 (00:25:25):So the next six months I installed all my own jobs, uh, realized really, really quickly that I was bad at paperwork. So I had to hire administrative shin assistance and people do net metering. And then I realized I didn't like talking on the phone. So I had to hire, uh, an admin person to answer the phone. Then I had to hire, um, um, a phone sales person to answer all the incoming calls. And I'm like, man, this is crazy. Now I have like 14 people that work for me. I gotta, I gotta start making a lot more sales. So, uh, it was kind of the, you know, they say the, the mother of invention is necessity and that was it. I had to learn how to sell a lot more just to support the company, but selling 30 jobs a month, you know, a lot of solar companies don't even do that much.Speaker 3 (00:26:06):So me myself could go out and support my whole company, but then I just kept growing it. You know, when I brought on other sales guys and, but I stay very conservative. So a lot of owners, you know, brag about their, their fancy watches or the drive fancy cars right away. I always knew this was a long-term play for me. And if I was going to expand faster than my competitors, I had to do it, um, through really being wise with my resources. And so I reinvested almost all the money for three years. We lived on about $30,000 a year. Now I had retired from the military. So I lived in California, man. No, no. I lived in Missouri. Yeah. And started the company headquarters. I also had my military retirement. So the medical and I had some pinching coming. So I had more money that, but out of the company, I only pulled the very minimum that my CPA told me.Speaker 3 (00:26:52):I had to pay myself to be legitimate where I wouldn't have probably pay myself anything. And that allowed me to reinvest in marketing and tools and a better management. And you know, it's kind of crazy there for a while that everyone at my company was making more money than me. But at the same time, I knew that long-term, I was gonna make a lot more money than everyone else. So, you know, that's the old saying that you've all heard, but do things that others aren't willing to do. So that later on you can do a lot. And so that's what was able to happen in my life is that there's three years of really investment allowed us to build out a fully integrated solar company. And we were able to get into things that other companies weren't, you know, we go as far as doing the customer's taxes for up to five years after they buy solar, we do internal financing.Speaker 3 (00:27:35):Um, 2020, we did $50 million in internal solar, solar loans, ourselves without paying finance fees. So you just can't do that without a significant amount of resources, but you only have a significant amount of resources when you don't spend resources. And so it was, um, one of those things that we just chose to stay in Missouri, live frugally, know all of our installers. We have a very different, uh, formula to install. They all live out of Missouri and making 2020 $5 an hour in Missouri is incredible. You know, that they can live really well by their home buy nice cars. They live really well. And so they're willing to travel out of Missouri, take the solar panels and go to Minnesota or go to Florida or go to Texas or go to they'll drive all the way here to Vegas to, to install solar panels. Now we try to rack up several jobs in the same week and our teams are really well-trained.Speaker 3 (00:28:25):So a team of three guys can install a job in one day and so they can stack up, um, you know, two teams can travel out here to Vegas knockout, you know, quite a few jobs in 10 jobs in a week and then travel back, you know? And so it's just a different way to look at business. So we try to solve problems, not necessarily spending more money on it, but how do we actually solve the problem? You know, and the most people would say, well, let's just hire a big EPC in Vegas or California or Florida, because that's easier. Cause that also costs a lot of money. And so we make a lot more money in a lot more profit margin because of that. We're also what I would call a white glove service with doing the customer's taxes. So make sure your benefits to the client.Speaker 3 (00:29:07):We are probably one of the more expensive solar companies in the country, um, which is a hard thing, right? Like it's, it's means that some sales reps don't want to work for us because they want to sell for a more competitively priced company. What we do is a process called value stacking, where we believe that once your value stack exceeds the price, that it doesn't matter what the price is, the client will buy it. So we just try to deliver such a tremendous amount of value that we're still able to sell at a higher price. And then we have a very good margin and then we reinvest that margin. And so last year we were able to break $101 million in revenue. I'm extremely profitable. And uh, we owe no money. We have no debt. We have three years of operating capital on hand at all times now.Speaker 3 (00:29:51):So we're the only, debt-free um, three years worth of capital company. I know of specifically in solar, it's nearly unheard of, um, through COVID we had, um, 24 dealerships that were sub-dealers basically under our brand and we were able to support all of them and their reps through COVID. We're able to support all of our staff, even though we shut down operations for install, all the installers cup paid, all the office workers got paid. Wow. And so it's something we're pretty proud of, but it's also means that while other companies buy Ferrari's, I'm still going to be here in 10 years so they can enjoy their Ferrari's and I'll enjoy my, my safety net, uh, money in the bank. It also allows me to have money to help other companies. So I'm an investor in over 50 companies at this point and, um, own equity in those.Speaker 3 (00:30:36):And so, um, those create passive income streams for me, which help, but it's also just a way that I can help other companies because they need the money. And they, unfortunately, most of them weren't good at saving money. They were the guys buying the Bentleys or Ferrari's. And so they come to me and, uh, ended up needing to, to borrow some funds. And I'm happy to do it as long as it's going to help the company and help them longterm. And obviously it helps me if I can own a chunk of their company as well. For sure.Speaker 2 (00:31:01):And now that's one thing I've noticed about you. Jerry is you're very giving gay. I mean, I'm not part of your company or anything, but I come in here, Jerry treats me like family and he's like, dude, all I'll get you a hotel. First thing he says, when I come into their house here, it's like, Hey, I'll get you a hotel room. We don't have like the best beds and stuff here. I'm like down, like, dude, I'll sleep on my couch, no longerSpeaker 3 (00:31:22):Talking about it. And this is a house for doorknockers I ever real bad, but everyone else has twin size bunk beds. And there's a bunch of, bunch of them upstairs, but we were thinking, Hey man, this guy just drove five hours and now he's going to sleep in a bunk bed. We all kind of had this moment where we're like, we probably should have thought this thing through. So we were like, do you want to hotel? Are you cool? And he's like, no, I'm cool. And then right after he said, he's cool. I see one of our guys carrying in a queen size, like Peloton matches. I'm like, thank goodness that somebody went out and bought a bed for this guy. So, um, but yeah. So thanks for saying that, man. I, I believe in this, this theory about investing where, um, if you're investing in the right people, um, there's no bad investment.Speaker 3 (00:32:04):And so even though it may not make monetary sense today or tomorrow, I invest my time, energy and resources and money into people that I want long-term relationships with. Because even though you don't work for me and you may never work with me, or we may never do anything specifically together, maybe you, um, send me a referral and you're like, Hey, am I coming? He doesn't cover Maine because it's the polar opposite side of the country from San Diego. Could you, do you want this referral in Maine? And absolutely I would. And I'll figure out a way to get in and installed a main, even though my install crews, if they're listening right now, we're like, what's Jerry talking about, I don't want to go to Maine. We would figure it out and make money on it. So I just believe in being very giving.Speaker 3 (00:32:44):And I think people will reciprocate that now I'm not stupid about it. I don't give to everybody. I, I give of my time. Um, most sparingly my time is the resource that I can't get back money. I can make more of time. I can't. And so I invest my time into things like the mastermind into my company and to the people I mentioned or indefinitely into things like this podcast, which I think is going to bear fruit for both your podcast and my companies. So by being a sponsor. And so I look forward to, uh, developing our relationship and um, giving him next week, he's going to email me and be like, Hey man, I really need a new Tesla. I was just wondering if he could spot me 120 K cause it's a plan.Speaker 2 (00:33:23):Yeah. I'm not, that'd be the sponsor. Find me a TeslaSpeaker 3 (00:33:28):It's company is going to be like, why is the side of your Tesla say Pi Syndicate on it? That's really weird.Speaker 2 (00:33:35):Yeah. But no, I, I definitely agree with that cause um, I worked with, you know, several different companies at this point too. And um, we were having conversations before this out. You know, some people are more giving stuff than others. And uh, so I think it pays dividends as long as you're smart about it. Like you're saying is just be that guy. That's not like the cheap guy. That's like, oh, this guy is going to nickel and dime me. But if you're investing into relationships, especially, you know, on business level, um, I think it pays dividends. Like I just, matter of fact, last week I did my, a church mission in Columbia down there and that's one of the things and you know, these south American countries, a lot of them are super poor. And so I get hit up all the time about people, ask them for money and stuff like that. So yeah, you gotta get ready, selects selective. But I just sent, you know, 500 bucks last week for a family's funeral that I knew down there and yeah, like, they're like, oh, um, we'll pay you back. We promise, I know 99% chance. They're not going to be, they're not going to pay me back because you know, yeah.Speaker 3 (00:34:31):I've decided, I've decided that, um, I do sometimes give loans, but if, if it's, if you like that, and I think that you're right, you know, there's a good chance. They won't be able to pay you back. I'm very upfront with it and say, it's a gift. And then say, if you're ever at a time in your life where you can give something to somebody else, go ahead and do that because they're going to feel guilty if it's dead, right. They're good people. I'm sure they are. And eventually that's going to wear on them and it's going to impact their life negatively because they're not going to pay you back. Chances are, um, cause they may not have the resources and stuff like that to do that. And so, so think about doing stuff like that as gifts I give my time, lot, I gift things, not connected to any type of repayment.Speaker 3 (00:35:12):Um, and gifting seems to reward me a lot better than loans. So now in businesses, if you want, um, a hundred thousand dollar loan, I'll do that too, but that's a lot, normally stuff like that as somebody in need it, you know, give it as a gift and um, you'll see dividends of that. It also helps you feel a lot better right away. Like it felt good giving them a loan if you had made the decision to just give it to them as a gift, which is basically, it sounds like what you did. But if you had said that in your head, I'm going to give it as a gift and tell them I'm giving it as a gift. It would have had a little bit more positive impact even in your inside yourself. Um, you know, the gratitude that you felt, being able to help someone.Speaker 3 (00:35:48):And so it's a cool way to, to manage your money like that. That the thing that I, uh, one of the things I talk about when I talk about gifting though, is my time. And so I don't know if you've ever heard a term called time vampires, but I, I definitely believe in the concept that there's some people that just siphon away your time. And so while I'm very free to help people and to mentor them and stuff like that, be selective on who you help. Just like you said, you get hit quite a bit for money, the same thing with time. And you're an influential person. You have a lot of value to add to other people's lives, but you have to start being selective. And one of the rules that I've set for myself is that I only interact daily on a day to day basis with 10 people.Speaker 3 (00:36:29):So if I ever get to a point where I'm talking to someone every single day, I either need to figure out if there's somebody I'm mentoring or if they're somebody that needs to be communicating with one of my 10 people. Um, and I have a wife and four kids. So that means I only have five people outside of that to communicate with on a day-to-day basis. So my, my intimate little work circles about five and it makes for some hard decision-making. I talked to the general manager of solar solutions. Um, she's in training for all intensive purposes. She's the CEO. And, uh, I've talked to her one hour in the last week and she's running a multimillion dollar company for me. And I trust that she's doing a great job. Um, but I don't have time. Day-to-day, she's not by any means a time vampire she's listening, but, um, I don't have time.Speaker 3 (00:37:17):So, but making those decisions, even when they're hard decisions like not to talk to your GM every single day, um, mean that it makes it much easier to make a decision about talking to a friend from high school that just wants to chat about video games or fantasy football. Yeah, I cut. I cut them out pretty quickly because if I don't have time for, you know, my GM, I really don't have time for them either. And so setting up some type of structure in your life to make decisions based on time and who you're going to invest time in is very, very important to go a lot further in life if you invest your time correctly.Speaker 2 (00:37:50):Yeah. I agree. That's a good point. So yeah, for all our listeners, I think it's a good thing to do. If another thing I've talked about is just, you know, a time audit, just really tracking what you actually did with your hours, how you spent your time. It's a lot of times we think we're being super productive, smart with our time, and then we actually check it. We just spent two hours talking about fantasy football to someone or, you know, playing a game on the phone, whatever, things like that.Speaker 3 (00:38:15):Yeah. With strangers now that I, uh, last year I had done the math on, you know, how much money I was making per hour that I worked. And the number was much, much larger than what I had previously thought about it being. And, um, in the last few years, it's led me to really, really feel guilty about wasting my time. So like, I, I love video games. I love world of Warcraft back in the day and things like that. There's zero chance that I could open up a computer, get on world of Warcraft tonight and play for four hours without having this tremendous amount of guilt. You know, just because my time is, I know what my time's worth right now. And if someone would ask me, Hey, would you give me $25,000 to play world of Warcraft? I would say, no, I'm not going to give you 25 grand to play a video game. But that's exactly what we do in investing our time and activities that don't actually generate income or generate a better relationship with those around us is it's time that we're really, really stealing from ourselves. Yeah.Speaker 2 (00:39:12):A hundred percent. So now that's a good, a good point with that. And so going back a little bit at Jerry, um, something I wanted to ask you about, we were talking before we started recording here is just like you're saying, um, so many people just sell their prices low. Um, you said you're like one of the higher price companies that sell solar. And I think that's awesome. I started out with the company that was kind of similar to that. They tried to bundle in like some solar cleaning in some like a, I dunno, yearly checkup type things dated. It kind of found some loopholes around it. And I think it made a few customers mad cause they put in the fine print that they would only do that if the customer like contacted them. And It was kind of a, maybe not.Speaker 3 (00:39:54):Yeah. The whole thing about being the most expensive company is you also have to do the best job. And so you can get away with that. What's crazy is it's easier if you're a good salesperson to sell being the most expensive than it is being the cheapest. The only person that thinks it's easier to sell being the cheapest are bad salespeople. That's what it comes down to. You're probably not listening to this podcast. If you think the only way to sell is by lowering the price. That's probably not your target audience. People are trying to learn. They're trying to get better. We grade sales reps, um, AB and C sales reps, um, see sales reps are sell by being cheap. And that's how we remember it. If the only way that they can sell is by being the cheapest in the room and they're not selling based on anything else.Speaker 3 (00:40:39):Then they're a C sells rep. There is definitely room in the solar industry for C sales reps. So if you sell based on price, don't feel bad about it. Just either educate yourself to get better or find a company that really is the cheapest. And that's where you need to, to be out, to make money. Um, be sales reps are those that, um, really are good at one or two things. They either technical experts or they are expert closers. And it's one of two things they're either the best closer in the whole world. I would refer to like, um, Mike O'Donnell or, uh, Taylor McCartney, you know, incredible closers, but I know more about solar than either one of them. So the other, the other B sales rep is, um, someone that, um, is very, very technical. I would look at, um, you know, um, quite a few people in the marketplace that I would look at Jake Hess would be the one that comes to mind, very, very technical, closer, you know, through, um, his academy.Speaker 3 (00:41:34):He trains people how to be very technical. And then the AA sales rep is those that combine both. So yes, Taylor and Mike can definitely answer those technical questions or they know how to pivot really well. And so they're a sales reps because at the end of the day, phenomenal closers and they know everything they need to know about solar to get the sell closed. Now Taylor's kind of bizarre because he does know it just a little bit, but he's that good of a sales rep that he's still in a sales role. And I was talking about something one day. He's like, I don't even know what you're talking about. It's like, okay, I guess I'm more of a technical sales rep instead of as good of a closer isSpeaker 2 (00:42:11):PESI oh, you asked him one time. Like, I don't even know what an inverter is.Speaker 3 (00:42:15):That's what he told me. That's what we were talking about us. I went different numbers, to be honest, I don't know what you're talking about. He's like, but I sold the last 14 doors I knocked on and I was like, wow, that's a that's okay. There's definitely some benefit. I noticed that they and Jake has been hanging out and I'm like, well, uh, hopefully those guys learn a lot from each other because of your powerhouse. Um, but yeah, and so the sales reps are like that. We specifically hire the sales reps because they have to be good closers and they have to know a lot about the technical side. Cause we have to justify our higher price. And um, explain why we're higher. One of the things is we give her a warranties instead of just fake claims. We also give free maintenance, but we give a 25 year true labor warranty.Speaker 3 (00:42:56):Um, anything that goes wrong. A lot of guys in the solar industry don't realize, but they're selling, what's called a workmanship warranty. And under a workmanship warranty, you would assume that if say a panel stops working, that the company would come out and fix it for free without charging the customer a fee, the truth is a workmanship warranty covers bad workmanship. So if they installed it incorrectly, which caused the panel to stop working a good company would come out and fix it. But a good company would do that for free. Even without a warranty in writing, they would say, yeah, you're right. That's our fault. Let us fix that. So it's pretty much just acknowledging that, Hey, we're a good company, which is, which is nice of them to say there's a 20 five-year workmanship warranty, but, uh, under the warranty and most of the terms of that panel stops working.Speaker 3 (00:43:39):It's the manufacturer's fault. You would have to pay that solar company labor to come out and replace that solar panel. And there's almost zero sales reps that understand that concept. And I guarantee you no homeowner understands that concept. So when they get into these 25 year loans, when you talk about company evaluations and how to evaluate the value of a solar company, those that give away a workmanship warranty are basically locking in that customer on a service plan for the next 25 years, that increases the company evaluation because they know they're going to make X amount of money servicing that system over the next 25 years at a company like mine. It actually decreases our company value because we know that the relationship with that client will just cause, um, cost over the next 25 years. So, um, was very few companies like ours that are giving free labor away, true free labor for the whole time, but we definitely do.Speaker 3 (00:44:32):And so we align ourselves up with even our battery manufacturers are full 25 year warranties. So everything we do as a 25 year warranty or more included with labor too. So even the solar panels and the batteries, if we were to go out of business, uh, they'll hire an electrician to come out and service it. So it's just a different pitch, but a good sales rep always feels more comfortable being the guy saying, I'm the best buy for me, then I'm the cheapest, you know, let's, it's a good deal. Let's do this, you know? So you'll kind of weed, weed out those people that aren't quite as.Speaker 2 (00:45:03):Yeah, I know. Yeah. It's interesting. If you go to these like marketing conferences and stuff, and then the online marketing and they say, there's no competitive advantage to being like, you know, unless I made all of the pack pricing, you're either like the cheapest or you're in the most expensive and you add more value, but there's no like advantage at all as being kind of like middle soSpeaker 3 (00:45:23):No, and you kind of disregard all the middle companies too. Um, and so I, I definitely think one of our strategies is we know we're going to be the most expensive. So we get that out of the way right away. We tell them we are, we actually tell them to shop around. And if they choose to go with a cheaper company, we'll even pay $50 per quote, that they give us from the other companies that they've shopped around with. So we encourage them to give us, go shop around with four quotes and then we'll come back and be the final one in the door, propose our price a hundred percent of the time. They're expecting us to undercut the cheapest bid. Um, cause they think it's a gimmick, right? You're giving me these quotes, you're going to undercut their price and then try to close me a hundred percent of the time.Speaker 3 (00:46:01):We make sure we're more expensive. In fact, if we're not the most expensive person, we raise our price by a thousand dollars and make sure because it's easier to sell in the most expensive. Now, not everyone buys though. And so just like a car lot, you you're the most expensive your Lamborghini dealership or whatever. That's how we treat it. But at the end of the day, if you say it's too expensive and you're getting ready to walk out, we say, hold on, wait a minute. Let's see if we can throw something else in. So we try to do value, add. So we may replace their air conditioner or we may help replace the roof or whatever it is. But very rarely will we do just a straightforward discount. We're never going to be like, okay, you're right. Let us let us price it out for $10,000 cheaper. There's probably not going to be us, but we'll win.Speaker 2 (00:46:42):Yeah. I think that's awesome. Because especially in California, there's no excuse for people to be selling like rock bottom prices. I mean, San Diego, you can sell a system, you know, $6 a watt, super expensive, and you're still saving them. You're still cutting their bill by 30%. Yeah. So it's like these companies that try to sell rock bottom line, what are you guys doing? We're still saving the customers.Speaker 3 (00:47:03):I think we all need to be on the same team, right? Like, um, I think there's places out there for the cheapest guys. The problem is, um, those guys need to go move to Missouri or Kansas or somewhere with 10 cent per watt, kilowatt hours of they want to sell cheap California. You're not competing against each other. You're competing against a utility company. So $6 a watt is completely fair price to charge. If you're versing the utility company, what that allows you to do as a company is make more profit. There is absolutely nothing wrong with profit. If you're helping the client, because that means you can take that profit and go make more clients. You can spend more money on marketing. You can spend more money on paying your people. You can spend more money on office space. You can do everything you can to grow.Speaker 3 (00:47:47):And at the end of the day, we all want to have more solar customers. We all believe the solar is good for the environment. And so at the end of the day, our mission is to sell as many people as we can. And people get twisted. People that are new to business think selling cheaper will help them sell more. It absolutely will. Not their resources you gain from selling a fairly priced product. That's beating out your competitor, which is the utility company is the correct price. And so I would never charge somebody. One of my ethical roles is I never charge more than what they're paying on the utility company. So solar solutions is a little different. They have to be able to pay the system off within 10 years through savings. And they have to be able to have a payment that's cheaper than their utility bill from day one, or we won't quote them.Speaker 3 (00:48:30):The system will tell them that they w we don't advise them to go solar in California. That wouldn't happen very often though. It's so good of a deal for everybody. Even as $6 a watt, you should be doing that, just make sure you're not going out and buying Ferrari's. You need to be reinvesting that money in yourself. And for you specifically in your podcast and your recruiting budget to help others come on board, because you're not going to be able to sell a prices like that forever. And we know that. So you use those resources to expand, to grow, to really make a dent in the industry. And it's so cool. I, I learned something from you earlier. We were talking to our guys about how saturated Las Vegas is. I don't think anyone would argue that San Diego's, if not the most saturated market, one of the most saturated markets in the United States, very cool market.Speaker 3 (00:49:17):And you still go out and door knock every day, and you still run into people that need solar and once solar. So it's incredible. We, we need to stop thinking of the scarcity mindset, where we're competing against other solar companies. We're still not even in San Diego. We're not. Um, and the truth is you mentioned it too, but those companies may knock the door once and you're going to knock the door five or more times. And so, um, I'm okay with competition as long as I'm better than them. And it sounds like you're, you're beating them so that that's healthy competition. Um, and so I think that that's a really cool thing to think about. We all need to keep our prices higher because in San Diego, if you can sell $6 a watt in the most competitive thing in the whole United States, that everybody should be pricing their structure out right below the utility company, let's do better than the utility company. But that means I operate in mainly the Midwest states. That means we don't sell as high in Kansas. We don't sell high in Texas. We don't sell as high at all in Tennessee. So it, it just all depends on where you're at, what their pricing is because the utility is the competitor, not, not the other solar companies. Yeah.Speaker 2 (00:50:21):I think that's a good rule to go by though, cause you don't want to charge them way more than they're paying forSpeaker 3 (00:50:26):Electricity. Heard some interesting guys pitch it. And if they knocked on my door, their ride, I probably would've bought it cause they're good enough to pitch, pitch it as an investment. Um, my individual role with investing is I want my money back within 10 years. I want it to completely be liquid. And, and that's really comes into about a 7% compounded interest rate or above. And so, um, I wouldn't personally make an investment that, that wasn't going to happen. I put all my money into investments like that. So why would solar be anything different if I'm going to put it on my house? I still want that kind of ROI. And so, um, I think I just ethically on a personal side, uh, that's translated to the ethics of my company to say, look, we're not going to sell it unless, unless they meet the standard for Jerry thinking, it's a good thing.Speaker 3 (00:51:13):Right? And that's my standard. There's, there's been some guys though that I talked to that view it as a financial investment in states that have very low prices and I don't think they're wrong. And there's also a lot of speculation about the price of utilities, really jumping up over the next three years. A good friend of mine, Mike [inaudible] talks about it. He's extremely convincing, right? Like he's the guy that I've listened to enough where I'm like, you know what, even if they are spending $20 more a month, Mike's probably right. It's, it's going to be okay. It's just not a company thing that we do. So that's our litmus test is we try to price it right below. Um, but definitelySpeaker 2 (00:51:48):Don't price it a dollar 85 watt. I think we can all agree that if you're the guy out there selling at a dollar 85, a watt, you need to listen to the podcast more often and learn how to sell more because there's no reason to do that. And at the end of the day, what I tell customers that are getting an incredible deal as I run the numbers and I say, Hey, your sales reps making $500 on this deal. Uh, who is it? Oh, it a power I've never heard of power. That's interesting. It must be a power app. Um, the sold out for a $500 commission. And I say, think about this, it's a 25 year agreement. Uh, you, you need customer service for the next 25 years. If something goes wrong, right. They're like, yeah, nice. Well, how much do you think the $21 a year is going to buy you in time for that guy to pick up the phone and answer your questions?Speaker 2 (00:52:33):The truth is, think of his commission, like prepaying to have an advocate for you for the next 25 years. And in my opinion, $500 is not enough money for a 25 year relationship. So we need to pay our reps well enough that they're do very good customer service or the company needs to make enough profit that they take that role on themselves. That the rep isn't the one responsible for customer service and taking care of. Cause if we sell somebody a $25,000 system, it is definitely our responsibility to take care of them for the next 25 years. Like that's, that's just the way it is. That's our job. Yeah. So yeah, I just got a call actually like a couple hours ago from Gaia sold four years ago. Call me just barely ins. Yeah. Luckily I made more than 500 bucks, but yeah, that's a good point though. Like I'm only making 500 bucks and it's a guy that's taken up all this time. That's time suck then. Uh, yeah. It's um, like you want to be making, you know, your time worth some money for sure. Yeah. Um, and yeah, the other thing that's, uh, I forget, I forget the question. I was going to ask you where I was going with.Speaker 3 (00:53:41):Well, we were talking a little bit, uh, before we started and you were, you were basically saying, um, you know, why did I step away from solar solutions? And, um, you know, I thought that was a really interesting question that I wanted to say for the podcast. Yeah. So the reason why is because I, I believe that the solar industry is at its peak right now. I think it's incredible. It's the new gold rush. Everyone we know in sales should be going into solar right now. It is the biggest opportunity. If you're not telling your friends and family members and neighbors, neighbors, that they should be selling solar, and they're working at a library or they're working at Starbucks, you're doing them a disservice. You should be so convicted that it's time to get into solar, that I needed to transition what I'm doing to align with that.Speaker 3 (00:54:26):So if I believe everybody should get into solar, that I need to build a company that isn't one of the most difficult sales processes that requires a rep like you with all your knowledge, to go out and sell for $6 a watt, I would need to do something more moderate. So energy co is meant to recruit anybody. You know, we're here at a recruiting class. I'm glad that you're able to say Hey to them while you were here. And there's some kids are now in this class that are 18 years old. There's not a lot of solar companies. I'd be excited about hiring a 18 year old. Right. And I had to go back to a training model that allowed me to recruit literally anybody off the street. Like I worked in a Starbucks that teacher, the person that's struggling. Cause they got a degree in psychology and they haven't worked since they graduated.Speaker 3 (00:55:12):They're like, what just happened? I paid all this money for a degree and I don't have a job. I wanted to go back to the days, like when we worked at security or pest control that literally anybody could do it. Right? Like you just had to knock doors. Solar gets more complicated than that sometimes. And so our whole concept here at energy co is a division of labor. So we split it into the, the setter, the educator and the closer they work together as a team, you know, there's a whole bunch of people that can set cause anybody can set just like in pest control security. He just got to say, even if they're terrible and they're like, Hey, do you want solar? Eventually somebody's going to say yes. Whereas the educator's a little bit harder. You've got to explain the one-on-ones and how solar works.Speaker 3 (00:55:51):But there are a whole bunch of second grade teachers out there that would absolutely love to make money per job. Um, in 30 minutes of work, right? And then our closers are definitely the rarest people. It takes a very specific skillset. And so w

ASCO Guidelines Podcast Series
Nervous System Toxicities: Management of irAEs Guideline (Part 9)

ASCO Guidelines Podcast Series

Play Episode Listen Later Nov 10, 2021 20:11


An interview with Dr. Bianca Santomasso from Memorial Sloan Kettering Cancer Center, author on “Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update.” She reviews neurologic toxicities in patients receiving ICPis, such as myasthenia gravis, Guillain-Barre Syndrome, peripheral neuropathy, aseptic meningitis & encephalitis in Part 9 of this 13-part series. For more information visit www.asco.org/supportive-care-guidelines   TRANSCRIPT [MUSIC PLAYING] SPEAKER: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. BRITTANY HARVEY: Hello and welcome to the ASCO Guidelines Podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey. And today, we're continuing our series on the management of immune related adverse events. I am joined by Dr. Bianca Santomasso from Memorial Sloan Kettering Cancer Center in New York, New York, author on Management of Immune Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitor Therapy ASCO Guideline Update and Management of Immune Related Adverse Events in patients Treated with Chimeric Antigen Receptor T Cell Therapy ASCO Guideline. And today, we're focusing on nervous system toxicities in patients treated with immune checkpoint inhibitor therapy. Thank you for being here, Dr. Santomasso. BIANCA SANTOMASSO: Thank you for having me. BRITTANY HARVEY: Then I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guidelines in the Journal of Clinical Oncology. Dr. Santomasso, do you have any relevant disclosures that are directly related to these guidelines? BIANCA SANTOMASSO: Yes, I'd like to disclose that I've served as a paid consultant for Celgene, Janssen Pharmaceutical, and Legend Biotech for advising them on the topics of T cell therapy side effects. BRITTANY HARVEY: Thank you. Then getting into the content of this guideline, what are the immune related nervous system toxicities addressed in this guideline? And what are the overarching recommendations for evaluation of these neurologic immune related adverse events? BIANCA SANTOMASSO: So neurologic immune related adverse events actually encompass a very diverse spectrum of neurologic syndromes that can occur as a complication of treatment with checkpoint inhibitors. So the spectrum that is covered by this guideline includes myasthenia gravis, Guillain-Barre syndrome, polyneuropathy, aseptic meningitis, and encephalitis. And although these are rarer than many of the other immune related adverse event types affecting other organ systems, they're increasingly being encountered due to more patients being treated with novel combinations of immunotherapies. And they're important to recognize, because along with myocarditis, they have generally more morbidity and even more mortality than irAEs affecting other organ systems. So it's important for clinical care providers to have a high index of suspicion for these events. Studies have suggested that these tend to occur in about 3% to 12% of patients, probably between 1% and 2% of patients developing severe events. So they're rare. But again, the events are probably more commonly seen in patients treated with combination checkpoint blockade. And we're increasingly seeing more combinations. So we should be on the lookout for these. Neurologic immune related adverse events can be divided into syndromes that affect the peripheral nervous system, so meaning the peripheral nerves, the neuromuscular junction, and muscle. So that would be Guillain-Barre syndrome, myasthenia gravis, and myositis. And those that affect the central nervous system, such as the brain, spinal cord, or leptomeninges. So those would be aseptic meningitis and encephalitis. The peripheral nervous system irAE appear to be more common than those affecting the central nervous system. And patients can present with a number of different symptoms that kind of relate to these syndromes. That can be as diverse as a headache to numbness, tingling, or focal weakness, such as a foot drop or facial weakness. You may see patients with severe altered mental status or personality changes or gait difficulty, walking difficulty, which could actually mean any number of syndromes. It's generally important to be aware that the timing of onset is generally early, a median of four weeks after the start of treatment, but can range anywhere from one week after the start of treatment to greater than a year. And because we know that cancer can spread to many parts of the nervous system, neurologic toxicity should be considered a diagnosis of exclusion. So that means that as part of the workup for neurologic immune related adverse events, it's imperative to rule out nervous system metastasis, stroke, and infection, which we know can occur at higher rates in patients with cancer. So for most neurologic immune related adverse events, diagnostic workup is similar. It should include MRI brain and/or of the spine, with and without contrast, and often a lumbar puncture for cerebrospinal fluid analysis, including cytology to rule out leptomeningeal metastasis. BRITTANY HARVEY: Thank you for that overview. In addition to those points for evaluation for all nervous system toxicities, what are the key recommendations for identification, evaluation, and management of myasthenia gravis? BIANCA SANTOMASSO: So for myasthenia gravis, presenting symptoms usually include fatiguable or fluctuating muscle weakness. It's generally more proximal than distal. And there's frequently ocular and/or bulbar involvement. So that means either ptosis, like a droopy eyelid, diplopia, or double vision, difficulty swallowing, dysarthria, facial muscle weakness, and/or head drop or neck weakness. Again, for any patient with new neurologic symptoms, an MRI of the brain or spine should be performed depending upon the symptoms to rule out central nervous system involvement by disease or some alternative diagnosis. And similar to idiopathic myasthenia gravis, acetylcholine receptor antibodies can be positive. So these should be checked. This is a blood test. But it's important to note that while these antibodies may be confirmatory, their absence does not rule out the syndrome. The rate of acetylcholine receptor antibody positivity in immune related myasthenia gravis has not been definitively established. So depending on the presentation, one might also consider sending a paraneoplastic panel for Lambert-Eaton myasthenic syndrome. The single most important point I'd like to make regarding suspected immune related myasthenia gravis is that orbital myositis and generalized myositis from immune checkpoint inhibitors can present similarly. For this reason, early neurology consultation and electrodiagnostic testing with repetitive stimulation or single fiber EMG becomes important and helpful to distinguish the two. And to make matters even more complicated, we've learned that there's an overlap syndrome, where patients may develop not only myasthenia gravis, but also myositis and/or myocarditis at the same time. So basically, the neuromuscular junction is affected. But the local muscle and myocardium, which is heart muscle that's kind of related, may be affected all at once. And this overlap of syndromes may increase disease severity and mortality. So they're important to recognize. So what this means is that when you encounter a patient with suspected myasthenia gravis, you should also be checking CPK, muscle enzymes, aldolase to evaluate for myositis, and troponin and electrocardiogram to evaluate for myocarditis. And this should be done even if there are no obvious symptoms. So onto the treatment of myasthenia gravis, this is similar to the management of the idiopathic form. Therefore, it's helpful to have the involvement of a neurologist. The immune checkpoint inhibitor therapy should be held. And patients with mild symptoms are often started on pyridostigmine and corticosteroids. And patients with more severe symptoms should initiate IVIG or plasmapheresis. And patients with more severe symptoms may need to be admitted to the hospital. So that their neurologic and pulmonary status can be monitored closely for improvement. Some patients may require ICU level of monitoring. And considering adding rituximab if symptoms are refractory, and often, as symptoms improve, the steroids can be de-escalated. BRITTANY HARVEY: Understood. Those are all very important points for clinicians to consider. So then following that, what are the key recommendations for identification, evaluation, and management of Guillain-Barre syndrome? BIANCA SANTOMASSO: So Guillain-Barre syndrome, like myasthenia gravis, also presents with weakness. Most often, patients present with a progressive ascending muscle weakness. The syndrome can start with sensory symptoms or neuropathic pain that can be localized to the lower back and thighs. In addition to the classic ascending weakness, there may be facial weakness, double vision, numbness or tingling in the hands or feet, loss of balance, and coordination. And shortness of breath may occur due to respiratory muscle weakness. The autonomic nerves can also be affected and can present as new severe constipation or nausea, urinary problems, or orthostatic hypotension. The reflexes are often reduced or absent, deep tendon reflexes. So again, as for all of the syndromes, early involvement by a neurologist is recommended, if possible. Usually, MRI imaging of the spine is important to rule out spinal cord compression. And it also may show cauda nerve thickening or enhancement, which can occur with this syndrome. And the second aspect is cerebrospinal fluid analysis is important for diagnosis. This is important really for ruling out leptomeningeal metastasis, since that could present similarly. And often, what can be seen in GBS is an elevated protein level in the cerebrospinal fluid. In addition, unlike idiopathic GBS, there can be an elevated white blood cell count in the cerebrospinal fluid. Electrode diagnostic testing can also be helpful for confirmation, and serum tests for antiganglioside antibodies, and a paraneoplastic antibody workup may also be considered. Bedside pulmonary function test and swallowing evaluation should be performed if there's a concern for respiratory or swallowing dysfunction. And some patients do need to have inpatient admission and monitoring if symptoms are severe or if they appear to be progressing from mild. For management, the checkpoint inhibitor therapy should be held. And patients are most often treated with IVIG or plasmapheresis. Corticosteroids can be added to the IVIG or plasmapheresis. These are not usually recommended for idiopathic Guillain-Barre syndrome. However, in immune checkpoint inhibitor related forms, a trial is reasonable. And steroids are usually given at a higher dose for five days and then tapered over several weeks. BRITTANY HARVEY: Understood. I appreciate that overview. So then what are the key recommendations for identification, evaluation, and management of peripheral neuropathy? BIANCA SANTOMASSO: So peripheral neuropathy, or polyneuropathy, is a rare but likely underreported complication of immune checkpoint inhibitor therapy. So in the large databases and meta-analyses, those have really focused on Guillain-Barre syndrome for reporting. But other types of neuropathies, such as painful length dependent sensory and motor axonal neuropathies, or polyradiculopathies or sensory neuropathies do occur after immune checkpoint inhibitors and are probably under-recognized. So evaluation of immune related neuropathy should include neurology consultation to guide the neurology phenotype determination and also the workup. The evaluation primarily relies on a combination of electrodiagnostic studies, serologic tests, and MRI neuroimaging. Because peripheral nervous syndromes can overlap, screening for neuromuscular junction dysfunction with electrodiagnostic testing and myopathy is recommended for any patient who presents with at least motor symptoms that are thought to be peripheral. Serum testing can be helpful for ruling out reversible causes of neuropathy. Spinal imaging is recommended to exclude metastatic disease. And for management, it usually involves holding the checkpoint inhibitor in mild cases, using neuropathic pain medication or steroids in more severe cases. And very severe cases that kind of resembled GBS would be managed as per the GBS algorithm with IVIG or plasmapheresis. BRITTANY HARVEY: Understood. And it's key to look out for those overlapping adverse events. So then following that, what are the key recommendations for aseptic meningitis? BIANCA SANTOMASSO: Right, so now we're getting into the central nervous system toxicity. So aseptic meningitis is an inflammation of the meninges. And it can present with headache, photophobia, neck stiffness. Patients can have nausea, and vomiting, and occasionally fever. The mental status is usually normal. And in patients presenting with headache, which in isolation, could suggest an aseptic meningitis, it's important to evaluate if they have any confusion or altered behavior, which might suggest an encephalitis. And this distinction is important, because suspected encephalitis triggers a different workup, which we'll be discussing later, and also even different management. So the workup for aseptic meningitis includes neuroimaging, usually an MRI of the brain. And on that imaging, we sometimes see abnormal leptomeningeal enhancement. It's important not to assume that this is cancer and to do a lumbar puncture to evaluate cerebrospinal fluid both for inflammation and to exclude other causes of meningeal disease, particularly neoplastic and infectious causes. So cytology, Gram stain, and culture, and other infectious studies should be negative. And it's recommended that empiric antibiotics or antiviral therapy be considered to cover for infectious meningitis until the cerebrospinal fluid results return negative. What's seen in the cerebrospinal fluid in aseptic meningitis is typically reactive lymphocytes, but also neutrophils or histiocytes may be prominent on the cytology. And while the symptoms can be severe, sometimes requiring hospitalization, the management of this entity, these are usually quite treatable. Aseptic meningitis generally responds very well to corticosteroids. So management involves holding the checkpoint inhibitor. And you can often get away with starting a fairly modest dose of corticosteroids, such as oral prednisone, 0.5 to 1 milligram per kilogram or the equivalent. And steroids can usually be tapered over two to four weeks. BRITTANY HARVEY: Great, thank you for reviewing those recommendations. So then you just mentioned the distinction of aseptic meningitis and encephalitis. So what are those key recommendations for identification, evaluation, and management of encephalitis? BIANCA SANTOMASSO: So in encephalitis, the mental status is not normal. It's characterized by, really, an acute or subacute confusion, altered mental status, altered behavior, memory deficits, including working memory and short-term memory. There can be, as associated symptoms, headaches, new onset seizures, psychiatric symptoms, which can include delusions or hallucinations. There could be weakness, sensory changes, imbalance, or gait instability, along with the mental status changes. And so similar to aseptic meningitis, the other central nervous system toxicity, it's important to distinguish encephalitis from other causes of altered mental status, such as CNS metastases, stroke, or infection. And as for the other syndromes, it's very helpful to have neurologic consultation early, if possible. An MRI of the brain is critical. And in addition, MRI of the spine may be obtained to evaluate for inflammatory demyelinating ischemic or metastatic lesions. In immune related encephalitis, MRI brain imaging may reveal T2 flare changes, typical of what can be seen in idiopathic autoimmune or limbic encephalitis. But most often, the MRI imaging is normal. So in this situation, a lumbar puncture for CSF studies to evaluate for evidence of inflammation can be very helpful. You can expect to see either a lymphocytic pleocytosis or an elevated protein, or CSF restricted oligoclonal bands. CSF analysis is also helpful for excluding other causes of encephalitis, particularly viral encephalitis. So HSV, Herpes Simplex Virus, or varicella zoster virus encephalitis should be ruled out and treated with antivirals while the tests are pending. So typically, these entities can be excluded by PCR testing for HSV and VZV. Electroencephalogram, or EEG, can also be helpful for revealing subclinical seizures or status epilepticus, which can occur as a complication of encephalitis or as a cause of persistently depressed sensorium. But these are not specific to encephalitis. Other testing that's done includes screening metabolic tests to look for alternative etiologies. And for this entity, serum and CSF autoimmune antibody evaluation should be sent to assess for malignancy associated neurologic syndromes. And your neurologist can help you with the workup and management, in particular which tests to send. There have been reported cases of antibody positive checkpoint inhibitor related encephalitis. For management, in contrast to aseptic meningitis, these are generally not as steroid sensitive. So you often have to treat with either higher steroid doses, even pulsed steroid doses, along with IVIG or plasmapheresis. If no improvement, escalation to rituximab and cyclophosphamide can be considered, with the assistance of neurology. This management guidance is taken from how to treat autoimmune encephalitities that are not related to checkpoint inhibitors. Unfortunately, these can be difficult to treat. The response may only be partial. So this is one area in need of better understanding of best therapeutics. BRITTANY HARVEY: OK, thank you for reviewing that and pointing out where there's future research needed as well. And I appreciate your reviewing the recommendations for each of these neurologic immune related adverse events. So then to wrap us up, in your view, how will these recommendations for the management of nervous system toxicities impact both clinicians and patients? BIANCA SANTOMASSO: Yeah, so I think this is a daunting list of toxicities. But I'll say that in most situations, the immune checkpoint inhibitor side effects are often manageable and reversible with proper supportive care. They can be serious, and they require close vigilance and prompt treatment and identification. But by knowing what to look for in early identification, that allows early intervention, which is really the key to reversibility and the best outcomes. So having these toxicities on your differential diagnosis is critical. And I think these guidelines really help inform both clinicians, and care providers, and patients on what the possible manifestations are. So we believe this guideline and its recommendations will help members of clinical teams with the recognition and the management of these unique toxicities. And again, it's timely recognition and early intervention that helps patients, really, by increasing their safety with early management. BRITTANY HARVEY: Great, well, thank you for your work on these guidelines and for taking the time to speak with me today, Dr. Santomasso. BIANCA SANTOMASSO: My pleasure. Thank you so much. BRITTANY HARVEY: And thank you to all of our listeners for tuning in to the ASCO Guidelines Podcast series. Stay tuned for additional episodes on the management of immune related adverse events. To read the full guideline, go to www.asco.org/supportive care guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, available in iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast. And be sure to subscribe. So you never miss an episode. [MUSIC PLAYING]

Extraordinary Women Radio with Kami Guildner
Jill Cruz – Helping women tap into their innate body wisdom and take pleasure in health practices — Episode 224

Extraordinary Women Radio with Kami Guildner

Play Episode Listen Later Nov 4, 2021 33:31


Today I'm pleased to introduce you to Jill Cruz, who will be one of our Extraordinary Women Ignite speakers next week. Jill helps women tap into their innate body wisdom and take pleasure in health practices. In this interview: Jill recalls the amazing influences her family had on her health and the diagnosis that made her take extra precautions to the only wealth that matters in her life. The three stages of action that Jill took before realizing that her patterns are rooted from fear of failure. Discover the effect of a powerful tool called inspiration (not motivation) which helped on her journey towards self-love. Listen to Jill's mission of helping others navigate through the painful and seemingly unnecessary battle towards health, self-love and body acceptance. Understanding the essence of "re-commit" for a life-long integration of practice and inspiration for the pursuit of self-love. Jill Cruz, MS, CNS helps women over 40 that hate dieting to lose weight and feel great without being deprived. Jill has a Master of Science degree in Human Nutrition and is a Board Certified Nutrition Specialist. Jill combines her strong science-based background with tons of practical nutrition, fitness, and lifestyle guidance, helping women achieve greatness AND happiness. She is on a mission to guide women to reach their wildest dreams for their health while loving the food they eat and the life they live. "Inspiration is the inner desire to do something because I deserve self-love." - Jill Cruz Let's meet Jill Cruz Jill Cruz Show Notes

Natural Medicine Journal Podcast
Utilizing Stool Testing in Clinical Practice: A conversation with Anthony Crifase, DC, CNS, DACBN

Natural Medicine Journal Podcast

Play Episode Listen Later Nov 3, 2021 31:58


Stool testing can be a valuable tool that clinicians can use in their practice. Chiropractic physician, nutritionist, and functional medicine practitioner Anthony Crifase, DC, CNS, DACBN, provides an overview about stool testing and shares his clinical insight on how he uses this tool in his practice. Listeners will learn about the different types of tests including specialty tests and when to use each test. About the Expert Anthony Crifase, DC, CNS, DACBN, LDN, CISSN, CPT, is a doctor of chiropractic, double-board-certified clinical nutritionist, licensed dietician nutritionist, certified sports nutritionist, and certified personal trainer. He has worked with hundreds of patients helping them to find the root issues of their health conditions. He is a program manager at Rupa Health, where he helps practitioners leverage the power of functional and specialty testing to provide greater outcomes to their patients. You can reach him at RupaHealth.com. About the Sponsor Rupa Health, the best way to order functional & integrative tests from 20+ specialty labs, reducing your time spent ordering labs by 90% and helping you provide a superior patient experience. From beginning to end, we take care of the entire labwork experience. Rupa is free for practitioners—sign up to learn more!

Charting Pediatrics
Early Identification of Central Nervous System Tumors in Primary Care Pediatrics with Adam Green, MD (S5:E10)

Charting Pediatrics

Play Episode Listen Later Nov 2, 2021 23:44


Central nervous system (CNS) tumors account for a quarter of all cancers in children aged 1 to 19 years. Nearly 70% of CNS tumors can be effectively treated, but early detection is critical to allow for the best possible treatments and outcomes. Too often, CNS tumors are initially misdiagnosed as more common pediatric conditions such as migraine, gastroenteritis or other psychologic and behavioral problems. In this episode, we discuss the classic signs and presentations of CNS tumors to support early detection.   Our guest for today's episode is Dr. Green. Dr. Green is part of the Center for Cancer and Blood Disorders Team at Children's Hospital Colorado and is Assistant Professor of Pediatrics, Hematology/Oncology/and Bone Marrow Transplantation at the University of Colorado School of Medicine. Do you have thoughts about today's episode or suggestions for a future topic? Write to us, Chartingpediatrics@childrenscolorado.org

Demystifying NMO
Get Nerdy: The Latest in NMOSD Research

Demystifying NMO

Play Episode Listen Later Nov 2, 2021 14:52


Embrace your inner nerd with host and CBJF scientific advisor Chelsey (PhD immunologist) as she reviews the emerging science and hot topics recently shared at the virtual European Committee for the Treatment and Research in MS (ECTRIMS). This is a major scientific meeting where clinicians and scientists in the field of central nervous system (CNS) diseases/disorders meet to share their recent data and findings with each other. Chelsey breaks down 4 buckets of NMOSD-related research topics: NMOSD- and MOG-associated disorders: overlaps and distinctions Unraveling complexities of NMOSDData updates on currently FDA-approved NMOSD treatmentsNeurodegeneration and demyelination in the CNS: Potential treatment targets in neuroregenerative processes

Living Well with Multiple Sclerosis
Let's Talk About Sex (and MS) | S3E43

Living Well with Multiple Sclerosis

Play Episode Listen Later Oct 27, 2021 51:42


Living Well with MS is proud to welcome back Dr. Aaron Boster, an Ohio-based neurologist specializing in MS, who has featured on episodes that tackled exploring how to make the right medication choices and the impacts of lifestyle choices on MS. Now we tap his expertise to help us grapple with an important topic that isn't discussed as often as it should be – sex. Sex and sexuality are vital dimensions of a healthy life, but how are they impacted by MS? Our discussion with Dr. Boster digs into the science and practical implications behind this topic, so let's talk about sex and MS!   Dr. Aaron Boster's Bio:   Dr. Aaron Boster is an award-winning, widely published, and board-certified neurologist specializing in multiple sclerosis and related CNS inflammatory disorders. He currently serves as the Director of the Neuroscience Infusion Center at OhioHealth. Witnessing his uncle's diagnosis with MS when he was 12, he and his family came to see a lack of coherence in the way MS was treated at the time. That experienced informed Dr. Boster's drive to do things differently. At OhioHealth, he spearheads a revolutionary model in MS treatment and patient care drawing on interdisciplinary resources and putting patients and families first. Dr. Boster is also an Adjunct Assistant Professor of Neurology at Ohio University Heritage College of Osteopathic Medicine, and a former Assistant Professor of Neurology at The Ohio State University, where he also formerly headed the Neuroimmunology division. OMS has recently been pleased to welcome Dr. Boster as one of the newest additions to its Board of Trustees.   Dr Boster has been intimately involved in the care of people impacted by multiple sclerosis; he has been a principal investigator in numerous clinical trials, trained multiple MS doctors and nurse practitioners, and been published extensively in medical journals. He lectures to both patients and providers worldwide with a mission to educate, energize and empower people impacted by MS.    Dr Boster grew up in Columbus, Ohio and attended undergraduate at Oberlin College. He earned his MD at the University of Cincinnati College of medicine and completed an internship in Internal Medicine and Residency in Neurology at the University of Michigan, followed by a two-year fellowship in Clinical Neuroimmunology at Wayne State University.    He lives in Columbus, Ohio with his wife, Krissy, son Maxwell, and daughter Betty Mae.   Questions:   Aaron Boster, welcome back to Living Well with MS, and thanks for joining us again. Before we dig into this episode's main topic – sex and MS – there's a recent bit of news to mention. You've joined the Overcoming MS board of trustees. There is no doubt OMS is happy to have someone of your medical and clinical expertise on its board. How has the experience been so far and what compelled you to join in this capacity? Let's shift gear into our main topic – sex and MS. This is quite important and perhaps not discussed as often as it should be. First off, how would you define sexuality in the context of MS? Is it common for people with MS to experience sexual dysfunction or other challenges with having a normal sexual life? Do the types of sexual dysfunction differ depending on the types of MS you have? If a man is experiencing sexual dysfunction connected to his MS, what are his options for overcoming or managing it? What if you're a woman experiencing sexual dysfunction connected to your MS. What are your options for managing it? Some people with MS encounter some sort of physical impediments or disabilities. How might that affect your sexual life and what can you do about it? Is there any specific research currently going on that studies MS and its influence on a person's healthy sexual life? If there was one critical takeaway you could share with anyone in our audience experiencing sexual issues related to their MS, what would it be? Before we wrap up, and on a totally different note, I couldn't let someone of your expertise leave the guest chair without asking you a question of personal interest to me as well as many other members of our community – about supplements. There are many out there to choose from, from Co-enzyme Q10 and probiotics to things like Ginkgo Biloba, Echinacea, St. John's Wort, Valerian, Ginseng, and many more. Is there a general framework for deciding whether to try a supplement and are there any whose positive effects are supported by an evidence base?   Links:   Check out Dr. Boster's popular YouTube channel covering all aspects of MS. Boster is now a trustee of Overcoming MS.   Coming up on our next episode:   In just a few days, you can get another dose of our podcast with the premiere of the 24th installment of our Coffee Break series, as we travel (in the eco-friendly virtual sense) to Christchurch, New Zealand to meet another fascinating member of the OMS community, Lieza Vanden Broeke. Lieza has a remarkable personal backstory, and her experience with MS will provide insights and inspiration to our global community. Plus, she's also the ambassador of the OMS Circle in Christchurch. Thanks to Lieza for her candid interview, and to our listeners for being part of the OMS podcast family!   Don't miss out:   Subscribe to this podcast and never miss an episode. You can catch any episode of Living Well with MS here or on your favorite podcast listening app. Don't be shy – if you like the program, leave a review on Apple Podcasts or wherever you tune into the show.   S3E43 Transcript Let's Talk About Sex (and MS)   Geoff Allix (Intro) (2s): Welcome to Living Well with MS, the podcast for Overcoming MS for people with multiple sclerosis interested in making healthy lifestyle choices. I'm your host Geoff Allix. Thank you for joining us for this new episode. I hope it makes you feel more informed and inspired about living a full life with MS. Don't forget to check out our show notes for more information and useful links. You can find these on our website at www.overcomingms.org/podcast. If you enjoy the show, please spread the word about us on your social media channels. That's the kind of viral effect we can all smile about. Finally, don't forget to subscribe to the show on your favorite podcast platform so you never miss an episode.   Geoff Allix (Intro) (44s): Now without further ado, on with the show.   Geoff Allix (48s): Living Well with MS is proud to welcome back Dr. Aaron Boster, an Ohio-based award-winning, widely published, and board-certified neurologist, and the founder of the Boster Center for Multiple Sclerosis, who was featured on past episodes that tackled exploring how to make the right medication choices and the impacts of lifestyle choices on MS. Now we tap his expertise to help us grapple with an important topic that isn't discussed as often as it should be – sex. Sex and sexuality are vital dimensions of a healthy life, but how are they impacted by MS? Our discussion with Dr. Boster digs into the science and practical implications behind this topic. So, Dr. Aaron Boster, welcome back to Living Well with MS.   Geoff Allix (1m 28s): And let's talk about sex and MS.   Dr. Aaron Boster (1m 30s): Thank you so much for having me. I'm delighted to be back. And you're right, this is an underappreciated topic which needs to be discussed much more frequently. So, I'm glad that we're doing this today.   Geoff Allix (1m 41s): Before we dig into the main topic of sex and MS, there's two things I'd like to mention. Firstly, I just want to call out that your YouTube channel, which is very easy to find, if you just search for Aaron Boster on YouTube, you'll find it. In fact, if you search for MS on YouTube, I think it would come pretty high. It is personally, I think the single best resource for a person with MS.   Dr. Aaron Boster (2m 7s): Wow.   Geoff Allix (2m 8s): Hugely it is... I don't know how many videos you probably are much more aware than me, but I'd say hundreds. There are huge numbers.   Dr. Aaron Boster (2m 15s): Yes, 450 some.   Geoff Allix (2m 18s): Right. So, whatever topic there is an episode there, and I've found it incredibly useful, incredibly informative. So, I would –   Dr. Aaron Boster (2m 25s): So, nice of you to say thank you.   Geoff Allix (2m 27s): Well, yeah, I mean, I just think it's, I encourage everyone just going to have a look. It's just, you don't have to look at every topic. Recently, there's one on cannabis and MS. At which in the UK, the police would have different opinions. So, bits aren't going to be, you know, I mean appropriate for everyone. But yeah, there's such a wealth of resources there. So, the second thing, you've joined the Overcoming MS Board of Trustees.   Dr. Aaron Boster (2m 56s): Yes.   Geoff Allix (2m 56s): Yeah, I think everyone at OMS is happy to have you on board, and your medical and clinical expertise. So, what compelled you to join? And how has it been so far?   Dr. Aaron Boster (3m 9s): Thank you. Let me answer those in reverse order. Today, it's been awesome. There's a significant onboarding process, and I've had a great time meeting the other Board of Trustees members, getting to know the Chair, the CEO, and really starting to get to understand the organization. So far, I've participated in one formal board meeting. It's been pretty great so far. I am really excited for what's coming with Overcoming MS over the next couple years. So, the fact that I get to participate is really, really special to me. Now, what compelled me to do it? Really two things if I may. The first thing is, if you look at my style of MS, my brand of delivering MS care, and the tenets that I have developed and talk about and teach.   Dr. Aaron Boster (3m 58s): And you look at the tenets of Overcoming MS, they are remarkably convergent, like remarkably so. When I list out being five for five, when I talk about the importance of family, I mean, we just listed six of the seven. I mean, we're very, very converged. That was one thing that as I started to learn more about Overcoming MS, I said, “Wow, these folks are really thinking along the same lines as me.” The second thing is, getting an MS diagnosis is scary. And it's a moment in time when people aren't sure what to do. And in certain locations there's awesome resources to shepherd someone through an early diagnosis.   Dr. Aaron Boster (4m 41s): But in many locations, that's probably lacking, and access is a major issue. And so, if you're in a spot where you're recently diagnosed or you don't know what to do, reaching for something that is ready made and awesome is a beautiful thing. And I'll be transparent. In my religion, there are a set criteria of things that you're supposed to do when someone dies. Okay. So, if you don't know what to do when you're grieving the loss of a loved one, there's some set things you're supposed to do: You're supposed to grieve for a certain amount of time. The community helps you in a certain fashion. And really, in the absence of knowing how to cope in grief with a loss, that is an awesome structure to have.   Dr. Aaron Boster (5m 24s): And in many ways, I think for someone newly diagnosed with MS, this is a beautiful thing to say, “Sure do this.” So, for both of those reasons, I'm really, really excited to participate. It's been a great experience so far. So more to come.   Geoff Allix (5m 39s): And one thing I would say that you have that Overcoming MS doesn't, but should do, I think as an extra pillar would be drink more water. And that's not an Overcoming MS thing. So, we're on a podcast. You can't see me. I'm just picking up my glass this very moment.   Dr. Aaron Boster (5m 56s): Sure. And I've got water in my mug, yeah, yeah. So, I'm   Geoff Allix (5m 59s): And I think that's, I know we're going off-topic here, but I think that it should be. It's such a simple thing. And because a lot of us have bladder issues and things, and then you sort of say, “Okay, maybe drink less because that's a bladder buster.” I even know it. I know, if I didn't drink enough, then I feel worse. It's one of those instant things. So, some of the things with MS, slow burn as a summary instant. Stress is instant, dehydration is instant.   Dr. Aaron Boster (6m 27s): Absolutely spot on. And, you know, I like to challenge people sometimes because I'll say, you know, drink more water, and they'll say something to the effect of, "You sound like my mom." You know, or like, that's silly advice. I'll say, “Okay, but try it.”   Geoff Allix (6m 39s): Yeah.   Dr. Aaron Boster (6m 39s): Try drinking an adequate amount of water for like three days and see what happens. You know because people are shocked. They're like, “Oh, my gosh, I really do feel better.”   Geoff Allix (6m 45s): Yeah. And you've made it really simple as well. So, I just drink a pint or half liter with each meal, and then drink a pint or half liter between each meal.   Dr. Aaron Boster (6m 56s): Yeah, then you're done. You just did.   Geoff Allix (6m 59s): Yeah.   Dr. Aaron Boster (6m 59s): Spot on. Yeah. Then you're good for the day. And unfortunately, so many people, and you give a great example as to why they may shy away from water intake, and inadvertently make their situation so much worse.   Geoff Allix (7m 10s): Yeah, so I'd like to. Yeah, so on your next board meeting. So, can we add an extra? Drink more water.   Dr. Aaron Boster (7m 19s): Okay. I'll bring it up. As we talk about sex, this, we will come back to this whole bladder thing. It is very, very related.   Geoff Allix (7m 27s): I was going to think, yeah. I was thinking you can't say, drink water during sex, that wouldn't work. But anyway. So, let's get on to our main topic, sex and MS. So, it's a very important one. I mean, it's obviously very important for the survival of the species as much as anything, but it's an important topic. And probably not discussed often enough, often embarrassing. So, how would you define sexuality in the context of MS?   Dr. Aaron Boster (8m 2s): So, you know, sexuality arguably would be defined as humans' ability to experience sexual feelings. It's a really broad blanket term for a lot of things related to sex. So, my first comment is I don't think of sexuality in someone impacted by MS any different than I do in any other human. And I think that's actually a very, very important distinction because there's nothing unique about the sexuality of human being if they happen to have a chronic illness or not. Now, playing out sexual behaviors, intimacy, all these wonderful things, MS can risk interfering.   Dr. Aaron Boster (8m 46s): And that's where we get into a really important discussion. And that's where sometimes we really need to try to help educate and intervene.   Geoff Allix (9m 1s): So, is sexual dysfunction more common for people with MS? Does it increase the chances?   Dr. Aaron Boster (9m 7s): It certainly is. Now, you know, MS is a situation where the immune system can affect any part of the supercomputer that runs your body - the brain, and the superhighway - the spinal cord. And unfortunately, there's plenty of specific areas in the brain and spinal cord where if there's damage, it could interfere with sexual functioning. And so, the spinal cord is a really good example. Very commonly, when someone has a transverse myelitis, inflammation in their spinal cord, then they may find that their limbs are numb or kind of weak. But they also will very likely notice problems with the down theres – bowel, bladder, and sexual function. And this is, unfortunately, all too common in the setting of MS.   Dr. Aaron Boster (9m 48s): I would also say that it's oftentimes overlooked by the MS clinic, something that's kind of glossed over and not discussed. And given that it's somewhat of a taboo topic in casual conversation, I think patients are sometimes a little bit nervous to bring it up.   Geoff Allix (10m 8s): And does the type of MS you have whether it's relapsing or progressive, does that affect the types of sexual dysfunction you might have?   Dr. Aaron Boster (10m 16s): I would say no. I would rather think about the kinds of sexual dysfunction a little bit differently. Not so much related to the phenotype of MS. So, someone with relapsing MS, or Primary Progressive MS, Secondary Progressive MS, what have you, I don't see different kinds of sexual problems. I would run about it as follows: primary sexual dysfunction, secondary sexual dysfunction, and tertiary sexual dysfunction. So, just to share a couple quick definitions that helped me when I'm thinking about this. Primary sexual dysfunction is a problem with the circuitry and hormones of sex. So, when the down theres are stimulated, there's a lot of circuitry that goes on to assist in intercourse.   Dr. Aaron Boster (10m 58s): That message in the down there has to go all the way up to the brain, through the spinal cord, where the brain interprets the activities and says, “Ah, okay.” And then it sends messages from the brain back down to the down theres to do certain things. We're talking about arousal, orgasm… excuse me, arousal, either erection or lubrication depending on the gender, and then eventually orgasm. And so primary sexual dysfunction can result from MS damage in the brain and spinal cord. And what can happen is you can end up with problems in the circuitry. And so, you can have difficulties with any of those things - arousal, erection, maintaining an erection, ejaculating or arousal, lubrication orgasm.   Dr. Aaron Boster (11m 43s): The other piece to this when I think about primary sexual dysfunction is imbalances in hormones. And I have, for several years now started to routinely screen gentlemen, for example, looking at testosterone levels. Not just to help with sexual function, but there's also ramifications through other aspects of MS, believe it or not. So that's kind of primary sexual dysfunction. And we'll talk maybe a little bit later about how we overcome those things. Secondary sexual dysfunction is important and very often overlooked. And it's a situation where there's problems with sex, not because of the circuitry of sex, not because of hormones, but because of MS symptoms that make things not sexy.   Dr. Aaron Boster (12m 24s): For example, if you're having intercourse, and you lose your bladder, it may stop the activity. I mean, you know, that's like scary to a lot of people. They would think, “Oh my goodness, gracious.” And if you're having intercourse and your leg goes into an extensor spasm, it's extremely painful, you're not having sex anymore. Yet even things like motor fatigue can make it so that, you know the activity of intercourse can become challenging, and these are all secondary sexual dysfunction issues. This is where, to be honest, we can really gain a lot of ground. Now, tertiary sexual dysfunction, I would define as not so much the circuitry of sex or symptoms that interfere with sex, but it's more of a psychological phenomenon where the human being doesn't feel sexual.   Dr. Aaron Boster (13m 11s): They don't feel like a sexual being. They feel maybe like an they feel ill. They don't feel that they can be sexy. And so, when I think about sexual dysfunction, I find it most helpful to kind of try to bucket things into those categories. And oftentimes, we're dealing with all three.   Geoff Allix (13m 35s): And so, if we break it down into men and women, what options would a man have if he's experiencing sexual dysfunction connected with MS? Or how could that be managed or helped?   Dr. Aaron Boster (13m 50s): Absolutely. And so, if we first think about arousal, and this is actually true for both men and women. I'll make sure to give distinctions. When we think about arousal, the first thing I want to do is I want to look at their medicines. And I want to look and see if I have them on medicines that can impair arousal. And you'd be shocked at how many can. So, unfortunately, many of the SSRI and SNRI antidepressants, which are used very commonly in humans can impair libido. And so, you may have significant sexual dysfunction because of a high dose of Zoloft, for example. And so, we need to look at that. And there's a host of other medicines that could interfere with arousal.   Dr. Aaron Boster (14m 31s): Also in the setting of arousal, for gentlemen, we'll look at testosterone levels, and look and see if his testosterone, which I would like to be above 400 is down like in the 100s. And maybe that's a component as to why that's a problem. Another very, very, very common because of loss of arousal or interest in both men and women is depression. Now depression is twice as likely to be experienced by a person impacted by MS compared to the general population. And one of the hallmarks of depression is something called anhedonia. Where just stuff that you enjoy just isn't really that much fun anymore. Like if you do really like book club or watching TV, doesn't do it for you.   Dr. Aaron Boster (15m 10s): And so that can happen with sex, which is a major thing. And because depression is so common in MS, we would be foolish not to screen for that, or ask the question, could that be related to arousal? And so other things that we think about in both men and women, recent psychosocial stressors. You'll hear about a guy lose his job, and then he's not interested in intercourse, because he's really dealing with, he's kind of stressed out. So, I really require not just some laboratories, but also a careful history and some open honest communication when dealing with the gentleman's issues as it relates to arousal.   Dr. Aaron Boster (15m 56s): The women, I guess, if it's okay with you, let me answer the same question for women just really quick.   Geoff Allix (16m 2s): Yeah, it's okay.   Dr. Aaron Boster (16m 3s): So, with women, we will look at all the same things I just said. Right? Hormone levels included. And then in depression included in the like. With women, there's actually interestingly two FDA approved therapies to help women with low libido, which is really cool. And interestingly, not known by many, many people. So, there's a medicine which is approved in the United States of the trade name Addyi, A-D-D-Y-I. And I'm spelling it for you because I'm blanking as I talk to you about the generic name. So, I'm sorry. And that is a pill taken once a day, which in about half of our patients results in improving female libido quite substantially.   Dr. Aaron Boster (16m 46s): There's also an injection that's administered by urologist. And I don't, I've never prescribed it. It's called PT141. And this is also a therapy that can be very, very helpful in helping with female libido. So, there's actually more options to help with female libido than male. And so that's the first area. And I want to stress that you can't really skip over it. It is so terribly important. When we then talk about the second phase of things that would be erection for gentlemen. I like to divide my thoughts about erections into half. There is obtaining an erection and then maintaining an erection adequate for a penetration of vagina, anus, mouth, whatever it is that you're trying to accomplish that evening or day.   Dr. Aaron Boster (17m 28s): And so, with erections, we want to find out, are you able to -- do you have erections when you wake up ever? Like it is the physiology, the circuitry of erections, is that intact? Are you able to maintain an erection on your own, like through masturbation, for example? And during intercourse, what's going on? And this conversation is important because, again, we have to think about primary, secondary, tertiary options. Primary sexual dysfunction, most commonly occurs because of spinal cord involvement in MS. And what essentially happens is the down there are stimulated and as the message is going up the spinal cord it dies.   Dr. Aaron Boster (18m 9s): So, the message is never delivered to the brain. So, the brain is not informed of the dealio. So, in this situation, something that can be extremely helpful is a plug in the wall vibrator, right? So, I sometimes on podcasts and whatnot have talked about the vibrator trick, which I'll share now. In the vibrator trick is where you spend 60 bucks American and you purchase a plug in the wall vibrator. And my favorite brand is Hitachi Magic Wand. I don't have a contract. Though I would do a branding deal with them in a heartbeat until –   Geoff Allix (18m 43s): I believe, they're mentioned on the Sex in the City way back.   Dr. Aaron Boster (18m 47s): Yeah, certainly. Certainly. So, this is marketed as a back massager. And it's a plug in vibrator. And the reason it's so important is we need kind of like overdrive stimulation, right? A double D battery vibrator is not going to cut it for this purpose. And then what you do is you apply a water-based lubricant to the genitalia because that increases skin sensitivity. And then you apply the plug in the wall vibrator, you know, the hardcore power from the wall, and you apply it on the glands, penis, you apply to the head of the penis, you applied it under the testicles, you apply it somewhere where it feels good. And this is providing overdraft stimulation. Just to make the point clear, I'll use an example of us talking right now.   Dr. Aaron Boster (19m 29s): So, I'm talking using my indoor voice because there's no interference between essentially my mouth and your ear, even though we're across the continent, and there's microphones, and speakers and stuff involved. Now, let's say that we were having this exact same conversation during business hours. I'm in my lobby of my office. Today is Sunday. But if this was a busy business day, it would be super loud in here. And you wouldn't be able to hear me when I used my indoor voice. So, I would have to use overdrive stimulation. I would have to scream, and really project really loudly so that you could hear me. And that's what we're doing with a plug in the wall vibrator as it relates to intercourse. We're providing overdrive stimulation so down there can get the message to the brain and let the brain know what's up.   Dr. Aaron Boster (20m 13s): Now the advantage of a plug in the vibrator is there's no side effects. It's relatively inexpensive. And you can do it by yourself during masturbation. You can do it before intercourse as a form of foreplay. You can literally hold the device between you and your partner with continuous stimulation during intercourse. And it works well for both men and women. So, everything that I just said with regards to obtaining erection can be applied to maintaining an erection by using the vibrator. And we have taught some gentlemen, if they have difficulties they'll withdraw, and then they can apply the vibrator to the shaft of the penis, it will become adequately erect again, and they can continue having fun.   Dr. Aaron Boster (20m 55s): And so, this is a very helpful tool. Now, probably the most widely utilized tool is a little blue pill, right? So, Viagra, Cialis, and the like are very, very helpful medicines, in helping gentlemen obtain and maintain erection, pharmacologically, they're superb. And so, if there isn't a cardiovascular risk, why you can't handle the Viagra or Cialis, what have you, that's a very useful tool. Taken about an hour before intercourse works best on an empty stomach. You do have to worry about light-headedness, and there's some blood pressure concerns. And that can make a really big difference in a guy's life. You know, it's of note that if you want to make an adult miserable, mess up their ability to eat good food or have sex, and then we'll be miserable.   Dr. Aaron Boster (21m 41s): And MS risks interfering with sex for sure. And so, a little blue after dinner mint can really change a guy's outlook on life. Now, again, on the topic of obtaining and maintaining erection, testosterone level is very, very relevant. Now, there's a bunch of other things you can do. For example, intracavernous penile injections. So, before the era of pills, we had the shots on the side of the penis, and everyone listened going, “Ooh!” But in exchange for that route of administration, you have a fantastic erection. And sometimes when pills don't work, we still go back to those tried-and-true methods.   Dr. Aaron Boster (22m 24s): Other things that you can do if you're a gentleman, using a device, you can trap the erection. So, you can use a vacuum device, which can be very, very effective. And if you're really serious about an erection, and those things aren't working, urologists can actually do penile implants. I have some patients who have been very, very happy with penile implants because nothing else was really working for them. So, you know, you might say, how dedicated are you to your erection? Because if you're dedicated enough, we can guarantee that you'll be able to be erect.   Dr. Aaron Boster (23m 6s): Getting into the same questions with women, we're really dealing with lubrication, alright? And engagement of the tissue to allow adequate arousal. And so, that's kind of the equivalent for women as erections are to men. And there's several ways of addressing difficulties that a woman may have with lubrication. So, one thing you can do is apply a water-based lubricant. Very straightforward, very, very effective. Another option is to apply an estrogen cream to the vulva. If you're not taking systemic hormones, and there are reasons why some women may not be appropriate for taking systemic hormones, because of cancer risks. Applying a hormone cream topically is really great because it's just absorbed locally.   Dr. Aaron Boster (23m 51s): So, there's no systemic risks. But applying an estrogen cream can really help with engagement and with lubrication. We very commonly prescribe a compounded cream which is called scream cream. And it is what it sounds like. It's a compounded mix, which includes Viagra and theophylline and several other agents which help in increase blood flow and encouragement and help with lubrication. And so, someone may have a can of scream cream that they use in preparation for intercourse. And so those things can be very, very helpful. Obviously, adequate clitoral stimulation, or vaginal stimulation through the same plug in the wall vibrator is a really smart tool.   Dr. Aaron Boster (24m 32s): And that can help with lubrication. Now, the tips for orgasm, for achieving orgasm are all along the same lines. Really we have to bring, for both men and women - primary, secondary, and tertiary measures to the table to achieve orgasm. And sometimes we have to take extra measures depending on the specifics of the individual. But the point that I hope I'm conveying is, is that: number one, there are a lot of options to make this better if you're a boy or girl. And number two, it's worth it. Right? It's worth it to have an excellent sexual experience. Sorry, that was a little bit of a long-winded answer.   Dr. Aaron Boster (25m 14s): I got a little carried away there but talk about that.   Geoff Allix (25m 15s): No, no its good. And so, what you've talked to us about was very medical. But you mentioned especially the tertiary side of it.   Dr. Aaron Boster (25m 25s): Yes.   Geoff Allix (25m 25s): I love the thinking as well.   Dr. Aaron Boster (25m 26s): Yes.   Geoff Allix (25m 26s): So, is it worth getting counseling, maybe couples counseling? Because still, it's difficult to -- and this happens, whether you have MS or not. It's to convince the other person it's useful.   Dr. Aaron Boster (25m 34s): Super, super important. In fact, if you said, “Aaron, what's the number one tip?” The number one tip is none of the stuff I just mentioned. The number one tip is talking to your partner. So, let's discuss that. Very commonly, independent from having a chronic condition like MS. Very commonly, we have hang-ups about sex, and we have areas of concern or embarrassment, or topics that we're shy about. For example, many people are reluctant to flatulate in front of their spouse. Right? So, that's the thing. Like, you know, we don't want to do that. And so, talking about sex is not something that most of us are just completely at ease doing.   Dr. Aaron Boster (26m 20s): Even with our spouse, even with a monogamous partner of 30 years. And when you have a chronic condition, like multiple sclerosis, which can, as we've talked about interfere with the circuitry and the success of intercourse, it adds complexity. It doesn't make it easier, it makes it harder. What I have found in talking to families for over a decade and a half now. And I'm very, very open about this topic in that oftentimes, the two members of the couple would love to talk to the other person. They are dying to talk the other person about this, and they are nervous.   Dr. Aaron Boster (27m 4s): And when they broach a conversation, it's almost cathartic because together, they can game out an earth shattering, toe-curling, blood-curdling orgasm that would set land speed records and make the neighbors call to make sure everyone's still safe. And it's accomplished because of communication with the partner. Say, and let me be a little bit granular. One partner may really enjoy a particular position in sex because it's really fun for them, which might cause the other partner with MS to go into spasms. Or it may make the other partner develop truncal ataxia, or maybe it overheats that partner. And the person with MS might not be sharing that.   Dr. Aaron Boster (27m 46s): They may not be telling the spouse or the partner, “Hey, listen, when you lay on top of me like that, you're a heavy dude, my body gets heated up and I can't feel anything. Get off me!” You know, simply talking about changing something as simple as a sexual position might be the answer to really meaningful intercourse. So, you are very spot on in bringing this up. And if you are uncomfortable talking about the topic, let's game out several things that you can do to broach the situation. Okay. So you could, for example, do couples counseling. Couples counselors are very wonderful because they can help be sounding boards.   Dr. Aaron Boster (28m 27s): “Did you hear what he just said? Let me repeat it for you.” I mean, you know, they're fantastic kind of notes. I really like couples counseling myself. There are sex counsellors, alright? I mean, maybe another thing to do is just to have the person listen to our podcast that we're doing right now and say, “Hey, the little balding, hyper neurologist in Columbus, Ohio was saying we should talk about sex. I mean, what do you think?” And maybe that broaches a conversation. But if you can sit down and talk about sex, and really what I would want you to bring to the table is the following: What are your goals? Seriously. Is your goal to help your partner achieve orgasm? If that's a goal, state it. State that's a goal.   Dr. Aaron Boster (29m 6s): Is your goal to simply be intimate and touch one another? I mean, these are things that you should talk about. Are you going to orgasm? State the goals. If there are certain things that you really like, and really don't like sexually, particularly the don't like part. “You know, I know that you're really like doing blankety blank to me, and that's very sweet. Except I can't feel it. I can't feel it.” So, you doing that is awesome. I just want to let you know that like I don't even notice that you're doing. So, FYI. I mean that kind of communication is really valuable. Because then the partner will say “Well, geez, Louise, let me not do that. Let me do something different.” And I think what you'd find is if you have this conversation, it will improve your sex life.   Dr. Aaron Boster (29m 55s): The conversation will lead to a better experience. It really will.   Geoff Allix (30m 1s): And so, we've talked a lot about that there could be nerve damage between brain and sexual organs and that's affecting your ability to have an erection, lubrication, orgasms. But what if a person with MS has physical impediments or a disability? You know, apart from their sexual organs don't work properly.   Dr. Aaron Boster (30m 22s): Yes.   Geoff Allix (30m 22s): How could that affect their sexual life? What could they do about that side of things?   Dr. Aaron Boster (30m 30s): So that involves playing smarter, not harder. Let me give you an example. If we think about a traditional Western missionary position of sex, the guy on top in this like, misogynist example, I apologize. It's kind of doing push-ups, right? Which is a tremendous amount of physical activity, keeping the core body strong and the arms, it's a lot. So that might not be feasible for someone. Right? Now, instead, install in your bedroom an eye hook in the ceiling beam, and install a sex sling. The whole world changes now. You place a partner on a sex sling, you can move them around, spin them, pivot them, push them, thrust, move, up, down, left, right, and it takes almost no effort, right.   Dr. Aaron Boster (31m 20s): And so, by changing from good old-fashioned force of will to using something like leveraging a sex sling, or using a wedge, they make these awesome wedges, which is kind of like bringing a gymnastics room into your bedroom. Where you can position a partner on a wedge. If you have problems in certain positions, again, this goes back to the talking about planning, don't do those things. And if other positions are more successful, do those things. Let's use another example of bowel and bladder issues. Very common. Someone has such fear of incontinence of urine or stool, they will not have sex, which is a travesty.   Dr. Aaron Boster (32m 3s): So, what can you do instead? You can, if necessary, do an inner in self cath, and empty your bladder completely, 100% guaranteed prior to intercourse. If you are prone to urinary tract infections, have your neurologist give you antibiotics that you take before or after sex, alright? If you are having trouble with constipation, you can spend a day or two pre-sex emptying out and getting completely evacuated. Even if that involves an or you know, digital rectal stimuli, or whatever is necessary, you can prepare for that. Do you see what I mean? There's a bunch of things that we can do. You have dyspareunia, which is a terrible word.   Dr. Aaron Boster (32m 47s): It means pain with sexual sensation. So, the act of sex hurts. We have to look into, why you have dyspareunia? If it's because of spasms of the vaginal canal, we might use a rectal suppository of valium before intercourse. If it's because of neuropathic pain and burning sensation, we might use a numbing cream. Right? My point here, is if we can identify -- because in my mind what you're saying those are all secondary sexual dysfunctions. If we identify what the problem is, we can game out how to make it better. Then if you remember nothing from my answer, I simply want you to remember sex swing.   Dr. Aaron Boster (33m 28s): Sex swing. Okay.   Geoff Allix (33m 29s): And in the last few years, the amount of research in MS medication has just leapt forward. I mean, it's gone from -- so my father had MS. There are no real treatments. When I first was diagnosed. Not really, like what? Five years ago? There were treatments then but there must be 4, 5, 6, 10 times that many now. That seems to be it's really escalating. So, are there any treatments going on or studies going on for people with MS, and their ability to have a healthy sexual life?   Dr. Aaron Boster (34m 5s): So, in preparation for our discussion, I actually looked this up because I wanted to be able to answer this question if asked. So, yay. And I went, the way I look up information like that is at the clinicaltrials.gov, which is a site for any clinical trial that's registered by the United States government. And there were 125 hits for when I searched for multiple sclerosis sexuality. And I looked through the first 10 or 20. All over the world, France, Turkey, Louisiana, Cleveland. So, there were trials throughout. Now, almost all of these are investigator-initiated trials. You know, so a clinic running a small study.   Dr. Aaron Boster (34m 46s): But my point here is yes, there's a lot going on. Looking at testosterone levels, looking at various pharmacotherapies, looking at behavioral therapies, a lot of stuff. And so, I hope if you're listening to this, it's reassuring to know that clinic doctors and researchers alike recognize this is such a critically important aspect to life that we're investing resources to try to help you make it better.   Geoff Allix (35m 9s): And you mentioned about testosterone. So, getting testosterone checked is that part of blood test?   Dr. Aaron Boster (35m 13s): Yes. So, the way that I do it in clinic is I draw a morning level of testosterone. And the reason it needs to be morning, a gentleman's testosterone is highest in the morning, and it goes down throughout the day. So, if you tested in the evening and have a low value, you don't really know if it's just because of the diurnal, you know, the fact that it drops down. So, you want to get the best most accurate reading. You do that in the morning. You know testosterone level in the morning. I get it on two separate occasions. And if it's low, the total testosterone is low, that's a blood test, then that opens up the opportunity to treat with testosterone. Which in MS helps gentlemen not just with intercourse, not just with erectile function and ejaculation in the bedroom, but it also helps improve cognition, and slow disability progression, and improve fatigue with gentlemen with MS.   Geoff Allix (36m 9s): And is there an equivalent for women with estrogen?   Dr. Aaron Boster (36m 12s): It's not the same rules, interestingly. It's not the same set of variables. And now looking at hormone levels in women is important. And particularly surrounding times of menopause, when we can see an uptick of MS symptoms, and specifically related to intercourse, as I was mentioning with lubrication. So that is relevant, but for a different set of reasons.   Geoff Allix (36m 38s): So, men definitely worth getting checked out on testosterone, but women…?   Dr. Aaron Boster (36m 43s): Not as much. No, I don't routinely check women's testosterone levels in my clinic.   Geoff Allix (36m 49s): Okay, and if, so, if there's one takeaway you could share with the audience, if people are having sexual issues related to MS, what would that be?   Dr. Aaron Boster (36m 57s): That the one takeaway would be to have open communication with your partners and with your clinicians, because there are ways to make it better. We don't have to just accept this is now the new state of affairs. On the contrary, there are plenty of things that we can do. And you're worth it. It's worth exploring and improving because it is such an important aspect of life, that it's not okay, you just to say, "Well, too bad."   Geoff Allix (37m 27s): And there's no reason, I mean, the two of us, I think, are probably beyond wanting to have more children at our age.   Dr. Aaron Boster (37m 35s): Correct.   Geoff Allix (37m 36s): There's no reason that a person can't be fertile as well as…   Dr. Aaron Boster (37m 43s): Oh, absolutely. So, there's a whole separate conversation. But I actually love to come back and talk to you about this. But there's a whole separate conversation about fertility, and pregnancy, and gestation and delivery related to MS. The quick skinny is MS has no bearing on fertility whatsoever. None. And as it relates to our conversation, if you're having intercourse, we need to be thinking about the appropriate use of contraception to avoid unplanned events such as unplanned pregnancies and things like that.   Geoff Allix (38m 17s): And before we wrap up, there's something I wanted to ask you on a completely different tack.   Dr. Aaron Boster (38m 26s): Absolutely.   Geoff Allix (38m 27s): So, just as someone who's got a lot of expertise in this area, and something that is of personal interest. Because of the podcast, I get asked lots about different supplements. So, people say, “Have you tried Coenzyme Q10? Have you tried lion's mane mushroom, St. John's Wort, ginseng, ginkgo biloba?” There's countless things. And some of them, I'm fairly sure, yeah, if your magnesium is low that's, you know, if anything's not off the normal levels, then yeah, absolutely.   Geoff Allix (39m 7s): But there's always someone championing a supplement or other. So firstly, is there a framework that you would use to decide whether to try a supplement?   Dr. Aaron Boster (39m 18s): That's an awesome question. Thank you for asking me that question. And it's a multi layered answer. So, I have two criteria, if you will. So, the first criteria, there are three things that must be met, if I'm going to greenlight a supplement. The first one is it can't be too expensive. So, each individual family has to decide if the cost of something is too expensive or not for them. And I bring that up because sometimes you may find supplements where it's actually a big chunk of their weekly check, and that's not okay with me. Particularly, if I don't have hardcore science suggesting that I can guarantee it works. So, it can't be too expensive. The second thing is it can't be dangerous.   Dr. Aaron Boster (39m 59s): And sometimes supplements are dangerous. Now, oftentimes, they're not. But let me give you an example. If an immune booster actually boosted your immune system, it would be dangerous to take when you have MS. And, you know, just because it's natural doesn't mean it's safe. I mean, cyanide is natural. So, the second criterion is it can't be dangerous. And sometimes I have to do some investigations, digging through various ingredients to try to answer that question. The third is that it can't be instead of something I know works. So, if you tell me that you want to take CoQ10. CoQ10 is not dangerous. CoQ10 is not generally expensive.   Dr. Aaron Boster (40m 41s): And if you're going to take CoQ10, along with your disease modifying therapy, I have no issues with that. But if you have to take your CoQ10 instead of your disease modifying therapy, where I have good solid scientific evidence that it helps you, now I have an issue. So that's my first criterion. The second criterion is more rigorous in that scientific evidence, you know, properly studied science to prove or disprove that something's helpful. And that second one, you know, we don't have a lot of info. There is some info for some supplements, and I'm going to go over a couple with you right now. But that would be the second one. And you know, it's worthwhile sharing, at least here in United States where I practice.   Dr. Aaron Boster (41m 24s): The supplements and vitamins are not monitored by the American FDA. So, if there's a bottle of a prescription medicine, and it says it does something, they can prove that. It's been proven, it does something or they can't say it. You know, if there's a side effect on the bottle, or a dosage on the bottle, it has to be proven. Like that's not a suggestion, it's a proof. If you bottle a supplement that you get at a health food store, let's say. What they say on it isn't proven. It doesn't have to be proven. So, they could say, for example, it will make you grow 10 feet tall. And they're allowed to say that even if it's not true.   Dr. Aaron Boster (42m 6s): And as a result, it calls into question, and it creates challenges and knowing whether something's okay, but which is kind of I think your point. So, when you look at the evidence, to me, this is a conversation about nutrition, right? And I start with, as we talked about, maybe a little bit earlier, I start with increasing water intake, believe it or not. I think if you're going to change one thing, increasing water is actually more relevant than any other vitamin or mineral or something that we're going to talk about. But that's my first one, honestly. After that, I really would rather spend time talking about healthy eating than I would about supplements. And I would like to engage in a conversation about eating real food, whole food, and avoiding heavy processed foods and the like.   Dr. Aaron Boster (42m 54s): But let's move into some recommendations about vitamins. The first vitamin that I think is actually the most studied with the most evidence for benefit of MS is vitamin D3. And so low levels of vitamin D correlate with increased risk of developing MS. And if you have MS, low levels of vitamin D are correlated with worse outcomes. And so, I routinely check a blood level for vitamin D, and if it's below 50, I supplement. And I use D3, because I feel like it's better absorbed in the human body. And I want to push that level above 40 below 100, or excuse me, above 50 and below 100.   Geoff Allix (43m 32s): So, can I just interject that. Because we measured it in a different way in the UK, and I think Europe. So, it's actually four times the number you're talking about. So, when you say 50, we say 200.   Dr. Aaron Boster (43m 40s): Oh, okay.   Geoff Allix (43m 40s): I don't know why that is just, it's not even an imperial metric thing. It's just because it is exactly –   Dr. Aaron Boster (43m 46s): Thank you for bringing that up. That's a really, really important point. And you know, another important point is you and I, even though we don't live in the same continent, both live in areas where there's not a lot of sun for a good portion of the year. And so, taking a vitamin D supplement is important because we can't get it, you know, the good old-fashioned way. Now, I have through my involvement with Overcoming MS become turned on to the idea that it doesn't take a lot of sun to soak up vitamin D. So, if you go out and let's say shirtless, or, you know, wearing a halter top, or what have you with some exposed skin, for 15 minutes, you'll absorb 5,000 international units of D3.   Dr. Aaron Boster (44m 30s): And now in the winter, Ohio with a foot of snow on the ground very few Ohioans are going to do that. But it is good to know that. Yeah. You know, and during the summer months you certainly do consider that. So, vitamin D3, I think, is very relevant. Past vitamin D3, my next recommendation. And I have to tell you, it's becoming increasingly something that I recommend. I'm on the cusp of recommending it for all people with MS. That's probiotics. So, taking a probiotic is really interesting. And there's an entire fascinating discussion surrounding dysbiosis and the impact of abnormal gut bacteria on the immune system.   Dr. Aaron Boster (45m 16s): Although that's not why I'm recommending it. That's a discussion which is ongoing and still a work in progress. But the reason I'm recommending it is for gut health. People impacted by MS very commonly have significant constipation. And sometimes people with MS have significant diarrhea or incontinence. And so, probiotics pull someone who has constipation more towards the center. And probiotics pull similar diarrhea more towards the center. And so, I really think probiotics are a very, very helpful tool. The next supplement that I would recommend beyond that is added fiber. Because particularly where I practice in the United States, the very low fiber diets, which is a major problem for multiple things, and actually has an impact on MS, in my opinion. And so supplementing fiber, I think is important.   Dr. Aaron Boster (45m 57s): Now, I would like you to do that with pears, plums, apples, and green vegetables but if you can't or aren't able, or don't want to do it that way, you can purchase a supplement like a FiberCon or Metamucil, or what have you, and then you can do it that way. Now, after that, it really depends on the situation. I think it's very reasonable for humans to take a multivitamin because, you know, we're not eating enough salads and vegetables with different colors. But the American diet is normally not devoid of things. It's not typically a problem with excess.   Dr. Aaron Boster (46m 39s): And so, if you just add a multivitamin that kind of covers your bases. Now, I don't recommend mega doses of say, vitamin B12 routinely, or vitamin C routinely, unless there's deficiencies that I'm discovering. So, I'm not a physician that recommends as a priority that you take a B12 complex. Many people do, because it helps with energy in some cases. But I really find that if I'm not, if I can get you to eat a healthy diet, I'm going to take care of that through eggs and other things. Now, there's specifics that are recurrent low dose naltrexone.   Dr. Aaron Boster (47m 21s): You mentioned L-carnitine, things like that. And there's varying levels of evidence for them. Some of maybe the best evidence would be some of, I think L-carnitine has some good evidence for energy. I believe that. I think that helps a lot. I think that's one that I look at. Then when you get into some of the other things, you can find small trials. Turmeric, for example. Low dose naltrexone, for example. And really, I deal those in a one-off fashion where someone's coming to me saying, “Aaron, what about this?” And then together, we kind of look through it. We look at the data if it's in existence, or if it's not, we discuss that. We go through my three criteria and then someone may try it. And here's the important part. If they try it, I want them to tell me what they found.   Dr. Aaron Boster (48m 7s): You know, did it seem to help? Do they notice a difference? When they stopped it, did it get changed in any fashion? And that's anecdotally one of the ways that we have to kind of assess things.   Geoff Allix (48m 20s): Because on the turmeric there are basically no risks, cost is very low, and there's anecdotal evidence, because it's been taken --   Dr. Aaron Boster (48m 36s): Yeah.   Geoff Allix (48m 36s): And it's been used on the Indian subcontinent for centuries or millennia.   Dr. Aaron Boster (48m 39s): And it's delicious.   Geoff Allix (48m 43s): Yeah, that's right.   Dr. Aaron Boster (48m 43s): You know, if someone wants to take turmeric, how about it? That doesn't violate any of the discussions we've had, and it may help.   Geoff Allix (48m 56s): Yeah. And if it doesn't help, you still like the food and carry on.   Dr. Aaron Boster (49m 4s): You know, its still and its still delicious.   Geoff Allix (49m 4s): Yeah. I'll just add, just on a personal level. Because I'm fairly similar to what you're saying. So, I take vitamin D3 every day. I take a probiotic every day. And the other thing I take is - so probiotic gut health. But also, to reduce UTI, so there's something I came across that in Germany, they're routinely prescribed called D-mannose?   Dr. Aaron Boster (49m 25s): Yes.   Geoff Allix (49m 26s): And I found that I, and this may be -- because I think some of these things work in some people and some don't. And it's not expensive. It doesn't have a lot of risks. And so, I thought I'll give it a try. And literally within a week, I didn't have a UTI problem at all. Literally, I don't have UTI problems at all from having D-mannose.   Dr. Aaron Boster (49m 50s): That's fantastic. I think that's a really, really great tip to share with people. And it's what I'm going to think about when I start my clinic tomorrow - about whether or not I'm not recommending D-mannose enough to folks with recurrent urinary tract infections. That's a pro tip. Thank you for sharing that one today.   Geoff Allix (50m 12s): Well, yeah, I mean, but it may just be that worked for me. So, yeah. But then that's the same.   Dr. Aaron Boster (50m 16s): Well, again, it's nice to have a toolbox where we can consider different things. And that's a very good supplement to keep in mind.   Geoff Allix (50m 30s): So, with that, I'd like to thank you very, very much for joining us, and welcome you to the Overcoming MS Board and it's fantastic news. Giving some of your expertise towards the head of the organization. And I thank you for joining us, Aaron Boster.   Dr. Aaron Boster (50m 48s): It's my absolute pleasure. Again, I love talking with you. And I hope that we get to do it again soon.   Geoff Allix (50m 35s): Thank you.   Geoff Allix (Outro) (50m 36s): Thank you for listening to this episode of Living Well with MS. Please check out this episode's show notes at www.overcomingms.org/podcast. You'll find all sorts of useful links and bonus information there. Do you have questions about this episode or ideas about future ones? Email us at podcast@overcomingms.org. We'd love to hear from you. You can also subscribe to the show on your favorite podcast platform, so you never miss an episode. Living Well with MS is kindly supported by a grant from the Happy Charitable Trust. If you'd like to support the Overcoming MS Charity and help to keep our podcast advertising free, you can donate online at www.overcomingms.org/donate.   Geoff Allix (Outro) (51m 22s): Thank you for your support. Living Well with MS is produced by Overcoming MS, the world's leading multiple sclerosis healthy lifestyle charity. We are here to help inform, support, and empower everyone affected by MS. To find out more and subscribe to our e-newsletter, please visit our website at www.overcomingms.org. Thanks again for tuning in, and see you next time.    

Lee Taft Performance Podcast
Episode 85: Why Train Basketball Deceleration (With Lee Taft)

Lee Taft Performance Podcast

Play Episode Listen Later Oct 26, 2021 8:08


Deceleration, for a basketball player, has two purposes. The first is to physically train the CNS and muscular system to be able to hand load. The second is to prepare the player for a change of direction and agility as the game unfolds. If you are not highly knowledgeable in these two areas, I highly encourage you to listen and learn.

Muscle For Life with Mike Matthews
Is Deadlifting Worth The Risk?

Muscle For Life with Mike Matthews

Play Episode Listen Later Oct 25, 2021 26:32


I've churned through over 150,000 emails, social media comments and messages, and blog comments in the last 6 years. And that means I've fielded a ton of questions. As you can imagine, some questions pop up more often than others, and I thought it might be helpful to take a little time every month to choose a few and record and share my answers. So, in this round, I answer the following question: Are deadlifts worth the risk? If you have a question you'd like me to answer, leave a comment below or if you want a faster response, send an email to mike@muscleforlife.com. Timestamps 5:22 - Are deadlifts a risky or dangerous exercise for your average lifter or lifestyle bodybuilder? 10:52 - What's the best alternative to the conventional deadlift? Rack pulls. 11:22 - Do deadlifts hurt your biceps? 15:56 - Is deadlifting especially difficult to recover from? Is 3 sets too much? 16:25 - What is CNS fatigue? 18:42 - Why should you deadlift? What are the benefits of deadlifting? 20:37 - Can deadlifts affect your hormones like testosterone? 24:18 - Do you need to deadlift? Are deadlifts required? Mentioned on the Show: My New Book Muscle For Life: https://muscleforlifebook.com/ Books by Mike Matthews: https://legionathletics.com/products/books/

RTL Today - In Conversation with Lisa Burke
57. Divorce in Luxembourg - the male perspective, 25/10/2021 00:04

RTL Today - In Conversation with Lisa Burke

Play Episode Listen Later Oct 24, 2021


Are there inequalities in divorce proceedings for men? Is ‘Résidence Alternée' the default ruling for child custody? In this podcast, I talk to Patryk Rybiński, the President of FAD Fathers Against Discrimination, http://fad.lu/, and Andy Adams, who have both experienced the inequalities of divorce when it comes to child custody and associated issues. Fathers Against Discrimination was set up to create a platform of dialogue: - to promote gender equality - to raise awareness of gender parental discrimination in Luxembourg Family Courts - to ensure that children's rights are respected They believe Luxembourg Family Law is outdated with regards to divorce and the rights of each parent during custody hearings of children. In 2015 there was a Council of Europe ruling which called on all EU member states to introduce Equal Shared Parenting as a base for family law. [CE Resolution 2079/15]. It has existed in Belgium and Denmark for a long time. There was a change in the Luxembourg law in November 2018 to state that Equal Shared Parenting - Alternating Residence should become the default. Patryk and Andy feel that ‘Résidence Alternée' is still not the default law in Luxembourg. Andy speaks about the 'holy trinity' of divorce being financial assets, property and custody, saying that most are split 50-50 except child custody. Once custody arrangements have been put in place, the court still needs to assign one home the main 'residence', even in the case of alternating parenting. This has all manner of consequences when it comes to receiving child benefit, tax benefits and deductions, access to health records, CNS cards, school reports, and so it goes on. “Zukunftskeess argues that regardless of even or odd number of children in a household the payment cannot be split because the IT system does not allow it. “ This particular quote from fad.lu reminds of the Little Britain sketches where David Walliams drawls "Computer says no". According to Patryk, there are no shelters for men and boys in Luxembourg, even though men also suffer from domestic violence (about 40% in 2019), and are most commonly the ones to leave the family home. Please subscribe to my series and leave me a review - it really helps my podcast to be found - and thank you for taking the time to do so! Get in touch with Lisa Burke if you have any thoughts for future podcasts at www.lisatoniburke.com

THE NEW HEALTH CLUB
Palo Santo Fund - How will psychedelic pharma look like?

THE NEW HEALTH CLUB

Play Episode Listen Later Oct 21, 2021 55:09


My guests today are Daniel Goldberg and Tim Schlidt, founders of the Palo Santo fund. The two them an their really impressive team got a big plan for the coming years: investing across the new psychedelic ecosystem and funding a new paradigm in well being.Palo Santo's diversified investment fund is helping to increase the supply of clinically effective and accessible mental health and addiction treatment solutions needed in today's world. Daniel Goldberg began seeing mental health as part of a spectrum and not something that needs to be so pathologized.As a founder of Palo Santo and Bridge Investments, Daniel has been actively investing with and supporting inspired entrepreneurs for 20 years. Years ago he saw the transformational potential of psychedelic medicines and has developed a deep network of relationships across the psychedelic research and business communities. His passion for the space is purpose‐driven and science informed. He is thrilled to be a part of Palo Santo's mission of supporting promising treatments while ensuring widespread access to safe, legal, and effective solutions. Tim Schlidt brings extensive knowledge investing across life sciences and healthcare services, and has held a lifelong passion for understanding and improving treatments for CNS disorders. He believes psychedelics are poised to shift the paradigm in mental health treatment and his primary mission in co-founding Palo Santo is to invest in companies and solutions that allow for broad access to those most in need of mental health care. Prior to co-founding Palo Santo, Tim covered the life sciences and health care services sectors as a private equity investor at Madison Dearborn Partners and an investment banker at J.P. Morgan and Greenhill. We talk about Daniels and Tims personal psychedelic experience they had BEFORE the founding of Palo Santo, the shift and the incredible change they saw coming, when a new generation of scientists engaged in psychedelics, about the psychedelic pharma model and what compound is Daniels and Tims favorite and we chat about what will possibly be happening and what I will see, if I would dare to take 5 MEO DMT: but that will happen on the next episode. https://www.palosanto.vc

Eeez n Beez
On the Pond Court Breakfast

Eeez n Beez

Play Episode Listen Later Oct 15, 2021 52:13


Happy Friday listeners! and welcome to episode 59!I hope your hungry this morning, because we dish up everything from the busy week!MLB Playoffs, who you betting on winning the World Series? MVP??Collage football, what a week for some upsets! What was the biggest upset of the weekend?NFL week 5 and drama with the Raiders head coach, as well as key injuries.Nascar and short-track racing recap and NPK updates from the week.NHL and NBA kickoff! Predictions could make for an interesting winter in CO!  We also talk all about the new faces in new places in the NBA! Lots of traveling over the post-season!Lets not forget about this past week in Rasslin'! WWE King of the Ring Finals and Queen of the Ring going down. AEW Dynamite was pushed back a few days to tonight due to the beginning of the NHL Season on TNT. RMP back and swinging, we will have a very special RMP guest next week so make sure to tune in for that!Keep an eye out for LB's next Murder Mystery! Coming very soon only on the Eeez N Beez Network.Check out the Eeez N Beez Merch Store this weekend for all your Eeez N Beez merch at a discount! This weekend only! Get it before it's gone!!Thanks for all the support, continue to spread the word, tune in, and always remember to EAT YOUR BREAKFAST!!!!Support the show (https://www.patreon.com/user?u=41702239&fan_landing=true)

Podcast for Healing Neurology
#52: Shae Datta, MD: Traumatic Brain Injury (TBI), gut-brain connection and supplements for healing

Podcast for Healing Neurology

Play Episode Listen Later Oct 14, 2021 52:17


Dr Shae Datta, MD, is a Sports NeuroTrauma Neurologist and the current Director of Concussion & Neuro-Cognition at New York University, Langone. Dr Datta specializes in helping people heal from brain injuries, especially including traumatic brain injuries and concussion (also called mTBI = mild traumatic brain injury). In this incredible episode, we wind our way first through the anatomy and physiology of the central nervous system, meaning the brain, spinal cord and associated microglia, astrocytes, relay neurons and the glymphatic clearance system of the CNS. Dr Datta then illuminates an understanding of the gut-brain axis with a special focus on psychbiotics, naming some of the specific types of probiotics that impact mood, cognition and the nervous system. She notes, ‘unhappy gut = unhappy brain'. The show returns to prognosis after brain injury and that every head injury is a unique story and very dependent on functional level, age, stress, co-morbidities, prior TBI and history of migraines. She reviews a bit of the TBI evaluation, which, barring a bleed in the head visible on CT, can often present with subtle findings regarding balance and ocular or vision changes that can potentially reflect outsized cognitive, sensory and/or motor challenges. We end the show with an exploration of a wide variety of treatments, some common (physical and occupational therapy) and some unique to Dr Datta's integrative training: choline, creatine, vitamins and others. Learn more from Dr Datta from her co-authored chapter on TBI in the Integrative Neurology textbook in the Andrew Weil Series: https://www.elliottbaybook.com/book/9780190051617 To see Dr Datta as a patient, find her at NYU Langone: https://nyulangone.org/doctors/1720493141/shae-datta

The Tailored Life Podcast
Ep. 660 - [Series] Program Design Pt.4: Periodization, Tempo, and Rest Periods.

The Tailored Life Podcast

Play Episode Listen Later Oct 13, 2021 47:50


Today's podcast is the final part of the 4 part series on Program Design! Cody continues to dive into what "evidence based program design" is all about. This episode will cover periodization and progression models, tempo, rest periods, programming methods like supersetting, and the practical application of all the above. ---- Join The Tailored Trainer (TCM's Membership Site) to gain full access to daily programming and a private coaching forum for guidance. Get a 7 Day FREE Trial HERE ASK CODY YOUR QUESTION HERE Check Out Free Guides and E-Books HERE Head over to http://buylegion.com/boomboom enter code boom boom at checkout to save 20%, start earning loyalty points, and supplementing with the top supplement company on the market. For training equipment, visit www.giantlifting.com and use promo code: TCM5 to save 5% on purchases. ---- Shownotes: Periodization Plan and Progression ModelStrength: Block or DUPThis may matter more in the bench than the squat, based on research. My guess as to why and how this applies elsewhere is that since the ceiling for squat load is higher - it might take longer before getting to the point of required periodization. So for lifts that plateau sooner due to strength capacities, periodization may be needed sooner. Hypertrophy: Double Progression ModelPeriodization style doesn't seem to matter based on all the literature done on this, so what's important is the model of progression that you feel good with and continuing to plan your training accordingly, in order to see continued progress AND a sustained high level of effort (RPE). https://www.sciencedirect.com/science/article/abs/pii/S0765159717302137 Concurrent: DUP or WUPBetter for intermediate and advanced lifters More evidence to support DUP than WUP What are the finer details of programming:Tempo, Rest, Super Setting, Cardio, etc. Why These Come Last Tempo Terms and DefinitionsNegative - eccentric Positive - concentric 3-2-1-2  Pauses Segmented reps Partials What Science Says: Tempo:Doesn't matter when volume is equated, however it may be more effective for hypertrophy as long as it does not compromise total volume (https://www.termedia.pl/Effect-of-different-eccentric-tempos-on-hypertrophy-and-strength-of-the-lower-limbs,78,43851,0,1.html). However, for strength the purpose is to maximize the concentric - therefore tempos may prevent strength gains due to less load being performed per rep, dropping the CNS drive to develop strength. Another study showed no significant difference in quad growth when rep cadence (eccentric and concentric) was controlled (3 sec, 3 sec) vs. a group that did not control tempo and just performed the lift. There was slightly more growth on the rectus femoris in the group not controlling tempo, which my guess would be because you don't need an exaggerated negative to fully stretch that portion of the muscle. But looking into this little detail is also somewhat splitting hairs (https://pubmed.ncbi.nlm.nih.gov/33306588/). Best bet here is to practice a full ROM whenever possible as that plays the largest role. Overloaded eccentrics were said to build muscle due to more muscle damage… but studios show otherwise (https://www.ncbi.nlm.nih.gov/pubmed/30113915)  Practical Application of Tempo:Use them to build motor control, movement quality, rehab, avoid injury, or as an intensification technique, primarily for motivation and enjoyment. Rest Periods: What Science SaysIntuition is best (https://www.ncbi.nlm.nih.gov/pubmed/?term=30866743) Longer is better for hypertrophy:30, 60, or 120 seconds - all showed similar results with lactate, because lactate levels take a long time to decrease, but worst results with performance in the shorter rest period intervals, which makes sense as well because ATP resynthesis and pH restoration tend to happen at a faster rate. The study showed exactly why longer rest intervals tend to be better with hypertrophy, because with shorter rest periods volume and load drop off quicker and therefore we're unable to do as much work, AND metabolic stress placed on the muscle didn't change between 30 seconds to 2 minutes between sets.  Practical Implementation3-5 Min on Compounds 1-3 Min on Accessories 1-2 Minutes on Isolation 0-30 Seconds Between Antagonistic Supersets Super-Sets, Definitions and Variations (Super, Tri, Giant, EMOM, EDT)Super-Sets Tri-SetsUpper Lower Full Giant Sets EMOM EOMOM EDT vs. AMRAP Aerobic Training ImportanceBENEFITS:Caloric Expenditure Cardiovascular Health Longevity Improve Oxidative System Increase Recovery-Abilities Work Capacity (Ability To Maintain High Outputs, For Longer) Balance Intensities Throughout The Training Week Mitochondrial Adaptations (Helps Energy Production) Energy System & Metabolism Enhancement Immune Strength ---- Apply for our World Renowned Coaching Program, RIGHT HERE. Remember to join our private FB community, RIGHT HERE. As Featured on: Huffington Post, Bodybuilding.com, The PTDC, Dr. John Rusin, Muscle For Life, HLHL, iN3, OPEX Fitness and More… ---- EXTRA RESOURCES:  https://pubmed.ncbi.nlm.nih.gov/28497285/ https://pubmed.ncbi.nlm.nih.gov/15673040/ https://pubmed.ncbi.nlm.nih.gov/28848690/ https://www.sciencedirect.com/science/article/abs/pii/S0765159717302137 https://journals.lww.com/nsca jscr/Fulltext/2015/04000/Systematic_Review_and_Meta_analysis_of_Linear_and.35.aspx http://article.sapub.org/10.5923.j.sports.20160606.04.html#Sec3 ---- Apply For Coaching: bit.ly/Coaching-App Get Your Free Copy of The Nutrition Hierarchy, HERE Learn How We Coach: Read This Case Study Article Top 4 Episodes: - Nutritional Periodization - Nutrition FAQ - Training FAQ - My Story ---- You can get access to ALL of our content in one place, now: www.tailoredcoachingmethod.com/links/ Check out all of our e-books by visiting www.tailoredcoachingmethod.com/products/ Tailored Coaching Method Coaching Info: www.tailoredcoachingmethod.com/online-coaching/ ---- Social Links: Blog – http://www.tailoredcoachingmethod.com/blog
 Facebook - https://www.facebook.com/tailoredcoachingmethod
 Instagram - https://www.instagram.com/tailoredcoachingmethod/ YouTube - https://www.youtube.com/TailoredCoachingMethod Podcast Youtube - https://www.youtube.com/channel/UCX9qbTBGTioX8tZLCmE6TIQ Email – info@tailoredcoachingmethod.com

PN podcast
Autoimmune encephalitis: clinical spectrum and management

PN podcast

Play Episode Listen Later Oct 11, 2021 30:38


Autoimmune encephalitis comprises a group of disorders in which the host immune system targets self-antigens expressed in the central nervous system (CNS). Some of the best-characterised diseases are associated with autoantibodies that target neuroglial antigens. These autoantibodies are considered pathogenic because they are directed against the extracellular—and hence in vivo exposed—domains of their target antigens. Associate Editor of Practical Neurology, Dr Tom Hughes, Department of Neurology, Cardiff, interviews Prof Sarosh R Irani, Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, Oxford University, about his recent paper, in which he summarised the well-known autoantibody-mediated encephalitis syndromes with neuronal cell-surface antigens and focus on practical aspects of their diagnosis and treatment, offer their clinical experiences of managing such cases and highlight more basic neuroimmunological advances that will inform their future diagnosis and treatments. Read the paper on the Practical Neurology website (https://pn.bmj.com/content/21/5/412) and the October print issue of the journal. The paper is also discussed by Practical Neurology editors, Dr Phil Smith and Dr Geraint Fuller, in their latest podcast: https://soundcloud.com/bmjpodcasts/editors-highlights-of-the-october-2021-issue?in=bmjpodcasts/sets/pn-podcast Please subscribe to the Practical Neurology podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the Practical Neurology Podcast iTunes page (https://podcasts.apple.com/gb/podcast/pn-podcast/id942932053). Thank you for listening.

About IBD
Finding Success with Nutrition Therapy

About IBD

Play Episode Listen Later Oct 11, 2021 32:39


IBD is not a condition that is easy to diagnose or treat. People who live with Crohn's disease or ulcerative colitis have needs that include guidance on nutrition. Diet is notoriously difficult to study but some research is starting to be done. Dannielle Jascot, MS, CNS, CDN, certified nutritionist and IBD patient talks over the recent results of the DINE-CD study, which compared the Specific Carbohydrate Diet and the Mediterranean Diet. Episode page and transcript: https://bit.ly/2YIaZXk Concepts discussed on this episode include: The Dine-CD Study and discussion of the results Local Crohn's and Colitis Foundation Chapters Buy Tickets to the Bottoms Up Event Find Dannielle Jascot on Facebook, Twitter, Instagram, and LinkedIn. Find Amber J Tresca at AboutIBD.com, Verywell, Facebook, Twitter, Pinterest, and Instagram. Credits: Mix and sound design is by Mac Cooney. Theme music, "IBD Dance Party," is from ©Cooney Studio.

A Healthy Curiosity
TCM Nutrition tips for a Healthy Digestive Microbiome

A Healthy Curiosity

Play Episode Listen Later Oct 6, 2021 58:28


Our digestion and gut health are wrapped up in a ton of other major functions in our bodies. Since we can't use what we can't digest and what we can't digest can cause problems, we can see cascading effects through numerous other bodily systems if something's not right. Here to unpack how the digestive system works and its central role in the body is Dr. Darlene Easton. She brings us some practical insights to help us understand our digestive functions and shift our understanding of our place in the world as living organisms. On Today's Episode of A Healthy Curiosity: Why Dr. Easton thinks everyone should be obsessed with digestion What she would like people to do differently to improve their microbiome and digestive health How we can use Chinese Medicine to address common issues,  like acid reflux, instead of over-the-counter medications Why bile is so important to our bodies Dr. Easton earned her MSAOM (1998), MSACN (2011) and DACM (20200. She is an NCCAOM diplomate and board certified CNS. Dr. Easton has earned 2 post-graduate certifications from Guangzhou TCM Hospital and 9 certificates from Zhejiang University Hospital. With 20 years in higher education, she's taught all aspects of TCM including dietary therapy and nutrition. She was an associate professor at NY College of Health Professions (1999-2003) and NYCC's Finger Lakes School of AOM (2003-2019). Dr. Easton is now in private practice offering health and nutritional consulting while she continues to teach online to professionals around the world. Links: TCM Hub Dr. Easton's Free Resource Handouts Connect with Dr. Darlene Easton: Website Dr.  Easton's  Online  Course Facebook Email -- Enjoying the show?  Help support us and keep the show going with the tip jar! Explore the Basics of Chinese Medicine course

The Oncology Nursing Podcast
Episode 175: The Power of Mentorship in Oncology Nursing

The Oncology Nursing Podcast

Play Episode Listen Later Oct 1, 2021 49:21


ONS member Erica Fischer-Cartlidge, DNP, CNS, CBCN®, AOCNS®, interim director of nursing practice at Memorial Sloan Kettering Cancer Center in New York City, and three other ONS leaders join Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss the importance of mentorship in nursing, mentoring approaches and recommendations, and benefits for mentors and mentees. Fischer-Cartlidge is the 2021 recipient of the Oncology Nursing Foundation's Connie Henke Yarbro Excellence in Cancer Nursing Mentorship Award. The advertising messages in this episode are paid for by Breast Cancer Index. Episode Notes Check out these from today's episode: NCPD contact hours are not available for this episode. Oncology Nursing Podcast Episode 99: How to Set Goals for a Successful Nursing Career Oncology Nursing Podcast Episode 150: Career Planning for Oncology Nurses ONS Voice article: Find Your Voice With ONS's Leadership Development Committee ONS Voice article: Having a Mentor Helps You Achieve Oncology Nursing Certification ONS Voice article: Mentors Changed My Career at Every Stage, From New Grad to Leader ONS Voice article: Nursing Leadership Has Space for You and Your Goals Learn more about the Connie Henke Yarbro Excellence in Cancer Nursing Mentorship Award. Oncology Nursing Forum article: The Value of Mentoring in Nursing: An Honor and a Gift ONS Leadership Learning Library ONS mentorship programs Receive career guidance with ONS Teach and mentor with ONS. Honor a mentor in your life with a donation to the Oncology Nursing Foundation to ensure future generations of oncology nurses have the same opportunity. To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Authentic Biochemistry
Omega three fatty acids and PE N-methyl transferase are associated with methylation and acetylation patterning in NK cells via AMPK and stress.DJGPhD. 29 September 2021.

Authentic Biochemistry

Play Episode Listen Later Sep 29, 2021 29:50


Omega-Three VLCPUFA's as asymmetrically distributed in membrane glycerolphospholipids mediate vesiculation and permeability of endothelia to circulating lymphocytes and leukocytes thus coupling folic acid, Vitamin B12 and epigenetic modification of chromatin to ultimately link bioenergetics with cytotoxicity and inflammation. This regulated system involves the neuroimmunoepigenome and the senescent environment of aging human vasculature, skeletal and cardiac muscle, and the CNS toward pathobiochemical increases in morbidity -presenting disease phenotypes. References J Biomed Biotechnol. 2011; 2011: 298348. Blood 2009 114:2567-2568; https://doi.org/10.1182/blood-2009-07-230904 Am J Clin Nutr. 2017 Oct;106(4):1157-1165. doi: 10.3945/ajcn.117.155648. BIOCHEMISTRY AND CHEMICAL BIOLOGY STRUCTURAL BIOLOGY AND MOLECULAR BIOPHYSICS March 2018 https://elifesciences.org/articles/34394 Sci Signal. 2017 Jan 31; 10(464): eaaf7478. Prostaglandins Leukot Essent Fatty Acids. 2015 Jul;98:49-55. doi: 10.1016/j.plefa.2015.04.007. Int J Biol Sci. 2015; 11(11): 1272–1280 --- Send in a voice message: https://anchor.fm/dr-daniel-j-guerra/message Support this podcast: https://anchor.fm/dr-daniel-j-guerra/support

The Menopause Movement Podcast
The Gut-Skin Connection

The Menopause Movement Podcast

Play Episode Listen Later Sep 28, 2021 55:28


We've been talking about the MENO-Mate way of eating in the Menopause Movement to help women ease their symptoms through diet, and I say this to the women who come through our programs: Inflammation really starts with our food. Today we're delving more into that and why our gut health has an important connection to skincare with Jennifer Fugo MS, LDN, CNS who is a clinical nutritionist empowering adults who've been failed by conventional medicine to beat chronic skin and unending gut challenges.   Discussion Points:  [0:00] Introduction  [5:04] Jennifer's background  [10:53] How Jennifer got into the skincare industry  [16:51] The difference of what Jennifer provides through Skinterrupt [19:47] How to diagnose a problem with the bacteria in the gut  [26:50] Practical tips on managing rosacea  [28:58] Diagnosing SIBO  [36:30] Coconut oil  [40:32] MCT oil [41:58] Other gut health issues that come with psoriasis and eczema   [46:18] What inflammation can do to  wreck your skin barrier  [49:09] Inflammation starts with our food    About the Guest: Jennifer Fugo, MS, LDN, CNS is a functional clinical nutritionist, founder of Skinterrupt, and the host of the Healthy Skin Show.   Jennifer received her Master's in Human Nutrition from the University of Bridgeport and Bachelors from New School University. She's a member of the American Nutrition Association, an Advisory Board member for the Nutritional Aesthetics Alliance, and a faculty member of LearnSkin.   In her clinical practice, she helps women and men with never-ending “stomach problems”, chronic skin rashes, brain fog, chronic fatigue, and autoimmunity find a way back to their best health. Jennifer listens to her clients and looks for missed or dismissed clues that ultimately point towards the root causes that underlie their nagging physical symptoms.   Jennifer also has extensive experience supporting people with various food sensitivities — especially those who are stuck on elimination diets without any improvement.   As a sought-after expert, advocate & speaker, Jennifer has been featured on Dr. Oz, Yahoo! News, CNN, Paleo Magazine, and Philadelphia Magazine. (To see more press, scroll down to the next section!)   She is the author behind the best-selling book “The Savvy Gluten-Free Shopper: How to Eat Healthy without Breaking the Bank“ and creator of the Eczema & Psoriasis Awareness Weeks.   Resources: Check my latest podcast or listen to the previous ones https://www.menopausemovement.com/blog   Connect with me on Instagram @drmichellegordon Follow me on Facebook https://www.facebook.com/drmichellegordon Join The Menopause Movement private group on Facebook https://www.facebook.com/groups/menopausemovement) Sign up for the BETA Course: Understanding Your Hormones and Managing Your Menopause (https://www.menopausemovement.com/betawait)     Find Jennifer through her website https://www.skinterrupt.com/listen/  Follow Jennifer on Instagram https://www.instagram.com/jenniferfugo/    For more podcast episodes, you may also visit my website. Tune in and subscribe to The Menopause Movement Podcast on YouTube,  Apple Podcasts, Spotify, and Stitcher.   Thank you for tuning in!  See omnystudio.com/listener for privacy information.

High Performance Health
Hormones, Weight Loss & Miracle Mindset with JJ Virgin

High Performance Health

Play Episode Listen Later Sep 27, 2021 56:18


JJ Virgin is a multi-best-selling author, nutrition expert and passionate advocate of eating and exercising smarter. In this episode, she talks with Angela about the power of the right mindset and creating your future self along with great content about how to successfully achieve weight loss. Dieting can become less effective as we age and JJ discusses the barriers that can get in the way of weight loss and the way to effectively detox and reset your system for a better future.   KEY TAKEAWAYS Mindset is a muscle and having a growth mindset can make all the difference We can all control how we show up and how we perceive things If you don't create your future self it will be created for you Everything starts with mindset and when you are in a place where you don't think you are good enough you hold yourself back When failure isn't an option and your ‘why' is so big you find a way to make it happen There are a range of factors that can get in the way of weight loss Stress lowers serotonin and leads to cravings for sugar and can cause insulin resistance so you feel hungrier We have made it acceptable to have more body fat but fat is not benign it has its own endocrine system making you more inflamed and causing more toxins in your system Toxins lower your metabolic rate and cause hormone disruption If you are extreme dieting and doing lots of cardio you are damaging your metabolism and slowing your metabolic rate We need to look at how we use diets and learn to use them therapeutically in the short term to help understand what we should put into our bodies every day to achieve good health You have to detox to lose fat and be able to reset Get everything out of your diet and find your new normal through bringing things back one by one and understanding what affects you Make the commitment to your future self that you are the most important thing   BEST MOMENTS ‘We need to use diets to connect the dots so we know what we should be eating, what works best for us' ‘It helps to really un-process your diet' ‘It is critical that we all think about what is ours to do and how we show up because that's what we have control of'   VALUABLE RESOURCES High Performance Health podcast series Transform your sleep DNA optimization High Performance website    Jjvirgin.com Mindsharecollaborative.com   ABOUT THE GUEST  JJ Virgin, CNS, BCHN, EP-C Triple-board certified nutrition expert and Fitness Hall of Famer JJ Virgin is a passionate advocate of eating and exercising smarter. JJ helps people stay fired up and healthy as they age, so they feel the best they ever have at age 40+. JJ is a prominent TV and media personality, whose previous features include co-host of TLC's Freaky Eaters, 2 years as the on-camera nutritionist for Weight Loss Challenges on Dr. Phil, and numerous appearances on PBS, Dr. Oz, Rachael Ray,Access Hollywood, and the TODAY Show. She also speaks regularly and has shared the stage with notables including Seth Godin, Lisa Nichols, Gary Vaynerchuk, Mark Hyman, Dan Buettner, and Mary Morrissey. JJ is the author of four NY Times bestsellers: The Virgin Diet, The Virgin Diet Cookbook, JJ Virgin's Sugar Impact Diet, and JJ Virgin's Sugar Impact Diet Cookbook. Her latest book, Warrior Mom: 7 Secrets to Bold, Brave Resilience, shows caregivers everywhere how to be strong, positive leaders for their families, while exploring the inspirational lessons JJ learned as she fought for her own son's life. JJ hosts the popular Ask the Health Expert podcast, with over 8 million downloads and growing. She also regularly writes for Rodale Wellness, Mind Body Green, and other major blogs and magazines. JJ is also a business coach and founded the premier health entrepreneur event and community, The Mindshare Summit. Visit www.jjvirgin.com for hundreds of free recipes and resources, plus state-of-the-art programs, products, and plenty of support to help you build your dream life.   CONTACT DETAILS Jjvirgin.com Mindsharecollaborative.com   ABOUT THE HOST Angela Foster Angela is a Nutritionist, Health and Performance Coach. She is also the Founder and CEO of My DNA Edge, an Exclusive Private Membership Site giving individuals the tools and bio hacks needed to optimise their genetic expression for optimal health and performance. After recovering from a serious illness in 2014, Angela left the world of Corporate Law with a single mission in mind: To inspire and educate others to live an energetic, healthful, and limitless life. Angela believes that we can truly have it all and has spent the last 5 years researching the habits and routines of high performers, uncovering age-old secrets, time-honoured holistic practices and modern science to create a blueprint for Optimal Human Performance.   CONTACT DETAILS Instagram Facebook LinkedIn High Performance Health FB Group See omnystudio.com/listener for privacy information.

Companions of the Compendium
Central California Coaching Clinic Part II: Acceleration and Maximum Velocity Training

Companions of the Compendium

Play Episode Listen Later Sep 23, 2021 17:29


In Part II we discuss the intricacies of rest and recoveries between intense workouts. I explain how to use games to make sports performance fun with acceleration. We talk about the load minimums and maximums that are unique to acceleration. I also explain how to use different systems to blend the training and keep it interesting. We explain the value of having actual cues for different movements for different contacts through challenging workouts. In maximum velocity, we discuss how to do the workouts correctly. Also, I educated the audience on how to force the body into new firing patterns to avoid rhythm lock or what the late great Charlie Francis called a dynamic stereotype. I explain what each of these training zones requires and how to use various movement patterns to make the CNS go into overdrive for adaptation into great maximal speeds. For elite performance technology please visit: https://store.simplifaster.com/sku/83/ To purchase the Sprinter's Compendium visit: https://store.vervante.com/c/v/V4081803315.html --- Support this podcast: https://anchor.fm/ryan-joseph-banta/support

The Healthy Skin Show
212: If You Struggle To Keep Momentum For Your Skin, Here's Why w/ Michelle Nilan, CNS

The Healthy Skin Show

Play Episode Listen Later Sep 16, 2021 37:15


Mindset is an important, albeit overlooked, piece of the skin health puzzle. How you feel about your skin condition can have a huge impact on your skin health journey! My guest today is my colleague, Michelle Nilan, CNS. Michelle is a clinical nutritionist, yoga teacher, and ACSM-certified personal trainer. She is the associate clinical nutritionist in my private practice and has been working with me since June 2020! She has a master's in human nutrition from the University of Bridgeport and a bachelor's in philosophy from Humboldt State University. Through her work with me, Michelle has developed an extensive understanding of the complex relationship between the skin, gut, and overall health, and values being able to turn this into practical, actionable guidance to help others become well. She is additionally well-versed in metabolic conditions, insulin resistance and diabetes, and nutrition for high-risk pregnancies. Michelle also has a history of her own skin struggles with severe cystic acne, fungal acne, and tinea versicolor, as well as with managing thyroid, hormone, and autoimmunity issues, and knows all too well what it feels like to have significant life-impacting symptoms completely dismissed and be told by doctors that she'd “just have to live with it." She is grateful for the opportunity to help others avoid the years of suffering she had to endure while trying to find and address the root causes on her own. Due to her work in philosophy, as well as her personal history of childhood trauma, she has a deep appreciation for the invisible mental and emotional suffering of skin and health issues that aren't obvious from the outside, and allows this to guide her approach of seeing a whole person rather than merely a collection of symptoms or a problem to fix. When she's not working with clients, Michelle enjoys staying updated with the latest nutrition research, lifting weights, reading, going to museums, spending time in nature, drinking coffee while people-watching, and playing with her cat Daoshi. Join us for Michelle's first-ever podcast interview as we discuss why you could be struggling to maintain momentum with your skin. Have you lost momentum in healing your skin rash? Tell me about it in the comments! In this episode: The three different types of mindsets when it comes to viewing your skin issues Self-sabotage + why this is a problem many of us struggle with Clues that you're possibly in a self-sabotaging behavior pattern Realizing the value of self-compassion How to begin accepting where you are + taking consistent action Quotes “There are really three main ways that you can see your skin issues, and those are engulfment, rejection and acceptance.” [1:43] “Depression a lot of times does come along with skin issues and there can be a learned helplessness because all of these protocols haven't worked, you've done this medication and that medication and this diet and read that book. But that's really a learned behavior, which means that you can learn to come out of that.” [2:02]

Thyroid Answers Podcast
Episode 95: Habits, Hypothyroidism, and Health

Thyroid Answers Podcast

Play Episode Listen Later Sep 14, 2021 59:50


In this episode, I have an in-depth discussion with the Raw Girl, Esosa Edosomwan MS, CNS, LDN. We discuss our habits and behaviors and their role in our health and quality of life. In this episode we discuss: The diet wars Habit vs behavior The minimum viable habit Motivation vs discipline How to change habits and behaviors More ...   Esosa E., MS, CNS, LDN is also known as “Raw Girl” of therawgirl.com is a dynamic Certified Nutrition Specialist, Behavioral Coach, host of the Staying Ageless Podcast, founder of Staying Ageless University, and published author with ten years of experience inspiring others to live their best healthiest lives. After completing her Masters in Nutrition and Integrative Health, Esosa worked as a Clinical Nutritionist at a wellness center where she provided nutritional coaching, meal planning, and offered dietary interventions to thousands of clients of all ethnicities and ages, with a variety of dietary preferences and suffering from a wide range of chronic conditions. Since then, Esosa has created her signature online programs: Staying Ageless 30+ which has a comprehensive curriculum designed to help women 30+ achieve optimal health and stay youthful using diet and lifestyle changes, and Raw Girl's Hormone Balancing Academy which is a healing program designed to holistically address fibroids, endometriosis, cysts, PCOS, and other hormonal imbalances. Clients who have worked with Esosa in group and private coaching have: lost hundreds of pounds, healed cystic and hormonal acne, achieved hormonal balance pre and post-menopause, had cancer downgraded, reversed nutritional deficiencies, prediabetes, diabetes, hypertension, reversed hair loss, and more. Esosa specializes in plant-based nutrition and transitioning, women's hormonal balance, weight loss, healing acne, and skin conditions, nutrition and lifestyle interventions to enhance beauty and increase longevity, candida and parasite cleansing, and detoxification. Outside of her passion for health, Esosa is an award-winning, globe-trotting producer and actress who has been featured in Glamour, Vogue, The New York Times,  Elle, Ebony, Black Enterprise, and more.   ESOSA E., MS, CNS, LDN (AKA RAW GIRL) CERTIFIED NUTRITION SPECIALIST & BEHAVIORAL COACH Nutritionist Website: www.therawgirl.com My Health Blog: www.rawgirltoxicworld.com Podcast: https://www.stayingagelessshow.com/ Email: rawgirltoxicworld@gmail.com   For ongoing health and beauty tips find me on social media:   Instagram: www.instagram.com/therawgirl  Facebook: www.facebook.com/TheRawGirl Twitter: www.twitter.com/TheRawGirl

Neurology Minute
Comparison of MRI Lesion Evolution in Different Central Nervous System Demyelinating Disorders

Neurology Minute

Play Episode Listen Later Sep 14, 2021 2:17


Dr. Eoin Flanagan discusses MRI lesion evolution in different CNS demyelinating disorders.

Hormones in Harmony
#137 Mercury Toxicity, Fibroids & Racism in Healthcare with ESOSA E.

Hormones in Harmony

Play Episode Listen Later Sep 13, 2021 64:17


Esosa E., MS, CNS, LDN also known as “Raw Girl” of therawgirl.com is a dynamic Certified Nutrition Specialist, Behavioral Coach, host of the Staying Ageless Podcast, founder of Staying Ageless University, and published author with ten years of experience inspiring others to live their best healthiest lives. After completing her Masters in Nutrition and Integrative Health, Esosa worked as a Clinical Nutritionist at a wellness center where she provided nutritional coaching, meal planning, and offered dietary interventions to thousands of clients of all ethnicities and ages, with a variety of dietary preferences and suffering from a wide range of chronic conditions. Since then, Esosa has created her signature online programs: Staying Ageless 30+ which has a comprehensive curriculum designed to help women 30+ achieve optimal health and stay youthful using diet and lifestyle changes, and Raw Girl's Hormone Balancing Academy which is a healing program designed to holistically address fibroids, endometriosis, cysts, PCOS, and other hormonal imbalances.  Clients who have worked with Esosa in group and private coaching have: lost hundreds of pounds, healed cystic and hormonal acne, achieved hormonal balance pre and post menopause, had cancer downgraded, reversed nutritional deficiencies, prediabetes, diabetes, hypertension, reversed hair loss and more. Esosa specializes in plant-based nutrition and transitioning, women's hormonal balance, weight loss, healing acne and skin conditions, nutrition and lifestyle interventions to enhance beauty and increase longevity, candida and parasite cleansing, and detoxification. Outside of her passion for health, Esosa is an award winning, globe-trotting producer and actress who has been featured in Glamour, Vogue, The New York Times,  Elle, Ebony, Black Enterprise and more.   Social/contact info: @therawgirl on Instagram, Twitter, and Facebook Podcast - Staying Ageless www.therawgirl.com www.stayingagelessuniversity.com   _______   We discuss: Biggest factors contributing to hormonal imbalances (inflammatory foods, parasites, heavy metals, candida overgrowth etc) Fibroids - symptoms, causes, treatment (conventional & holistic approaches) Esosa's approach to diet & why she recommends a plant based diet to those struggling with hormone imbalances Discrimination & racism in medicine & the ‘health & wellness' world   Mentioned: Rejuvelac https://annwigmore.org/livingfoods-wheatgrass-sprouting/living-foods-wheatgrass-rawfoods-sprouts/   Fonio Find Pierre Thiam on Instagram: @chefpierrethiam and @yolelefoods   -------   MY LINKS:   Try my favourite ORGANO KING coffee - https://vivanaturalhealth.myorganogold.com/gb-en/   Grab my favourite BluBlox glasses - https://bit.ly/2UXkNqT   Buy Queen of the Thrones CASTOR OIL PACK with 10% discount using code HORMONES10 - https://shopdrmarisol.com/discount/HORMONES10?rfsn=5737791.50c64b   -------   Got a podcast question? Send you emails to hormonesinharmony@gmail.com    Enjoyed this episode? Leave me a rating and review so that I can share this podcast with more women   Want more from me? You can find me online…   Website www.vivanaturalhealth.co.uk   Instagram www.instagram.com/vivanaturalhealth   Facebook www.facebook.com/vivanaturalhealth   Email enquiries@vivanaturalhealth.co.uk   Tune in now on iTunes, Spotify, my website or watch on Youtube (Viva Natural Health)   If you are enjoying the podcast, please leave me a rating and review, as this helps me to reach more women and continue to interview awesome guests!   Make sure you hit subscribe so that you never miss an episode!

Living Well with Robin Stoloff
When It Comes To Healthy Skin, Trust Your Gut

Living Well with Robin Stoloff

Play Episode Listen Later Sep 11, 2021 19:14


We often don't connect skin health to the health of our gut, but the two are undeniably connected. In this episode, I explore the relationship between our skin and diet with Jennifer Fugo, MS, LDN, CNS, functional clinical nutritionist, founder of Skinterrupt, and the host of the Healthy Skin Show.   In her clinical practice, she helps women and men with never-ending “stomach problems”, chronic skin rashes, brain fog, chronic fatigue, and autoimmunity find a way back to their best health. Jennifer also has extensive experience supporting people with various food sensitivities — especially those who are stuck on elimination diets without any improvement. 

Virginia Water Radio
Episode 594 (9-13-21): Neurons, Ions, and Water

Virginia Water Radio

Play Episode Listen Later Sep 10, 2021


CLICK HERE to listen to episode audio (4:18).Sections below are the following: Transcript of Audio Audio Notes and Acknowledgments ImageExtra Information Sources Related Water Radio Episodes For Virginia Teachers (Relevant SOLs, etc.). Unless otherwise noted, all Web addresses mentioned were functional as of 9-10-21. TRANSCRIPT OF AUDIO From the Cumberland Gap to the Atlantic Ocean, this is Virginia Water Radio for the week of September 13, 2021.  This revised episode from December 2018 is part of a series this fall of episodes on water connections to the human body and human biology. MUSIC – ~ 15 sec – Lyrics:  “Well you're nothing but a pack of neurons, in a shapely bag of goo.  All your thoughts and dreams, your hopes and schemes, are electrochemical, too.”This week, that music sets the stage for describing some biochemical and electro-chemical aspects of the water-based environment inside of us.  Have a listen for about 45 more seconds. MUSIC – ~47 sec – Lyrics: “Well the first time I ever saw your face, dear, my ions began to diffuse.  Your eyes aglow made the sodium flow through those membrane avenues.  When our fingers unite, more than synapses excite, and those lips I can't refuse.  I know we're more than just a chemical reaction, ‘cause I'm in love with you-oo-oo, I'm in love with you.  Well you're nothing but a pack of neurons, controlling a bag of goo.  All your thoughts and dreams, your hopes and schemes, are electrochemical, too.  You are what you eat, ‘cept for what you excrete, so watch out what you chew.  You're nothing but a pack of neurons, and I'm in love with you-oo-oo, I'm in love with you.  This is the part where the sodium and potassium ions do a little soft-shoe.”You've been listening to part of “Pack of Neurons,” by Bob Gramann of Fredericksburg, Va., on his 2008 album, “Mostly Live.”  According to Mr. Gramann, the title “Pack of Neurons” was inspired by the use of that phrase in The Astonishing Hypothesis, a 1994 book by Francis Crick on human consciousness.   Dr. Crick shared the 1962 Nobel Prize in Physiology or Medicine with James Watson and Maurice Wilkins for their discoveries of the structure of the DNA molecule. Mr. Gramann's song is a light-hearted look at the fundamental role of neurons, of nerve cells, in transmitting the electrical impulses that control humans' mental and physical processes.  Those nerve impulses are transmitted along neurons by changes in the concentration of electrically-charged atoms of sodium and potassium. [Note, not in audio: Neurons are the type of nerve cell that transmits impulses.  The nervous system also has other supporting cells.]  Water is vital as the solvent for those charged atoms, known as ions.  And not just in neurons, but in all biological cells, a water-based solution is the medium in which biochemical substances exist and react.  Regarding water-based solutions, chemist Linus Pauling in 1970 wrote, “One of the most striking properties of water is its ability to dissolve many substances”—including, we might add, ions transmitting the nerve impulses that right now are allowing you to hear or read these words.Thanks to Bob Gramann for permission to use this week's music, and we close with about 20 more seconds of “Pack of Neurons.” MUSIC – ~21 sec - Instrumental SHIP'S BELL Virginia Water Radio is produced by the Virginia Water Resources Research Center, part of Virginia Tech's College of Natural Resources and Environment.  For more Virginia water sounds, music, or information, visit us online at virginiawaterradio.org, or call the Water Center at (540) 231-5624.  Thanks to Stewart Scales for his banjo version of Cripple Creek to open and close this show.  In Blacksburg, I'm Alan Raflo, thanking you for listening, and wishing you health, wisdom, and good water. AUDIO NOTES AND ACKNOWLEDGEMENTS This Virginia Water Radio episode revises and replaces Episode 450, 12-10-18, and Episode 93, 12-19-11. “Pack of Neurons,” from the 2008 album “Mostly Live,” is copyright by Bob Gramann, used with permission.  Bob Gramann's Web site is http://www.bobgramann.com/. Click here if you'd like to hear the full version (1 min./11 sec.) of the “Cripple Creek” arrangement/performance by Stewart Scales that opens and closes this episode.  More information about Mr. Scales and the group New Standard, with which Mr. Scales plays, is available online at http://newstandardbluegrass.com. IMAGE Diagram of a neuron.  Image from the National Institutes of Health/National Cancer Institute, “SEER Training Modules: Introduction to the Nervous System—Nerve Tissue,” online at https://training.seer.cancer.gov/anatomy/nervous/; the specific URL for the diagram was https://training.seer.cancer.gov/anatomy/nervous/tissue.html, as of 9-8-21. EXTRA INFORMATION ABOUT THE HUMAN NERVOUS SYSTEM The following information is quoted from National Institutes of Health/National Cancer Institute, “SEER Training Modules: Review: Introduction to the Nervous System,” online at https://training.seer.cancer.gov/anatomy/nervous/review.html, accessed 9/10/21. *The nervous system is the major controlling, regulatory, and communicating system in the body. It is the center of all mental activity including thought, learning, and memory. *The various activities of the nervous system can be grouped together as three general, overlapping functions: sensory, integrative, and motor. *Neurons are the nerve cells that transmit impulses.  Supporting cells are neuroglia. *The three components of a neuron are a cell body or soma, one or more afferent processes called dendrites, and a single efferent process called an axon. *The central nervous system consists of the brain and spinal cord.  Cranial nerves, spinal nerves, and ganglia make up the peripheral nervous system. *The afferent division of the peripheral nervous system carries impulses to the CNS; the efferent division carries impulses away from the CNS. *There are three layers of meninges around the brain and spinal cord.  The outer layer is dura mater, the middle layer is arachnoid, and the innermost layer is pia mater. *The spinal cord functions as a conduction pathway and as a reflex center.  Sensory impulses travel to the brain on ascending tracts in the cord. Motor impulses travel on descending tracts. SOURCES Used for Audio Stewart W. Holmes, “You are Nothing but a Pack of Neurons,” ETC: A Review of General Semantics, Vol. 51, No. 4 (Winter 1994-95), pages 406-412, accessed online at https://www.jstor.org/stable/42577594?seq=1#metadata_info_tab_contents(subscription may be needed for access).Nobel Media AB, “The discovery of the molecular structure of DNA—the double helix,” Sept. 30, 2003, online at http://educationalgames.nobelprize.org/educational/medicine/dna_double_helix/readmore.html. Linus Pauling, General Chemistry, Dover Publications, New York, N.Y, 1970).  The quotation used in this episode's audio is found on page 447. Scott K. Powers and Edward T. Howley, Exercise Physiology: Theory and Application to Fitness and Performance, 8th Edition, McGraw-Hill, New York, N.Y., 2012.  See particularly pages 142-148, “Organization of the Nervous System.”Publishers Weekly, “Review of The Astonishing Hypothesis: The Scientific Search for the Soul, by Francis Crick,” Jan. 3, 1994, online at https://www.publishersweekly.com/978-0-684-19431-8. University of Bristol (England), School of Medical Sciences, “Brain Basics: The Fundamentals of Neuroscience,” online at http://www.bris.ac.uk/synaptic/basics/basics-0.html. For More Information about the Human Nervous System Eric Cudler, “Neuroscience for Kids,” online at https://faculty.washington.edu/chudler/neurok.html. National Institutes of Health/National Cancer Institute, “SEER Training Modules: Introduction to the Nervous System,” online at https://training.seer.cancer.gov/anatomy/nervous/. RELATED VIRGINIA WATER RADIO EPISODES All Water Radio episodes are listed by category at the Index link above (http://www.virginiawaterradio.org/p/index.html).  See particularly the “Science” subject category. Following are links to other episodes on connections of water to human biology.  Please note that some of these episodes are being redone in fall 2021; in those cases, the respective links below will have information on the updated episodes.  Episode 195, 1-6-14 – Water thermodynamics.Episode 287, 10-26-15 – Skeleton system connections to water.Episode 393, 11-6-17 – Disease: Influenza.Episode 450, 12-10-18 – Neurological system connections to water.Episode 466, 4-1-19 – Water intake and sports.Episode 517, 3-23-20 and Episode 519, 4-6-20 – Disease: Water connections to COVID-19.Episode 592, 8-30-21 – Overview of water's roles in the body.Episode 593, 9-6-21 – Circulatory system connections to water. FOR VIRGINIA TEACHERS – RELATED STANDARDS OF LEARNING (SOLs) AND OTHER INFORMATION Following are some Virginia Standards of Learning (SOLs) that may be supported by this episode's audio/transcript, sources, or other information included in this post. 2020 Music SOLs SOLs at various grade levels that call for “examining the relationship of music to the other fine arts and other fields of knowledge.” 2018 Science SOLs Grades K-3 plus 5: Matter3.3 – Materials interact with water.5.7 – Matter has properties and interactions. Grade 66.6 – Water has unique physical properties and has a role in the natural and human-made environment. Life ScienceLS.2 – All living things are composed of one or more cells that support life processes, as described by the cell theory. BiologyBIO.2 – Chemical and biochemical processes are essential for life.BIO.3 – Cells have structure and function. ChemistryCH.5 – Solutions behave in predictable and quantifiable ways.Virginia's SOLs are available from the Virginia Department of Education, online at http://www.doe.virginia.gov/testing/. Following are links to Water Radio episodes (various topics) designed especially for certain K-12 grade levels. Episode 250, 1-26-15 – on boiling, for kindergarten through 3rdgrade.Episode 255, 3-2-15 – on density, for 5th and 6th grade.Episode 282, 9-21-15 – on living vs. non-living, for kindergarten.Episode 309, 3-28-16 – on temperature regulation in animals, for kindergarten through 12th grade.Episode 333, 9-12-16 – on dissolved gases, especially dissolved oxygen in aquatic habitats, for 5th grade.Episode 403, 1-15-18 – on freezing and ice, for kindergarten through 3rd grade.Episode 404, 1-22-18 – on ice on ponds and lakes, for 4ththrough 8th grade.Episode 406, 2-5-18 – on ice on rivers, for middle school.Episode 407, 2-12-18 – on snow chemistry and physics, for high school.Episode 483, 7-29-19 – on buoyancy and drag, for middle school and high school.Episode 524, 5-11-20 – on sounds by water-related animals, for elementary school through high school.Episode 531, 6-29-20 – on various ways that animals get water, for 3rd and 4th grade.Episode 539, 8-24-20 – on basic numbers and facts about Virginia's water resources, for 4th and 6th grade.

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Eeez n Beez
Breakfast with the Hilton Sisters

Eeez n Beez

Play Episode Listen Later Sep 10, 2021 49:59


Welcome back fanz! Episode 54 this week includes a special guest duo, and we don't have to go far to find the amazing talent! The Hilton sisters join us this week, as they prepare to dominate this Saturday at CNS! Make sure to stay tuned for LIVE updates from CNS this weekend on our YouTube channel.Also we dive into NFL week 1 preview! Nascar/Short=Track racing including the 3 hour this weekend at the SpeedDrome, and some clues into next week's special guest!AEW's All Out review, Wednesday Night's Dynamite, and Rampage later on tonight! AEW has taken over!WWE RAW and SmackDown review, and NXT from the past week are reviewed as well.Please go to Apple Podcast and leave us a 5-star review to help drive us up the charts!Continue to stay tuned to the Eeez N Beez YouTube channel this weekend! We have a few surprises this weekend. Also, we are slowly learning our way onto  Twitch, so make sure to subscribe to our channel there!Look out for a NEW episode of LB's Murder Mysteries!!Check out New Eeez N Beez & Lauren's Murder Mysteries Merch dropping soon!So, stay tuned, turn up and don't forget... EAT YOUR BREAKFAST!Support the show (https://www.patreon.com/user?u=41702239&fan_landing=true)

Mind Pump: Raw Fitness Truth
1636: How to Increase Grip Strength, the Most Effective Way to Bulk, High Reps Vs. Low Reps & More

Mind Pump: Raw Fitness Truth

Play Episode Listen Later Sep 8, 2021 72:08


In this episode of Quah (Q & A), Sal, Adam & Justin answer Pump Head questions about the best way to increase grip strength, what it means to sweat a lot during a workout, the CNS effect of high reps with lower weight vs. low reps with higher weights, and the most effective way to bulk. 1636: The Mind Pump robot debate rages on. (4:48) Highlighting the massive mistake that scientists and government officials make when it comes to the obesity epidemic. (9:58) Mind Pump Recommends, Untold: Caitlyn Jenner on Netflix. (16:55) An interesting move by Bud Light. (25:05) Reliving all your worst childhood moments through your kids. (28:44) Busting the widespread myth that as you get older your mental capacity declines. (31:25) The Bishop Sycamore football controversy. (35:52) Is Jake Paul retiring from boxing?! (37:30) The ribs from Butcher Box are out of this world! (44:03) New product alert from Felix Gray! (45:39) #Quah question #1 – What is the best way to increase grip strength? (49:35) #Quah question #2 – Should I be concerned about my excessive sweating when working out? (56:47) #Quah question #3 – What is more taxing on the nervous system, high reps with lower weight or low reps with higher weight?(1:00:07) #Quah question #4 – What is the most effective way to bulk? Should I track or be intuitive? (1:04:20) Related Links/Products Mentioned September Promotion: MAPS Performance and MAPS Suspension 50% off!   **Promo code “SEPTEMBER50” at checkout** Reducing sugar in packaged foods can prevent disease in millions Untold: Caitlyn Jenner | Netflix Official Site Bud Light Releases Pumpkin Spice and Toasted Marshmallow Hard Seltzers Key Mental Abilities Can Actually Improve During Aging ESPN tricked into televising football game of 'fake' high school Bishop Sycamore Did Jake Paul just retire from boxing? Visit Butcher Box for this month's exclusive Mind Pump offer! Visit Felix Gray for an exclusive offer for Mind Pump listeners! Mind Pump Store Association of Grip Strength With Risk of All-Cause Mortality, Cardiovascular Diseases, and Cancer in Community-Dwelling Populations: A Meta-analysis of Prospective Cohort Studies The ONLY Forearm Workout That Matters (TRY THIS!!) | MIND PUMP 5 Exercises For HUGE Forearms & A STRONGER Grip (FREE Big Arms Guide) How to Build a Strong Core with Kettlebell Farmers Walk – Mind Pump TV MAPS O.C.R. | Muscle Adaptation Programming System Intuitive Nutrition Guide | MAPS Fitness Products Mind Pump # 1427: Don't Make These 6 Bulking Mistakes  Mind Pump Podcast – YouTube Mind Pump Free Resources People Mentioned Joe De Sena (@realJoeDeSena) on Twitter Jake Paul (@jakepaul) on  Instagram

The Nurse Practitioner - The Nurse Practitioner Podcast
Acute Care for COPD Exacerbations

The Nurse Practitioner - The Nurse Practitioner Podcast

Play Episode Listen Later Sep 4, 2021 26:45


In this episode of The Nurse Practitioner Podcast, Dr. Julia Rogers, DNP, RN, CNS, FNP-BC discusses acute care for COPD exacerbations.

Waist Away: The Intermittent Fasting & Weight Loss Podcast
#372 - Intermittent Fasting If I Have Adrenal Fatigue Or Adrenal Stress, What Eating Window To Have, Your Parasympathetic Nervous System, Rest And Digest State, and more - with Dr. Doni Wilson!

Waist Away: The Intermittent Fasting & Weight Loss Podcast

Play Episode Listen Later Aug 31, 2021 36:41


Welcome back to the podcast! In today's episode, Chantel spoke with Dr. Doni Wilson! Dr. Donielle (Doni) Wilson, is a naturopathic doctor, professional midwife, clinical nutritionist, bestselling author, researcher, natural products formulator, and mother practicing in the New York tri-state area, and (Manhattan, Long Island and Connecticut) and “virtually” in regions throughout the world.   She holds a doctorate in naturopathic medicine from BASTYR UNIVERSITY and is a certified professional midwife (CPM) and doula (though she does not attend births at this time) and a certified nutrition specialist (CNS). She completed a residency in naturopathic medicine at Bastyr University.   Since 2000, Dr. Doni has helped thousands of women, men, and children to find solutions to their most puzzling health issues.   Dr. Doni uses the latest advances in naturopathic medicine, lab testing, and investigative techniques to uncover the root cause of illness and craft individual programs that guide the body back to health. She does this with the approach she developed based on her research on how stress affects our health.   Enjoy! Connect with Dr. Doni: Stress Warrior Book (FREE): https://doctordoni.com/stresswarrior  https://doctordoni.com/  https://facebook.com/drdoniwilson  https://instagram.com/drdoniwilson  https://youtube.com/user/doniwilsonnd  Join Our Facebook Group: https://www.facebook.com/groups/TheChantelRayWay/  Order The Brand New Book, One Meal And A Tasting: https://chantelrayway.com/onemeal/      Order All The Books: Waist Away: The Chantel Ray Way - 2nd Edition:  https://www.amazon.com/gp/product/0999823116/ref=dbs_a_def_rwt_hsch_vapi_tpbk_p1_i0    Fasting to Freedom: The Gift of Fasting: https://www.amazon.com/Fasting-Freedom-Gift-Chantel-Ray/dp/0999823132/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr=    Freedom From Food: A Six Week Bible Study Course: https://www.amazon.com/Freedom-Food-Bible-Study-Course/dp/0999823159/ref=pd_bxgy_img_3/135-7722513-4171815?_encoding=UTF8&pd_rd_i=0999823159&pd_rd_r=91d59435-2126-4f9d-867e-00646964e3e4&pd_rd_w=mg3U0&pd_rd_wg=FcVwL&pf_rd_p=fd3ebcd0-c1a2-44cf-aba2-bbf4810b3732&pf_rd_r=NWM3687GJSRKKQ4BYQP4&psc=1&refRID=NWM3687GJSRKKQ4BYQP4    Connect With Us:   Leave us a review: https://chantelrayway.com/review/    Share YOUR Story: https://chantelrayway.com/contact/   Contact directly through email at questions@chantelrayway.com    Enjoy refreshing, all-natural wine: https://chantelrayway.com/wine/   Listen to the new audiobook as a podcast HERE: https://chantelrayway.com/purchase-audio-book/   Free Video Preview: https://chantelrayway.com/top-12-thin-eater-tips-free-video/   Check out the VIDEO COURSE here: https://chantelrayway.com/video-course/   Check out the FASTING RESET SUMMIT HERE: https://fastingresetsummit.com/   Purchase on Amazon Here: https://www.amazon.com/shop/intermittentfastingthechantelrayway   Strengthen your immune system with Vitamin C: https://chantelrayway.com/vitaminc/    Enjoy a FREE smoothie recipe book: https://chantelrayway.com/freerecipe/   Re-energize with nutritious algae Energybits: https://chantelrayway.com/energybits    Castor Oil: https://chantelrayway.com/castoroil   Connect with us on Social Media:   YouTube Channel Link: https://www.youtube.com/channel/UCteFjiVaY6n0SOAixcyZbWA   Like us on Facebook at https://www.facebook.com/TheChantelRayWay       Things we love: https://chantelrayway.com/things-i-love-2/   Facebook group: https://www.facebook.com/groups/TheChantelRayWay   ***As always, this podcast is not designed to diagnose, treat, prevent or cure any condition and is for information purposes only. Please consult with your healthcare professional before making any changes to your current lifestyle.***

CNS Journal Club
CNS Guidelines Podcast_Deep Brain Stimulation for Obsessive Compulsive Disorder Update

CNS Journal Club

Play Episode Listen Later Aug 30, 2021 24:10


The use of bilateral anterior limb of internal capsule (ALIC) DBS for OCD was approved by the US Food and Drug Administration (FDA) under a humanitarian device exemption (HDE) in 2009.9 Following this HDE approval and publication of the 2014 CNS guidelines, there have been additional published studies reporting the use of DBS for OCD, although most do not meet criteria to be included in this guidelines update. The purpose of this update is to review the literature following publication of the original guidelines and to update the recommendations as appropriate. Based on the availability of new literature, the current guideline is a major update resulting in modification and update of prior recommendations as well as an updated discussion. J. Bradley Elder, MD Julie G. Pilitsis, MD, PhD Nader Pouratian, MD, PhD Michael D. Staudt, MD, MSc Vin Shan Ban, MD Joravar Dhaliwal, MD Megan Still, MD

Marked Safe: A Disaster Podcast
Stop Your Laughing: Minamata Disease

Marked Safe: A Disaster Podcast

Play Episode Listen Later Aug 25, 2021 62:26


This week, we don our emotional bat dresses, there's an alligator in someone's pants, a corporation is totally upstanding, murderous sludge gets upcycled, fishermen storm a factory, a lot of people die, and we explore possible alternate timelines.Content warnings: maltreatment of alligators, neurological symptoms in animals, eating eels, serious illness/possible death of five year old child, CNS disease, experimentation on cats, miscarriage, stillbirth, infant deformities, community shunning, invasive medical exam.Links:Episode 75 Mercury: The cost of progressJohnny Depp Claims He Is Being Boycotted By Hollywood, Worries About ‘Minamata' ReleaseLessons learned from previous environmental health crises: Narratives of patients with Minamata disease in TV documentaries as the main media outletMinamata diseaseMinamata DiseaseMINAMATA`S HEROESMysterious chemical found in dead cat's brain reopens debate over mercury poisoning disasterMinamata disease compensation agreements of 1959Something in the Water: Life after Mercury PoisoningThe Minamata Disaster and the Disease That FollowedThe Minamata Disaster and the True Costs of Japanese Modernization

Just Ingredients
22 - Dr. Josh Axe, Ancient Remedies and how they help us heal today

Just Ingredients

Play Episode Listen Later Aug 20, 2021 47:17


Dr. Josh Axe, founder of Ancient Nutrition and DrAxe.com, is a certified doctor of natural medicine (DNM), doctor of chiropractic (DC) and clinical nutritionist (CNS) with a passion to help people get healthy by empowering them to use nutrition to fuel their health. He is the bestselling author of KETO DIET, Eat Dirt, and COLLAGEN DIET, and author of the new, best-selling book Ancient Remedies. Dr. Axe founded the natural health website DrAxe.com, one of the top natural health websites in the world today. Its main topics include nutrition, natural remedies, fitness, healthy recipes, home DIY solutions and trending health news. Dr. Axe is also the co-founder of Ancient Nutrition, which provides protein powders, holistic supplements, vitamins, essential oils and more to the modern world. Dr. Axe is an expert in functional medicine, digestive health and herbal remedies and founded one of the largest functional medicine clinics in the world, in Nashville, TN, and served as a physician for many professional athletes. Most recently, he launched his podcast, The Dr. Axe Show which features interviews with top health influencers such as Dr. Oz, The Skinny Confidential, Dr. Perlmutter, Dr. Will Cole & many more! He has an incredible fanbase on Facebook (2.7m) & Instagram (656k) and shares his many health tips on these platforms with the goal of transforming lives using food as medicine. In today's episode, Dr. Axe teaches about the bridge between ancient remedies and western medicine. Focusing on how to improve gut health, hormones, immune health, and the gut/brain connection, Dr. Axe shares how to heal through food, herbal remedies, supplements, and more. For 30% off Force of Nature Starter Kits and Bundles: Use code JUSTINGREDIENTS30 at: https://www.forceofnatureclean.com/shop/?cc=justingredients30

The Curbsiders Internal Medicine Podcast
Reboot #164 Stroke and TIA Deconstructed

The Curbsiders Internal Medicine Podcast

Play Episode Listen Later Aug 16, 2021 77:34


Enjoy this Curbsiders classic and stay tuned this Wednesday, August 18, 2021 for a brand new Stroke and TIA Triple Distilled episode. Update your management of stroke and TIA in primary care. Stroke neurologist, Chris Favilla MD (University of Pennsylvania), walks us through the plumbing of the brain, so we can identify ischemic risks in stroke and TIA patients to prevent recurrences.  Learn factors that make a TIA high risk, which imaging studies to order, new research around aspirin dosing, dual antiplatelets, DOACs, cardiac monitoring and more!  Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders  Credits Producers: Molly Heublein MD; Matthew Watto MD, FACP Writer (including CME questions): Molly Heublein MD Cover Art: Bryan Brown MD Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Emi Okamoto, MD; Matthew Watto MD, FACP Guest: Chris Favilla, MD Sponsor: Indeed indeed.com/internalmedicine Get a $75 sponsored job credit to upgrade your job post at Indeed.com/internalmedicine. Sponsor: Qalo qalo.com/curb Head to qalo.com/curb to get 20% off your purchase today. Time Stamps* Time Stamps refer to ad-free version 00:00 Intro, disclaimer, guest bio, and a bad pun 04:20 Chris' one-liner, advice as a teacher, book recommendation -The Goldfinch,  07:40 Molly's pick of the week -Extreme Measures (book) by Jessica Zitter 08:40 A case of TIA; definition of TIA 12:14 Stroke territories 14:24 New definition of TIA 16:00 Differentiation from complex migraine 19:17 Risk stratifying TIA and ABCD2 score 22:00 A bit on tPA 24:01 Workup for TIA; workup for amaurosis fugax 25:36 CNS imaging studies after stroke or TIA; Choice of imaging study 33:15 HINTS exam for posterior circulation stroke 34:48 Is an echo necessary? Bubble study for PFO? 38:32 Duration of afib monitoring 40:24 Echo reports: what to look for in patient with stroke or TIA; “soft markers” 41:55 Blood testing after Stroke and TIA (lipid panel, HbA1C; +/- RPR, coags, CBC) 43:50 Folic acid; Sparkle trial: high dose atorvastatin versus placebo for secondary prevention 47:00 Incidental finding: multiple patchy infiltrates in a patient without stroke or TIA; Is it significant? 48:50 Aspirin therapy after TIA; Dosage adjustment based on weight? 51:10 A case of stroke; TOAST trial and classification of acute stroke; ESUS; aortic arch atheromas 55:58 Large artery strokes (hypoperfusion, acute thrombosis, artery to artery embolization) 57:15 Antiplatelets after stroke and TIA; DAPT and duration of therapy 62:57 Antidiabetic drugs and stroke 63:40 Lightning round: CHA2DS2VASc score and women; how much afib is significant?; 66:32 Are all DOACs created equal?; 68:20 Regaining function after a stroke; 69:47 Silent infarcts on imaging 71:54 Resources for stroke: Decision making in neurology textbook 73:28 Outro

The Lindsey Elmore Show
Health benefits of eating raw | Esosa Edosomwan

The Lindsey Elmore Show

Play Episode Listen Later Aug 10, 2021 50:25


Esosa Edosomwan, MS, CNS, LDN also known as “Raw Girl” of therawgirl.com is a dynamic Certified Nutrition Specialist, Behavioral Coach, host of the Staying Ageless Podcast, founder of Staying Ageless University, and published author with ten years of experience inspiring others to live their best healthiest lives. After completing her Masters in Nutrition and Integrative Health, Esosa worked as a Clinical Nutritionist at a wellness center where she provided nutritional coaching, meal planning, and offered dietary interventions to thousands of clients of all ethnicities and ages, with a variety of dietary preferences and suffering from a wide range of chronic conditions. Topics covered in this episode: • Why nutrition is so important. • Who is best for certain diet protocols? • Some Chinese medicine principles • About Staying Ageless University. • Nutrition advice. Referenced in the episode: • The Lindsey Elmore Show Ep 112 Learning to heal yourself with purpose & direction | Dr. Patrick Hanaway To learn more about Esosa Edosomwan and her work, head over to www.therawgirl.com For a free class – 6 Major Keys to Determine Your Ideal Diet, go to: https://www.therawgirl.com/6waysfreeclass Must watch past episodes: • The Lindsey Elmore Show Ep 107 | Intermittent fasting as key pillar of health | Dr. David Jockers • The Lindsey Elmore Show Ep 113 | Reversing Diabetes | Dr. Brian Mowll The Metabolic Makeover Summit is happening free and online August 30th to September 5th and registration is now open. Head over to www.lindseyelmore.com/metabolicmakeover We hope you enjoyed this episode. Come check us out at www.lindseyelmore.com/podcast.

The Livin' La Vida Low-Carb Show With Jimmy Moore
1749: Kristina Hess On Keto Symposium, Insulin Resistance, And Finding Your Keto Way

The Livin' La Vida Low-Carb Show With Jimmy Moore

Play Episode Listen Later Jul 28, 2021 49:50


On today's episode of the LLVLC Show, Kristina Hess drops by to talk with Jimmy about finding your Keto Way. “From a genetics perspective it's how you live that has an impact on turning things on and off.” Kristina Hess In today's show, Jimmy chats with licensed dietitian and clinical nutritionist Kristina Hess, CNS, LDN about the upcoming FREE virtual LIVE Keto Symposium she is holding all day on Saturday, September 25, 2021 featuring popular favorites from the keto and carnivore community and MC'd by Jimmy himself. Get the full details about this incredible event and listen to friends Jimmy and Kristina get all nerdy on the science of ketogenic diets in this fun, engaging, and informative interview. Kristina is a premier health coach and licensed dietitian/nutritionist who works with clients to support them in making lifestyle changes that produce real and lasting results. Kristina has a Masters degree in Clinical Nutrition and Integrative Health from MUIH – Maryland University for Integrative Health and several certifications in areas ranging from Mindful Eating, Heartmath,to Ericksonian Hypnosis to Sport Nutrition. Kristina received her health coach certification from the Institute for Integrative Nutrition. Kristina's integrative and functional approach is an arm within the Functional Medicine model of the IFM. Functional Medicine views us all as being different; genetically and biochemically unique. A functional approach is deeply science based and views everything that happens within us as a connected network or web of relationships. Kristina's private practice in Connecticut is called Thrive Results Coaching.

Mind Pump: Raw Fitness Truth
1598: Why People Should Avoid HIIT, How Forced Reps Can Cause Muscle Loss, Ways Poor Health Prevents Body Fat Loss & More

Mind Pump: Raw Fitness Truth

Play Episode Listen Later Jul 16, 2021 78:57


In this episode of Quah (Q & A), Sal, Adam & Justin answer Pump Head questions about whether certain people should avoid HIIT, if forced reps are a good idea or are too taxing on the CNS, the number of sets & reps one should do for each body part if training with full body workouts, and how poor gut health affects the metabolism and the ability to efficiently lose body fat. The benefits and value of the safety squat bar and the sled for the avid aging lifter. (3:18) The high school football update with Justin. (14:33) Math is not racist. (18:51) Why the guys are disappointed in themselves regarding some comments made in their recent interview with Melissa Urban. (20:38) Weird News with Sal: Homeless man with no arms stabs someone with his feet! Plus, how a man uses cherry pies for sexual kicks. (27:21) Sal's incredible superpower. (32:56) Mind Pump reviews ‘The Tomorrow War'. (34:38) Have scientists figured out the mystery that is the Bermuda Triangle? (38:14) How the guys are looking good on camera in large part to Caldera. (43:34) #Quah question #1 – Should certain people avoid HIIT? Or is it a good workout for all people? (47:39) #Quah question #2 – What are your thoughts on forced reps with the help of a training partner? Do you guys think this is a good idea or could it be taxing on the Central Nervous System (CNS)? (58:31) #Quah question #3 – How many sets and reps should you do for each body part if you're training with full-body workouts? (1:05:50) #Quah question #4 – How does poor health affect the metabolism and your ability to efficiently lose body fat? (1:10:41) Related Links/Products Mentioned July Promotion: MAPS HIIT and the No BS 6-Pack Formula 50% off!  **Promo code “JULYSPECIAL” at checkout** Visit PRx Performance for an exclusive offer for Mind Pump listeners! **Code “mindpump5” at checkout** How To Do The Sled Push The RIGHT Way! (AVOID MISTAKES!) - Mind Pump TV Visit Organifi for the exclusive offer for Mind Pump listeners! **Code “mindpump” at checkout* Is mathematics racist? California could blaze pathway with woke math Mind Pump #1592: The 30 Day Diet Experiment That Launched An Empire With Melissa Urban Man with no arms stabbed stranger with his feet: police ‘Pervert hid cherry pies under women's car tires for sexual kicks' Watch The Tomorrow War | Prime Video Loki | Disney+ Originals Bermuda Triangle mystery 'solved,' scientists claim Visit Caldera Lab for an exclusive offer for Mind Pump listeners! **Code “mindpump” at checkout for the discount** Why Most HIIT Programs Only Work for Short Periods of Time – Mind Pump Blog 5 HUGE Mistakes Skinny Guys Make with Workouts – Mind Pump Blog MAPS Fitness Anabolic | Muscle Adaptation Programming System Mind Pump Podcast – YouTube Mind Pump Free Resources People Mentioned Melissa Urban | Whole30 (@melissau)  Instagram Paul Chek (@paul.chek)  Instagram

Bulletproof Radio
7 Rules to Reverse Aging and Live Longer – Ann Louise Gittleman with Dave Asprey : 840

Bulletproof Radio

Play Episode Listen Later Jul 15, 2021 46:15


After more than four decades and more than 35 books, Ann Louise Gittleman, Ph.D., CNS, continues to break new ground in integrative and functional medicine. She's a Columbia-trained nutritionist and author internationally recognized as a pioneer in dietary, longevity, environmental, and women's health issues.In this episode of Bulletproof Radio, Ann Louise recommends a paradigm shift in which your biology is not your biography. Her seven new rules for radical longevity include: immunity, toxic overload, advanced glycation end products, fascia, cellular rejuvenation, minerals, gut-brain connection.During her long career, she's examined overlooked factors that contribute to weight gain beyond diet and exercise. Decades before Keto, Paleo, Carnivore, and Intermittent Fasting diet trends, Ann Louise wrote that obesity and diabetes were caused by a lack of the right type of fat and an excess of the wrong kind of carbohydrate in her first book Beyond Pritikin (1988). “I'm so grateful that people now realize that you can eat fat, lose weight, and feel stronger and healthier and live until 120,” Ann Louise says. “It's all about the right kind of fat. And also, intermittent fasting has now come into play. I wrote about that in 2005. And in those days, people never realized how important it was. Now we have the research, we've got the anecdotal and the clinical studies. And I think that all these ideas are really ideas whose time has truly come.”In her newest book, “Radical Longevity: The Powerful Plan to Sharpen Your Brain, Strengthen, Your Body, and Reverse the Symptoms of Aging,” Ann Louise combines research with traditional healing wisdom to teach you how to live to 100 years old and beyond. She examines topics from heavy metals and EMFs, to cellular regeneration and emotional detox. She says by using epigenetics to slow and reverse many of the most worrisome aging conditions, you can preserve your “youth span” and enhance your immunity, heart, brain, muscles, joints, skin, and hair. You can even revitalize your sex drive.You can learn even more from Ann Louise as she tackles health trends and topics on her podcast, “The First Lady of Nutrition.”Enjoy! And get more resources at Dave.Asprey/podcasts.Got a comment, idea or question for the podcast? Submit via this form.WE APPRECIATE OUR PARTNERS. CHECK THEM OUT!Revitalize Your Mitochondria: https://www.timelinenutrition.com, use code ASPREY10 to get 10% off the plan of your choiceTrack Your Health: https://info.insidetracker.com/dave, save 25%Get Salty AF: https://drinklmnt.com/dave, try the new watermelon and grapefruit flavors for summer7TH ANNUAL BIOHACKING CONFERENCE: SEPTEMBER 17-19, 2021Dave Asprey and Upgrade Labs host a transformative 3-day event featuring thought-provoking keynotes and fully immersive experiences that push the limits of human advancement, performance and longevity. You will connect with the world's most innovative minds in the field of human optimization and biohacking. Join the community, at the Hyatt Regency Orlando, Florida. https://www.biohackingconference.comDAVE ASPREY BOX This quarterly subscription box gives you access to biohacking resources that can support you in achieving your health goals and unlocking your potential. Go to https://daveaspreybox.com/UPGRADE YOURSELF EVEN MORELearn directly from Dave Asprey in his new membership group https://ourupgradecollective.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.