Podcasts about copt

What separates the Orthodox Church and the various Non-Chalcedonian churches? Is it merely semantics and misunderstandings, as some today proclaim? The Holy Monastery of Gregoriou on Mount Athos, in this 1994 treatise, gives a detailed examination of the issues and offers much for anyone interested in the truth of Christ, His Church, and the Non-Chalcedonian heresy.

L'exposition à des polluants de l'air durant la grossesse altère le développement du fœtus Les brèves du jour Les paresthésies, autrement dit les fourmillements à la surface de notre peau La science en chansons : Cro-Magnon La plus grande base de données génétiques sur les plécoptères

show number 2Radio.NewHeightsEduction.orgwww.NewHeightsEducation.orglink to advertisementhttps://rumble.com/v2bx63e-nheg-commercial-with-voice-over.html

Redstone Gateway is proud to present Season 2 of Uncommon Access, a podcast that creates opportunities for Huntsville/Madison-area thought leaders to discuss defense, business, and what the future of work looks like in our region.This informal interview-style discussion is hosted by James Lomax, Director for Asset Management + Leasing at Corporate Office Properties Trust (COPT). James is instrumental in overseeing the growth and asset performance at Redstone Gateway and within COPT's regional portfolio.

*Warning: contains subject on suicide* **If you're in Canada and are in crisis, dial the 1.833.456.4566** **If you're in the US and are in crisis, dial the 1.800.273.8255** Here's my interview with Daniel Wassef, first Copt to win a Guinness Record! We talk about imposter syndrome, faith, hope, mental health, and of course Guinness Records!

This week Mother Natalia and Father Michael are joined by two special guests, Mother Gabriella from Christ the Bridegroom Monastery and Natalie Bishay, a Coptic Orthodox since birth. Natalie shares some of the beauties of Coptic Orthodoxy, including their mentality of being servants and their process of electing men for the priesthood.Live Episode:We're excited to announce a live episode today, Wednesday, August 24th.Proto-Cathedral of St. Mary Byzantine Catholic Church5329 Sepulveda Blvd, Sherman Oaks, CA 91411Divine Liturgy will begin at 6:30 PM, followed by dinner and a live recording. A main course will be provided but please bring a side to share. Come for all or part of the event! We hope to see you there!Bridegroom's Banquet - the monastery's annual fundraiser is Saturday, September 10th. All details can be found here, including a link to register to attend in-person, and a link for donations if you can't attend in-person. Thank you for your generosity!Follow and Contact Us!Follow us on Instagram and FacebookWe're on YouTube!Join our Goodreads GroupFr. Michael's TwitterChrist the Bridegroom MonasteryOur WebsiteOur NonprofitSupport the show

Ascultați podcast-ul ”Pași spre viață”, o emisiune dialog cu Cristina Olariu și pastorul Ghiță Mocan.

What on earth is the Coptic Church? Most of us only know about the 21 Coptic martyrs of 2015, or about the Coptic Church rejecting the Council of Chalcedon in 451. But who are the Copts? Why did they part ways with the rest of the Church? And has persecution prompted us to reconsider if we're closer to them than we think? This week, Onsi (our resident Copt!) gets quizzed by Rhys and Colin.NOTE: most books below are linked via Bookshop.org. Any purchases you make via these links give The Davenant Institute a 10% commission, and support local bookshops against chainstores/Amazon.Currently ReadingOnsi: Three Arabaic Treatises on Aristotle's Rhetoric: The Commentaries of Al-Farabi, Avicenna, and Averroes  Colin: his own tweets Rhys: The Warden by Anthony TrollopeTexts Discussed"Unity Across the Chalcedonian Divide" by Lukas StockThe 21: A Journey Into the Land of Coptic Martyrs by Martin Mosebach"Cyril of Alexandria, letter to John of Antioch (Formula of Reunion)" by Cyril of AlexandriaSpotlightSubscribe to read the Winter 2022 edition of Ad Fontes

Vă invităm la o întâlnire cu Ștefan Colceriu, doctor în filologie clasică și cercetător la Institutul de Lingvistică al Academiei Române, și Alin Suciu, docent și cercetător la Academia de Știinţe din Göttingen despre volumul „Apoftegmele Părinților deșertului. Versiunea coptă sahidică sau Patericul copt“ O ediţie critică cu studiu introductiv și note de Ștefan Colceriu și traducere inedită din limba coptă sahidică de Melania Bădic, Ștefan Colceriu, Emanuel Conţac, Alexandru Mihăilă, Delia Mihăilă, Georgian Toader, Monica Vasileanu şi Cristian Vechiu. „A spune că Patericul egiptean a avut un rol crucial în dezvoltarea spiritualității și culturii creștine este un truism. Succesul la public al colecțiilor de spuse ale Părinților pustiei, cunoscute în genere ca „Apoftegmele Părinților deșertului“, a produs o asemenea emulație în generațiile succesive de practicanți, încât puțini au fost cei care au scăpat de ispita adăugării câte unei apoftegme la corpusul originar. În volumul de față propunem textul editat critic al versiunii copte sahidice a Apoftegmelor Părinților și traducerea lui în limba română. Am ales să ne ocupăm de versiunea coptă a Patericului întrucât, prin vechimea, coerența și dispunerea materialului, e de mare relevanță pentru istoria întregii constelații de tradiție a Apoftegmelor. Prezenta ediție critică nu e o simplă actualizare a uneia mai vechi, ci o întreprindere de anvergură pentru obținerea unui produs științific nou și autonom și deopotrivă o premieră absolută în spațiul culturii române. Prezentul volum este rezultatul muncii unei echipe de filologi clasici, teologi și filozofi care s-au constituit într-un grup de studiere a limbilor Bibliei, cu o atenție specială asupra limbii copte sahidice. Grupul s-a întâlnit săptămânal, vreme de șapte ani, la Colegiul „Noua Europă“ din București, loc care a găzduit proiectul grație amabilității domnului Andrei Pleșu, rector și președinte al Fundației „Noua Europă“, precum și întregii echipe de la NEC. Miza ultimă a acestui volum și a constituirii grupului este lansarea în România a unui domeniu de studiu aflat în plină expansiune în lumea științifică occidentală, dar care nu și-a găsit locul în universitățile de la noi. Sunt semne că suntem pe cale să ne atingem scopul.“ — ȘTEFAN COLCERIU ------ Cartea este disponibilă în librării și online https://www.libhumanitas.ro/apoftegmele-parintilor-desertului.html

James Lomax, director of asset management and leasing at Corporate Offices Properties Trust (COPT) joins the podcast to share his perspective on office and retail commercial properties post-pandemic and his insights on what to expect in these sectors in the future. AT COPT, James is responsible for market performance of revenue generating assets at Redstone Gateway, a 468-acre amenity-rich office park joint venture development adjacent to Redstone Arsenal as part of an Enhanced Use Lease with the federal government. He believes leadership is best displayed through community service. In addition to his role at COPT, James has served as past president of Rotaract Club, was a local Chamber of Commerce Young Professional of the Year nominee in 2017, 2019, 2020, and was a Leukemia & Lymphoma Society Man of the Year nominee in 2015. He is currently a board member of the Huntsville Rotary Club and the treasurer of the North Alabama Commercial Real Estate Association (NALCOM). He was appointed by the Huntsville City Council to the Medical Clinic Board - Fifth Avenue in 2016 and re-appointed in 2020. James is a featured regular contributor to the Alabama Center for Real Estate Blog. COPT is a member of ACRE's Alabama Cabinet.

Redstone Gateway presents Uncommon Access, a podcast that creates opportunities for Huntsville/Madison-area thought leaders to discuss defense, business, and what the future of work looks like in our region.This informal interview-style discussion is hosted by James Lomax, Director for Asset Management + Leasing at Corporate Office Properties Trust (COPT). James is instrumental in overseeing the growth and asset performance at Redstone Gateway and within COPT's regional portfolio.

Listen in on a mentorship call with Josh who is looking to start up his online personal training business. Our Mentorship is live and included with the purchase of any CPT or COPT certification bundle. Learn more about the mentorship below:We here at Fitness Mentors want each and every trainer to crush it immediately after receiving their certification. Seeing as there is an industry void in trainer support we decided to gather over a decade worth of resources that help trainers in their first and most crucial year.  Fitness Mentors is excited to now offer a FREE YEAR LONG MENTORSHIP with the purchase of any CPT and COPT Certification bundle.  This mentorship includes: One on One career planning mentorship call with our CEO Eddie Lester 100 hours of audio and video career resources with topics like: How to start a personal training business Resume Writing  How to train clients online Insurance, start up documents and step by step guides Marketing  Guide on how to get clients  How to sell your services  The client care process  Personal growth, purpose and motivation Program design & implantation  Access to private webinars  Business building peer to peer forum Workout templates  Show Links:https://www.fitnessmentors.com/personal-trainer-mentorship/https://www.fitnessmentors.com/how-to-make-money-as-a-personal-trainer/https://www.fitnessmentors.com/ncca-certifications/Support the show (http://www.fitnessmentors.com)

Today we talk how I started the Copt Cast, and the experiences that lead me to it. Hope you enjoy the episode as much as I enjoyed making it!Links : Feel Free to suggest a topic using our Contact Form Here's your Kawaii Clip of the Week

In this episode, CEO of Fyzio4U Rehab Staffing Group, Dr. Monique J. Caruth, talks about how she, as a businesswoman, reacted to Covid-19. Dr. Monique J. Caruth, DPT, is the CEO of Fyzio4U Rehab Staffing Group providing home health services in Maryland. She currently serves as the Southern District Chair of Maryland APTA and is the Secretary-elect of the Home Health Section of the APTA. She holds a Masters and PhD in Physical Therapy from Howard University, and she is a proud immigrant from Trinidad & Tobago. Today, we hear what it’s like treating potentially Covid-positive patients, Monique tells us about the screening tool she developed, and we hear about the impact of the pandemic on mental health. Monique elaborates on the importance of Ellie Somers’s list of notable PTs, and she talks about her experiences of losing patients. How did she pivot her business to keep it afloat? How has her perspective as both a clinician and a business owner helped her pivot her business? Monique tells us about obtaining PPE, offering Telehealth visits, and she gives some advice to Home Health PTs, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “We started seeing a spike in clients in mid-April when the hospitals didn’t want to discharge patients to the nursing homes; they were discharging them directly home, so the majority of our clientele were Covid-positive patients.” Monique has started compulsively disinfecting all surfaces. Monique’s screening tool: Step 1: Check temperatures every morning before seeing a patient. Step 2: Ask questions about symptoms, traveling, and possible contact with Covid-positive people. Step 3: Ensure PPE is worn. “Gone are the days of spending extra time and doing extra work there.” “One of the biggest things for therapeutic outcome is having a good relationship with your patients. Going into the home, you’re probably the only person that they’re getting to talk to most days. I saw the need to improve on soft skills and being approachable with your patients.” “Some sort of contact needs to be maintained. Even though some patients may have been discharged, they would contact the physician via Telehealth visit and ask to be seen again.” “Everyone deserves to get quality care.” “Some people say, ‘this person probably got Covid because they were being reckless’. You can slip-up, be as cautious as possible, and still get Covid.” “We’re going to see a huge wave of Covid cases coming in the next few months. With elective surgeries stopped, that’s going to be our only client population. To prevent the furloughs from happening again, I would just advise to do the screenings, get the PPE, and go and see the patients.” Why don’t women get recognition in a profession that’s supposed to be female-dominated? “People send out stuff to vote for top influencers in physical therapy. You tend to see the same names year after year, but you never see one that strictly focuses on women in physical therapy. I see many women doing great things in the physical therapy world, but because they don’t have as many followers on Twitter or Instagram, they don’t get the recognition that they deserve.” “The thing that I love about Ellie’s list is she put herself on it.” “In doing stuff you have to be kind to yourself first and love yourself first. Many of us don’t give ourselves enough praise for the stuff that we do.” “You can’t save everybody. When you just graduate as a therapist, you think you can save everyone and change the world – it takes time.”   More About Dr. Caruth Dr. Monique J. Caruth, DPT, is the CEO of Fyzio4U Rehab Staffing Group providing home health services in Maryland. She currently serves as the Southern District Chair of Maryland APTA and is the Secretary-elect of the Home Health Section of the APTA. She holds a Masters and PhD in Physical Therapy from Howard University, and she is a proud immigrant from Trinidad & Tobago.     Suggested Keywords Therapy, Rehabilitation, Covid-19, Health, Healthcare, Wellness, Recovery, APTA, PPE, Change,   To learn more, follow Monique at: Website:          Fyzio4U Facebook:       @DrMoniqueJCaruth                         @fyzio4u Instagram:       @fyzio4u LinkedIn:         Dr Monique J Caruth Twitter:            @fyzio4u   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here  Speaker 1 (00:01): Hey, Monique. Welcome to the podcast. I'm so happy to have you on. Speaker 2 (00:06): Oh, thank you for inviting me. It's a pleasure to be on once again. Speaker 1 (00:10): Yes. Yes. I am very excited. And just so the listeners know, Monique is the newly minted secretary of the home health section of the APA. So congratulations. That's quite the honor. So congrats. Speaker 2 (00:26): Thank you very much. And Speaker 1 (00:28): We were just talking about, you know, what, what it was like being an elected position. I was on nominating committee for the private practice section. I just came off this year. Not nearly as much work as a board member. But my best advice was you'll you'll make great friendships and great relationships. And that's what you'll take forward aside from the fact that it's, you know, a little bit more work on top of the work you're already doing Speaker 2 (00:57): Well, I better get my bearings, right. So I will be on task from the one. Yeah. Speaker 1 (01:04): Yeah. I'm sure you will. And now, today, we're going to talk about how you as a business woman pivoted reacted to COVID. So we're, Monique's in Maryland, I'm in New York city. So for us East coasters, it really well, we know it hit New York city very hard in March in Maryland. When did that wave sort of hit you guys? Was it around the same time? Speaker 2 (01:33): I would say mid March, April because I had returned back to the rest of the first week of March. And then things just started going crazy. They were saying, Oh we have to be aware of COVID. But I was still seeing my clients that I had. Then we started getting calls saying that family members are worried that we'll be bringing COVID into the home. So they wanted to cancel visits. So we were getting a lot of constellations and then electric surgeries was shut down and that meant a huge drop in clients as well. Then we started seeing a spike in clients in mid April when the hospitals didn't want to discharge patients to the nursing homes, they were discharging them directly to home. So the majority of our clientele was COVID positive patients. Speaker 1 (02:36): And now as the therapist going in to see these patients, obviously you need proper protection. You need that PPE. So as we know, as all the headlines said, during the beginning of the pandemic, couldn't get PPE. So what do you do? Speaker 2 (02:54): Well, we were fortunate in Maryland that governor Hogan had PPE equipment ready at state health departments for agencies to collect. So they did ration them out. Also one of the agencies that I contract with MedStar hospital provided PPS to all the contractors and employees that were visiting COVID patients in the home. So we had the goggles face shield gowns mask, everything. There would be a specialized bag with vital sign equipment for that patient specifically that would be kept in that house and then taken back and disinfected at the end of the treatment. So we, we were shored through weekly conferences on what to do do South screenings and screening prior to each visit. So for my contractors, I developed a screening tool to ask questions if clients were having symptoms or if any family members in the home are having symptoms. And if they had exposure to anyone where COVID symptoms in the past 14 days, so we'll know what you will, that person as a person on, on the investigation or somebody who's COVID positive. So we had done the correct equipment when we go into the homes. Speaker 1 (04:18): And what does that, what does that look like? And what does that feel like for you as a therapist, knowing that you're going into a home with a patient who's COVID positive? I mean, I feel like that would make me very nervous and very anxious. So what was that like? Speaker 2 (04:36): To be quite honest, I was scared at first I try to avoid it as much as possible. But I got to a point where I needed to start seeing people or, you know, the business would go under. So you're nervous because nobody really knows how the disease will progress, what would happen. So it's a risk that you're taking. I, I probably developed compulsive disorder, making sure everything was like wiped down and clean. Even getting into the car, you know, this is affecting the stairway, the door handles double checking, making sure that they know the phone was wiped down. You know, as soon as you get in the house, after you strip washing from head to toe, making sure that, you know, you don't have anything that could possibly be brought onto the home. Speaker 1 (05:35): Right. And so when you say going back to that screening tool that you say you developed, what was, what was, what was, what did that entail for you for your contractors? Because I think this is something that a learning moment for other people, they can maybe copy your screening tool or get an idea of what they can do for their own businesses. Well, it's Speaker 2 (05:58): One that they we use to make sure that we don't have any symptoms. So checking the temperature every morning before you actually go to see a patient and asking the question, like certain questions, when, when you're scheduling a visit if they're filing in a coughing or sneezing when was the last time they got exposed or if they've been exposed to someone who traveled in the past 14 days or who's had any symptoms in the past 14 days. And so that was basically if they answered, no, then you be like, okay, fine. All you just need to do is wear the mask and the gloves and make sure that the patient that you're seeing wears the mask as well. Speaker 1 (06:41): Yeah. That's the big thing is making sure everybody's wearing a mask. Have you had any problems with people not wanting to wear a mask in their home when you go into treat them? Speaker 2 (06:51): We've had some, but most have been very compliant with, you know, wearing the mask because they realize that they, they, they do need the service. So like some patients who have like CHF or COPT that will have problems breathing while doing the exercises, I would allow them to, you know, take it off briefly, but I will step back six feet away and make sure that, you know, they get their respiration rate on the control. Then they put it back on. We'll do the exercise. Speaker 1 (07:22): Yeah. That makes sense. And are you taking, obviously taking vitals, pull socks and everything else temperature when you're going into the home? Speaker 2 (07:31): Yes. Yeah. Yeah. Speaker 1 (07:34): Okay. And I love the compulsive cleaning and wiping down of things. I'm still wiping down. If I go food shopping, I wipe everything down before I bring it into my home. And I realize it's crazy. That's crazy making, but I started doing it back in March and it seems to be working. So I continue to do it. And I'm the only one in my apartment, but I still wipe down all the handles. Speaker 2 (08:02): I would say don't lose sight of it though. Speaker 1 (08:07): I am. And I love that. You're like wiping down the car. I rented two car. I rented a car twice since COVID started. And I like almost used a can of Lysol one time. Like I liked out the whole thing and then I let it air out. And this is like in a garage going to pick it up for a rental place. And then I have like, those Sani wipes, like the real hospital disinfectants. And then I wiped everything down with those. And then I got in the car. Speaker 2 (08:36): Well, I saw it's very difficult to find Lysol here right now. So when you do find it, it's like finding gold. I know, Speaker 1 (08:44): I, I found Lysol wipes. They had Lysol wipes at Walgreens and I was like I said, Lysol wipes. And she was, yes. I was like, Oh my gosh. And then last week I found Clorox wipes, but in New York you can only get one. You can't there's no, Speaker 2 (09:04): Yeah. Care's the same thing. Toilet paper, whites, Lysol owning one per customer. So yeah, Speaker 1 (09:09): One per customer. Yeah, yeah, yeah. Oh, that's yeah, I was a thank God. I, I found one can of Lysol, one can at the supermarket and it was like, there is a light shining down on it and it was like glowing, glowing in the middle of the market. I'm like, Oh but I love, I love that all the screening tools that you're using and I think this is a great example for other people who might be going to P into people's homes who may be COVID positive. And I also think it's refreshing for you to say, yeah, I was nervous. Speaker 2 (09:47): I'm not going, gonna lie. You know, you still get nervous because you never know, like someone could be positive. And you're going in there, but you always want to be cautious because you're like, Oh my God, I hope I didn't like allow this to be touched or you forgot to wipe this and stuff too. So Speaker 1 (10:07): How much time are you spending in the home? Because there is that sort of time factor to it as well, exposure time. Right. Speaker 2 (10:16): It depends on the severity of the condition. But anywhere from like 30 minutes to like 45 minutes. Speaker 1 (10:25): Yeah, yeah, yeah. I know gone, gone are the days of, you know, spending that extra time and doing all this extra, extra work there, because if they're COVID positive, then I would assume that the longer you're in an exposed area, even though you're fully covered in PPE, I guess it raises your Speaker 2 (10:48): Well. Yeah. And, and the, in the summer, I would say, you know, depending on the amount of work that you had to do, like if you had to do like bed mobility and transfers with the patient, you'd be sweating under that gong. So you really want to want to be in there like a full hour anyway. But they were advising to spend, you know, minimum 30 minutes and to reduce the risk of you contracting it as well, too. Speaker 1 (11:17): Makes sense. So, all right. Speaker 2 (11:20): Decondition so they really can't tolerate a full hour. Speaker 1 (11:23): Right? Of course, of course. Yeah. That makes, that makes good sense. So now we've talked about obtaining the proper PPE. What other, what other pivots, I guess, is the best way to talk about it? Did you feel you had to do as the business owner? What things maybe, are you doing differently now than before? Speaker 2 (11:49): Well, as I said, I had to start seeing most of the cases to make sure that people were still being seen and like using telehealth. We started doing that. So eventually, well sky came on board to offer telehealth visits. So we were able to document telehealth visits as well. And people are responsive to those which worked out pretty well. So with some cases we'll do a one visit in the home and then do the follow-up visit telehealth. So one visit being in a home one weekend, one telehealth, if it was a twice a week patient. So that would also reduce the risk of exposure. Speaker 1 (12:40): Yeah. Yeah. Excellent. Now let's talk about keeping the business afloat, right? So yes, we're seeing patients. Yes. We're helping people, but we were also running a business. We got people to pay, we got people on payroll, you gotta pay yourself, you got to keep the business afloat to help all of these patients. So what was the most challenging part of this as from the eye of the business owner? Not the clinician. Speaker 2 (13:07): Well, you, you get fearful that you may not have enough patients to see, to cover previous expenses. So that was one of the reasons I did apply for the PPP loan. And as I mentioned to you before I was successful in acquiring that probably like around July and that, you know, cover like eight weeks of payroll, if that but it was strictly dedicated to payroll, nothing else. So everything else I had to do was to cover the bills and stuff, because that was just for payroll. Some of the agencies that we contracted for were having difficulty maintaining reimbursing. So that became a challenge as well, too. So what does that mean? Exactly. so when we contract with agencies, they're supposed to be paying us for this, the rehab services that we provide. Some of them were late with their payments as well, but I still had to pay my contractors on time. Speaker 1 (14:19): Got it. Okay. Got it. Oh, that's a pickle. Speaker 2 (14:22): Yeah, that's the thing. So that meant like sometimes some, you know, weeks of payroll, I would have to probably go over the lesson and making sure that the contractors were paid. Speaker 1 (14:37): And how about having a therapist? Furloughs? Did you have any of that? Did you know, were there any people, like maybe therapists in your area who were furloughed from their jobs and coming to you, like, Hey, do you have anything for me? Can you help? What was that situation? Speaker 2 (14:54): Yes. So I started getting free pretty among the calls about having to pick up to do work because they were followed or laid off. We currently have one contractor was working for ATI full-time that got followed. Now she's doing the home health full-time right now as a contractor we have some that are still doing it PRN, even though they went back to like their full-time jobs. But yes, we had people looking for cases to see, just to supplement the the income. Then we had a reverse situation where some people more comfortable getting the unemployment check than seeing patients at all. So, so that you had different scenarios, but it wasn't that we were in need of therapists during that time because people were willing to work. Speaker 1 (16:00): Yeah. Excellent. Excellent. And from the, I guess from your perspective being owner and clinician, so you're seeing patients you're running a business where there any sort of positive surprises that came out of this time for you, something that, that maybe made you think, Hmm. Maybe I'm going to do things a little differently moving forward? Speaker 2 (16:30): Yes. incorporating more telehealth visits. Definitely one of them and using the screening to there it helps in a lot of situations. So it makes you aware of what you might possibly be going into when you're going into the home. And I am realizing that there is one of the biggest things for therapeutic outcome is having a good relationship with your patients. So since most people aren't locked down, a lot of the patients that we do see they live by themselves, or they may just have one or two people in the home and they may possibly be working. So when going into the home, you're probably the only person that they're getting to talk to most days. So you, I saw the need to improve on soft skills and being approachable with your patients. So that was definitely a, a big thing for me. Speaker 1 (17:46): And how is that manifesting itself now? So now, you know, you figure we're what April, may, June, July, August, September, October, November, December eight, nine months in, so kind of having that realization of like, boy, this is this, I may be the only person this person speaks to today, all week, perhaps. I mean, that's can be a little, that can be a big responsibility. So how do you, how do you deal with that now that you're, you know, 10 months into this pandemic and yeah. How do, how do you feel about that now? Speaker 2 (18:29): Well, I still feel like some sort of contact needs to be maintained. So even though some patients may have been discharged they would contact the physician via a telehealth visit and asked to, you know, can you see it again? But you still maintain contact, make sure that, you know, you dropped a line and say, Hey, just following up to see if you're okay. That sort of stuff. So they, they will remember and they'll keep coming. Speaker 1 (18:58): Yeah, yeah, yeah. Oh yeah. It is such a responsibility, especially for those older patients who are, who are alone most of the time. I mean, it is it's, you know, we hear more and more about the mental health effects that COVID has had on a lot of people. So and I don't think that we're immune to those effects either. I mean, how, how do you deal with the stress of, because there's gotta be an underlying stress with all of this, right. So what do you do, how do you deal with that stress? Speaker 2 (19:38): Well, one was warmer. I would try to at least take the weekends off to go do something or those and like being around people where you can, you know, laugh and, you know, watch movies, you know, goof up, you know, I have to think about work, those things help. Speaker 1 (19:59): Yeah. Just finding those outlets that you can turn it off a little bit. And I love taking the weekends off every once in a while. I have to do that. I have to remember to do that. And I'm so jealous that you're just, you just came off of a nice little vacay as well. Speaker 2 (20:19): Well it was needed. I probably won't be taking one on till probably sometime next year, so yeah. But it was, it was definitely needed. Speaker 1 (20:32): Yeah. I think I'm going to, I think I'm going to do that too. All right. So anything else, any other advice that you may have for those working in home health when it comes to going to see those during these COVID times, whether the patient has, has had, has, or has had COVID what advice would you give to our fellow home health? Pts? Speaker 2 (21:00): Well, I know I've been hearing quite a lot of PT saying that they didn't want to treat COVID patients and they should not be subjected to treating COVID patients, but as we get more awareness of what the diseases and we take the necessary precautions, I think we will be okay. Cause everyone deserves to get quality care. And I know some people will say this person probably got COVID because they were being reckless and stuff. I mean, you can slip up, be as cautious as possible and still step up and get COVID. That doesn't mean you should be denying someone to receive that treatment just to make sure that you're protected when you do go in. Because we're gonna see a huge wave of COVID cases coming in the next few months and with elective surgeries being stopped and everything like that, that's going to be our only client population and to prevent the fools and the layoffs from happening again, I would just advise them, you know, do the screenings, make sure you get your PP and we'll see the patients. It's it's not as bad as, you know, they make it seem. Speaker 1 (22:16): Yeah. Excellent advice. Excellent advice. And now we're going to really switch gears here. Okay. So this is going to be like like a, a three 60 turnaround, but before we went, before we went on the air, Monique and I were talking about just some things that, that you wanted to talk about and recent happenings in the PT world, and you brought up sort of a list of influential PTs that was compiled by our lovely friend Ellie summers. So go ahead and talk to me about why that list was meaningful to you and why you kind of wanted to talk about it. Speaker 2 (23:03): Well, you know, for the past few years I've been noticing like people send us stuff to vote for like top influencers and, and physical therapy and stuff. Do you tend to see the same names like yesteryear? But you've never seen one that just strictly focuses on a woman in physical therapy. And I see a lot of women doing great things in the physical therapy world, but because they do not have as many followers on like Twitter or Instagram, they don't get the recognition that they deserve. For example, Dr. Lisa van who's I think she's doing incredible, incredible work with the Ujima Institute. I actually consider her a mentor of mine. She, she calms me down when I try to get fired. What's it and stuff, Speaker 1 (24:03): Not you. I don't believe it. Speaker 2 (24:06): So I appreciate her for that. So for Ellie to actually construct this list and, you know, I've, I've been observing her, her tweets on her posts for a while, and I see that she questions. Why is it that, you know, women do not get the recognition in a profession that is supposed to be female dominated. So for her to do the side, you know, it was, it was really thoughtful and needed. Speaker 1 (24:40): Yeah. Yeah. And you know, her shirt talk that she gave at the women in PT summit couple of years ago, I think it was the second year we did, it was so powerful. Like everybody was crying like in tears, she's crying, everyone else is crying. And that was the year Sharon Dunn was our keynote speaker. She got everybody crying. It was like everybody was crying the whole time, but crying in like in, in not, not in a sad way, but crying in a way because the stories were so powerful and really hit home and we just wanted to lift her up and support her. But yeah, and you know, the thing that I love the most about Ellie's list is she put herself on it. Yes. How many times have you made a list and put yourself on it? I can answer me. Never, never, never in a million years, have I made a list of like influential people to put myself on it? Never know. So I saw that and I was like, good for you. Good for you. Speaker 2 (25:44): Because you know, sometimes you, you and, and doing and doing stuff, you, you have to be kind to yourself first, love yourself first. And, and her doing that, I, I believe she's demonstrating that that is something that's that needs to be done. A lot of us, we don't give ourselves enough praise for the stuff that we do. Speaker 1 (26:05): Absolutely. Absolutely. It's sort of, it's a nice lead by example moment from her. So I really appreciated that list and, and yes, Dr. Vanhoose is like a queen. She's amazing. And every time, every time I hear her speak or, or I get the chance to talk with her through the Ujima Institute to me, it's amazing how someone can have the calm that she has and the power she has at the same time. Right. I mean, I don't have that. I don't, I even know how to do that, but she just, like, she's just gets it, you know? I don't know if that's a gift. It's a gift. Yeah, totally, totally. Okay. So as we wrap things up here, I'm going to ask you the one question that I ask everyone, and that is knowing where you are now in your life and in your career. What advice would you give to your younger self you're? You're that wide-eyed fresh face PT, just out of PT school. Speaker 2 (27:16): You can't save everybody. You can't save everybody nice. When you, when you just graduate as a therapist, you think you can save everyone a change, a wall. It takes time. Speaker 1 (27:33): Yeah. Oh, excellent answer. I don't think I've heard that one yet, but I think, I think it's true that having, and it's not, that's not a defeatist. That's not a defeatist thinking at all. Yeah. Speaker 2 (27:54): I think this year have thing come to more deaths as a therapist with patients than I have probably in the 12 years that I've been practicing. I'm sorry. Yeah, because you know, you do patients that you get attached to, you know, you have this person passed away and stuff like that. So it's good while it lasts, but to protect yourself mentally and emotionally, you just realize that you can save everybody. Yeah. I think this fund DEMEC is teaching us that too. Speaker 1 (28:35): Yeah. A hundred percent. Thank you for that. And now money, where can people find you website? Social media handles Speaker 2 (28:47): Social media handles are the same on Twitter and Instagram at physio for U F Y, Z I O. Number for you Facebook slash physio for you as well. And www physio for you.org is the website Speaker 1 (29:01): Awesome. Very easy. And just so everyone knows, I'll have links to all of those in the show notes under this episode at podcast dot healthy, wealthy, smart.com. So if you want to learn more about Monique, about her business I suggest you follow her on Instagram and Twitter, cause there's always great conversations and posts going on there initiated by Monique on anything from home health to DEI, to words of wisdom. So definitely give her a follow. So Monique, thank you so much for coming on. Let's see. Last time was a really long time. I can't believe it, it seems like 10 years ago, but I think it was really like three, three years ago. I think it was DSM like three years ago though. It seems like forever ago. So thank you for coming on again. I really appreciate it. Speaker 2 (29:56): You're welcome. And thank you for having me. Okay. Absolutely. And everyone needs to be safe. Okay. Yeah. Speaker 1 (30:01): Yes, you too. And everyone else, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.  

Today we talk about Cheburashka, as well as how he relates to me as a Copt living in outside of Egypt . Hope you enjoy the episode as much as I enjoyed making it !Links : Feel Free to suggest a topic using our Contact Form Here's your Kawaii Clip of the Week

Professor Waguih Ishak is a prominent Copt living in Cupertino, California and is also the Chief Technologist at Corning Research and Development Corporation in Sunnyvale, California, an innovative glass technology company. Professor Ishak will take us on the fascinating journey of his life beginning in Egypt then on to Canada and finally settling in Silicon Valley. Nader Hanna (who leads a new news service: www.copticnn.com) and myself spend the forthcoming two episodes learning about Professor Ishak's upbringing in Cairo, his studies and research that lead him to completing a PhD in Toronto and then finally to Silicon Valley. Not only does he have a PhD but so does his wife and two sons! Professor Waguih Ishak discusses with us his involvement in Technology and his love for innovation and how he sees Technology develop into the future. He also brings to the forefront his involvement in the Coptic Church in Canada and the USA and how he sees the Church utilising this technology. Besides these exciting subjects, Professor Ishak also takes us into the intriguing journey of how he discovered his family roots that lead him to take a DNA test in order to find out more about his family history. Be sure to tune in for the next two episodes to be inspired by the journey of the blessed servant of God and a man who has succeeded to reach the status of Chief Technologist at one of the most prominent companies in Silicon Valley. A visionary who may inspire you in your life's journey.

Professor Waguih Ishak is a prominent Copt living in Cupertino, California and is also the Chief Technologist at Corning Research and Development Corporation in Sunnyvale, California, an innovative glass technology company. Professor Ishak will take us on the fascinating journey of his life beginning in Egypt then on to Canada and finally settling in Silicon Valley. Nader Hanna (who leads a new news service: www.copticnn.com) and myself spend the forthcoming two episodes learning about Professor Ishak's upbringing in Cairo, his studies and research that lead him to completing a PhD in Toronto and then finally to Silicon Valley. Not only does he have a PhD but so does his wife and two sons! Professor Waguih Ishak discusses with us his involvement in Technology and his love for innovation and how he sees Technology develop into the future. He also brings to the forefront his involvement in the Coptic Church in Canada and the USA and how he sees the Church utilising this technology. Besides these exciting subjects, Professor Ishak also takes us into the intriguing journey of how he discovered his family roots that lead him to take a DNA test in order to find out more about his family history. Be sure to tune in for the next two episodes to be inspired by the journey of the blessed servant of God and a man who has succeeded to reach the status of Chief Technologist at one of the most prominent companies in Silicon Valley. A visionary who may inspire you in your life's journey.

After repenting from accidentally killing the tyrannical Copt, Musa sees the man he helped the day before in another altercation. When Musa moves to help him he criticizes the man for being trouble caused. Assuming that Musa is going to strike him, the Israelite speaks of the killing from the previous day, forcing Musa to […] The post 30-Musa Escapes to Madyan- In the Company of the Prophets – Shaykh Abdul-Rahim Reasat appeared first on SeekersGuidance.

This lecture was recorded on 19th November 2014

In this interview Lisa interviews Jez Morris, a clinical sleep physiologist on everything sleep apnoea and also cardiac testing. They do a deep dive into the symptoms and treatments and consequences of not picking up sleep apnoea.   Lisa has a personal interest in this as it pertains to brain function and rehabilitation and it was one of the key factors in saving her mum Isobel's life after a major aneurysm and stroke.  Jez explains the different types of sleep apnoea and co morbidities and risk factors.   You can visit Jez and his team at Fast Paced Solutions www.fastpacedsolutions.co.nz    About Fast Pace Solutions It was a common belief in the need for equitable health care – and improved accessibility for all – that led to three healthcare professionals joining forces to provide primary-based diagnostic services to GPs, specialists and concerned patients themselves. Fast Pace Solutions offers a range of cardiorespiratory diagnostic tests aimed at early and fast diagnosis of heart, lung and sleep-related complaints. Working closely with a range of health professionals and operating out of their new premises in the Strandon Professionals Centre, Michael Maxim, Jez Morris, and Alan Thomson want to encourage more people who have issues with breathing, dizziness, palpitations or sleep to get themselves checked out. Visit them at www.fastpacedsolutions.co.nz  Ambulatory Blood Pressure Monitoring Ambulatory blood pressure monitoring (ABPM) is concerned solely with detecting problems related to high blood pressure – a hugely significant health risk which is currently on the rise. Blood pressure monitoring involves wearing a cuff linked to a small device which measures your blood pressure every half hour (or hourly during the night) over a 24-hour period, while you go about your day. Many studies have confirmed this method is superior to clinic blood pressure testing in predicting future cardiovascular events and targeting organ damage. This means your doctor can provide a much more accurate diagnosis and effective management plan Holter Monitoring A Holter monitor is a small, lightweight heart rate monitor that measures the rhythm as well as the rate of your heart for a continuous period of 24 or 48 hours. The monitor has three leads which are attached to your chest via ECG electrodes. The Holter monitor's primary purpose is to correlate symptoms such as heart palpitations, rapid breathing or dizziness with the ECG (see below) and rule in or out any abnormal rhythm activity. The patient is required to document all symptoms in a diary. 24 Hour Holter Monitor Exercise Tolerance Testing An exercise tolerance test (or ETT) requires a patient to exercise on a treadmill in the clinic while being monitored by a 12-lead ECG (electrocardiogram) and blood pressure machine and is often used if we don't pick anything up on a Holter heart monitor. The ETT replicates how your body behaves under stress and can pick up issues such as angina and demonstrate how adequate your heart function is as well as your exercise tolerance. Chest pain and shortness of breath while exercising are common indicators for this test. Cardiac Event Monitoring Similar to a Holter monitor, but worn for a full week, cardiac event monitors (or cardiac event recorders) are used to correlate a patient's heart rate and rhythm to their ECG (electrocardiogram) over a period of 7 days. A cardiac event recorder is preferred when symptoms are less frequent and allows a patient to activate an "Event" button to snapshot a rhythm when they experience any abnormal symptoms. It is often used for younger patients. 7 Day Holter ECG and Oximetry An electrocardiogram (ECG) measures the electrical activity of your heart via 12 leads attached to your chest and body. It takes only a few minutes and records your heart's rhythm, checking for abnormal activity which may indicate damage to your heart or blood vessels caused by high blood pressure. An ECG can detect problems long before they become significant issues. In fact, everyone over the age of 45 should have an ECG. Oximetry measures your oxygen levels while you sleep, or for selected hours of the day. Resting ECG Sleep Studies Getting enough quality sleep at the right times can help protect your mental health, physical health, quality of life, and safety. Snoring is one of the most under-acknowledged symptoms in the management of health. Although often seen as a benign problem, it can cause disharmony in relationships as well as significant disruption to sleep. Ongoing sleep deficiency can raise your risk for some chronic health problems such as high blood pressure, heart failure, diabetes and many breathing disorders – sleep apnoea is a major cause of cardiac and respiratory issues. We offer an advanced at home sleep study to assess the severity of snoring/sleep apnoea and impact of cardiac and respiratory health. Level 3 Sleep Study Level 4a Sleep Study (Oximetry)   We would like to thank our sponsors for this show: For more information on Lisa Tamati's programs, books and documentaries please visit www.lisatamati.com   For Lisa's online run training coaching go to https://www.lisatamati.com/page/runni... Join hundreds of athletes from all over the world and all levels smashing their running goals while staying healthy in mind and body.   Lisa's Epigenetics Testing Program https://www.lisatamati.com/page/epige... measurement and lifestyle stress data, that can all be captured from the comfort of your own home   For Lisa's Mental Toughness online course visit: https://www.lisatamati.com/page/minds...   Lisa's third book has just been released. It's titled "Relentless - How A Mother And Daughter Defied The Odds" Visit: https://relentlessbook.lisatamati.com/ for more Information   ABOUT THE BOOK: When extreme endurance athlete, Lisa Tamati, was confronted with the hardest challenge of her life, she fought with everything she had. Her beloved mother, Isobel, had suffered a huge aneurysm and stroke and was left with massive brain damage; she was like a baby in a woman's body. The prognosis was dire. There was very little hope that she would ever have any quality of life again. But Lisa is a fighter and stubborn. She absolutely refused to accept the words of the medical fraternity and instead decided that she was going to get her mother back or die trying. This book tells of the horrors, despair, hope, love, and incredible experiences and insights of that journey. It shares the difficulties of going against a medical system that has major problems and limitations. Amongst the darkest times were moments of great laughter and joy. Relentless will not only take the reader on a journey from despair to hope and joy, but it also provides information on the treatments used, expert advice and key principles to overcoming obstacles and winning in all of life's challenges. It will inspire and guide anyone who wants to achieve their goals in life, overcome massive obstacles or limiting beliefs. It's for those who are facing terrible odds, for those who can't see light at the end of the tunnel. It's about courage, self-belief, and mental toughness. And it's also about vulnerability... it's real, raw, and genuine. This is not just a story about the love and dedication between a mother and a daughter. It is about beating the odds, never giving up hope, doing whatever it takes, and what it means to go 'all in'. Isobel's miraculous recovery is a true tale of what can be accomplished when love is the motivating factor and when being relentless is the only option.   Here's What NY Times Best Selling author and Nobel Prize Winner Author says of The Book: "There is nothing more powerful than overcoming physical illness when doctors don't have answers and the odds are stacked against you. This is a fiercely inspiring journey of a mother and daughter that never give up. It's a powerful example for all of us." —Dr. Bill Andrews, Nobel Prize Winner, author of Curing Aging and Telomere Lengthening.   "A hero is someone that refuses to let anything stand in her way, and Lisa Tamati is such an individual. Faced with the insurmountable challenge of bringing her ailing mother back to health, Lisa harnessed a deeper strength to overcome impossible odds. Her story is gritty, genuine and raw, but ultimately uplifting and endearing. If you want to harness the power of hope and conviction to overcome the obstacles in your life, Lisa's inspiring story will show you the path." —Dean Karnazes, New York Times best selling author and Extreme Endurance Athlete.   Transcript of the Podcast: Speaker 1: (00:01) Welcome to pushing the limits, the show that helps you reach your full potential with your host, Lisa Tamati, brought to you by LisaTamati.com. Speaker 2: (00:12) Welcome back to the show. This week I have an exciting episode with a clinical sleep physiologist. Jeez Morris, who's been a friend of the family for years and we've actually been in business together. We had a hyperbaric oxygen therapy clinic, but today we're going to be talking about sleep apnea, what it is, what the risks are involved when you have sleep apnea, how to assess it. The symptoms and sinuses are really, really important topic. It's so important that, you know, I don't believe that my mum would be alive if we hadn't picked up that she had sleep apnea. So it's a very interesting episode to learn all about sleep, what it does for your body, and it's a really fantastic interview. So I hope you enjoy the show with, jeez Morris. Um, just a reminder to I have my new book relentless out, which is available on my website. Speaker 2: (01:03) Um, it tells a story and part of that story, uh, from bringing her back, uh, from a major aneurism, a part of that rehabilitation journey was, uh, diagnosing her with sleep apnea in dealing with that. So it's really pertinent to today's topic. Um, I am currently working on a brain rehabilitation course that I'm going to be offering to people since the release of my mom's book and the story of her, um, incredible, amazing comeback journey, um, from being not much over a vegetative state to being now fully functioning again, um, fully healthy. Um, I have been inundated with requests for people wanting help with brain rehabilitation, whether it's strokes, dementia, Alzheimer's, uh, TBIs, concussions and so on. So I'm in that, in the throws of making that course because, uh, you know, I just can't deal with so many one-on-one. Um, so look out for that. It's going to be available hopefully within the next couple of months if I can get my energy. Um, and really looking forward to sharing that with the world as well on the back of this book. So right now let's go over to James Morris and learn all about sleep apnea. Speaker 2: (02:16) Well, hi everyone. Lisa Tamati here. and pushing the limits. So thank you for being with me again today. I have a friend of mine who is a sleep physiologist, a clinical sleep physiologist. Jeez Morris, how are you doing? Geez. Oh, very, very good now. Um, jeez and I have a bit of a history together. Um, I'm uh, he, when my mum had a stroke and everyone knows that she had an aneurysm and a stroke a few years ago, um, and I was doing better with the hospital because I wanted the sleep apnea test done and I couldn't get one done. Um, saved for going to my friend dues who is asleep physiologists and saying, geez, can you come and help me please? Can we do a test? Um, we did that um, slightly against the roles Speaker 3: (03:00) at the hospital at the time, wasn't that, uh, we came back with severe sleep apnea with oxygen and then was at the worst point at around 70% during the night, which is pretty disastrous. So I'm going to talk to you today with uh, jeez about, um, sleep apnea, what it is, what you need to be aware of. And we're also going to go into a new cardiac system that is, that got there. That's going to be really interesting. So jeez, firstly, thank you for helping me back then. My pleasure. I don't know if my mum would be sitting here today. I'm healthy and well, if it wasn't for you coming in and doing a stake assessment, it's that important and this is why the subject is really important to me to get out there and to let people know about this. So just can you just tell me a little bit your background, um, and then you know, what is sleep apnea? Speaker 3: (03:52) Okay. My background is actually an anesthetic technology. I used to work as an anesthetic technician here at base. Um, and as the years went by I got approached by a colleague of mine yeah. And T surgeon David Tolbert who was on a real interest in sleep, Mmm. Apnea because of the upper airway and asked me if I could help him with regards to treatment. And that the relationship developed and I got really interested in this area because it's so fascinating that eventually we set up I primary based sleep clinic that then sort of spread a bit and there's quite a few around the country. Um, because sleep is something we all take for granted in some respects, but it actually has a significant role within normal health. Hmm. So that, that's, that's how I started in this field. I'm still doing it 18 years later. Speaker 3: (04:47) Yep. And you've, so you've had a series of clinics throughout New Zealand at one stage and um, yeah, sleep apnea is what is it defined as specific place? So w w how, you know, people hear this word but they don't often know what the heck it means. Okay. So sleep apnea is a condition that has pretty sure, I realize it basically pauses in breathing during sleep, uh, for a number of reasons. Um, it affects about two to 7% of the population. However, that's with moderate to severe. Um, basically, but what we talk about now is sleep disordered breathing because we know there's a range of respiratory sleep issues affecting the patient. So sleep apnea itself is fundamentally, you can tell, cause if you've got obstructive sleep apnea, which is the main one [inaudible] it's a classic symptom. So all sleep obstructive sleep apnea, but not everybody who shores has obstructive sleep apnea. Speaker 3: (05:56) Okay. So that's key. So snoring is, is like, um, a pain in a joint. If we are a runner or sports person, if you get pain in your neck, you don't tend to ignore it. Yeah. You want to know what's happening because it's an abnormal process, right? Shoring is an app, normal process. And as a symptom of something, it could be benign, it may not. So we actually say that up to about 20% of the population will suffer from pathological or issues related to snoring. And that's the key here. So if you snore to start, you really should just get it checked out. We know that snoring gives you a higher chance of developing high blood pressure. Hmm. Um, from there, high blood pressure can lead to other cardiac and physiological issues. Absolutely. Yeah. So that's, that's where we start. Okay. The most common is obstructive sleep apnea. Speaker 3: (06:57) Then we move into things like central sleep apnea. That's what mum has. Yeah. Because basically if we see these conditions, there's lots of reasons why we'll see central sweep here. We see it in severe cardiac problems and basically it's a miscommunication where you just physically stopped breathing. So obstructive apnea is the, is the airwaves physically shutting off? Yeah. So you get this jerky movement of patients who have got it until they breathe. Central sleep apnea is a pause, just a stop in breathing. Wow. So they will be breathing quite normally. Then they stop, go silent. There's no effort to breathe nothing. Um, and you can see it for a number of reasons. In your mom's case, it was due to a stroke, uh, that caused her to stop breathing. But we see it in neurological conditions. We see it in change. Stokes breathing is a common cause of central apnea change. Speaker 3: (07:58) Stokes is a word that sort of worries me when I heard that. It's what we tend to see in the pre pre mortal issue. So just before people die, they go into this change. However, there's 31 reasons we see more, more that we can see, change, dehydration, heart conditions, all sorts of things because there's not, it's a metabolic condition. It's why we get changed up. So anything that can cause a metabolic issue can cause change steps. Yup. And this is this waxing and waning of, of the respiratory pattern. The center of a nice smooth process. This is what got a particular sound to it. Speaker 3: (08:48) It's usually, it's, it's a form of hyperventilation. She'll see the patient sort of get deeper and deeper, deeper, and then weighing off again and then flat. So people refer to it sometimes as like a death rattle. Yep. Okay. Yeah. Yeah. And there's a scary, scary way. And so that's, and so that's happens when you've got a central problem that can happen. Central sleep apnea can be caused by different Cheyne Stokes is one pot, one tile of central apnea. Some people just physiologically stop breathing. Yeah. Because of a stroke or a head injury, a neurological condition. Something in the brain that's been affected by the strokes, our blood supply to a particular gland or a particular part of, uh, of the primary. Primarily. Yeah. Neurological. Yeah. Primarily. Yeah. Okay. Um, all right, so that's two of them. Is there a, is there a third variation? There's a few other ones. Speaker 3: (09:50) We've got hyperventilation, which is, um, a reduction of breathing of at least 50% in the, in the volume of breath, but taking with a subsequent, um, reaction. So in other words, you know, your oxygen level starts to drop or you physiologically wake up. Yeah. Uh, hyperventilation in itself, I mean, everyone will stop breathing and the brief assert, so about two, about five times out, we're not going to stress too much about it from a risk perspective, but hyperventilation, we're seeing more and more because like obstructive sleep apnea, one of the main cause of that is weight. Obesity is, is, you know what I mean? Again, within healthcare, I know that people feel that we pushed away question a lot, but obesity with good is a significant health issue that we're not, we don't seem to be successfully addressing. Yep. So you've then got hyperventilation syndromes, you've got obesity hyperventilation syndrome that can be significant, uh, detrimental to long term health. Speaker 3: (11:01) Yeah. Okay. And this has seen a bit of a, um, you know, a circle because what's your, what's your obese and then you have this, then you'll get more obese because there's, there's a big, big connection between things like leptin levels and stuff that control appetite, especially in fragmentation. Yeah. So theoretically you mean the worst you sleep the hungry you are. Because at the end of the day, that's how we function as, as a survival mechanism, as a building. Yet, if we're feeling low on energy, we tend to eat to get fuel to feel energetic. Unfortunately, a lot of the foods that we might grate to when we're feeling like that tend to be the highest fat snacky type foods. So in a lot of cases, people who are, who are significantly overweight may not eat big meals, but they eat are very, but a lot of very small, high fat milk, which compounds the issue. Yeah. Speaker 2: (12:01) And that's done in Graham on as being a part of that equation. Yeah. So your satiation mechanisms aren't quite as good and of course when you, when you're not sleeping well, I mean there's, there is a whole lot of knock on effects, which I've talked about on a couple of episodes on the podcast. So it all starts to tie into to each other and has huge impacts on your, your mental health, your physical health, your brain, you know, mission, everything. Speaker 3: (12:29) Yeah. Well what we tend to see in people who to be, cause that's what we're really pushing her obstructive sleep apnea. These patients will first of all go to bed. They'll then start to sleep, start to snore. So sleep in itself. It's a very complex process. People always think you're awake, you're asleep. That's it. It's not. We talk, we talk in w we talk about sleep architecture, how your sleep is structured. So for the first seven minutes or so stage one sleep, that's the time you're getting comfortable, your eyes are closed. It's not true sleep. It's that like pre sweet sort of process. Then then we're supposed to drop into stage two, which is what we define as true sleep is when you actually go to sleep physiologically things start to settle down. You're hearing still going so you can still be erased at that stage and we spend 20 to 25 minutes there and then we move into what we call Delta wave sleep stages for him. When the brain goes into that slow wavy pattern, so you've basically got an inactive mind instill a veritable active body so you can still Twitch and stop after about 90 minutes of these processes you then stack and drop into what is REM sleep, Speaker 2: (13:44) which is that Speaker 3: (13:46) dream fell asleep. Yeah. Which is very, very important within a human, so like, and then we just cycle through that every 90 minutes or so. So you get to have about five, six, seven periods of REM during the night. What we tend to see in people with obstructive sleep apnea is that they'll start to snore at stage one too. Stages three four they'll start to obstruct. Once they stopped breathing, about six seconds later, their oxygen levels start to drop. We then get this sympathetic nerve activation that causes them to physiologically wake up to their heart, beats faster, that blood pressure goes up. Um, and it brings them back to a stage where the obstruction disappears, which may be level one, level two, but that Reiki did deep sleep. And then a lot of cases that these patients don't get true REM periods, pure sleep architecture. Speaker 3: (14:43) It's completely fragmented. And we're talking, and we, I've seen people stop breathing, I mean over a hundred times an hour, which means is that our heart rate variability is phenomenal during the night. So in effect, these people are working harder to sleep, to stay awake. So of course, but the body's a learning mechanism, it starts to say, well, I'm burning more energy doing this than I am by just staying awake. So people tend to start to develop this really bad sleep pattern where they can't get to sleep properly or they wake up frequently during the night. So you mean, you mean sleep is really important for things like growth hormone production, cortisol productions, all of these things. Your adrenals have hormones. They have very poor short term memory, their fatigue, blood pressure tends to be high and you mean eventually things are going to shut off. Speaker 3: (15:40) Yeah. And, and your health is going to seriously be a farrier, right? Absolutely. Yeah. And this is, this is so it's so important and just not, you know, all the sort of stuff needs to be taught at school. So what happens in the sleep process? Cause we all just fake. We go to bed and we go to sleep. You know, we don't know about deep sleep and REM sleep and in the life stages of sleep and how it, how it actually affects our physiology the next day and how our brain function isn't going to work. And what about the, I read a study recently on the brainwashing. Yeah. Function that happens when we're in asleep and that the brain shrinks. You're talking about, yeah. You're talking about amyloid. Cool. Yeah. Yep. Yep. Speaker 3: (16:24) Which is good when we're young because I think, I mean, this is getting into real neurophysiology. So, excuse me. So basically when you're growing or developing synopsis, it sits with that neuro logical function. Mmm. It's a, it's a byproduct of metabolism, of neurophysiological by metabolism and needs to be washed out. Um, which tends to happen during sleep while you were asleep and we beat her is dispersed ready for the next day. So it washes out the break. Yeah. Yep. It's a brainwash. That's what they're calling it. Yeah. They flush it out. Yep. And is it important a protein, but it flushes out all the and the rent. However, what we find sleep apnea patients or insomnia patients and where is that? I don't fully do they, that's why they wake up feeling groggy. Yeah. Yeah. Confused sometimes. Um, we noticed in outside of ms patients that there is a significant higher level within Sam or in place. Yeah. Yeah, yeah. So yeah, that is an important function as well. And we can see that not just in sleep pattern. We can see that in insomniacs and people. Wow. Wow. That is fascinating because if we not washing out those plaques every day and getting rid of them as that cause they build up when we're awake, from what I understand, we're functioning. Yeah. It starts to up over time. And this, Speaker 2: (17:50) you know, over a period of 20 years can lead to where they're suggesting it can lead to Alzheimer's. Early onset Alzheimer's. Yeah. Yeah. It's a long side process. So if we can get it early, we can, we can stop that process happening. Um, and this is really, this is the whole point of this conversation is, is to get people to be aware of what are the signs of sleep apnea, what are the things that are going to happen when you're asleep as off. Um, and what we can do about it. Um, uh, you know, we referred, um, just a bit earlier to mum's story. Um, and mum was in the hospital, excuse me, um, for three months and she'd been in Wellington, uh, in the acute phase and the ICU and then in the neurological ward down the air and she'd been on supplemental oxygen. Speaker 2: (18:36) Um, when, when she came back through to new Poloma, she was taken off of supplemental oxygen cause she was now stabilized if you like. Um, and I noticed that she was gone from terrible to really, really terrible. Like there was hardly any higher function going on at all. Um, and that's when my brain started to tick over and you know, my history with, you know, um, training at altitude and data races at altitude and I'd seen like things like she had a bacteria in the mouth that was just doing gross, horrible things. Yeah. And that was a really a signal to me like, Hmm. Bacteria, lack of oxygen. Uh, jeez. Sleep apnea basically was the connection that I made there. Um, oxygen in the body, you know, and lack of oxygen causes bacteria to spread and, and proliferate. Um, so it's really, really important that we, we address this. This is not something we should be putting off. So you is inherit in your clinics, you would do the sleep assessment on people, which is an overnight procedure or a test. Speaker 2: (19:44) Then if someone comes back with sleep apnea, they get a C-PAP machine? Well, it depends, right? So first of all, the key to anyone as to acknowledge that they have sleep patient. So the reason we can tell people who have sleep issues is people always say, you're mean I have sleep problem, but during the day they still function. Normally people with a true sleep problem don't function so well. So that constantly fatigued. Yeah. Tired, short term memory, it's usually quite poor because they're not dreaming. And part of the process of dreaming is the burn information to a hard drive if you like. So if you're not dreaming, you're not retain that information. So short term memory tends to disappear. There's petite. Quite often they're slightly on the higher. So those are the key things. Now I definitely, yeah, if you're not snoring, it's not obstructive sleep apnea, but it could be upper airways resistance syndrome or something like that. So in other words, you're having difficulty breathing during the night. Speaker 3: (20:47) People often wake up for headaches. They often wake up during the night, Speaker 3: (20:51) um, maybe once or twice. Um, so these are the common symptoms we see meet. But 70% of most GP consults will involve the word fatigue. Tired, no energy. Yeah. So that should be your key. If you're feeling tired during the day, most people come by their GPS because the GPS are becoming more and more aware of sleep specific. Um, because we spend one third of the day doing it. Yeah. Um, we would then go through a simple questionnaire like you're tired and scale Epworth sleepiness score is that, is that common tired and scale that we use to address how try it or how it affected people. And this involves eight simple questions about the ability to fall asleep doing certain things. And I would have run this through with Uma and basically it's things like if you sat reading a book, what's your chance of falling asleep? Yeah. Not possible. Moderate be high or high or sitting at traffic lights. Um, you mean what's the chances of you falling asleep? And believe it or not, there are people who want to positively, hi. Oh God. Every question. I remember one person telling me in Oxford, he said, I said, yeah, I mean, it's not very good if you're falling asleep at traffic lights. And he said, yeah, we can, we can sit for 20 minutes to traffic lights. So maybe we need to readdress it so that we're sleeping. Speaker 3: (22:17) Then we would probably carry out for most people who complain of sleep. The first thing I think to do would be to carry out a very simple respiratory sleep study and there's a couple of types you can do at home. There's all this imagery which surely looks up to gin levels during your sleep and that's a little clip that you wear on your finger, touched with a little monitor, some of wireless, they go on the watches and that's the simplest way and it has a very good correlation to sleep apnea so we can use it as a very simple cheap test. Yeah. As an a level three sleep study, which looks at as a thoracic efforts. So we're looking for specific obstructive central events or under breathing with a nasal cannula, an oxygen saturation monitor, and they can be done at home. Yeah, every simple test I can give us really detailed information, but level two sleep studies is when you're getting into neurophysiology side of sleep. Speaker 3: (23:16) Now 96% of sleep disorders. Alright. There were spiritually, mostly the very small percentage are the neurological disorders that we see that REM behavior disorders, the narcolepsy's, all of those more complex disease States that really require much higher levels of Oh, acuity and testing. Right. But the majority, and that's a medicine what we're supposed to address, the majority of patients can be, can be looked at from a respiratory. Yep. Um, once we get a test, we can then identify the severity of any underlying respiratory problem. No. Talk about sleep. Obstructive sleep apnea, which is where we get airway physically closes during the night. Yep. We talk about mild, moderate, severe. Yeah. Mine is any and vent above five to 15 events. Then we talk about moderate, which is 15 to 30 events an hour and anything over 30 we talk about severe. Yeah. This scale is really more focused on funding of therapies. Speaker 3: (24:27) Yeah. It's on impact of disease. That's terrible. Well, we know that people with certain tend to have a higher risk morbidity, mortality, but we also know that people with moderate with other pathology, awesome have significant risks. But more and more evidence is saying that if you don't treat the mild, they will become exactly there. Related to it is at the bottom of the cleft problem that we have. It's like fun. It always comes down to funding not how healthy you're going to be, but you'll be basically that's sleep apnea. Yep. Obstructive sleep apnea, obstructive sleep apnea can't be treated. Yeah. That's the good thing. What we talk about is things like conservative measures. Conservative measures are always going weight loss. Yeah. Fitness levels. Yep. Cause obviously the fitter you are just sending you out in the majority of cases. Yes. Um, so those are, those are simple things you can do to help. Speaker 3: (25:40) However the research is not green. Yup. Yup. For ag. And then we're moving more into the surgical options. Obviously you've got the weight related surgery, which is very difficult. Very Patrick. Yeah. To get, quite often we look at the upper airway as being part of dish mechanism that's causing the issue finish things like the obvious nasal deviations that we can. But you can see the obvious ones from rugby Plains, but obviously there are also, there's also subtle deviations. Then there's things within the knees or pathway that can cause problems. Their adenoids leaving you. Now tonsils is a controversial area in the area of sleep medicine. Yep. Because tonsils or something that's roughly what disappears. We get, Oh yeah, yeah. Um, however, saying that it would be the conversations I have with GPS about this is quite interesting because being in this, but I look at tonsils and everybody, well look at the back of the throat cause I'm looking at what we call a modern putty index, which is how far back the larynx and the size of the tongue. Speaker 3: (26:54) Um, but also I'm looking at tonsils and quite frequently you'll see extremely large asymptomatic in males predominantly. Wow. So if you've got tonsils that are kissing but asymptomatic, which means you don't get tonsillitis as such, then they're going to be causing an issue. Yeah, sometimes. Yep. Yes. Well in children now for sleep disorders. Um, the first line of therapy, children who might snort snoring to all the parents out there in children is not, it's not cute. It's not cute. And noise from a child while they sleep, um, is not cute cause they're supposed to be perfect breathers. Yup. But the first line of therapy, now children, but snoring or anything like that, just taking out there, don't bother with sleep studies. They just take out the tonsils and the admins, which in a significant number of cases can improve it. And there was a study out of the States where they took, uh, patients, children diagnosed with ADHD, trying to remember the study. Speaker 3: (27:56) Yep. And what they did was, uh, they took this group of patients were all treated, remove tonsils and adenoids. And what they found was that 50% of them, I think it was 50% ended up being taken off that Ritalin medication because it was hype. Children react differently to tiredness than adults. We get, we get authentic, we get children get hyperactive when they're tired. And we've seen that because everyone who knows your kids and then they crash. Yeah, exactly. Cause what they are is tired. Yeah. So when they get tired they send them like they run around. Speaker 3: (28:33) So surgery, surgery can help in some cases with obvious deformities. Um, success rate surgery for sleep apnea in the mild to moderate, probably about 63%. Wow. And surgery like anything carries Chris from an aesthetics from the surgery itself. So it's not a guaranteed cure. Then we're moving into things like most guides, uh, mandibular splints that designed the whole, the jewel in a prominent position pulling the, pulling the tunnel way from the back of the throat because as you fall asleep, nobody can physically swallow that up. Yeah. But their tonnes can drop back and include the airway. That's why in recess we pull the jaw forward. If you pull the jaw forward, your pull the tongue away from the back of the truck making that larger space. Monday splints can work very well. Um, there's different types of over the cancer, not so successful, but one is designed by a specialist orthodontist of which there are a number now in the country, um, can have an 80 plus percent success rate. Speaker 3: (29:39) That can be very good, but I probably won't be able to do that work very well. Okay. Yeah. Um, for more mild cases and some moderates, there's a thing called microvalve, Serafin therapies, Sarah events. These are the things you stick a little plastic over your nose and what they do is you breathe in normally through lots of holes, but as you breathe through your nose, lots of the valves closed down and one valve remains open. So you get like a, what we call a valve silver effect, like blowing through your nose and that back pressure keeps the airway splinted open. Wow. So it's a physiological form of C-PAP, which is what, yeah. Yeah. What's his, what mom's got like a sticking plaster that you see some athletes or is it on the inside? The strips on the outside. I for anatomical for collapse where the AOS actually collapse. Speaker 3: (30:45) So those things pull the nose. I was slightly out. These things stick over the, there's over the holes here. Oh yeah. That there. Interesting to work with. Very interesting feeling. But they can work. Probably don't use that run ongoing costs. You've got to use them every day. If you don't use them, it comes back. Yeah. So they're quite expensive. Right. But as an alternative to seatbelt, there's also this tummy device that don't think we turn the stabilizing device, the TST, very bizarre looking device that basically works upon the fact that if your tongue falls back, you pull your tongue forward. Now in the old days, very old days of anesthesia, we used to have a thing called a tongue clip, but we could collect the tongue, pull it out to open up the airway. Um, we've moved on from there. This is a TSD is like a suction device that you squeeze, stick your tongue in and it sucks your tongue forward. Speaker 3: (31:47) Yup. They read it to be cheap. Some people swear by them. I've tried most of these things. I couldn't sleep with it. This is the, it isn't, but it is an option. It is an option to try the only thing guaranteed to reverse sleep apnea. Yeah. Or it is what we call continuous positive airway pressure. Yup. And basically in simple terms is a pneumatic splint, so it blows air into the airway via either a nasal mask or a full face mask. Yup. While you're asleep, um, you can get very little cushions now that you wear like oxygen, things that can also be used for this machine. Um, and that blows air in. So when you breathe, you're breathing out against pressure so that then hold the airway open. Yeah. It's a new magic process. So you breathe in and out again to this flow or like that if you can wear it is guaranteed to reverse obstructive sleep apnea. Speaker 3: (32:55) Yeah, it's gold standard for therapy. And interestingly enough, it's only been around since about 1982 so relatively new therapy, but is now widely used worldwide for, that's the one that mum's got. Um, and she has to wear it every night and all night. Um, and you know, it's quite an invasive thing to have on. It's not pleasant for her. Um, having the central, uh, sleep apnea is guaranteed in that case? Like with obstructive or is it a bit, a bit more, it really depends upon that the, the, the reasoning behind the central event. Yeah. Um, in most cases it can improve it to an extent that it's okay. Um, in some cases it doesn't, but we stop an obstructive component. It proves your physiology changed to make the change they him and go away. There are some machines that are specifically designed to treat certain types of breathing, like Cheyne Stokes, the ASB system. Speaker 3: (34:03) Yeah. That can only be used. There are certain, a very small group of patients who can't use ASP because there's a higher risk of problems. Right. Like with any therapy, there's always risks. CPR tends to be generally safe if used appropriately in the right patients. And there are then machines that will provide backup. Correct. So if the machine senses that you're not breathing, it doesn't ventilate you, but it reminds you to take a breath. Yep. So we can use things called by levels or bilateral S T's with, with a minimum respiratory REM required. Yeah. So it will, it will. If you stop breathing, it will cook you with air to say take a breath. Is it the machine that mum's got? You know, because it regulates when she's breathing it's, yeah, yeah, yeah. Then when she stops breathing or you hear the machine crank up, yeah, you might, your mom's on auto type ventilate auto sheet. We'll have backup, right? Yeah. Right. And this is similar to what I've been delayed heroes in the hospital and not flight. Speaker 3: (35:17) C-PAP is not ventilation. C-PAP. C-PAP is stopping a reverse vacuum cleaner to your nose and away you go. It's, it's, it's helping. It's not breathing for you. It's like a walking stick. It's making your breathing more effective than if you weren't using it. I know ventilator is physically breathing for you. Now there are two types of ventilator says invasive ventilation. Well there's noninvasive ventilation. Noninvasive ventilation is legacy pap, but basically that the pressures are split. So you breathe in at one pressure and you breathe out at another pressure. Yep. And there is a, that can be a backup rate added to that. So that's, that's term. There's noninvasive ventilation. Those are the ones we tend to see used on patients with hyperventilation syndrome or severely large patient who cannot tolerate time levels of C-PAP. Breathing against the pressure of 10 centimeters may not be as bad, but the minute you start to get to 60 18 prep coming sent to me is a pressure that's a hurricane blowing, you know, so then we need to look at how we change. So we have an inspiratory pressure pressure, noninvasive ventilation. So in any form of respiratory failure, which is the end game of some disease States, they work really, really well. And it's becoming more and more used as opposed to inter invasive ventilation in a lot of cases. Now I've just read some reports out covert, they're starting to look at noninvasive ventilation as an alternative, right? Probably with noninvasive ventilation. Speaker 3: (37:04) Oh yeah. So you've gotta be really tough and the other ventilator, no, see, perhaps not recommended covert patients anyway, even though it's starting to be used as an alternative, but needs to be used very carefully. And we've got, um, uh, I've been looking at the research. Of course, Jason and I had a hyperbaric oxygen clinic, which we opened up to mum's story. Um, but the hyperbaric and covert, um, it's showing promising results. Uh, I, I saw, I saw that, yeah. The issue with coach, we're in the infancy of a disease state. We don't know what the longterm benefits, risks, outcomes next 10 years, 20 years of research is going to be around the last three. But hell's happened to us. So we keep on sleep apnea. Speaker 3: (38:07) Yeah, very true. But yeah, so, so, so treatment for sleep apnea with with C-PAP is very, very common. It's effective. Um, we really started to look at muscle diseases well because what we noticed with patients with mild disease, so they can still suffer all the same as severe disease. They can still be cycling, hypertensive or control. They can still be difficult to control diabetics. They can still suffer extreme daytime tiredness, um, and things like that. So, so C-PAP can be used as a management tool from mold too severe. Yep. So we were one of the first groups that probably made it more available to the mind. Yeah. Cases because in our opinion, the benefits fired out, weighed and the risks associated with treatment and at the end of the day, every therapy of any kind should be the decision that the patient not absolutely. Speaker 3: (39:10) Depending on what that treatment is, of course, and something like that. I don't see very low risk with a high reward in medicine. That's what we're looking. Is there any difference between when you were, say I'm now reading a sleep thing study last week is sleeping on your side versus sleeping on your back and can you actually sleep, and this is a question after I read that I was on your back all the time because of the sleep app machine. Is she actually able to sleep on the side? Yeah, of course she is. The machine she has got will automatically adjust for any change impression, so it will go up or down as required. Yeah. That's the benefits of that type of machine that that algorithm look. Positional sleep. Yes. You can talk to any partner who has suffered a partner who snores after a glass of wine or beer or whatever. Speaker 3: (40:05) We always poke them to roll them onto their site. Positional treatment for snoring can work and it's one of the conservative methods we recommend you. I mean there are very fancy machines are designed to be worn around the neck. Um, tell it when you were starting to. Sure. And then it plus as you would look for the electric shops to turn you on your side. Wow. The, the, the most practical tool you've got for positional sleep apnea is what your grandmother would have said, which is show up button in the back of your pajamas or get a tennis ball with a loop of elastic. Thread it through. I'm wearing like a backpack and that physiologically keep you on your side. There's no doubt that we can see. So obviously Pat on the back because all this depression is pushing down on their side. All that is moved away from, especially on the left side. Wow. If you turn onto your left, it's easier to breathe. That's why in the recovery position we turn people to their left. Wow. Speaker 3: (41:09) Pressure on their, on their venous return helps improve blood pressure, but it also moves and everything away from, from where your track here. So, um, you know, I, I sleep on my side but when I sleep on my left I can always feel my own heartbeat and then I always get worried. I'm putting pressure on my heart on the other side. If anything, if anything, probably be more on the right cause that's why we talk about pregnant women with debt gravid uterus. If you, if you lay on your side, that weight comes on to the vena cave on the right side. So actually restricts blood flow, especially return. Yeah. So your blood pressure theoretically needs to be higher. So in medicine we tend to turn people onto their left side and especially pregnant, when will we say light his left side. Great tap. Positional sleep can work very, very well in those people who are purely shorts. Speaker 3: (42:09) Yep. Yeah. It makes slightly improved sleep apnea, but because of all the other factors involved, it's not always there. Okay. But a sleep study, you can tell us that because part of the sleep study told us which side the patient is sleeping on when is happening. Yep. And we can, we can see that so we can recommend position therapy. What about like, um, I know it was several and you probably have a, have a crack at me for talking about him on the phone. Guys. I, he, he sits on his back and he sleeps on the couch. He wants to sit. I sit him up higher with pillows, um, in behind them and then a snoring is a lot less. Yeah, if you laying flat, yeah, it's okay to raise the head of the bedside. If you get a raise, the head of the bed, it's always been to put a pillow under the mattress as opposed to empty your head because the biggest problem is it a head forward and you make this more obstructive. Oh, if you want to put it in the yourself and put it in the shoulders, your headsets slightly flat or sniffing the morning air. This is the position we used to call it an anesthesia. So their head is flushed back, straightens the airway and it's easier to temporary sleeping in a chair. It's not a cool thing because you're not going to, you're not going to sleep, you're not going to sleep as well. Especially in patients who let's say have respiratory problems COPT they've got what we call overlap syndrome, so they've got sleep apnea. Speaker 3: (43:42) They tend to sleep in chess cause they feel they can breathe each year. The problem is is it's not very good for you from a health perspective and sleeping setup because of venous return, pressure on the kidneys and the heart. Other things probably blood flow to the brain. Yeah. Yeah. So if, if people are sleeping checks because we find it easier to sleep than they really need to be assessed to find out. I've got another fatal on my hands coming up. I can say yes for a number of reasons. Sleep apnea. Interestingly enough, we talked about it being related to obesity and other disease States, but it's also predominantly higher in men than women until about the age of 50. So postmenopausal women trach it to men very fast and it tends to be the effects of, it tends to be than what we see on men. Speaker 3: (44:33) Um, is that the weight gain side of what happens is because of the loss of certain hormones in postmenopausal women, especially around respiratory issues, um, we tend to see more in Mali, men especially but also higher percentage. So there is a ethnic link, we're not sure if that's because of body habitus to that. So the shape of the body and the upper airway rather than that, it just isn't working out, whether it's the increased weight, shorter neck, things like that. So yeah, so you mean there is, there should be a definite and I think there is a definite push within modem to check sleep apnea. If you've ever been onto a Mariah, not a pilot in a positive way. So you want me to probably one of the best places to have a sleep person would be on my mind very quickly identify and this is why, you know, sharing this sort of information so that people can directly, because it's with all, you know, all the health stuff that I talk about. Speaker 3: (45:40) Um, you know, it's being informed. It's knowing that the stuff is out there. It's being aware that there is a, perhaps a problem that needs to be checked as the first line of getting people in the door. You mean if you want to look statistically around research, you know what I mean? You ask three times more likely to have a stroke. If you have sleep pap, you're three times more likely to die. If you have sleep apnea, you're significantly more likely to develop diabetes. If you have sleep or especially what we call uncontrolled diabetes, you're more likely to develop heart problems, more likely to develop respiratory problems. I mean, we're talking significant percentages. If you look at something like what we call label hypertension, so blood pressure that is difficult to control. 80% of patients with difficult to control blood pressure will have some varying levels of sleep. Speaker 3: (46:29) Disordered breathing. Yup. 55% of cardiac patients, especially at S patients will have a compending or causative sleep disordered breathing. Yep. So the numbers start to stack up more and more and more. We're looking at nighttime physiology as a D as a predictor for daytime, especially around things like blood pressure. 24 hour blood pressure now is something that's becoming standard practice because we've historically treated blood pressure on one off. Yeah. Precious. Yeah. When we're noticing that nocturnal hypertension is a better predictor of cardiovascular mortality and morbidity than daytime blood pressure. Wow. So more and more GPS now are moving towards 24 hour blood pressure. You know, you go to your GP and he asked for it. Speaker 3: (47:23) Yet there's a few GPS in town who will do 24 hours. Most of the GPS will refer into somewhere like this where we were doing quite a few 24 hour blood pressures and Holter monitoring. Because my area of special interest has always been the impact of sleep on cardiovascular disease or on on cardiac health, which was why I've sort of moved into that sideways, into more cardio-respiratory physiology than I was sleep. So tell us about, a little bit about the clinic that you're in now. Fast based solutions, which is based in your Plymouth. If anybody wants to talk to jazz and come and see you guys. What is it that you do? You showed me a machine before that you can actually wear. Yeah. So basically we moved sideways and I teamed up with two other guys. Mike Maxim is a cardiac physiologist and Alan Thompson, who's a, who's an anesthetic technologist, we looked at what we could provide to primary care as a, as a midway step between primary medical care and secondary medical care. Speaker 3: (48:26) So we sort of set out to say, wow, we can bride these tests a lot faster probably because we have less restrictive process. Yep. Um, and so we're doing things like Holter monitoring. Holter monitoring is monitoring the heart over 24, 48, seven day period depending on, on what we're looking for and basically monitors cardiac speak to the variation. So it's great for identifying an arrhythmias. This is ASA Fletcher, all of those conditions. Uh, atrial fibrillation is something we're seeing more and more, um, potentially a significantly life threatening condition if not picked up and manage because of the increased risk of stroke and things. Um, so we brought in more and also we're seeing a higher demand from people wearing wearable technology who have started to notice that happy changing, going faster, slightly out to be, yeah, because they're exerting and it causes concern. And part of medicine is to address concerns and fear. Speaker 3: (49:38) So we do, we do Holter monitoring. So we're using small halted co monitors that allow us to monitor patients in a more free fashion. The old ones used to have lots of wires that restrict things. These things you can run cycle. So they're great for people who are active because that's where they notice the problem. So we can monitor the patient in the situation in which they noticed that problem. It's a lot more effective. The older, bigger ones are cumbersome. So you can't run in them cycles when you can with these. Yep. So it allows us to monitor patients or effectively, and we can even do cardiac ones on there so we can get really tiny patches. So we do those, we do exercise tolerance testing to check for narrowing the vessels. So it's a a test that you run on a treadmill and we'd look at your ECG 12 lead ECG. So quite in depth in ECG while you're doing it. Um, would you ambulatory blood pressure, 24 hour monitoring spiral Metairie cause that forms part of the cardiac paradox. You know what I mean? You talk about cardio respiratory disease cause they both obviously work together and they affect each other. Yeah. So that's what we're doing here. We're doing more direct to patient management. Speaker 2: (50:58) Are you working with athletes? Speaker 3: (51:03) We get a lot of athletes come through because they're the ones who, who noticed a change. Yeah. And they just want to be reassured that what they're feeling is not a problem, which is fine. Yeah. Optimize performance. Yeah. Speaker 2: (51:21) Yeah. A lot of, um, uh, I've got a few colleagues, you know, I've been doing, you know, ultra marathon stuff for years and they've got Speaker 3: (51:29) over-sized carts, um, as a result. Okay. Yeah. That's exercise induced cardiomyopathy. Yeah. Um, it's not very common, but we do see it and some patients who've been exercising to an extremist for long periods, any muscle that you can overwork can become hypertrophic. You know what I mean? That's the whole point of bodybuilding damaging tear muscle to develop definition. And we see that in things like guilt, um, and insomniacs would that, but their cortisol, they're a highly stressed person who can get adrenal atrophy, atrophy, hypertrophy from that because you're constantly kicking out high levels of cortisol. Why they can't sleep and it's all at the wrong time of day. So you mean that's, yeah. Exercise-induced Caribbean cardiac conditions. They're not common, but there's some that we can check for. Yeah. Probably more common amongst people are hanging out with, Speaker 2: (52:39) you know, it's not common. I don't have it. Um, but I, yeah, my wife's husband used to have that problem. Um, been exercising for just, you know, huge amounts for many, many years. Um, and it's mostly mean isn't it? Then Speaker 3: (52:53) it is mostly men, mostly men that they're giving. It's like with rugby players in that it'd be interesting to look at their sleep at the same time. Yeah. Because that's why we've moved this way. Cause sleep hearts, lungs all work together for good or a bad reason. Speaker 2: (53:11) Yeah. I mean this is something that I've been trying to educate people on. You know, the difference between um, you know, like functional medicine and naturopathic medicine and the need for more integrated as it were, more integrated. Look at the whole person and not just, we here in lines near in the hat near you, study the brain and study the kidneys. But having people make can look at the whole sort of system or systems within the body that can really take a more holistic or overlooking approach. Speaker 3: (53:41) Yeah. Look, I think you mean one of the issues we face in any form of health care is the fragmentation of the system. And that we are so busy these days that predominantly we only look at the field in which we are so much. Whereas you, I mean you sit at the GP level, you've got to try and work out. So you're a policeman if you like, or a police person trying to work out which way you need to go. So it's very difficult when you send someone, let's say for a heart test because you think it's a cardiac issue and the test comes back, not a cardiac issue, but that doesn't help you. All it's told you is what we're trying to develop probably more so here is to look at the patient that's been referred for a heart problem and maybe just looking a bit wider and saying, well look, if it's, if it's not your heart, we should be looking at your sleep or if it's not your sleep, we should be looking at other physiology. Um, and trying to give a more packaged answer to provide the same. Well, Nope, we've done a Holter. It's fine. However they mentioned they should and we noticed that they have. Speaker 2: (54:52) Yep. Sort of overview a little bit wider. I mean obviously you can't be an expert in the mechanics of the feet at the same time as being doing what you're doing, but you know it, Speaker 3: (55:05) it's similar. It used to occur I think long time ago when we run much smaller population, people could have more time as a specialist to look at all areas healthcare, but obviously as, as the health system that was invented back then didn't take into account that would be a population of 5 million with significant ability to study more areas of healthcare. So a lot of the people who are in specialties are just overwhelmed with that specialty. And what we'll probably need to be doing more of is having a step that allows people to look more broadly house. And that may include, as you said, homeopathic or alternate providers because my treatment to just purely disease, most practitioners I think health or otherwise would agree with that, that everything should be more patient focused as opposed to outcome. Speaker 2: (56:03) It's really important to have educational programs like this one because it does take the pressure off the GP knowing everything about everything. If you're aware of what's out there, what could possibly be going on and some of the, you know, sort of just, um, you know, comorbidities that can exist. You know, like I'm doing a brain radio rehabilitation course I'm doing at the moment, um, to help people. And the, the, the interrelatedness from whether it's looking, it's not a good word, but you know what I mean. Um, from brain injury and hormones or adrenal insufficiency and hypertrophy, tourism and thyroids, um, they can all really be affected through brain injury. Um, and then, um, the knock on effects of those and the signs and symptoms and things that I always look at within the course. I'm building out what's the foundational aspects of good health, you know, some of the basics around hydration and nutrition and, um, sleep. Um, and then looking at the next layer to be introduced because there's no use me giving you or giving you, uh, telling you to go and have a hyperbaric session, Speaker 3: (57:15) which will help your brain, Speaker 2: (57:16) which we know has beneficial things for neurological problems when you're eating fish and chips every night. [inaudible] you know, got, I've got some underlying other problems and not exercising and not doing the other pieces of the puzzle. So we need to have, um, an approach that looks at how do I build some foundation with health basics for status as well as the dressing, the actual no problem Speaker 3: (57:40) that we've got on top of that. Yeah. Yeah. You mean, I think you mean if I can say that it's a key to what we've been talking about is, is, is we take what happens during the day very seriously, but health should be a wider conversation. Human sleep is important. Not every reason you can sleep is insomnia. Yeah. So tablets don't always fix sleep issues. They're a great tool and it can actually be more problematic than the issue. So that's the main thing. It's the snoring is not good. If I could get that point across. Yes. And if, if you don't think you sleep well, which is probably majority of population, just check it out. Speaker 3: (58:28) I'm sorry, I probably sounded a bit garbled. But sleep is such a few, Gerry, to try and look at sleep in its entirety is, is quite a difficult area. I mean, the simple ones are asleep, happier snoring, tiredness during the day, no matter how old you ask, snoring is not good. Yeah. As a matter whether you're male, female, adult kids, get it checked. And it's a simple case of just talking to your, your practitioner, especially if you've got chronic conditions. Um, and, and, and look at your sleep health as, as importantly as you do your daytime health. That's probably a key. Speaker 2: (59:07) That's a key takeaway. And I think, you know, go and get yourself a seat. Go and find out if you, if you think you have a problem, uh, if someone, you know, has had a stroke. Um, I mean, I, I, I think it should be standard practice for everybody who's had a injury to get some sort of sleep assessment done at some level. Um, you know, I'm, I'm absolutely convinced my mum would, wouldn't be here if we hadn't done that. And then subsequently also hyperbaric was a key factor in her success. Um, so obviously very passionate about sharing this message today. Um, jeez, just as we wrap up, um, so we've talked, we've given people a couple of takeaways, you know, and if they're snoring through something about it, if you, if you're feeling absolutely in the gutter, uh, and not get a good night's sleep, if you are waking up a number of times, uh, we've seen about sleeping on the side, it's on the left side is, is, is really ideal. Speaker 2: (59:59) Weight loss is really important. If you're obese, you need to be taking this seriously. Seriously. There's a lot of comorbidities that they come along with having sleep apnea and it can be a bit of a, what do you call it, a circle that leaves a vicious circle that leads into each other. Um, so I think that's some really, really key takeaways. And from the cardiac perspective, I'm very keen to come and check out what, what you guys are doing there. It's a new clinic. Um, and um, relay that back as well. Um, I think, uh, having these new facilities and this new technology available to us is just absolutely awesome. Um, and there's so many great things happening in so many different areas of medicine that we, you know, just sharing a bit of information about it is really key. So if anybody wants to reach out to you at the clinic, we can, they find you guys. Speaker 3: (01:00:52) Okay. So, yeah, I mean you can do the usual webpage, www fast pace solutions.co. Dot. NZ. Um, you can call it, we do have a phone number, but as you notice that, Speaker 2: (01:01:06) so I'll put that in the, in the show notes so people can reach out. Speaker 3: (01:01:10) We're available on Google. Most of the GPS in turn know where we are as do the specialists at the hospital because we're obviously working very closely with the hospital supporting us. So that's really good. Um, with regards to your mom, I just like to say, I mean from a medical perspective, I'm pretty stunned at the way your mom's recovering. I, I, I have to sort of put my hand on my heart as a medical person when I first went through with your eyes. Yeah. I wasn't positive, but it's not purely that the sleep, why does he like that? I've got to acknowledge that what you and your family put in to that was phenomenal. Yeah, it really works. Um, and I think you need to take a little bit more credit with you and your boys, your brothers. It gave you that a reason to come and do my garden, which was awesome. Excellent. I tell him to give me a call anytime. Look. Yeah. So do, do take some credit for that. It wasn't a medical outcome. It was Speaker 2: (01:02:15) faceted approach. And you know, I always look at the silver linings and things. Geez. And when I, when I went through this horrible situation with mum, there are people like you and others who came out of the woodwork and all gave me their expertise in that area that I was searching and I was hungry for help and information. And that having that open mindedness and being able to research and I continue to do it has now lead to a complete new profession. You know, um, it's interesting where you end up in a, in a book that I hope is gonna, uh, empower other people to fight like crazy. I mean there was, you know, we weren't given no hope from, from the hospital. We would tell her, put he

Kim Kardashian was recently baptized into the Armenian Oriental Church. So, she's a Copt. Actually, no. But she's in full communion with the Copts. I flush it out--Copts, Chalcedon, Kardashians, Kanye.Extended Lightning Segments. Boston, Evander Holyfield's mama, Cure de Ars, more.

Kim Kardashian was recently baptized into the Armenian Oriental Church. So, she's a Copt. Actually, no. But she's in full communion with the Copts. I flush it out--Copts, Chalcedon, Kardashians, Kanye. Extended Lightning Segments. Boston, Evander Holyfield's mama, Cure de Ars, more.

Eu cred ca ce conteaza cu adevarat este ne fim de ajutor unii celorlalti.

Joel C. Rosenberg is the best-selling author of 13 novels and five nonfiction books and an expert on the politics of the Middle East. Listen as he shares how and why Middle Eastern leaders are reaching out specifically to American Evangelicals, and the opportunities that’s opened for those leaders to hear Biblical truth. What are important things American Christians should understand about the Middle East, including persecution our brothers and sisters there face? Why is the gospel finding fertile soil, even in the face of radical Islamist groups? Which countries are seeing more people come to Christ…and why? And how can we pray for the nation of Israel, and for other nations in the region? Visit Joel’s web site, and order his new novel, The Persian Gamble, here (affiliate link).

Christianity was firmly rooted in Egypt by the second century. Now, the Coptic Christian of Egypt, as well as others, suffer persecution at the hands of the predominately Muslim population, and human trafficking is used to abduct Christian women and girls for conversion to Islam and marriage to Muslim men.

Christianity was firmly rooted in Egypt by the second century. Now, the Coptic Christian of Egypt, as well as others, suffer persecution at the hands of the predominately Muslim population, and human trafficking is used to abduct Christian women and girls for conversion to Islam and marriage to Muslim men.

Christianity was firmly rooted in Egypt by the second century. Now, the Coptic Christian of Egypt, as well as others, suffer persecution at the hands of the predominately Muslim population, and human trafficking is used to abduct Christian women and girls for conversion to Islam and marriage to Muslim men.

Christianity was firmly rooted in Egypt by the second century. Now, the Coptic Christian of Egypt, as well as others, suffer persecution at the hands of the predominately Muslim population, and human trafficking is used to abduct Christian women and girls for conversion to Islam and marriage to Muslim men.

Why I am really proud of my Coptic faith

Why don’t voluntary or compliance carbon offset markets work? The numbers simply don’t add up. A lack of connection between the certificates and the physical inventory means that both parties—the seller and buyer—take credit for a reduction in emissions. And this double counting (issuing two certificates for a single credit) leads to a surplus of certificates under which the associated markets crash and burn. The good news is, the blockchain will allow us to start over and do the math correctly, ensuring that a traded certificate represents a real reduction in emissions.  Ross and Christophe are joined by Aldyen Donnelly, the Director of Carbon Economics for Nori. She has enjoyed a 40-plus year career as a small business developer and consultant, with a focus on cost-effective methods of reducing pollutants. In 1996, Aldyen designed a non-profit consortium of Canada’s largest emitters, bringing those corporations together to reduce and remove emissions via a carbon offset market. By 2002, the Greenhouse Emissions Management Consortium (GEMCo) was the largest private sector buyer of carbon credits in the world.  Aldyen joins Ross and Christophe to discuss how GEMCo employed double-entry bookkeeping to trade in certificates that represented an actual reduction in inventory and why the voluntary and compliance markets that followed did not. Aldyen explains the fundamentals of cap and trade, the concept of ‘pump and dump,’ and the function of a derivatives market. She shares her experiences with landmark climate change work like the Kyoto treaty, COPT, and the Vancouver Stock Exchange. Listen in for Aldyen’s insight into how the transparency of blockchain technology can help farmers become more productive and profitable—with or without the benefit of carbon credit sales!   Key Takeaways [2:18] Aldyen’s experience through the GEMCo Brought together consortium of Canada’s largest emitters Pretend that existing carbon offset markets work Purchase offset credits, seek emissions reduction/removal   [3:40] The fundamentals of cap and trade ‘Quota-based supply management’ Government-induced limits on particular sector   [5:44] Aldyen’s involvement with COPT and the Kyoto treaty Proposed global cap and trade on carbon emissions of developing nations Work with tech innovation, company adoption led to her focus on greenhouse gasses   [9:18] How the principles of GEMCo differed from current markets GEMCo offset credits represented reduction in physical inventory (double-entry bookkeeping) Other markets lack connection between certificates and physical inventory (double counting) Surplus of compliance certificates cause markets like Chicago Climate Exchange to crash in 3-7 years   [15:30] The elements of a good market Trade in certificates that represent real emissions reductions Removing carbon from atmosphere only viable path forward   [18:33] How the ‘additionality test’ limits innovation Must prove that project wouldn’t make profit without carbon credit sales Cannot build sustainable new economy, eliminates incentive to find new ways to make money   [20:38] The difference between voluntary and compliance markets Voluntary means no obligation to offset (e.g.: airplane) Compliance indicates obligation imposed by government (i.e.: California Cap and Trade) Both implement additionality test Both lack contractual link between inventory and certificate   [27:06] Aldyen’s role in the Vancouver Stock Exchange Served as public governor (not part of brokerage community) Brought in for experience in carbon markets   [29:10] The concept of ‘pump and dump’ Create illusion of increased demand, sell at higher price Cryptocurrency can contain without regulations Nori token = one credit, link with physical commodity   [34:07] How a derivatives market could be useful for Nori Commodities markets about allocation, distribution of ownership Derivatives markets about allocation, distribution of risk Accounting discipline required for lasting derivatives opportunity Easier to build accounting discipline on foundation of blockchain   [39:02] The benefits of blockchain technology for farmers Changing farm practices costs money up front 50% quit between year three and year five More productive, profitable by year seven Blockchain transparency provides asset to borrow against in tough time   [44:42] Aldyen’s climate change solution Everyone who sells energy, building products worldwide would report global fossil content Obliged to reduce at 3% per annum with option to buy carbon removal credits   Connect with Ross & Christophe Nori   Resources Aldyen’s Website Aldyen on Twitter Kyoto Protocol

Wing-It Worldwide

Wing-It Worldwide

Shaykh Yasir Qadhi now moves on to discuss the predicaments that were a part of the life of the Prophet ﷺ. The major part of this lecture is focussed on yet another tragedy in the life of the Prophet ﷺ – the death of his son, Ibrahim. The mother of Ibrahim was Maria RA. Who ... Read more