Podcasts about congestive

Dr. Dustin Jones // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult Division Leader Dustin Jones as discusses the gap between someone given a diagnosis and then a prognosis. Whether it's a matter of seconds or decades, we'll discuss the huge opportunity in that gap to impact our patients as well as practical takeaways. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION DUSTIN JONESGood morning, folks. Welcome to the PT on Ice daily show brought to you by the Institute of Clinical Excellence. My name is Dustin Jones, one of the lead faculty within the older adult division. Today, we are going to be talking about minding the gap between diagnosis and prognosis. Mind the gap between diagnosis and prognosis. I'm going to share a personal story of some experiences I've had lately as a patient within the healthcare system. And I've experienced what many of our patients are experiencing as well, and that is that gap between receiving a diagnosis and then potentially, sometimes not even, right, receiving a prognosis of what that diagnosis actually means. This is an area that we spend most of our time in with the folks that we serve, and I think this is a huge opportunity to serve these folks well and potentially do some damage control and kind of rewrite a narrative that's going on in their head. So this Mind the Gap phrase, it originates from the United Kingdom. So if you ever go on any public transit, you're in a subway, for example, and you've got kind of the train platform and the train pulls up on kind of the curve of that train platform, it's going to say, mind the gap, basically beware, right? Beware of the gap between this platform and the train. And this, this phrase, you know, is a cautionary tale, right? That you are being careful. And I feel like that, cautionary perspective, it needs to be applied to when we give something a name, aka a medical diagnosis, and then the prognosis. That we need to mine that gap, that space in between giving someone a diagnosis and when they're giving the prognosis of that particular situation. I'll share my story. If you're watching this, you see an obnoxiously large bandage on my forehead. I have recently had a spot on my on my temple that was a little curious, right? So I went to the dermatologist to get it checked out. I haven't been to a dermatologist in, man, probably 20 years at this point. I don't get regular checkups or anything along those lines. But I went, they saw the same spot. They say, hey, let's take a biopsy of this and see what this is. All right, cool. So they take a biopsy, about five days to get results. And in that five day period, you got all this stuff running through your head, right? What could this be? Could this be some super gnarly, Skin cancer, for example, is this gonna be something serious or is it is it, you know Just something to not worry about. I don't know. I'm in that five-day period then I get the call from the office This is a call that I've been waiting on for about, you know Five days solid days now and I get a call and the individual that called me was I would say Roughly kind of 22 24 year old pray fresh out of undergrad working as kind of the billing clerk within this dermatology practice. And she calls me and says, hello, is this Mr. Jones? I said, yes, this is him. All right, thank you. It's good to talk to you. I wanted to give you your lab results and just kind of tell you the next steps going forward. So with that area on your temple, well, you have, you know, basal cell carcinoma. So you got skin cancer there. and we're gonna schedule a Mohs surgery to take that out. And then you've got a dysplastic nevus, I'm probably butchering the pronunciation of that, on your scalp and we're gonna excise that as well. When would you like to schedule these procedures? Literally, that's all this person said. And so I want you to put yourselves in the shoes of someone that may at some point have learned about the different types of skin cancer and which ones are more concerning than others. But in that moment, you may not remember, right? You're giving this diagnosis of cancer and a procedure that you have had some patients, right, that have had a Mohs surgery before. Very straightforward procedure where they basically just shave off skin and then assess if they got all the cancerous cells. And they just continue to do that until they find no cancerous cells. A lot of our patients, especially if you work in geriatrics, you're used to these types of surgeries, but you may not necessarily understand what it really means, right? And then, you know, the seven-syllable diagnosis for the other lesion, and it's gonna get excised, you know, just all these words. And just imagine what can happen, what runs through your mind in that situation. And it was fascinating for me because this was all laid out on me. without any context, without any prognosis, no understanding in the moment of what this actually meant. and they were trying to schedule a procedure. And I asked to speak to someone to kind of give me an idea of what this means. And it took about three minutes to get a PA on the phone to kind of give me an idea of what this actually meant, right? Basal cell carcinoma, very, it's the least aggressive out of any of the skin cancers. You take that out, you don't have to worry about it. We'll just follow up with regular skin checks. Not a big deal whatsoever. all this other piece that you have, it's basically just a mold that we're not necessarily sure if it could turn into something gnarly, so we're just gonna take it out just to be sure. That was not given to me, but that three minute gap, the stories that I told myself were fascinating. I was thinking about my life insurance policy. What are my kids gonna do if I'm not gonna be on this planet for much longer? What's Megan, my wife, gonna do? Just thinking about all the ripples that come with that getting that diagnosis and just realizing, you know, your mortality in that very short period of time. So I would say overall, this is, I would say a relatively minor interaction, right? Everything's all good. I had this Mohs surgery yesterday. It's bandaged up. You know, I've got a nice little scar. It's going to be fine, right? But think about what this is like for so many of our patients. When they go to that doctor's visit, that specialist, and they get that diagnosis, And sometimes it is hours, days, weeks, months, and even decades before they get that prognosis of what it actually means to have that name, that diagnosis on your medical chart. This is where we typically operate, right? This is where we are typically interacting with individuals. and this can be a very, very scary place for folks. It has huge implications in their day-to-day life. So let's go through some common examples that we're gonna see where we are kind of in the midst of the gap between that diagnosis and prognosis. Two of the most common ones that I've experienced working with older adults is degenerative joint disease and then osteoporosis. So degenerative joint disease, you know, you have someone that may have some back pain, whatever, maybe knee pain. They go and get the image, right? and they see the image report, especially nowadays with your access to MyChart, for example, where you can see a full-blown report without full context, right? You're reading, you know, radiologist's report verbatim, and you see degenerative joint disease. And oftentimes, how often are these folks actually given context of what that actually means? How often are they told? You know what? At this stage of the game, this is actually considered to be normal. If we were to take a hundred pictures of a hundred people, right, at least 75 of those individuals are going to have the same findings, right? But not all those people are going to be in pain. So yes, you have this on your image, but it's not necessarily abnormal or something to be that concerned about. How many folks are hearing that when they see that diagnosis on that report, right? so often is left untouched, unnoticed, unaddressed, and they can have this perspective that their joints are just absolutely disintegrating day by day by day. And you stretch that out over years and decades. Think about how they can learn to perceive their joints, their body, their ability to adapt, their ability to improve. Do they have a positive or negative perception of the days ahead, right? Oftentimes, it's going to contribute to a negative perception that it's just downhill from here. That is something that we can clear up. We can show, hey, we know you had this diagnosis. This is actually considered to be a relatively normal part of aging that a lot of folks have this on their imaging and they're doing awesome. They're doing things. similar to what you want to be able to do, I know that you can get to that point and I can help you get there, right? So DJD is one. The next one is osteoporosis. This is more common in the realm that I'm working in. I'm working in the context of fitness right now at Stronger Life in Lexington. So it's a gym for folks over 55 and we have so many folks that come to us that have a diagnosis of osteoporosis. And oftentimes that diagnosis is given based on a number of a certain area of the body that may be demonstrating low bone mineral density. And I always ask folks when they have that diagnosis, do you have your DEXA scans? Has anyone gone over your DEXA scan with you? And nine times out of 10, they say, no, no one's ever really walked me through this DEXA scan and what it actually means. So I had them bring it in. And when you talk through a DEXA scan, you'll see that they will run their bone marrow density at different parts of their body. And so you could, you know, have those numbers ran at, you know, their bilateral femurs, for example, the lumbar spine, thoracic spine. And so if someone shows below negative 2.5, for example, on that DEXA scan, in one of those areas, they're gonna be giving this diagnosis of osteoporosis. And oftentimes when you're looking at that DEXA scan, it may only be one one place it may be osteoporosis like a negative 2.6 in the right neck of the femur and then the left femur may be in an osteopenic range it may be kind of under that negative 2.5 maybe negative 2.3 negative 2.2 that's a different story right that when they are given that diagnosis of osteoporosis nine times out of ten they perceive that every bone in their body is brittle and is going to self-combust under any load, right? And that is just not the case whatsoever. Usually it's in a certain area that is a little more troublesome than others and we can give target interventions to build that area up and to show noticeable changes in that DEXA scan if we can work with these people over a longer period of time. And so osteoporosis diagnosis is another one. They're often not given what that prognosis actually means, and often not, they are given a message of hope that they can actually do something about this beyond taking a pill and crossing their fingers for that next DEXA scan for those numbers to change, right? There's a lot that we can do. So these are two of the dozens of situations that we often encounter, right, where people are given that diagnosis And then they may get a prognosis or they may not. And that is where we live. And I want us to just really consider and appreciate the negative implications of this. The fear, the lower physical activity. Increased fear will often encourage them to be more conservative with their physical activity because they're afraid to get hurt for example. We've had folks at Stronger Life that have gone to a doctor's visit and gotten a diagnosis, osteoporosis being one of the, I would say three, but one of them that if not given a clear prognosis and they will be scared to death and almost try to cancel their membership to say they can't exercise anymore. That this is a very, very delicate situation that we often find ourselves in. So now let's talk about what we can do about this, right? I think I like to think about this in three steps. Assess, inform, and advise. Assess, inform, and advise. When you're doing your chart review, when you're doing that evaluation, you see some of these diagnoses. Congestive heart failure is another one. The different categories of congestive heart failure, some are more serious than others, right? But man, that term alone will scare you to death, right? Assess what diagnosis do they may have and what's their knowledge of that? I would include surgeries in that as well. Knee replacements. Total hips, right? Assess their knowledge and perception of that particular diagnosis. Do they have an accurate perception of what it means to have osteoporosis? Do they have an accurate perception of what it means to have a total knee replacement and the implications that that actually has on your life after? Right? Because so many folks think they can't do X, Y, and Z and that's just not the case. We're learning that day in and day out with these folks challenging a lot of these perceptions. So assess. once you assess and you can inform. I feel like this is where this is something that I wish we would not have to do, right? I don't want to have to feel like I need to clear up someone given a medical diagnosis without an accurate prognosis, but sometimes we have to. But I think we do need to be very careful here that we don't kind of overstep our boundaries and really speak to this person's situation in the sense of where we probably don't have any right to do that, right? So this is where I'd like to speak in generalities. I don't, I'm not going to pull up someone's, you know, imaging and assess it myself per se and say, Oh, this is, you know, okay, this blah, blah, blah, and compare it to others. Like that, that's not my job. Right. But I can say I've had folks that have had that diagnosis that have responded really well to this treatment. I've had folks that had that diagnosis and they were able to do X, Y, and Z. We can inform them of what can happen with some of these diagnoses, but I would want to respect our medical colleagues there, so hear me out on that. So we assess and then we inform, all right? This is where, particularly with osteoporosis, this is where I will get their DEXA scan, And I will just say, hey, this area, this is where you have osteoporosis. This area over here, this is actually osteopenic. It's a little bit stronger, a little bit more dense than this area over here. Give them context and inform them of that particular diagnosis when we can, right? And then last but not least, we advise. What can they do about it? What can they do about it? We need to give them control to give them the ability to rewrite the script, to develop some of that self-efficacy of the confidence that they can do something about that diagnosis that they've been given. And that's going to look different for each person, right? But there's so much that we can do, especially with DJD, with osteoporosis, with congestive heart failure. These are not, not death sentences. They are not death sentences. There are a lot of things that we can do as clinicians to help maybe improve their situation, and ultimately, a lot of times, to prevent further decline. There's a lot that we can do with a lot of these 10-syllable, very scary medical diagnoses. So, we assess where they're at, their perception of their diagnosis and perception of their prognosis. Is it accurate, right? Then we inform them. We want to try and make it more accurate and realistic based on the evidence, but based also on what you've seen as well in your clinical practice, and then we want to advise. When we're able to do that with someone that has not been given a clear prognosis or context of their diagnosis, man, you've really given their life back. You've answered so many difficult questions they've been wrestling with for sometimes hours, but sometimes decades, and you can really change their life as a result of some of these conversations. All right, thank you all for listening so far. I appreciate y'all. Before I log off here, I want to mention a few of our MLA live courses coming up. So this is an awesome two-day, very practical weekend where we dive into a lot of exercise, application, prescription, but also a lot of these nuanced conversations about kind of the softer skills of implementing that fitness-forward approach in the context of geriatrics, where we may talk about diagnosis and prognosis and how we can bake that into an exercise regimen to get people to really push themselves at a level they probably haven't done before. SUMMARY Awesome weekend. So, I want you to check out, if you're around Madison, Wisconsin, we're going to be in your neck of the woods March 23rd, that weekend. Then April 5th and 6th, we've got four MOA Lives across the country going on at the same time. I'll be in Urbana, Illinois. We have one in Raleigh, North Carolina, Burlington, New Jersey, and then Gretna, Louisiana, just outside of New Orleans. All right, there's tons of other MLive courses across the country going on through the spring, summer, fall, so be sure to check on there if none of those are close to you, but we're grateful for y'all listening and watching wherever you consume this podcast. Y'all crush the rest of your Wednesday, and we'll see you soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

TODAY ON THE ROBERT SCOTT BELL SHOW: Remembering 9/11, ‘Never forget' new meaning, Stella Morabito, The Weaponization of Loneliness: How Tyrants Stoke Our Fear of Isolation to Silence, Divide, and Conquer, Birth certificate questions, New Mexico Gov tyranny, Constitutional oath violation, Richard Vague, The Paradox of Debt: A New Path to Prosperity Without Crisis, Removing parasites, Congestive heart failure, Homeopathic Hit - Rhus Tox and MORE! http://www.robertscottbell.com/natural-remedies/remembering-911-never-forget-new-meaning-stella-morabito-the-weaponization-of-loneliness-how-tyrants-stoke-our-fear-of-isolation-to-silence-divide-and-conquer-birth-certifica/ Remembering 9/11, ‘Never forget' new meaning, Stella Morabito, The Weaponization of Loneliness: How Tyrants Stoke Our Fear of Isolation to Silence, Divide, and Conquer, Birth certificate questions,... http://www.robertscottbell.com

Are you tired of suffering from debilitating headaches? Headaches can have various causes and triggers. In this episode, Marcus will unveil the top 10 homeopathic remedies that offer effective relief for acute situations. Empower yourself as a home prescriber and unlock the natural secrets to conquering headaches.Episode Highlights:02:20 - Why do people get headaches03:30 - Congestive headaches06:17 - Bursting splitting frontal headaches08:05 - Headache after a long journey10:17 - Headache with a sensation13:31 - Headaches from shock, grief, and disappointment15:18 - Headaches from grief and disappointed love17:01 - Headaches from toxicity and drugs19:52 - Headaches from overeating22:09 - Headaches extending from back to the right side and over the eye23:40 - Persistent headache after illnessAbout our host: Marcus Fernandez is the esteemed founder and principal of The Centre for Homeopathic Education (CHE). With a profound passion for natural healing and a commitment to advancing homeopathic medicine, Marcus has dedicated his career to providing comprehensive education in the field. Under his leadership, CHE has become a globally recognized institution, offering rigorous programs that combine theoretical knowledge with practical training. Marcus's patient-centered approach and holistic philosophy have earned him a reputation as a respected figure in the homeopathic community. Through his tireless efforts, Marcus continues to shape the future of homeopathy, inspiring and equipping aspiring practitioners to make a meaningful impact in healthcare.FREE GIVEAWAYSAccess free  The Home Prescriber Bookhttps://chehomeopathy.com/lp-funnel-hp-ebook-s-page/Access the free  Home Prescriber Coursehttps://www.cheonline.co.uk/the-home-prescriber-courseJoin our Home Prescriber Group on Facebook here https://www.facebook.com/groups/1403255933427640

Overview Creatinine Normal Value Range Pathophysiology Special considerations Elevations in creatinine Decreases in creatinine Nursing Points General Normal values 0.7 – 1.4 mg/dL Pathophysiology Muscle breakdown and use Creatine -> creatinine Released into bloodstream Filtered through kidneys Excreted in urine Creatinine more specific to kidney function Special considerations Green top Submitted with renal panels or chems Creatinine clearance Tests creatinine in urine Compare to serum creatinine 24 hour urine Toss first urine sample, then start On ice Increased creatinine values Renal disease Rhabdomyolysis Muscle breakdown Trauma Extreme workouts Congestive heart failure Dehydration Shock Decreased creatinine values Loss of muscle mass Muscular dystrophy Decreased protein intake Pregnancy Liver disease Assessment Assess patient's nutritional status Assess urine output Consider other causes for increase in creatinine Muscle Therapeutic Management Treat cause of renal insufficiency Dialysis vs medication Nursing Concepts Lab Values Elimination

Overview Blood Urea Nitrogen (BUN) Normal Value Range Pathophysiology Special Considerations Elevated Values Decreased Values Nursing Points General Normal value range 7-20 mg/dL Pathophysiology Protein broken into amino acids -> Ammonia Ammonia converted to urea Urea excreted via kidneys Special considerations Green top tube Submitted in multiple panels Chem 7/Chem 10 CMP Renal panel Elevated values Renal failure Congestive heart failure Myocardial infarction Dehydration Urinary obstruction Diabetes Decreased values Liver failure Overhydration Inadequate protein intake Malnutrition Pregnancy Assessment Assess patient's nutritional status Assess urine output Find primary cause for renal impairment (pre-/intra-/post-renal) Therapeutic Management Treat cause of renal insufficiency Dialysis vs medication Nursing Concepts Lab Values Elimination

Objective: Determine the significance and clinical use of  alkaline phosphatase in clinical practice   Lab Test Name: Alkaline Phosphatase – ALP   Description: Measures amount of ALP in circulation Located in several places in the body: Liver Intestines Biliary tract Bones Placenta Different isoenzymes of ALP are used to determine: Liver, bone, intestine and other cancers Bone turnover in postmenopausal women   Indications: Evaluation of ALP: Hepatobiliary disease Malignancies Bone disease Bone damage in renal patients   Normal Therapeutic Values: Normal – 40-130 U/L Collection:  Plasma separator tube   What would cause increased levels? Increased levels assessed in: Liver disease Bone disease Pregnancy Amyloidosis Lung cancer Pancreatic cancer Congestive heart failure Ulcerative colitis Hodgkin's disease Chronic renal failure Sarcoidosis   What would cause decreased levels? Hypophosphatasia (spelling error on existing outline on NURSING.com) Anemia Kwashiorkor Cretinism Hypothyroidism Zinc or magnesium deficiency Scurvy

Join Noor Subah, MD, cardiology fellow at MercyOne North Iowa Heart Center, as she explores the topic of heart failure, a condition that affects millions of Americans. Get an overview of heart failure, its prevalence and its impact on people's lives. Dr. Subah dives deep into the symptoms of heart failure and the key differences between systolic and diastolic heart failure. We also debunk some common misconceptions about this condition. We also cover: Congestive heart failure. Testing for heart failure. Treatment and medications. Reversing heart failure. Impact of heart failure on day-to-day life. Lowering your risk of heart failure. Tune in to gain valuable insights into how to manage and prevent heart failure!

U.S. cotton acreage is expected to drop this year while wheat acreage is expected to go up.  We'll get a Texas wheat crop update from John Fenderson of Westbred Wheat. Cattle numbers have come down substantially in the last couple of years.  Cotton farmers gathered in Lubbock last week to hear the latest in the cotton industry.  This is a good time of year to fertilize Texas gardens and landscapes.  Congestive heart failure in cattle in increasing.  The Texas Parks and Wildlife Department is recognizing landowners who have made efforts to conserve land, water and wildlife.

$5 Q-BANK: https://www.patreon.com/highyieldfamilymedicine Intro 0:30, Asthma 1:29, COPD 7:50, Pulmonary function tests 13:03, Interstitial lung disease 16:23, Pneumonia 21:09, Tuberculosis 27:55, Fungal lung infections 32:03, Bronchiolitis 34:14, Acute bronchitis 35:14, Stridor 36:06, Croup 36:57, Foreign body aspiration 37:30, Epiglottits 39:38, Anaphylaxis 40:12, Angioedema 41:40, Nasopharyngeal obstructions 42:39, Lung cancer 45:05, Pulmonary embolism 47:43, Pneumothorax 51:00, Pleural effusion 54:09, Congestive heart failure and pulmonary edema 57:20, Non-cardiogenic pulmonary edema 1:01:38, Pulmonary hypertension 1:05:07, Honorable mentions 1:08:04, Practice questions, 01:10:42

In this episode of the Healthy Happy Life Podcast, we take a deep dive into congestive heart failure and demystify the condition. Congestive heart failure affects millions of people around the world, and it can be a confusing and overwhelming diagnosis. We break down the causes and symptoms of heart failure, including the role of fluid build-up in the body, and explore the different types of heart failure.We also discuss the various treatment options available, including medications, lifestyle changes, and surgical procedures. This is a comprehensive look at what it means to live with congestive heart failure and the impact it can have on a person's life. My hope is that by the end of this episode, you will have a better understanding of heart failure and feel empowered with this knowledge.This video is intended to be informational only.  It is not a medical consultation, nor is it personalized medical advice.  For medical advice, please consult your physician.Be sure to download your copy of my book, Under Pressure: A Guide To Controlling High Blood Pressure!  It's packed with valuable guidelines, tips, and information that will help you to lower your blood pressure and improve your health. Click here now to get your copy today. Subscribe to my YouTube Channel so you'll never miss my latest videos.Be sure to follow me on social media✔️ YouTube✔️  Instagram✔️  Clubhouse✔️  Facebook 

Al has improved mental clarity, mood, chronic pain, sugar addiction, hunger, weight, macular degeneration, dental health, energy levels, and sleep. He is off all prescription drugs. Prior to the carnivore diet, Al also reversed type 2 diabetes on the Atkins diet. Read A'ls story: https://carnivore.diet/al-improved-dental-health-respiratory-system-carnivore-diet/ Timestamps: 00:00 Trailer 00:29 Introduction 01:14 Al's experience with mass in lung 06:22 Saliva pH 08:59 Carbohydrates break down into glucose 10:16 Diabetes diagnosis 12:34 Al's diet today 13:11 Eating chicken on the carnivore diet 14:21 Grain-finished vs grass-finished beef preference 16:21 Cognitive benefits of carnivore diet 17:53 Congestive heart failure 20:13 Being given diuretics 21:57 Chronic cardiac condition  23:42 Heart attacks and loss of cardiac function 25:34 Losing faith in the healthcare system 27:53 Fibromyalgia management on the carnivore diet 29:25 Digestive benefits of carnivore diet 31:58 Influencing friends and family 33:42 Is carnivore diet easier? 36:23 Losing desire for alcohol or smoking on the carnivore diet 39:26 Life expectancy for US males 41:11 Bug burgers  See open positions at Revero: https://jobs.lever.co/Revero/ Join Carnivore Diet for a free 30 day trial: https://carnivore.diet/join/ Book a Carnivore Coach: https://carnivore.diet/book-a-coach/ Carnivore Shirts: https://merch.carnivore.diet Subscribe to our Newsletter: https://carnivore.diet/subscribe/ . ‪#revero #shawnbaker #Carnivorediet #MeatHeals #HealthCreation   #humanfood #AnimalBased #ZeroCarb #DietCoach  #FatAdapted #Carnivore #sugarfree  ‪

Get a free nursing lab values cheat sheet at NURSING.com/63labs   Objective: Determine the significance and clinical use of  alkaline phosphatase in clinical practice   Lab Test Name: Alkaline Phosphatase – ALP   Description: Measures amount of ALP in circulation Located in several places in the body: Liver Intestines Biliary tract Bones Placenta Different isoenzymes of ALP are used to determine: Liver, bone, intestine and other cancers Bone turnover in postmenopausal women   Indications: Evaluation of ALP: Hepatobiliary disease Malignancies Bone disease Bone damage in renal patients   Normal Therapeutic Values: Normal – 40-130 U/L Collection:  Plasma separator tube   What would cause increased levels? Increased levels assessed in: Liver disease Bone disease Pregnancy Amyloidosis Lung cancer Pancreatic cancer Congestive heart failure Ulcerative colitis Hodgkin's disease Chronic renal failure Sarcoidosis   What would cause decreased levels? Hypophosphatasia (spelling error on existing outline on NURSING.com) Anemia Kwashiorkor Cretinism Hypothyroidism Zinc or magnesium deficiency Scurvy

Get a free nursing lab values cheat sheet at NURSING.com/63labs   What is the Lab Name for Albumin Lab Values? Albumin   What is the Lab Abbreviation for Albumin? alb   What is Albumin in terms of Nursing Labs? Albumin is a transport protein in the blood. It helps maintain the oncotic pressure of the blood. Albumin levels will drop if synthesis is slowed, protein intake is inadequate, or there are increased losses. Albumin has a long half life, however, so levels are not a good indicator of acute illness.   What is the Normal Range for Albumin? 3.5 – 6.0 g/dL   What are the Indications for Albumin? Evaluation of chronic illness Liver disease Nutritional status   What would cause Increased Levels of Albumin? Dehydration Hyper infusion Albumin   What would cause Decreased Levels of Albumin? Inadequate intake Liver disease Inflammation Chronic disease Losses (fistula, hemorrhage, kidney disease, burns) Over hydration Increased catabolism Congestive heart failure

The term “heart failure” makes it sound like the heart is no longer working at all and there's nothing that can be done. Actually, heart failure means that the heart isn't pumping as well as it should be. Congestive heart failure is a type of heart failure that requires seeking timely medical attention, although sometimes the two terms are used interchangeably. Your body depends on the heart's pumping action to deliver oxygen- and nutrient-rich blood to the body's cells. When the cells are nourished properly, the body can function normally. With heart failure, the weakened heart can't supply the cells with enough blood. This results in fatigue and shortness of breath and some people have coughing. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult.

Congestive heart failure affects dogs and cats in a similar way to people. Regardless…

SEASON 2 EPISODE 34 HOST: SHEILA GLAVEE GUEST: JIMMY ROENICK PwS Quote: "Some people wish it will happen, some want it to happen, others make it happen" - Michael Jordan Our guest this week is Jimmy Roenick and this is what he had to share on PODCAST with SHEILA. "15 years ago I was admitted to the Mount Carmel Cardiac center, because I couldn't breath and my legs had ballooned up to 5 times the normal size! I was a chain smoker at just over 3 packs a day! A Alcoholic, and Drug abuser , opiate pain pills my poison of choice, I was in a horrible Marriage and when I was admitted to the cardiac care center I tipped the scales at 420 lbs! My Life wasn't in a very hopeful or promising place! That day in the cardiac unit my diagnosis wasnt full of hope and promise either, Congestive heart failure, caused by pulmonary edema and a lower aeo itrtic heart aneurysm! The Doctors said not only was I so sick, I wouldn't ever work again, my chances of survival were grim and at best I would be on Oxygen 24-7 and need a literal bag of medicine to just keep me alive! I was 40 years old! My Health would improve slightly then back slide horribly when I would let my guard down basically when I would stop listening to the medical team trying to keep me alive! Soon I was back visiting all my old Demons and they remembered me well! Like best friends at a highschool reunion ,Whiskey Pain pills , and Lots of Junk food! I was already a type 2 Diabetic taking 2 different pills in a attempt to control my blood sugar, I remember one time going to the Doctor for a monthly check up after a Night of drinking Whiskey mixed with a few percocet and getting a blood sugar reading of nearly 400! If you don't know, normal sugar levels are 100 or less! I remember acting shocked telling the Doctor this makes no sense I have been eating healthy and trying to exercise by walking , my acting wasn't so good he wasn't buying my BS, I was sent home with a prescription for insulin and trulicity both self injectable medicine's! My Life was in a pretty Dark and miserable place like I said earlier not much hope! That was then , this is now! my life is so Very Different now I hardly recognize it! Drugs and Alcohol Gone! Cigarettes long Gone! Poor Health Gone! Bad Marriage Oh Yeah! Gone! This is me now! At 55, I am an Athletic Beast healthier and stronger than most 30 year olds! Best of all that Hopeless feeling Gone! My Life Now is Blessed! CONTACT FOR JIMMY ROENICK jimmyroenick@gmail.com LINKS TO CONNECT WITH PODCAST WITH SHEILA https://linktr.ee/Podcastwithsheila Please don't forget to support this mission of spreading positivity around the world by subscribing, liking and sharing our episodes. THANK YOU

15 years ago, I was admitted to the Mount Carmel Cardiac center, because I couldn't breathe, and my legs had ballooned up to 5 times their normal size! I was a chain smoker at just over 3 packs a day!An Alcoholic, and Drug abuser, opiate pain pills were my poison of choice, I was in a horrible marriage and when I was admitted to the cardiac care center, I tipped the scales at 420 lbs.! My Life wasn't in a very hopeful or promising place!That day in the cardiac unit my diagnosis wasn't full of hope and promise either, Congestive heart failure, caused by pulmonary edema and a lower aortic heart aneurysm! The Doctors said not only was I so sick I wouldn't ever work again, but my chances of survival were also grim, and at best I would be on Oxygen 24-7 and need a literal bag of medicine to just keep me alive! I was 40 years old! My Health would improve slightly then backslide horribly when I would let my guard down basically when I would stop listening to the medical team trying to keep me alive!Soon I was back visiting all my old Demons and they remembered me well! Like best friends at a high school reunion, Whiskey Pain pills, and Lots of Junk food! I was already a type 2 Diabetic taking 2 different pills to control my blood sugar, I remember one time going to the Doctor for a monthly check-up after a Night of drinking Whiskey mixed with a few Percocet and getting a blood sugar reading of nearly 400! If you don't know, normal sugar levels are 100 or less! I remember acting shocked telling the Doctor this makes no sense I have been eating healthy and trying to exercise by walking, my acting wasn't so good he wasn't buying my “Bull” I was sent home with a prescription for insulin, and Trulicity both self-injectable medicine's!My Life was in a Dark and miserable place like I said earlier not much hope!That was then, this is now! my life is so Very Different now I hardly recognize it!Drugs and Alcohol Gone!Cigarettes are long Gone!Poor Health Gone!Bad Marriage Oh Yeah! Gone!This is me now! At 55 I am an Athletic Beast healthier and stronger than most 30-year-old folks!Best of all that Hopeless feeling is Gone!My Life Now is Blessed!My name is Jimmy RoenickI want to share some of the Steps Truths and wisdom I have found, mostly the hard way on my journey not only to self-improvement but for my very Survival!

Congestive heart failure affects dogs and cats in a similar way to people. Regardless…

Vidcast:  https://youtu.be/00KdCNwbiec   Consistently satisfying sleep may reduce your chances of dying from a worn out heart by 42%.  Epidemiologists at Tulane University followed a huge UK population of 408,802 patients over a 10 year period looking for correlations between sleep patterns and the development of congestive heart failure.   Over those 10 years, 5221 developed heart failure.  This disease incidence was 34% lower in those with no daytime sleepiness, 17% lower in those without insomnia, 12% lower for those sleeping 7 to 8 hours a day, and 8% reduced for early risers.   Congestive heart failure can be deadlier than cancer.  Its only cure is a heart transplant.  Protect your ticker by sleeping soundly and exercising consistently.   https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.050792   #sleep #heartfailure  

Are you looking for an awesome cheatsheet that reviews the facts to know about Lymphedema and Lipedema for the NPTE? Look no further: https://www.kylericeprep.com/Lymph Sammie presents with an enlargement in her bilateral lower extremities; however, no symptoms are present distal to the ankle. The patient reports that legs are tender to touch and easily bruise. Which of the following conditions is the MOST likely present? A. Fibromyalgia B. Lipedema C. Lymphedema D. Congestive heart failure Did you get this question wrong?! If you were stuck between two answers and selected the wrong one, then you need to visit www.NPTEPASS.com, to learn about the #1 solution to STOP getting stuck. --- Support this podcast: https://anchor.fm/thepthustle/support

September 2020Operational AnnouncementsMessage from William Oneal the director of operationsQA/QI UpdatesEmployee Spotlight (Greta)Lung sounds, focusing on Congestive vs Constrictive pathology, FAQ: Hidden Trauma, Killer Bleeds FAQ, permissive hypotension and MAP scores

Congestive heart failure, or CHF, is a pretty common problem in dogs. The heart…

Congestive heart failure, or CHF, is a pretty common problem in dogs. The heart…

Congestive heart failure is common and can have devastating effects on patients' quality of life. Until recently few treatments were available, but that has changed. Congestive heart failure management has substantially improved. Hutter Family Professor of Medicine at Harvard Medical School James L. Januzzi Jr, MD, reviews the diagnosis and treatment of congestive heart failure. Related Article(s): Heart Failure With Reduced Ejection Fraction

In today's VETgirl online veterinary continuing education podcast, we review the cardiorenal and endocrine effects of synthetic canine BNP1-32 in dogs. If you're using pro-BNP to help differentiate pulmonary versus cardiac disease, you need to pay attention. Congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD) in dogs is relatively common and yet generally carries a poor long-term prognosis with current standard medical therapies [e.g., diuretics, angiotensin converting enzyme (ACE) inhibitors, and pimobendan]. Additional therapies remain a topic of investigation. The body's natural diuretic system revolves around the natriuretic peptides, including brain natriuretic peptide (BNP1-32). BNP1-32 causes diuresis, natriuresis, vasodilation, and inhibits the renin-angiotensin-aldosterone system (RAAS) via binding to natriuretic peptide receptor A (NPR-A) and greater production of cyclic guanosine monophosphate (cGMP).

In today's VETgirl online veterinary continuing education podcast, we review the cardiorenal and endocrine effects of synthetic canine BNP1-32 in dogs. If you're using pro-BNP to help differentiate pulmonary versus cardiac disease, you need to pay attention. Congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD) in dogs is relatively common and yet generally carries a poor long-term prognosis with current standard medical therapies [e.g., diuretics, angiotensin converting enzyme (ACE) inhibitors, and pimobendan]. Additional therapies remain a topic of investigation. The body's natural diuretic system revolves around the natriuretic peptides, including brain natriuretic peptide (BNP1-32). BNP1-32 causes diuresis, natriuresis, vasodilation, and inhibits the renin-angiotensin-aldosterone system (RAAS) via binding to natriuretic peptide receptor A (NPR-A) and greater production of cyclic guanosine monophosphate (cGMP).

In this VETgirl online veterinary CE podcast, we review lung utlrasonography use in coughing dogs. Coughing is a common clinical sign associated with a variety of respiratory etiologies in dogs, including dynamic airway collapse, bronchitis, pneumonia, heartworm disease, and neoplasia. Congestive heart failure (CHF) is commonly reported to be associated with coughing in dogs, although there is much debate as to whether this clinical sign could actually be directly attributable to pulmonary edema (which is generally interstitial or alveolar in location) given the distribution of cough receptors primarily in the large airways. It is possible that coughing in dogs with congestive heart failure is due to cardiogenic airway compression, or concurrent primary respiratory disease.

Congratulations SpaceX for their sucessful manned Crew Dragon mission to the ISS.Gentlemen, we can rebuild him. We have the technology. It's not as great as Steve Austin's bionic eye from the Six Million Dollar Man, but it's pretty cool. Scientists have made a bionic eyeball inspired by the actual working of the human eye. This cool tech isn't ready to go in a human head yet, but when it is we can only hope it's cheaper than Steve's eye.Robots are here, and they're coming for your jobs. Now even actors don't have job security. Miquela is a CGI replacement for advertising models is now leaving Instagram and breaking into acting. Which raises a concerning question. How long until they replace the podcasters?Football manager is one of the most popular management simulators. Recently they've come under fire from Manchester United for copyright issues. Despite letting it slide for almost 30 years, Man U have decided it's time to sue.This week in gaming DJ jumps at shadows in Alan Wake and Professor goes full Groundhog Day in Into the Breach.Bionic eyes giving sight- https://bgr.com/2020/05/24/bionic-eye-human-prosthetics/- https://www.nature.com/articles/s41586-020-2285-xThe Rise of Virtual actresses: Miquela- https://www.theguardian.com/film/2020/may/25/are-virtual-actors-about-to-put-hollywoods-humans-out-of-work-miquelaMan United suing Football Manager- https://www.theguardian.com/football/2020/may/22/manchester-united-sues-football-manager-makers-over-use-of-nameGames PlayedProfessor– Into The Breach – https://store.steampowered.com/app/590380/Into_the_Breach/Rating: 4/5DJ– Alan Wake – https://store.steampowered.com/app/108710/Alan_Wake/Rating: 4/5Other topics discussedSailor Moon Redraw : Jar Jar Binks edition- https://knowyourmeme.com/photos/1854154-sailor-moon-redrawCochlear Implant (A cochlear implant (CI) is a surgically implanted neuroprosthetic device to provide a person with moderate to profound sensorineural hearing loss a modified sense of sound. CI bypasses the normal acoustic hearing process to replace it with electric signals which directly stimulate the auditory nerve.)- https://en.wikipedia.org/wiki/Cochlear_implantWhy some people turned down a 'medical miracle' and decided to stay deaf- https://www.insider.com/why-deaf-people-turn-down-cochlear-implants-2016-12Lil Miquela Instagram profile- https://www.instagram.com/lilmiquela/James Dean will be digitally resurrected for a new film. Is it movie magic or dark arts?- https://www.washingtonpost.com/arts-entertainment/2019/11/07/james-dean-will-be-digitally-resurrected-new-film-is-it-movie-magic-or-dark-arts/Peter Cushing CGI resurrection in Star Wars Rogue One- https://www.theguardian.com/film/filmblog/2016/dec/16/rogue-one-star-wars-cgi-resurrection-peter-cushingThe Drip: having a large amount of swag typically used in the context of clothing- https://www.urbandictionary.com/define.php?term=the%20dripAdobe Voco (Adobe Voco will be an audio editing and generating prototype software by Adobe that enables novel editing and generation of audio.)- https://en.wikipedia.org/wiki/Adobe_VocoDetroit: Become Human (Detroit: Become Human is a 2018 adventure game developed by Quantic Dream and published by Sony Interactive Entertainment.)- https://en.wikipedia.org/wiki/Detroit:_Become_HumanSouth Park – They Took Our Jobs- https://www.youtube.com/watch?v=N-kgb1QtSnUFootball Manager ((also known as Worldwide Soccer Manager in North America from 2004 to 2008) is a series of football management simulation video games developed by Sports Interactive and published by Sega.)- https://en.wikipedia.org/wiki/Football_ManagerP90 (The P90 or ES C90, as it was previously known, is a submachine gun featured in the Counter-Strike series. They are based off FN P90.)- https://counterstrike.fandom.com/wiki/P90- https://en.wikipedia.org/wiki/FN_P90Generic Trademark (A generic trademark, also known as a genericised trademark or proprietary eponym, is a trademark or brand name that, because of its popularity or significance, has become the generic name for, or synonymous with, a general class of product or service, usually against the intentions of the trademark's holder.)- https://en.wikipedia.org/wiki/Generic_trademarkAn introduction to YouTube Copyright in United Kingdom- https://www.bl.uk/business-and-ip-centre/articles/an-introduction-to-youtube-copyrightPro Evo Soccer (More experienced gamers often use "patches", editing the actual game code and modifying the graphical content to include accurate kits for unlicensed teams, new stadiums, and footballs from Nike, Inc., Puma,Umbro and Mitre, as well as more Adidas balls. Most patches also contain licensed referee kits from FIFA and the official logos of the various European leagues.)- https://en.wikipedia.org/wiki/Pro_Evolution_Soccer#GameplayQuantum Break (From Remedy Entertainment, the masters of cinematic action games, comes Quantum Break, a time-amplified suspenseful blockbuster. The Quantum Break experience is part game, part live action show—where decisions in one dramatically affect the other.)- https://store.steampowered.com/app/474960/Quantum_Break/Control (After a secretive agency in New York is invaded by an otherworldly threat, you become the new Director struggling to regain Control in this supernatural 3rd person action-adventure from Remedy Entertainment and 505 Games)- https://store.steampowered.com/app/870780/Control/Elvis the Alien (Elvis (real name: Aelphaeis Mangarae) is an alien from the Maian race. He is a 'Protector' (bodyguard) for the Maian ambassador who travels to Earth at Daniel Carrington's request.)- https://perfectdark.fandom.com/wiki/Elvis‘Labyrinth’ Sequel: New Director revealed- https://deadline.com/2020/05/labyrinth-sequel-scott-derrickson-director-maggie-levin-write-script-doctor-strange-1202943188/‘Labyrinth’ Sequel idea : Jennifer Connelly’s Sarah grows up to be the Goblin King.- https://twitter.com/kaytaylorrea/status/1265493556988387328Love, Stranger (TNC Podcast)- https://thatsnotcanon.com/lovestrangerpodcastShout Outs22 May 2020 – Pac-Man turns 40 - https://www.digitaltrends.com/gaming/pac-man-turns-40-seven-secrets/?utm_source=reddit&utm_medium=webThe yellow dude with the insatiable appetite for power pellets is turning 40, having racked up everything from sales records to a breakfast cereal. And there is no gaming icon who is more recognizable — or who has done more to bring gaming to the front of the collective cultural mind. Pac-Man’s raison d’être is chomping dots. And Iwatani says food was central to the design of the character. As he thought about how to design a game that would attract female players, he thought about how much his wife loved to eat dessert. That verb — eat — began the thought process that led to the game. The original name for Pac-Man in Japan was Puck-Man. Midway Games, which distributed the title in the U.S., changed it to Pac-Man so vandals wouldn’t cut out part of the P to create something that didn’t fit in a family-friendly arcade. The name Puck came from the Japanese expression “puck puck” which loosely translates to “munch munch.” When Pac-Man made his debut on May 22, 1980, video games were largely considered a boy’s club. Creator Toru Iwatani, in a panel presentation at GDC 2011, said he wanted to create a game to change that. “The reason I created Pac-Man was because we wanted to attract female gamers,” he says. “People had to go to the arcade center to play games. That was a playground for boys. It was dirty and smelly. So, we wanted to include female players, so it would become cleaner and brighter.”22 May 2020 – Perfect Dark turns 20 - https://comicbook.com/gaming/news/perfect-dark-20-years-old-fans-want-new-game/Rare Ltd's Nintendo 64 classic Perfect Dark turned 20 years old. Released on May 22nd, 2000, the game was Rare's follow-up to GoldenEye 007. Rare originally intended to make another Bond game, but was outbid by Electronic Arts. Instead, Rare decided to develop their own franchise, introducing the world to protagonist Joanna Dark. The resulting game was a massive success, and a prequel was released on Xbox 360. Although critics widely praised its graphics,artificial intelligence, and number of multiplayer options, they frequently criticised its occasional frame rate drops. The game received the BAFTA Interactive Entertainment Moving Images Award for 2000 and theGolden Satellite Award for Best Interactive Product in 2001. The game is occasionally cited as one of the greatest video games of all time. A remaster, also titled Perfect Dark, featuring enhanced graphics and online multiplayer, was released in 2010.22 May 2020 – Berlin WW2 bombing survivor Saturn the alligator dies in Moscow Zoo - https://www.bbc.com/news/amp/world-europe-52784240After hatching in Mississippi, Saturn was soon brought to Germany, residing at the Berlin Zoological Garden. It was here that his association with Adolf Hitler originated, as Hitler reportedly enjoyed visiting the zoo and especially liked the alligator. It was from this period that the popular rumor emerged that Saturn was Adolf Hitler's "pet". This may have originated with the author Boris Akunin, a Russian writer who hypothesized in an article that this may have been the case. In actuality, he was not Hitler's personal pet, as he was on public display at the zoo. However, some sources report his display at the zoo as being part of a personal menagerie of Hitler's, while Dmitry Vasilyev, a veterinarian at the Moscow Zoo, contends that while Saturn was not Hitler's pet, the two certainly came into contact, as Hitler was known to have visited the Berlin Zoo on occasion. During World War II, much of the Berlin Zoo was destroyed. Of the zoo's 16,000 animals, only 96 survived. When the aquarium building was destroyed by a bomb on 23 November 1943, 20 to 30 alligators and crocodiles were killed. Press reports documented that the streets near the aquarium were littered with alligator andcrocodile corpses, but that some, including Saturn, had survived and were wandering through the city in search of food. Saturn was discovered by British soldiers three years later. The British then gave the alligator to the Soviets in 1946. He lived at the Moscow Zoo until 22 May 2020, when he died of old age.23 May 2020 – Lost series finale turns 10 - https://observer.com/2020/05/lost-series-finale-the-end-jean-higgins-jeff-pinkner-damon-lindelof/The 10-year anniversary of its series finale, “The End,” was a grippingly divisive chapter in modern pop culture history. Although the final strokes of its conclusion were not set it stone when that pilot first aired, consideration to the endgame had always been brewing. To unpack how the series navigated the minefield of fan expectations while battling the network for direction, Lost‘s conclusion was rockier than most fans at home realized. From the very beginning of the show’s development, the Lost title was meant to have a double meaning. Yes, the characters themselves were physically lost in the world on this mysterious island. But, more crucially, they were each spiritually lost in their own lives. The show always tried to remain true to the characters and, by the end, to some spiritual outlook about life and our purpose. It also edged open new doors into its story even as the show approached its very end. Lost often felt artistically bold, but that didn’t come without drawbacks. “The End” polarized audiences deeply. Several critics named it among the worst series finales of all time, while others called it an underrated masterpiece. Regardless of the ongoing debate that still ensnares “The End,” Lost as a whole remains one of the most acclaimed television shows in history.Remembrances25 May 1939 – Sir Frank Watson Dyson - https://en.wikipedia.org/wiki/Frank_Watson_DysonEnglish astronomer and Astronomer Royal who is remembered today largely for introducing time signals ("pips") from Greenwich, England, and for the role he played in proving Einstein's theory of general relativity. In 1928, he introduced in the Observatory a new free-pendulum clock, the most accurate clock available at that time and organised the regular wireless transmission from the GPO wireless station at Rugby of Greenwich Mean Time. He also, in 1924, introduced the distribution of the "six pips" via the BBC. Dyson was noted for his study of solar eclipses and was an authority on the spectrum of the corona and on the chromosphere. He is credited with organising expeditions to observe the 1919 solar eclipse at Brazil and Principe, which he somewhat optimistically began preparing for prior to the Armistice of 11 November 1918. Dyson presented his observations of the solar eclipse of May 29, 1919 to a joint meeting of the Royal Society and Royal Astronomical Society on 6 November 1919. The observations confirmed Albert Einstein's theory of the effect of gravity on light which until that time had been received with some scepticism by the scientific community. Dyson died on board a ship at the age of 71 while travelling from Australia to England in 1939 and was buried at sea.25 May 1981 – Ruby Payne-Scott - https://en.wikipedia.org/wiki/Ruby_Payne-ScottRuby Violet Payne-Scott, Australian pioneer in radiophysics and radio astronomy, and was the first female radio astronomer. On 18 August 1941, Payne-Scott joined the Radiophysics Laboratory of the Australian government's Commonwealth Scientific and Industrial Research Organisation (CSIRO). During World War II, she was engaged in top secret work investigating radar technology, becoming Australia's expert on the detection of aircraft using Plan Position Indicator (PPI) displays. After the war, in 1948, she published a comprehensive report on factors affecting visibility on PPI displays. She also made important contributions to prototype radar systems operating in the 25cm microwave band, achieving significant improvements. Payne-Scott's expertise as both a physicist and an electrical engineer distinguished her among her colleagues, most of whom lacked a formal physics education. From 1946 to 1951, Payne-Scott focused on these 'burst' radio emissions from the sun, and is credited with discovering Type I and III bursts, and with gathering data that helped characterise Types II and IV. As part of this work, together with Alec Little, she designed and built a new 'swept-lobe' interferometer that could draw a map of solar radio emission strength and polarization once every second, and would automatically record to a movie camera whenever emissions reached a certain intensity. In 2018, the New York Times wrote a belated obituary for her, detailing how her work helped lay the foundation for a new field of science called radio astronomy. In 2008, CSIRO acknowledged Payne-Scott's contribution to science, and established the Payne-Scott Award, intended "for researchers returning from family-related career breaks". She died from complications of dementia at the age of 68 in Mortdale,New South Wales.25 May 1981 – Fredric Warburg - https://en.wikipedia.org/wiki/Fredric_WarburgFredric John Warburg, British publisher best known for his association with the author George Orwell. During a career spanning a large part of the 20th century and ending in 1971 Warburg published Orwell's Animal Farm as well as Nineteen Eighty-Four, and works by other leading figures such asThomas Mann and Franz Kafka. Other notable publications included The Third Eye by Lobsang Rampa, Pierre Boulle's The Bridge over the River Kwai, Adolf Hitler's Mein Kampf and William Shirer's The Rise and Fall of the Third Reich. Warburg started his publishing career in 1922, as an apprentice at Routledge & Sons, where he came under the tutelage of William Swan Stallybrass, a man he regarded as "the greatest scholar-publisher of his day". After Stallybrass died in 1931 Warburg became increasingly dissatisfied with Routledge and in 1935 he was dismissed. Later that year he and Roger Senhouse purchased the publishing firm of Martin Secker, which had gone into receivership, and renamed it Secker & Warburg. The firm became renowned for its independent left-wing position, being both anti-fascist and anti-Communist, which put it at loggerheads with many intellectuals of the time. He died from Congestive heart failure at the age of 82 in London.Famous Birthdays25 May 1865 – Pieter Zeeman - https://en.wikipedia.org/wiki/Pieter_ZeemanPieter Zeeman, Dutch physicist who shared the 1902 Nobel Prize in Physics with Hendrik Lorentz for his discovery of the Zeeman effect. In 1896, shortly before moving from Leiden to Amsterdam, he measured the splitting of spectral lines by a strong magnetic field, a discovery now known as the Zeeman effect, for which he won the 1902 Nobel Prize in Physics. This research involved an investigation of the effect of magnetic fields on a light source. He discovered that a spectral line is split into several components in the presence of a magnetic field. The importance of Zeeman's discovery soon became apparent. It confirmed Hendrik Lorentz’s prediction about the polarization of light emitted in the presence of a magnetic field. Thanks to Zeeman's work it became clear that the oscillating particles that according to Lorentz were the source of light emission were negatively charged, and were a thousandfold lighter than the hydrogen atom. This conclusion was reached well before Thomson's discovery of the electron. The Zeeman effect thus became an important tool for elucidating the structure of the atom. He was born in Zonnemaire.25 May 1889 – Igor Sikorsky - https://en.wikipedia.org/wiki/Igor_SikorskyIgor Ivanovich Sikorsky, Russian–American aviation pioneer in both helicopters and fixed-wing aircraft. His first success came with the S-2, the second aircraft of his design and construction. His fifth airplane, the S-5, won him national recognition as well as F.A.I. license number 64. HisS-6-A received the highest award at the 1912 Moscow Aviation Exhibition, and in the fall of that year the aircraft won for its young designer, builder and pilot first prize in the military competition at Saint Petersburg. After immigrating to the United States in 1919, Sikorsky founded the Sikorsky Aircraft Corporation in 1923, and developed the first of Pan American Airways' ocean-crossing flying boats in the 1930s. In 1939, Sikorsky designed and flew the Vought-Sikorsky VS-300, the first viable American helicopter, which pioneered the rotor configuration used by most helicopters today. Sikorsky modified the design into the Sikorsky R-4, which became the world's first mass-produced helicopter in 1942. He was born in Kiev.25 May 1944 – Frank Oz - https://en.wikipedia.org/wiki/Frank_OzFrank Richard Oznowicz, American actor, puppeteer, director and producer. He began his career as a puppeteer, performing the Muppet characters of Miss Piggy, Fozzie Bear, Animal, and Sam Eagle in The Muppet Show; and Cookie Monster, Bert, and Grover in Sesame Street. He is also known for the role of Yoda in the Star Wars series, providing the voice for the character in several films and television series. His work as a director includes Little Shop of Horrors , Dirty Rotten Scoundrels, The Score and Death at a Funeral . Oz has performed as a Muppet performer in over 75 productions including Labyrinth, video releases, and television specials, as well as countless other public appearances, episodes of Sesame Street, and other Jim Henson series. His puppetry work spans from 1963 to the present, although he semi-retired from performing his Muppets characters in 2001. Oz is also known as the performer of Jedi Master Yoda from George Lucas' Star Wars series. Jim Henson had originally been contacted by Lucas about possibly performing Yoda. Henson was preoccupied and instead suggested Oz to be assigned as chief puppeteer of the character, as well as a creative consultant. Oz performed the puppet and provided the voice for Yoda in The Empire Strikes Back , Return of the Jedi , Star Wars: Episode I – The Phantom Menace , and Star Wars: The Last Jedi. Oz had a great deal of creative input on the character and was himself responsible for creating the character's trademark syntax. He was born in Hereford,Herefordshire.Events of Interest25 May 1895 – Oscar Wilde arrested for indecency - https://www.history.com/this-day-in-history/oscar-wilde-is-sent-to-prison-for-indecencyWriter Oscar Wilde is sent to prison after being convicted of sodomy. The famed writer of Dorian Gray and The Importance of Being Earnest brought attention to his private life in a feud with Sir John Sholto Douglas, whose son was intimately involved with Wilde. Homosexuality was a criminal offense and serious societal taboo at this time in Britain. Wilde had gone back and forth between hiding his sexual orientation and attempting to gain some measure of public acceptance. At Wilde’s first criminal trial, he was cross-examined extensively on the “love that dare not speak its name.” Wilde managed to secure a mistrial when a lone juror refused to vote to convict. The second trial began on May 21. Although many of the potential witnesses refused to betray Wilde by testifying, he was convicted. The judge remarked at his sentencing, “It is the worst case I have ever tried. I shall pass the severest sentence that the law allows. In my judgment it is totally inadequate for such a case as this. The sentence of the Court is that you be imprisoned and kept to hard labor for two years.26 May 1897 – Dracula goes to sale in London - https://www.history.com/this-day-in-history/dracula-goes-on-sale-in-londonThe first copies of the classic vampire novel Dracula, by Irish writer Bram Stoker, appear in London bookshops on May 26, 1897. It earned him literary fame and became known as a masterpiece of Victorian-era Gothic literature. Written in the form of diaries and journals of its main characters, Dracula is the story of a vampire who makes his way from Transylvania—a region of Eastern Europe now in Romania—to Yorkshire, England, and preys on innocents there to get the blood he needs to live. Stoker had originally named the vampire “Count Wampyr.” He found the name Dracula in a book on Wallachia and Moldavia written by retired diplomat William Wilkinson, which he borrowed from a Yorkshire public library during his family’s vacations there. Vampires–who left their burial places at night to drink the blood of humans–were popular figures in folk tales from ancient times, but Stoker’s novel catapulted them into the mainstream of 20th-century literature. Late 20th-century examples of the vampire craze include the bestselling novels of American writer Anne Rice and the cult hit TV series Buffy the Vampire Slayer. The 21st century saw the wildly popularTwilight film and book series.25 May 2010 – Fireball was released in Italy-https://www.scifihistory.net/may-25.html- https://www.betafilm.com/en/product/d/fireball.html- https://horrornews.net/559/film-review-fireball-2009/On this day in 2010 (in Italy), Fireball burned up the charts of the home video marketplace. The feature starred Ian Somerhalder and Lexa Doig, and here's the plot summary : Tyler “The Fuse” Draven is a former pro linebacker who has finally hit rock bottom. Draven has been caught using steroids and is no longer allowed to play pro football; if that’s not enough he has a news reporter constantly harassing him waving a camera in his face. After attacking the news reporter Tyler is sent to prison and one would think that would be the end to this mans story however a fire erupts in the prison and melds with the steroids in Draven’s blood stream causing him to suddenly be able to control heat and fire, now somebody is gonna pay!IntroArtist – Goblins from MarsSong Title – Super Mario - Overworld Theme (GFM Trap Remix)Song Link - https://www.youtube.com/watch?v=-GNMe6kF0j0&index=4&list=PLHmTsVREU3Ar1AJWkimkl6Pux3R5PB-QJFollow us onFacebook- Page - https://www.facebook.com/NerdsAmalgamated/- Group - https://www.facebook.com/groups/440485136816406/Twitter - https://twitter.com/NAmalgamatedSpotify - https://open.spotify.com/show/6Nux69rftdBeeEXwD8GXrSiTunes - https://itunes.apple.com/au/podcast/top-shelf-nerds/id1347661094RSS - http://www.thatsnotcanonproductions.com/topshelfnerdspodcast?format=rssInstagram - https://www.instagram.com/nerds_amalgamated/General EnquiriesEmail - Nerds.Amalgamated@gmail.comRate & Review us on Podchaser - https://www.podchaser.com/podcasts/nerds-amalgamated-623195

In this VETgirl online veterinary CE podcast, we review lung utlrasonography use in coughing dogs. Coughing is a common clinical sign associated with a variety of respiratory etiologies in dogs, including dynamic airway collapse, bronchitis, pneumonia, heartworm disease, and neoplasia. Congestive heart failure (CHF) is commonly reported to be associated with coughing in dogs, although there is much debate as to whether this clinical sign could actually be directly attributable to pulmonary edema (which is generally interstitial or alveolar in location) given the distribution of cough receptors primarily in the large airways. It is possible that coughing in dogs with congestive heart failure is due to cardiogenic airway compression, or concurrent primary respiratory disease.

In this episode, we talk about congestive heart failure! From patient assessment to treatment of congestive heart failure exacerbations, we've got it covered. Ever wonder how we choose to dose diuretics? Look no further! Congestive heart failure made easy just for you. 

Dr. Aaron Frosham is the guest for this episode of Mountain Land Pelvic Health Podcast. Dr. Frodsham received his bachelors degree from Brigham Young University, attended medical school a the University of Vermont College of Medicine followed by his residency in radiology at Yale University, Hospital of St. Raphael and concluded with his internship in vascular and interventional radiology at Warren Alpert Medical School of Brown University. During this podcast,…

Thomas Cowan, MD shares compelling evidence that ‘charged water’ drives peripheral circulation and the heart’s job is to actually slow this down. This discussion is super fascinating (and may challange your biases).  ➢This episode is brought to you by Best Blue Light Blocking Glasses Avail BluBlox! http://bit.ly/32IuFXA *Their new REMedy sleep mask is amazing! Book: Human Heart, Cosmic Heart by Cowan https://amzn.to/2Md2j0O Cancer and new biology of water: https://amzn.to/2IpNVBi 04:38 Filtering your water leaves water unstructured and demineralized. It needs to be remineralized and placed in a vortex to be restructured. 08:05 In the 1920s Rudolph Steiner said that the heart does not pump the blood. 12:15 Blood goes slower as it proceeds through the arteries until it gets to the capillaries where it stops, shimmies and gets going again. 16:07 Your heart does not have the force you would need to push blood through your blood vessels. 20:07 The motive for movement is at the level of the capillaries. 03:39 There are 4 phases of water. The water in cells is in a gel phase. 24:46 The gel layer of your cells is always negatively charged, which means it has separated the charges. There are positive charges in the water inside the cell. The positive ions/protons repel each other and start the water flowing. 26:50 Water cannot go up a tube more than 33 feet before the pressure of the weight of the water is too heavy. 27:30 Xylem tubes in plants are lined with hydrophilic proteins that separate the charges, shifting fluid using the same method as your body uses to move blood up your veins. 28:20 A vein is a thin walled tube with hydrophilic surfaces that creates a gel layer. 29:12 Muscle contraction in the legs is not a primary mover, though it is a contributor. 30:24 Your heart stops the blood. Incoming flow hits the cavity of the left ventricle which contains a valve. The heart holds the blood back a few milliseconds, converts the laminar flow into a vortex. 32:12 Your heart participates in the movement of the blood, but not because of a pushing of the walls. Movement comes from the movement of the blood. 33:07 The heart is like a hydraulic ram. 33:45 The efficiency of the hydraulic ram is about 70%. Only 70% comes out each cycle. A pump must always work at 100% efficiency. The efficiency of the heart is 70%. 35:06 Congestive heart failure is when the blood stops moving forward and only a small percentage comes out. 35:17 Since the heart is not pumping, the problem in congestive heart failure is insufficient flow. 36:22 Hypertension and hypertrophy are not the disease, they are the compensation response and therapy. 37:50 Flow is increased with sunlight, direct contact with the earth, good diet, and increased exercise. 38:50 Earthing/grounding causes you to absorb negative ions, a sort of energy source. 41:44 Our ability to make gels is destabilized by the insults of modern life. 42:54 The vortex of blood created by your heart is like a tornado. Vortex is the creative form of life. 44:12 We ignore life force in today’s science. 50:41 Any plant takes water and structures it. 53:55 The structuring of water occurs naturally through the interaction of blood vessels and the natural energy sources that are freely available to us. 54:48 The flow through a hydrophilic tube increases when you place your hand upon it. 01:04:11 The traditional way to eat vegetables is wild and perennial. 01:16:42 Dr. Cowan’s favorite morning activity is going right out to the garden and spending hours there. 01:18:18 Dr. Cowan’s desert island nutrient is eggs. 01:18:58 Dr. Cowan’s elevator pitch is that any form of coercion (ie: going to school, paying taxes, getting vaccinated) is the opposite of freedom.

PRITI NYC is one of the best and greatest Nail Polish Company in New York, they have various varieties of nail polish. If you want to buy Nail Polish and any other product then you can contact with PRITINYC’s official website. So, now we are going to discuss about “what your nails say about your health” Pale Nails Very pale nails can sometimes be a sign of serious illness, such as: 1. Anemia 2. Congestive heart failure 3. Liver disease 4. Malnutrition White Nails If the nails are generally white with darker rims, this can show liver problems, such as hepatitis. In this image, you can see the fingers are also jaundiced, one more sign of liver distress. Yellow Nails One of the most common causes of yellow nails is a fungal infection. As the infection worsens, the nail bed may retract, and nails may thicken and crumble. In rare cases, yellow nails can indicate a more serious condition such as severe thyroid disease, lung disease, diabetes or psoriasis. Bluish Nails Nails with a bluish tint can mean the body isn't getting enough oxygen. This could indicate a lung problem, such as emphysema. Some heart problems can be associated with bluish nails. Rippled Nails If the nail surface is rippled or pitted, this may be an early sign of psoriasis or inflammatory arthritis. Discoloration of the nail is common; the skin under the nail can seem reddish-brown.

Lead administrator and physician from Bellin Health share their journey of navigating the corridor from volume to value-based healthcare and address these important questions:•What does volume-to-value mean for you?•How are physicians reacting to this new population health model?•Why have you decided to focus on understanding cost of care?•From a population health perspective, what focus areas are you targeting for 2019?Andrea Werner, MSW is Senior Vice President for Cardiovascular and Pulmonology; Neurosciences, Orthopedics, and Sports Medicine; and Pathology and Radiology for Bellin Health in Green Bay, Wisconsin. James Rider, MD is the Director of Cardiovascular Research, Nuclear Cardiology, and the CHF program for Bellin Health in Green Bay, Wisconsin. Lori Walsh, MHSA is Vice President - Membership and Senior Consultant for MedAxiom.

Dan Solloway explains how to handle congestive heart failureThis show is broadcast live on Tuesday's at 1PM ET on W4HC - Health Cafe Live Network (www.w4hc.com) part of Talk 4 Radio (http://www.talk4radio.com/) on the Talk 4 Media Network (http://www.talk4media.com/).

Kelsey might be off for the day.. but that doesn't mean the guys can't go through her diary!!

An echocardiogram technician told me I have a beautiful heart and that got me going. What makes for good heart health? What role do genetics, lifestyle, and environment play? Dr. Erica Pitsch talks about the Framingham Heart Study, John talks about congestive heart failure and Mended Hearts, and Saurabh shares how yoga and meditation help his stress level and coping with myotonic muscular dystrophy. 

Podcast summary of articles from the November 2018 edition of Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include upper airway obstruction, bedside skin ultrasound in pediatric patients, syncope, hypercalcemia, ketamine for psychiatric agitation, and board review on congestive heart failure plus bonus material on rheumatoid arthritis.  Guest speaker is Dr. Daniel Kinker.

Hedda Martin has congestive heart failure and the hospital where she is to have the transplant told her to set up an online fundraiser to pay for the operation. When the story hit the internet, people expressed outrage at the transplant center. In this episode of Consumer Tech Update, Kim looks at the big picture of what these types of stories really mean once they go viral.

Hedda Martin has congestive heart failure and the hospital where she is to have the transplant told her to set up an online fundraiser to pay for the operation. When the story hit the internet, people expressed outrage at the transplant center. In this episode of Consumer Tech Update, Kim looks at the big picture of what these types of stories really mean once they go viral.

Dr Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Did you know that despite being one of the wealthiest nations in the world, the United States population has a shorter life expectancy compared to almost all other high-income countries in the world? Well, stay tuned to learn what Americans could do to narrow the life expectancy gap between the United States and other industrialized nations. Coming right up after these summaries.                                 Are microRNAs involved in nitrate tolerance? Well, the first original paper this week provides some answers. This is from co-corresponding authors Dr Bai and Zhang from Central South University in Changsha, China. Nitrate tolerance develops when there's dysfunction of the prostaglandin I2 synthase and prostaglandin I2 deficiency. These authors hypothesize that prostaglandin I2 synthase gene expression may be regulated by a microRNA-dependent mechanism in endothelial cells. They induce nitrovasodilator resistance by nitroglycerin infusion in Apoe deficient mice and studied endothelial function in both the mouse models as well as human umbilical vein endothelial cells. They found that nitric oxide donors induced atopic expression of microRNA 199a/b in endothelial cells, which was required for the nitrovasodilator resistance via repression of prostaglandin I2 synthase gene expression. Targeting this axis effectively improved nitrate tolerance. Thus, the atopic expression of microRNA 199 in endothelial cells induced by nitric oxide may explain prostaglandin I2 synthase deficiency in the progression of nitric tolerance. Thus, microRNA 199a/b may be a novel target for the treatment of nitric tolerance.                                 What are the long-term outcomes of childhood left ventricular noncompaction cardiomyopathy? Well, the next paper presents results from the National Population-Based Study in Australia. First author, Dr Shi, corresponding author, Dr Weintraub, from Royal Children's Hospital in Melbourne, looked at the National Australian Childhood Cardiomyopathy Study, which includes all children in Australia with primary cardiomyopathy diagnosed at less than 10 years of age between 1987 and 1996. Outcomes for left ventricular noncompaction patients with a dilated phenotype will compare to those with a dilated cardiomyopathy.                                 There were 29 patients with left ventricular noncompaction with a mean annual incidence of newly diagnosed cases of 0.11 per hundredth thousand at risks persons.                                 Congestive heart failure was initial symptom in 83%, and 93% had a dilated phenotype. The median age at diagnosis was 0.3 years of age. Freedom from death or transplantation was 48% at 10 years after diagnosis, and 45% at 15 years. Using propensity score inverse probability of treatment-weighted Cox regression, the authors found evidence that left ventricular noncompaction with a dilated phenotype was associated with a more than two-fold greater risk of death or transplantation.                                 The next paper reports the first application of multiomics and network medicine to calcific aortic valve disease. Co-first authors Dr Schlotter and Halu, corresponding author Dr Aikawa from Brigham and Woman's Hospital and Harvard Medical School in Boston, and their colleagues examined 25 human stenotic aortic valves obtained from valve replacement surgeries. They used multiple modalities, including transcriptomics and global unlabeled and label-based tandem-mass-tagged proteomics.                                 Segmentation of valves into disease stage–specific samples was guided by near-infrared molecular imaging. Anatomic-layer specificity was facilitated by laser capture microdissection. Side-specific cell cultures was subjected to multiple calcifying stimuli, and the calcification potential and basil or stimulated proteomics were evaluated. Furthermore, molecular interaction networks were built, and their central proteins and disease associations were identified.                                 The authors found that global transcriptional and protein expression signatures differed between the nondiseased, fibrotic, and calcific stages of calcific aortic valve disease. Anatomical aortic valve microlayers exhibited unique proteome profiles that were maintained throughout disease progression and identified glial fibrillary acidic protein as a specific marker of valvula interstitial cells from the spongiosa layer. In vitro, fibrosa-derived valvular interstitial cells demonstrated greater calcification potential than those from the ventricularis. Analysis of protein-protein interaction networks further found a significant closeness to multiple inflammatory and fibrotic diseases. This study is significant because it is the first application of spatially and temporarily resolved multiomics and network systems biology strategy to identify molecular regulatory networks in calcific aortic valve disease. It provides network medicine–based rational for putative utility of antifibrotic and anti-inflammatory therapies in the treatment of calcific aortic valve disease. It also sets a roadmap for the multiomic study of complex cardiovascular diseases.                                 The final paper tackles the controversy of antibiotic prophylaxis for the prevention of infective endocarditis during invasive dental procedures. This is from a population-based study in Taiwan. First author, Dr Chen, corresponding author, Dr Tu from Institute of Epidemiology and Preventive Medicine College of Public Health in National Taiwan University aimed to estimate the association between invasive dental treatments and infective endocarditis using the health insurance database in Taiwan.                                 They chose 2 case-only study designs. First a case-crossover, and second, self-controlled case series. Both designs used within-subject comparisons such that confounding factors were implicitly adjusted for. They found that invasive dental treatments did not appear to be associated with a larger risk of infective endocarditis in the short period following invasive dental treatment. Results were consistent from both study designs. The authors also did not find any association between invasive dental treatments and infective endocarditis even among the high-risk patients, such as those with a history of rheumatic disease or valve replacement.                                 In summary, these authors found no evidence to support antibiotic prophylaxis for the prevention of infective endocarditis before invasive dental treatments in the Taiwanese population. Whether antibiotic prophylaxis is necessary in other populations requires further study.                                 Alright, so that wraps it up for our summaries, now for our feature discussion.                                 The United States is one of the wealthiest nations worldwide, but Americans have a shorter life expectancy compared with almost all other high-income countries. In fact, the US ranks only 31st in the world for life expectancy at birth in 2015. What are the factors that contribute to premature mortality and life expectancy in the US? Well, today's feature paper gives us some answers. And I'm just delighted to have with us the corresponding author, Dr Frank Hu from Harvard T.H. Chan School of Public Health, as well as our dear associate editor, Dr Jarett Berry, from UT Southwestern.                                 Frank, could you begin by telling us a bit more about the inspiration for looking at this, what you did, and what you found? Dr Frank Hu:       So, we look at the impact of healthy lifestyle habits, life expectancy in the US as a nation. As you just mentioned, Americans have a shorter life expectancy compared with almost all other high-income countries, so in this study we wanted to estimate what kind of impact of lifestyle factors have, premeasured that and life expectancy in the US population.                                 What we did is to combine three datasets. One is our large cohort, Nurses’ Health Study, and Health Professionals Follow-Up Study. We use this large cohort to estimate the relationships between lifestyle habits and mortality. And the second data set we use is to get age and sex to specific mortality rates in the US as a nation. This is the CDC WONDER dataset. And the third dataset we used is the NHANES dataset, this is the National Health and Nutrition Examination Survey. We used this dataset to get the prevalence of healthy lifestyle factors in the general US as a nation. So, we used the three datasets to create age-specific, sex-specific life tables and estimated life expectancies.                                 At age 50, according to the number of healthy lifestyle habits that people would follow, what we found is that following several lifestyle factors can make a huge difference in life expectancies.                                 Here we talk about five basic lifestyle factors: not smoking, maintaining a healthy weight, exercise regularly—at least a half hour per day—and eating a healthy diet, and not drinking too much alcohol. No more than one drink per day for a woman, no more than two drinks per day for men. What we found is that, compared with people who did not adapt any of those low-risk habits, we estimated that the life expectancy at age 50 was 29 years for woman and about 26 years for men. But for people who adapted all five healthy lifestyle habits, life expectancy at age 50 was 43 years for women and 38 years for men. So, in other words, a woman who maintains all 5 healthy habits gained, on average, 14 years of life, and the men who did so gained 12 years life compared with those who didn't maintain healthy lifestyle habits. So I think this is a very important public health message. It means that following several bases of healthy factors can add substantial amount of life expectancy to the US population, and this could help to reduce the gap in life expectancy between the US population and other developed countries. Dr Carolyn Lam: Thank you, Frank. You know that is such an important public health message that I am going to repeat it. Adhering to five lifestyle risk factors mainly, don't smoke, maintain a healthy weight, have regular physical activity, maintain a healthy diet, and have moderate alcohol consumption, AND a woman could increase her life expectancy at age 50 by 14 years and a man could do that by 12 years more. That is absolutely amazing.                                 Okay so Frank, actually, I do have a question though. These are remarkable datasets obviously, but they also go back to the 1980s. So did you see any chief risk factor that may have played more predominant apart with time? Dr Frank Hu:       We didn't specifically look at the changes in risk factors life expectancy, but among the five risk factors, not smoking is certainly the most important factor in terms of improving life expectancy. The good news is that prevalent smoking in the US has decreased substantially in the past several decades. However, the prevalence of other risk factors has actually increased. For example, the prevalence of obesity has increased two- or three-fold and the prevalence of regular exercise remained at a very low level, and also the diet quality in the US population is relatively poor. So, the combination of those risk factors have contributed to relatively low life expectancies in the US population. Dr Carolyn Lam: Right. Obesity, not smoking, I hear you. I just wanted to point out to all the listeners too, you have to take a look at Figure 1 of this beautiful paper, it’s just so beautifully illustrated in it.                                 Jarett, you helped to manage and bring this paper through. What are your thoughts? Dr Jarett Berry: Yeah, I just want to echo your comments, Carolyn, and Dr Hu. This is a fabulous paper, and a very important contribution characterizing these important associations in the US population. And I think, and the discussion thus far has been really helpful in putting all of this into context.                                 I do want to ask you, just a couple of, I guess more, philosophical questions about some of the observations in the paper. And one of them is the prevalence of the low-risk factor, those with a large number of low-risk factors, for example, in both the Nurses Health and in the Health Professional Follow-Up Study, you observed that the presence of five lifestyle factors was less than 2%. And it's interesting you see this in a large number of datasets and I think important, maybe for our readers to realize that there's two sides to the coin here.                                 One, the benefit of these low risk factors, but also, unfortunately, the low prevalence of these collections of healthy lifestyle factors that you've outlined.                                 Could you comment a little bit on that, and what that means, both maybe from a scientific point of view of perhaps, more importantly, from a public health stand point? Dr Frank Hu:       Yeah and this is very important observation and the number of people or the percentage of people who maintained all the five low-risk lifestyle habits is quite low in our cohort, even the nurses and health professionals, they are more health conscience in the general population. They have much better access to health care and also better access to healthy foods and have physical activity facilities. Despite all this potential advantages, and these more percentage of people who are able to maintain all five lifestyle risk factors.                                 On the other hand, about 10 to 15% of our participants did not adopt any of the five low-risk lifestyle habits. So it means that we still have a lot of work to do in terms of improving the lifestyle habits that we discussed earlier. The five risk lifestyle factors and in the general population, I think the percentage of people who adapt all the five lifestyle factors, probably even lower than 2%. And so that means that we have a huge public health challenge in front of us and have to improving the five lifestyle risk factors. One of the most important public health challenges as mentioned earlier is obesity because currently we have two-third of the US population is overweight or obese. So that's something I think is major public health challenges for us. Dr Jarett Berry: Right, and it’s interesting looking at your Table 1, and those individuals who have all five low risk factors. It's interesting that the prevalence of physical activity was incredibly high. I have a great interest of impact of exercise on these types of outcomes and it's interesting that in both cohorts, six or seven hours a week of exercise was the mean physical activity level in those with five risk factors. So, it's interesting and in some ways, these lifestyle factors, they do tend to congregate or covary with one another such that those individuals who do spend that kind of time, albeit unfortunately more rare than we would like to see it, the increase in physical activity does tend to have a positive impact, not only on the weight, but also on healthy lifestyle or healthy diet choices. Dr Frank Hu:       Right, yeah this is a very good observation that what I do want to point out that our definition of regular exercise is pretty cerebral to put it in terms of the definition. So we define moderate to vigorous physical activity in our cohorts. We included not just running, playing sports, but it was also walking in a moderate intensity. So it means that people can incorporate physical activity into their daily life. For example, by walking from a train station and with climbing stairs in their workplace and so on and so forth. So here physical activity means both recreational activity and also moderate intensity activities such as graceful walking. Dr Carolyn Lam: Frank, I think both of us listening are breathing a sigh of relief there and just for the listeners to understand too. These factors were dichotomized, right, and so you were describing the type of exercise and actually you used a three and a half hour per week limit to define healthy or not.                                 Similarly, just for reference the alcohol intake was 5 to 15g a day for women, or 5 to 30g a day for men. And normal weight was defined as a BMI of 18.5 to 24.9. I'm just thinking that if I were listening I'd want to know those cutoffs.                                 Now, can I ask a follow-up question, therefore to this dichotomy. As far as I understand you counted each of these risk factors equally, but did you try to do a weighted analysis by any chance? Did any one of them play a bigger role than others? Dr Frank Hu:       That's an interesting mathematical question because it’s very difficult to assign different weights to different risk factors because we look at, not just total mortality but also cardiovascular mortality and cancer mortality. So, you would have to use different weights for different causes of mortality. That would make the analysis much more complicated. But we did calculate a different type of score using five categories of each risk factor and then using that score, we were able to rank people in more categories so for that score the range is from five to 25, and we categorized people into quintiles or even more categories and the contrast in life expectancy between the lowest and the highest group is even greater. So, it means that, the higher number of healthy lifestyle factors, the greater life expectancy. Also, with each category, each lifestyle factors a high degree of adherence to that factor, the greater health benefit people will get. So, I think it's really accumulative fact of multiple risk factors and also the degree of adherence to each of the factors. Dr Carolyn Lam: Again, such an important public health message.                                 Jarett, how do you think this is going to be received by the public at large? Dr Jarett Berry: Very well received. I mean this is a very important observation demonstrating some of these disconcerting observations about life expectancy in the United States and as we think about strategies for improving the public health, I think Dr Hu's group has really helped us outline, very clearly, what other bodies such as the American Heart Association have been saying for years now, that lifestyle factors are so important in influencing cardiovascular risk, and in this case, life expectancy. It really does put, once again, the right amount of emphasis on the role these lifestyle factors of improving the public health. I think it’s going to be very well received and really helpful and important observation that all of us need to hear. Dr Carolyn Lam: Listeners, don't forget this important message and tell your friends about it, please.                                 Thanks for joining us today, don't forget to join us again next week.  

https://learntruehealth.com/ithrive to get the docuseries for free!   Fasting For Healing   http://learntruehealth.com/fasting-for-healing Fasting is a fantastic way to heal naturally from several health conditions. According to my guest today, Dr. Alan Goldhamer, fasting is safe and effective when done right. So read on to learn everything you need to know about this healing method.    Discovering Fasting   Dr. Alan Goldhamer recalls that when he was in 4th grade, his best friend Doug always beat him in basketball.  He wanted to get healthier to beat his best friend, and he happened to find a book about fasting by Herbert Shelton.   Herbert Shelton was  American author, naturopath, alternative medicine advocate, pacifist, and vegetarian. He was also a supporter of and fasting. But Dr. Alan Goldhamer still failed in beating Doug despite his efforts to fast and adopt a plant-based diet. Because apparently, his best friend Doug took the same program.  Pursuing A Medical Degree   As Dr. Alan Goldhamer got older, he met a chiropractor when he was 16 years old. That chiropractor said he had the best job in the world. He further explained that it's because the body did all the healing, the patient did all the work, and all he had to do was take credit for the good results. Since then, Dr. Alan Goldhamer decided that pursuing a medical degree was his calling.   Dr. Alan Goldhamer eventually went to a chiropractic school in Oregon. But he says it didn't give him the background that he wanted, which was to be able to take on certain kinds of treatments and specific conditions.    Due to his desire to learn more, Dr. Alan Goldhamer, later on, went to Pacific College of Osteopathic Medicine in Australia. He did his residency there and worked with hundreds of patients who kept getting well.   TrueNorth Health Center   In 1984, Dr. Alan Goldhamer felt it was time to go back to the United States with his wife who is also a doctor. Together they opened the TrueNorth Health Center. Fast forward today, it's been 33 years since they have been helping people recover their health using diet and lifestyle modification.    He shares that usually when people have diabetes, heart conditions or autoimmune disease, their physician will usually recommend taking 1 to 5 drugs. If you do exactly as you were told, Dr. Alan Goldhamer says those doctors will guarantee you'll never get well. According to him, that's the promise of conventional treatments for health conditions.   Track Record   "We have a program that ends the disease. But only if you also eat well, exercise and go to bed on time," said Dr. Alan Goldhamer. "Our alternative approach can get you healthy enough to eliminate the need for medications."   Most of Dr. Alan Goldhamer's patients were entirely able to remove medications by eliminating the reason why they needed the medication. Dr. Alan Goldhamer says it's really because of a management strategy towards healthy living.   Dr. Alan Goldhamer's patients who have diabetes, autoimmune disease, cancer, obesity and metabolic syndrome have benefited from fasting. The TrueNorth Health Center has also dealt with patients suffering from kidney diseases, although their fasting program is modified.   Furthermore, Dr. Alan Goldhamer also reveals that his team has done a fasting safety study. Hence, they assure everyone that fasting is safe as long as you follow the appropriate protocols.    In Dr. Alan Goldhamer's center, patients are appropriately screened and then undergo a physical exam, lab assessment, and monitoring. The center's patients are also seen twice a day by the center's staff of doctors wherein they evaluate every patient's clinical presentation.   "We had 174 consecutive patients who underwent fasting, and we have seen a wide variety of conditions," said Dr. Alan Goldhamer.   What Is Fasting?   Dr. Alan Goldhamer says that fasting has been around for a long time. Virtually most religious traditions recognize it as an essential component for a good reason.    "Fasting is a biological adaptation. If it weren't for fasting and the ability to fast, our species could not have done what we have done, which is wandering away from the tropics," Dr. Alan Goldhamer said.   Dr. Alan Goldhamer also reveals that because of the biological adaptation of fasting, human beings can go up to 70 days without eating. This is because our brain has changed from burning glucose to fat. So if you didn't burn fat, we would have to break our proteins down to provide glucose. And after a period, we would eventually die.   "We are capable of doing fasting. And at our TrueNorth Health Center, we have water fasting programs from 5 to 40 days. But we do not make our patients do fasting any longer than necessary to get the problem solved," said Dr. Alan Goldhamer.   The Truth About Salt   Dr. Alan Goldhamer says sodium is an essential nutrient without which we die. He says it is such a critical nutrient that our body is designed to detect it in minimal quantities. In fact, when you can taste natural sodium, you know that particular food is healthy for you.   "Salt tells you vegetables are good. But when you concentrate it, it artificially stimulates the dopamine production in the brain, and that leads to overeating. That's why people are fat and sick cause they eat salt or sugar," explains Dr. Alan Goldhamer.   Furthermore, Dr. Alan Goldhamer says salt has a whole bunch of problems when it is introduced in high concentration. Typically we'd be getting about have a milligram of sodium per calorie. But Dr. Alan Goldhamer says people in our culture are often eating 2 to 5 milligrams of sodium per calorie or even more.    "When we put salt in the food, the body has to hold fluid to neutralize and compensate for it. That's why blood pressure goes up. And it is also why many people aged 65 or older have hypertension," said Dr. Alan Goldhamer.   Dr. Alan Goldhamer also shares that salt also helps us get fat. Salt makes us eat more before we feel satisfied. And there's a lot of physiological consequences of excess sodium.    Among the physical effects of salt include:   Fluid retention Joint pains Edema Swelling Non-healing of wounds  Congestive heart failure Respiratory issues  "Avoid added salt. Get all the salt you need by eating whole plant foods, seeds, nuts, and fruits. You don't have to add highly processed foods which are full of chemicals," said Dr. Alan Goldhamer.   GMO   In episode 133 of the Learn True Health, Jeffrey Smith was my guest.  He is the creator of anti-GMO documentaries and GMO awareness.    Jeffery Smith discussed that there was a study in Canada. The study found that eating GMO foods, specifically B2 corn, created the B2 toxin which explodes the stomach of insects. They discovered that when we eat that type of corn, GMO genes get into the bacteria of the gut.    Over time, the gut started creating the B2 toxin inside of people. Even if they no longer eat corn, their body was still very concentrated with the B2 toxin.    "We have to figure out how to make plants more resistant to chemicals produced by companies. A great way to reset is through fasting and whole foods plant diet. Only then will clinical symptoms begin to improve," Dr. Alan Goldhamer said.   Dr. Alan Goldhamer also shares that his team just completed a study with their colleague, Luigi Fontana at Washington University. For the first time, they looked at the microbiome before and after fasting. They are already done with sample collection and data is currently being processed.   Dr. Alan Goldhamer's Diet   Dr. Alan Goldhamer usually eats any of the following for breakfast: fresh fruit, leafy greens like lettuce, cucumber, and celery. Sometimes he alternates between oatmeal, cornmeal, nuts or seeds.    For lunch or dinner, he usually indulges in large salads and steamed vegetables. He pairs it with a serving of complex carbohydrates like potatoes, rice beans, sweet potato, and squash. If he goes hungry between mealtimes, he usually satisfies his hunger pangs with another salad.   Ideally, the diet has to be very nutrient-rich and low density. Dr. Alan Goldhamer stresses that whether raw or cooked, he is more concerned about what his patients are eating rather than how they are preparing it.    Best Diet Choices   Dr. Alan Goldhamer believes that raw foods and vegetables are not always possible to get enough total calories in, without overdoing the sugar or the fat. He says that it is vital to see sufficient calories in the diet which is 10 to 12% of calories from protein, 5 to 18% from fat, and the balance of complex carbohydrates.  As far as juicing is concerned, Dr. Alan Goldhamer believes that it is indeed suitable for people who can't eat whole foods. But he says the best solution to gain optimal health is to eat whole foods.   "We're advocating a whole plant food diet with limited amounts of concentrated high-fat foods," said Dr. Alan Goldhamer. "You also have to eliminate foods like meat, fried foods, eggs, salt, oil, and sugar. It's not about changing the food that you have to worry about but rather changing the palate."   Bio Dr. Alan Goldhamer is a graduate of Western States Chiropractic College and the Pacific College of Osteopathic Medicine and for 34 years has been the director of the TrueNorth Health Center in Santa Rosa CA. TrueNorth is the largest facility in the world specializing in medically supervised water-only fasting. He is the author of the Health Promoting Cookbook and the co-author of The Pleasure Trap.   Dr. Alan Goldhamer is the principal investigator in numerous studies involving fasting that have been published in the peer-reviewed medical literature.   Get To Know Dr. Alan Goldhamer!   Official Website Books by Dr. Alan Goldhamer The Health Promoting Cookbook The Pleasure Trap  Recommended Link:  Learn True Health - Episode 133   The Links You Are Looking For: Support Us on Patreon & Join the Learn True Health Book Club!!! 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It beats 80 times a minute, about 115,000 times in one day or 42 million times in a year. It pumps five or six quarts each minute, or about 2,000 gallons per day. During a typical lifetime, it will beat more than 3 billion times -- pumping an amount of blood through the body that equals about 1 million barrels. If that was oil, it would supply your house with power till the year 84,000…or let you drive a Toyota Prius to the Sun and back 34 times.  Of course we are not talking about pumping oil but the human heart pumping blood.  The human heart is a fist-sized powerhouse that acts as the engine of life; pumping blood through the body’s system of blood. In addition to transporting fresh oxygen from the lungs and necessary nutrients to the body's tissues, blood also pulls the body's waste products, like carbon dioxide, away from the tissues. A necessity to sustain a heathy life. Nearly every family will experience the effects of Cardiovascular Disease. Congestive heart failure alone touches 5 million people in the U.S., it’s devastating effects reducing the quality of a person’s life and leading to early mortality. On this episode, we talk to, Dr. Gerald Buckberg, one of the world’s foremost experts on battling heart disease and fixing the human heart.

Podcast summary of articles from the June 2017 edition of Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include epinephrine in cardiac arrest, pediatric blunt chest trauma, LuCUS protocol for congestive heart failure, pregnancy associated spontaneous coronary artery dissection, pediatric foreign body ingestion, and board review on Lyme disease.  Guest speakers include Dr. Matthew Ahern of the Cleveland Clinic Emergency Services Institute, Dr. Emily Rose from The University of Southern California, and Dr. Court Crenshaw of the Metrohealth EM Residency Program

The ferritin test may be the most important blood test you ever get, especially if you have a thyroid problem. When I began my training in the diagnosis and management of internal disorders immediately after graduation, one of the first things we studied heavily was blood chemistry analysis.  My teachers always stressed the importance of taking a careful look at iron levels in the blood and a rare test known as the ferritin test. What is ferritin? Ferritin is an iron-containing protein and is the primary form of iron stored inside your cells.  Even though there is a small amount of ferritin released into your bloodstream, it is an accurate marker of how much iron is actually stored in your body.  Iron is primarily stored in your liver, muscles, spleen and bone marrow but if you have too much it can accumulate in your organs and the brain. You either have too much iron, too little or just the right balance in your body and the ferritin test can give us an excellent picture of how much iron is actually stored in your body.  Iron is found in your red blood cells but it also accumulates in your organs and tissues. Iron is important for healthy oxygen transport throughout your body so you can see how vital it really is for your health.  Too little iron will result in anemia which basically means that your red blood cells cannot carry enough oxygen to your cells and you start to develop signs of oxygen deficiency.  Signs of anemia include: Weakness Dizziness Headaches Pale skin Fatigue Low body temperature Memory loss Hair loss Poor brain function Hypothyroidism Adrenal fatigue Spoon-shaped finger and toenails Smooth tongue Burning sensation in the tongue Sores at the corners of the mouth Dry skin Shortness of breath Ringing in the ears (tinnitus) Leg pains Chest pain Pica (cravings for specific substances, such as licorice, chalk, dirt, or clay) Too much iron can have the opposite effect because iron creates a lot of oxidative stress which is basically too many free radicals that create inflammation.  These free radicals eat up your antioxidants like vitamin C and E creating deficiencies. Menstruating females lose a small amount of iron every month during their cycle so they tend not to build up too much iron in their bodies.  However, iron levels can get too low when your diet is deficient in iron and you have absorption issues due to things like gluten and gut infections.  I tend to see low ferritin levels quite a bit in chronically-ill women who are still cycling but it is also common in postmenopausal women who never restored their iron levels before entering menopause. Since men do not have a menstrual cycle, we are the most at risk for accumulating iron.  As iron builds-up in a man’s body he may develop the following symptoms as it accumulates in the brain and other body tissues (most of these also apply to women): Brain fog Fatigue Low sex drive and erectile dysfunction (iron accumulates in the testicles) Mood swings, especially anger Digestive problems as iron builds-up in the gut Anxiety Depression Fatigue after meals (insulin resistance) Memory loss Joint pain Weight loss Abdominal pain Hair loss Congestive heart failure Iron is extremely “heavy” in the bloodstream so it forces the heart to work harder as it pumps this heavy metal through your blood vessels resulting in blood pressure changes and more inflammation in your arteries. This is where the ferritin test is so important because it can tell us if there is too much or too little iron in your body.  It’s a simple blood test but rarely ordered during general check-ups and standard blood panels however I believe it is one of the most important and overlooked tests in medicine today.  This is why I include it in every patient’s blood panel even if it was normal within the last year.

Shortness of breath is a chief complaint that we encounter each day in the ED.  This chief complaint encompasses a huge differential and this is a long podcast.  As always, I'll break this chief complaint down into the diagnoses that we can't miss and how to treat the underlying causes of shortness of breath for both kids and adults.