Podcasts about crp

*Wheat disease pressure was light this year.  *The Farm Service Agency is now accepting applications for general and continuous CRP.  *Texas cotton gins saw a lot more business last year compared to the previous two years. *The Texas legislature is once again strengthening the right to farm and ranch.  *Texas Panhandle wheat suffered from a lack of moisture early in the spring.  *The Natural Resources Conservation Service wants employees out in the field.  *The hot summer is near and that can affect turfgrass production.  *Avian Influenza has been found in many mammal species in the Texas Panhandle.  

Host Bob St.Pierre is joined by Pheasants Forever and Quail Forever's Director of Government Affairs Andrew Schmidt to discuss the current Conservation Reserve Program (CRP) signup and its relevance for bird hunters. There are currently 1.8 million acres available for CRP enrollment this fiscal year with a signup underway right now through June 6th. Schmidt also discusses new proposals aimed at improving CRP and increasing funding for walk-in access programs. Episode Highlights: • Schmidt examines how bird populations have correlated with CRP acreage since the program began in 1985 and emphasizes the role of CRP acres in increasing public access through state walk-in programs. • The discussion covers a range of benefits provided by CRP, including contributions to rural economies via wildlife habitat, enhancement of water resources and soil health, and risk mitigation for farmers and ranchers. • Schmidt outlines the distinctions between general CRP, continuous CRP, CREP, and other signups, and explains how the Voluntary Public Access and Habitat Incentive Program (VPA-HIP) increases public access for bird hunters.

In this episode, I complain about the gnats. As one should. I share about my short, but effecient spring drilling season. I then focus on the CPR sign up for 2025 and the issues I am experincing. Mostly the good problems, but challenging aspects of getting back in! I hope you found this interesting and helpful thank you for listening!Real Estate Inquiries www.basecampcountry.com/agent-jesse-knox/Jesse.Knox@basecampcountry.comHabitat Inquiries: jknox0623@gmail.com

Jeffrey Mosher welcomes back Teri Sand, SHRM-CP, PHR, CBSP, CRP, Business Services Manager, Capital Area Michigan Works!, Lansing, MI, but serving Ingham Eaton, and Clinton Counties Theme: Teri talks about the fourth annual DHHS Job Fair, which took place the previous day, and previews the upcoming Juneteenth Job Fair. Question 1: Yesterday was the fourth annual MDHHS Spring Job Fair. Can you tell us about this event, how many employers and job-seekers attended, and how it's changed over the years? The annual DHHS job fair is quickly becoming one of the signature events on the Capital Area's workforce development calendar. MDHHS partnered with Capital Area Michigan Works!; Catholic Charities of Ingham, Eaton & Clinton Counties; and the Lansing Police Department for this year's event. It started in the parking lot of the Ingham County Health Department in 2022, coming out of the pandemic, and featured 20 or so employers, including local government agencies. This year, we had more than 40 employers and [[approximate number of job-seekers]] at the event. The event took place at the Gannon Building on Lansing Community College's main campus to accommodate the number of employers and potential employees. Practically every job sector and industry was represented — public and private, large corporations and small businesses. Question 2: Nowadays, so much of the job search process is digital. Someone looking for work can fill out dozens of applications from the comfort of home, and employers can use screening tools — including A.I. — to zero in on the highest quality candidates. What's the advantage of attending in-person job fairs like these, both for the employer and the worker? First of all, we need to remember that although technology like internet access and smartphones seem ubiquitous, not every job-seeker has access to them. That's why, in addition to helping people fill out digital applications at our American Job Centers, we also teach digital literacy to help people who need to upskill be able to find more job opportunities online. Second, Capital Area Michigan Works! is proud to invite employers who are offering full-time, permanent jobs paying $15 an hour or more. That means the employers have quality jobs to offer. It's our mission to not only help residents of the tri-county area find work, but find good jobs with self-sustaining wages. These employers are also open to hiring from the Capital region's substantial New American population, giving those with limited English proficiency a chance to fully participate in the local economy. Finally, and perhaps most importantly, what's missing from filling out a form on a website and interviewing over Zoom is the human connection between employers and applicants. If employers only look for keywords on resumes and cover letters, they might miss the crucial soft skills that potential employees have to offer. A cover letter and resume emailed to a hiring manager might not convey the passion, drive and integrity that a job-seeker brings to the table. And I think that really speaks to the core of what we do: bridging the gap between employer and employee, creating a human connection that leads to long-term success for both sides. Question 3: For employers or workers who were unaware of this event, do you have any similar opportunities coming up? Where can people find more information? Next month, the Job and Community Resource Fair sponsored by Juneteenth/NAACP Lansing Branch and Capital Area Michigan Works! will take place from 11 a.m. to 3 p.m. on Saturday, June 21, at St. Joe Park on Hillsdale Street in Lansing.

Send us a textTake the Health Type Quiz or Join the Newsletter herePlease give me podcast feedback with a few questions hereIn this episode, I revisit the most powerful tool for longevity—exercise—and unpack fresh research that changes how we should think about its timing, type, and impact.We begin with a quick recap of the foundational elements covered in Episode 2, emphasizing that aerobic activity can lower the risk of mortality, heart attack, stroke, cancer, and dementia by 20–30%, even when started later in life. Then we explore compelling new studies that show how exercise affects everything from blood pressure to brain volume. A meta-analysis of 14,000 participants shows even 15–20 minutes of moderate exercise daily lowers blood pressure. A review of 19 trials links physical activity to better sleep efficiency and reduced wake time. In terms of weight management, a meta-analysis of 116 randomized trials finds that even 30 minutes of exercise weekly leads to measurable weight loss, with a dose-response up to 300 minutes per week.Exercise also appears to influence mood. A review of 33 observational studies involving nearly 100,000 adults suggests that 5,000–7,000 steps daily correlate with reduced depressive symptoms. While causality remains uncertain, the association is intriguing. Beyond mental health, strength training may reduce inflammation: 19 trials show CRP levels dropped in  adults who engaged in resistance training. Perhaps most excitingly, a smaller study found higher cardiorespiratory fitness linked to greater hippocampal volume and better memory in older adults.To optimize these benefits, we explore emerging science around exercise timing and routine structure. A large study of 14,000 users wearing devices found that intense workouts within two hours of bedtime delayed sleep onset by 36 minutes. Perhaps finish workouts at least four hours before sleep for better rest. Interestingly, data from over 400,000 adults reveals that women gain more longevity benefit from exercise than men—and with less time invested.We also cover weekend warriors. A UK Biobank study showed no difference in health outcomes based on when exercise occurred, debunking the belief that daily consistency is essential—what matters is that you do it. If you're sleep-deprived, caffeine might restore performance, as shown in a 10K time trial study. Lastly, a novel study using post-workout cold exposure showed that cold immersion reduced blood flow and amino acid uptake for up to 3 hours.

Welcome back to another riveting episode of Coffee Time Wednesday!   hokseynativeseeds.com (for backyard prairie and CRP mixes)   Vermeer Drills on the Moon Source

In this episode of Mikkipedia, Mikki explores a commonly overlooked health marker—C-Reactive Protein (CRP). While traditional lab ranges often label values under 5 mg/L as "normal," Mikki explains why even mild elevations (around 3–4 mg/L) can signal underlying low-grade inflammation. She breaks down what CRP actually reflects, the various root causes (from gut issues and food sensitivities to overtraining and hormonal shifts), and what practical steps you can take to investigate and lower it. If your blood work seems “fine” but you're not feeling your best, this episode is for you.Tune in to learn:What CRP is and why “normal” might not be optimalCommon hidden triggers of low-grade inflammationHow to track and troubleshoot symptoms across lifestyle, diet, and hormonesThe role of food sensitivities, histamine, overtraining, and gut healthStrategic testing, supplements, and self-experimentation tips Contact Mikki:https://mikkiwilliden.com/https://www.facebook.com/mikkiwillidennutritionhttps://www.instagram.com/mikkiwilliden/https://linktr.ee/mikkiwillidenSave 20% on all Nuzest Products WORLDWIDE with the code MIKKI at www.nuzest.co.nz, www.nuzest.com.au or www.nuzest.comCurranz supplement: MIKKI saves you 25% at www.curranz.co.nz or www.curranz.co.uk off your first order

Explore stroke prevention with Essentia Health, climate challenges with H2O Radio, Nebraska's CRP program struggles, and cultural restoration with Our Living Lands.

Joe's Premium Subscription: www.standardgrain.comGrain Markets and Other Stuff Links-Apple PodcastsSpotifyTikTokYouTubeFutures and options trading involves risk of loss and is not suitable for everyone.0:00 US Planting Window2:49 "Perfect" Brazil Weather4:51 Tariff Exemptions8:26 USDA Budget Cuts9:44 The Funds10:45 Black Sea Drone Attack

In this episode of the School of Doza Podcast, Nurse Doza breaks down the science behind five powerhouse fruits that can naturally boost your immunity. Learn how compounds found in elderberries, tart cherries, avocados, grapes, and cocoa can support immune function, reduce inflammation, and help you stay well year-round. Boost Your IMMUNITY with These 5 Super Fruits! 5 KEY TAKEAWAYS Elderberries contain powerful flavonoids and anthocyanins that enhance immune response and reduce virus activity. Tart cherries rival over-the-counter anti-inflammatories and help lower blood pressure and CRP levels. Avocados, technically berries, offer healthy fats and nutrients essential for resolving inflammation and supporting gut health. Grapes provide resveratrol and other compounds that help modulate immune responses and protect against autoimmune conditions. Cocoa is a potent anti-inflammatory fruit that supports gut health and reduces cortisol, benefiting stress resilience and immunity. FEATURED PRODUCT The D from MSW Nutrition is packed with high-dose Vitamin D3, Vitamin K2, and magnesium—nutrients critical for immune function, calcium absorption, and overall wellness. As discussed in today's episode, strong immunity depends on key vitamins and anti-inflammatory support. The D delivers just that.  Get The D TIMESTAMPS 00:00 START 01:08 What's new at the Nurse Doza Clinic: NAD+ injections 03:42 Why fruits are foundational for immunity 05:30 #1: Elderberries – flavonoids, immune support, antiviral power 12:10 Nurse Doza's elderberry routine during pediatric rotations 15:25 #2: Tart cherries – antioxidant-rich and anti-inflammatory 20:18 CRP and inflammation markers in cherry studies 22:10 #3: Avocados – nutrient-dense and great for immune health 28:45 Healthy fats, fiber, and inflammation resolution 32:00 #4: Grapes – resveratrol, flavonols, and immune modulation 37:40 Grapes' role in gut and cardiovascular health 40:20 #5: Cocoa – flavanols, gut-brain axis, and immune enhancement 45:35 Recap of all five super fruits for immune health 47:00 Final thoughts on food as medicine RESOURCES MENTIONED Elderberry Overview – Examine: https://examine.com/supplements/elderberry/?show_conditions=true Elderberry & Immunity Study: https://pmc.ncbi.nlm.nih.gov/articles/PMC4848651/ Blueberries & Anti-Inflammation: https://pmc.ncbi.nlm.nih.gov/articles/PMC7442370/ Tart Cherry Research: https://pmc.ncbi.nlm.nih.gov/articles/PMC6413159/ Cherry Anthocyanins & Inflammation: https://pmc.ncbi.nlm.nih.gov/articles/PMC6259571/ Avocado & Immunity Study: https://pmc.ncbi.nlm.nih.gov/articles/PMC10349765/ Avocado Nutrition Breakdown: https://www.eatingwell.com/article/8026117/avocados-benefits/ Grape Polyphenols Study: https://pmc.ncbi.nlm.nih.gov/articles/PMC9497968/ Resveratrol & Immune Modulation: https://pmc.ncbi.nlm.nih.gov/articles/PMC8778251/ Cocoa & Gut Health Study: https://www.sciencedirect.com/science/article/pii/S0955286321002746?via%3Dihub Cocoa & IBD Research: https://pmc.ncbi.nlm.nih.gov/articles/PMC3671179/ Cocoa Polyphenols & Immunity: https://pmc.ncbi.nlm.nih.gov/articles/PMC3488419/

We've all had patients struggling with chronic conditions like long COVID, fibromyalgia, Lyme disease, and chronic fatigue. Despite all the tools in our functional medicine toolkit, there's still something missing. How can we truly help them? I'm excited to have Ashok Gupta back on the New Frontiers podcast to offer a new take on healing from chronic illness. He explains that many chronic diseases stem from a malfunction in the brain's threat detection system, where the body overreacts to perceived threats, triggering immune, nervous system, or mood responses, creating a vicious cycle. Ashok shares how retraining the brain and calming the nervous system can reset the body's response to chronic stress and presents the growing body of research supporting the Gupta Program, including new subjective measurements like CRP showing its impact. What excites me most is the potential for this approach to help some of my toughest-to-treat patients. With more studies emerging, I'm increasingly hopeful this could be a game-changer. It's a conversation you won't want to miss! ~DrKF Check out the show notes at https://tinyurl.com/2t55s3y3 for the full list of links and resources. GUEST DETAILS Ashok Gupta Email: ashokguptaprogram@gmail.com https://guptaprogram.com/ Ashok Gupta is an internationally recognized speaker, filmmaker, and health practitioner who specializes in supporting individuals with chronic illness. After overcoming ME (Chronic Fatigue Syndrome) through his own neuroplasticity research, Ashok developed the Gupta Program in 2007 to help others recover. He has published several medical papers and continues to research chronic conditions, with recent studies demonstrating the effectiveness of the Gupta Program. Ashok is dedicated to advancing holistic approaches to healing and improving outcomes for those facing chronic illness. THANKS TO OUR SPONSORS DIAMOND DUTCH: https://dutchtest.com/for-providers Biotics Research: https://www.bioticsresearch.com/ GOLD TimeLine Nutrition: https://tinyurl.com/bdzx2xms Vibrant Wellness: https://www.vibrant-wellness.com/ EXCLUSIVE OFFERS FROM OUR SPONSORS OneSkin: Get 15% off OneSkin with the code DRKARA at oneskin.co/DRKARA MiToQ: Target mitochondria for better health and longevity with MitoQ's advanced supplements at mitoq.com/drkara CONNECT with DrKF Want more? Join our newsletter here: https://www.drkarafitzgerald.com/newsletter/ Or take our pop quiz and test your BioAge! https://www.drkarafitzgerald.com/bioagequiz YouTube: https://tinyurl.com/hjpc8daz Instagram: https://www.instagram.com/drkarafitzgerald/ Facebook: https://www.facebook.com/DrKaraFitzgerald/ DrKF Clinic: Patient consults with DrKF physicians including Younger You Concierge: https://tinyurl.com/yx4fjhkb Younger You book: https://tinyurl.com/mr4d9tym Better Broths and Healing Tonics book: https://tinyurl.com/3644mrfw

Welcome to the land podcast, a platform for people looking to educate themselves in the world of land ownership, land investing, staying up to date with current land trends in the Midwest, and hearing from industry experts and professionals. On today's episode, we dive into a dynamic conversation with land expert Skip Sligh on the Land Podcast. From top-dollar timber decisions to understanding soil health and the fine line of financial moves in landownership, this episode brims with wisdom for the avid land connoisseur. It's a treasure trove of tips mixed with the hearty realities of managing the wild. Veneer walnut timber Strategies for balancing land income Evolving land values post-election Waterhole setups for mature bucks Maximizing land value & plotting Exploring map tech for hunters Soil management tips for fruitful yields Strategies for investing in 'forever farms' Effective bush honeysuckle extermination Balancing income and wild habitat on CRP land https://www.whitetailmasteracademy.com Use code 'HOFER' to save 10% off at www.theprairiefarm.com Massive potential tax savings: ASMLABS.Net -Moultrie: https://bit.ly/moultrie_ -Hawke Optics: https://bit.ly/hawkeoptics_ -OnX: https://bit.ly/onX_Hunt -Painted Arrow: https://bit.ly/41ZtK5i 

Originally uploaded February 4th, re-edited April 20th. Teri Sand, SHRM-CP, PHR, CBSP, CRP, Business Services Manager, Capital Area Michigan Works!, Lansing, MI, but serving Ingham Eaton, and Clinton Counties THEME: Capital Area Michigan Works! Business Services Manager, Teri Sand, recaps some of CAMW!'s key statistics from 2024 and available resources in 2025. Question: What is the Business Services team at CAMW!, and what impact did they have on businesses in 2024? ● CAMW!'s Business Services team partners with businesses when recruiting, hiring and training workers at no cost. ○ Each year, we work with more than 450 employers from all industries to fill job openings and provide other recruiting needs. ○ We aim to help employers increase job retention, increase employee training and develop recruitment strategies tailored to each business's specific needs. ● Over the course of 2024, CAMW! served 469 businesses from across several industries including: ○ Auto Repair. ○ Business Services. ○ Childcare. ○ Communications. ○ Finance. ○ Food service. ○ Government. ○ Healthcare. ○ Insurance. ○ IT. ○ Manufacturing. ○ Nonprofit. ○ Retail. ○ Trades and Transportation. ● Across these industries, CAMW! aided in filling 1,455 jobs, which were typically full-time, permanent and paying at least $15 per hour. Question: What key recruitment and workforce development services did CAMW! provide to employers in 2024? ● In 2024, CAMW! offered a wide range of recruitment and workforce development services to support employers in finding, hiring and retaining employees. ● CAMW! assisted employers with using and navigating the mitalent.org website. ○ Mi Talent is a platform that connects employers with job seekers by displaying active job listings and upcoming networking events for businesses. ○ Throughout 2024, we showed employers how to create MI Talent accounts, post and update job ads, search for candidate profiles to find qualified candidates and how to create hiring events to attract new talent. Question: What were some other highlights CAMW! had in 2024, and how did these initiatives impact the community? ● There were many amazing programs and initiatives that took place in 2024 that allowed us to connect with our current and future workforce. ● MiCareerQuest Capital Area, a career exploration event that connects students and employers through hands-on exhibits, was one event that made a huge impact on the community. ○ Over 2,000 students attended morning sessions of the event last year, and over 70 local businesses highlighted their industries through exhibits. Question: What services and resources will CAMW! continue to offer to businesses and job seekers in 2025? ● CAMW! will continue to help businesses find skilled workers, and support job seekers with training and applying to positions. ● For businesses: ○ CAMW! will help employers find the right employees by connecting them through MI Talent, Employer of the Day events and hosting job fairs and other programs like MiCareerQuest.

In this episode, we're digging deep — literally and figuratively — into the land management that powers our hunts at Whiskey Sloughs. From strategic slough creation along the Platte River to native grass and sunflower plots on our CRP ground, we break down the year-round work it takes to hold birds and build habitat that thrives. We also take a walk through our Upland CSA, where intentional habitat management creates wild-style experiences for pheasant, quail, and chukar hunters alike. Whether you're a landowner, a habitat nerd, or just someone who wants to know what goes into a world-class hunt — this one's for you.

Nutrition Nugget! Bite-size bonus episodes offer tips, tricks and approachable science. This week, Jenn is talking about CRP (C-Reactive Protein), a fascinating blood test that could be key to understanding your body's hidden inflammation. Did you know your CRP levels might reveal more than your heart health? How could this test impact your long-term wellness? Tune in to find out! Like what you're hearing? Be sure to check out the full-length episodes of new releases every Wednesday.  Have an idea for a nutrition nugget?  Submit it here: https://asaladwithasideoffries.com/index.php/contact/       RESOURCES:Want to Jump Into Round 2 of the Healthy Vibe Tribe? Start HERE: https://bit.ly/gotrimprofileBecome A Member of Salad with a Side of FriesJenn's Free Menu PlanA Salad With a Side of FriesA Salad With A Side Of Fries MerchA Salad With a Side of Fries InstagramNutrition Nugget: AntioxidantsThe Ultimate Biohack

In this AMA-style solo episode, I break down the controversial trend of $6,000 full-body longevity scans and answer your burning questions about inflammation, postpartum health, and realistic biohacking options. Curious about biological age, postpartum inflammation, or budget-friendly wellness? This episode is your guide to smart, sustainable longevity. Send me a DM on Instagram to get your questions answered! I TALK ABOUT:  04:00 – $6,000 for a Longevity Scan: Longevity Medicine Institute 11:00 – At-home and affordable longevity tests you can start today: True Diagnostic, Viome, Tiny Health code: BIOHACKINGBRITTANY, Levels Health CGM, Function Health, Siphox code: BIOHACKINGBRITTANY 18:00 - Wearables: Oura Ring, Whoop, BioStrap, Garmin, Circular Ring 21:25 – Dementia, brain aging, and why cognitive longevity matters 23:00 - Daily FREE things you can do for longevity 25:30 – My personal CRP numbers and what they mean for postpartum inflammation 29:25 – Why inflammation is the top silent driver of chronic diseases  33:00 – My current inflammation protocol: Akkermansia, fermented cod liver oil, bone broth, collagen peptides 36:00 – Movement and lymphatic support and retesting for inflammation: PartiQlar supplements, Kineon code: BIOHACKINGBRITTANY 38:35 – The emotional toll of healing and how to truly ask “how are you?” SPONSORS: Protect your reproductive health with Leela Quantum Tech's EMF-blocking underwear. Use code: BIOHACKINGBRITTANY for an extra 10% discount on all of their products! Go to calroy.com/brittany and save over $50 on a 3-month supply of Calroy's Arterosil HP and Vascanox HP, my preferred supplements for optimal blood flow and nitric oxide support for your vascular system. RESOURCES: Optimize your preconception health by joining my Baby Steps Course today! Optimize your preconception health and fertility through my free hormone balancing, fertility boosting chocolate recipe! Download it now! My Amazon storefront Lifespan book by Dr. David Sinclair LET'S CONNECT: Instagram, TikTok, Facebook Shop my favorite health products Listen on Spotify, Apple Podcasts, YouTube Music

Story at-a-glance Chronic inflammation drives diseases like heart disease, Alzheimer's, cancer and autoimmune conditions. However, standard tests only measure generalized inflammation and does not pinpoint the exact tissues affected Researchers at Case Western Reserve University have developed a new method to track inflammation at its source using antibodies that detect molecular markers left by reactive oxygen species (ROS) Unlike traditional markers like C-reactive protein (CRP), this new approach could allow doctors to identify specific organs under inflammatory stress, leading to earlier and more precise diagnoses Emerging research challenges the idea that chronic inflammation is just unresolved acute inflammation. Researchers suggest it results from a lack of anti-inflammatory mediators, not just excessive inflammatory signaling Key drivers of chronic inflammation include excess linoleic acid, endocrine-disrupting chemicals, endotoxins and electromagnetic fields (EMFs)

Optic neuropathies encompass all congenital or acquired conditions affecting the optic nerve and are often a harbinger of systemic and central nervous system disorders. A systematic approach to identifying the clinical manifestations of specific optic neuropathies is imperative for directing diagnostic assessments, formulating tailored treatment regimens, and identifying broader central nervous system and systemic disorders. In this episode, Gordon Smith, MD, FAAN speaks with Lindsey De Lott, MD, MS, author of the article “Optic Neuropathies” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. De Lott is an assistant professor of neurology and ophthalmology at the University of Michigan in Ann Arbor, Michigan. Additional Resources Read the article: Optic Neuropathies Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Guest: @lindseydelott Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Smith: Hello, this is Dr Gordon Smith. Today I'm interviewing Dr Lindsey De Lott about her article on optic neuropathies, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Lindsey, welcome to the podcast, and perhaps you can introduce yourself to our audience. Dr De Lott: Thank you, Dr Smith. My name is Lindsey De Lott and I am a neurologist and a neuro-ophthalmologist at the University of Michigan. I also serve as the section lead for the Division of Neuro-Ophthalmology, which is actually part of the ophthalmology department rather than the neurology department. And I spend a good portion of my time as a researcher in health services research, and that's now about 60% of my practice or so. Dr Smith: I'm super excited to spend some time talking with you. One, I'm a Michigan person. As we were chatting before this, I trained with Wayne Cornblath and John Trobe, and it's great to have you. I wonder if we maybe can begin- and by the way, your article is outstanding. It is such a huge topic and it was actually really fun to read, so I encourage our listeners to check it out. But you begin by talking about misdiagnosis as being a common problem in this patient population. I wonder if you can talk through why that is and if you have any pearls or pitfalls in avoiding it? Dr De Lott: Yeah, I think there's been a lot of great research looking at misdiagnosis in specific types of optic neuropathies; in particular, compressive optic neuropathies and optic neuritis. A lot of that work has come out of the group at Emory and the group at Washington University. But a lot of neuro-ophthalmologists across the country really contributed to those data. And one of the statistics that always strikes me is that, you know, for example, in patients with optic nerve sheath meningiomas, something like 70% of them are actually misdiagnosed. And a lot of those errors in diagnosis, whether it's for compressive optic neuropathy or some other type of optic neuropathy, really comes down to the way that physicians are really incorporating elements of the history in the physical. For example, in optic neuritis, we know that physicians tend to anchor pretty heavily on pain in general. And that often tends to lead them astray when optic neuritis was never the diagnosis to begin with. So, it's really overindexing on certain things and not paying attention to other features of the physical exam; for example, say presence of an afferent pupillary defect. So, I think it just really highlights the need to have a really relatively structured approach to patients that you think have an optic neuropathy when you're trying to sort of plan your diagnostic testing and your treatment. Dr Smith: I do maybe five or six weeks on our hospital service each year, and I don't know if it's just a Richmond thing, but there's always at least two people in my week who come in with an optic neuropathy or acute vision loss. How common is this in medical practice? Or neurologic practice, I should say? Dr De Lott: Optic neuropathies themselves… if you look across, unfortunately we don't have any great data that puts together all optic neuropathies and gives us an actual sort of prevalence estimate or an incidence estimate from year to year. We do have some of those data for specific types of optic neuropathies like optic neuritis and NAION, and you're probably looking around five-ish per one hundred thousand. So, these aren't that common, but at the same time they do get funneled to- often to emergency rooms and to neurologists from our ophthalmology colleagues and optometry colleagues in particular. Dr Smith: So, one other question I had before kind of diving into the topic at hand is how facile neurologists need to be in recognizing other causes of acute visual loss. I mean, we see acute visual loss as neurologists, we think optic neuropathy, right? Optic neuritis is sort of the go-to in a younger patient, and NAION in someone older. But what do neurologists need to know about other ophthalmologic causes? So, glaucoma or acute retinal disorders, for instance? Dr De Lott: Yeah, I think it's really important that neurologists are able to distinguish optic neuropathies from other causes of vision loss. And so, I would really encourage the listeners to take a look at the excellent article by Nancy Newman about vision loss in this issue where she really kind of breaks it down into vision loss that is acute and chronic and how you really think through distinguishing optic neuropathies from other causes of vision loss. But it is really important. For example, a patient with a central retinal artery occlusion may potentially be eligible for treatments. And that's very different from a patient with optic neuritis and acute vision loss. So, we want to be able to distinguish these things.  Dr Smith: So maybe we can pivot to that a little bit. Just for our listeners, our focus today is going to be on- not so much on optic neuritis, although obviously we need to talk a little bit about how we differentiate optic neuritis from non-neuritis optic neuropathies. It seems like the two most common situations we encounter are ischemic optic neuropathies and optic neuritis. Maybe you can talk a little bit about how you distinguish these two? I mean, some of it's age, some of it's risk factors, some of it's exam. What's the framework, of let's say, a fifty-year-old person comes into the emergency room with acute vision loss and you're worried about an optic neuropathy? Dr De Lott: The first step whenever you are considering an optic neuropathy is just making sure that the features are present. I think, really going back to your earlier question, making sure that the patient has the features of an optic neuropathy that we expect. So, it's not only vision loss, but it's also the presence of an apparent pupillary defect in a patient with a unilateral optic neuropathy. In a person who has a bilateral optic neuropathy, that apparent pupillary defect may not be present because it is relative. So, you really would have to have asymmetric vision loss between the two eyes. They should also have impairment of their color vision, and they're probably going to have some kind of visual field defect, whether that's central scotoma or an arcuate scotoma or an altitudinal defect that really respects the horizontal meridian. So, you want to make sure that, first and foremost, you've got a patient that really meets most of those- most of those features. And then from there, we're looking at the other features on their history. How acute is the onset of the vision loss? What is the progression over time? Is there pain associated or not associated with the vision loss? What other medical issues does the patient have? And you know, one of the things you already brought up, for example, is, what's the age of the patient? So, I'm going to be much more hesitant to make a diagnosis of optic neuritis in a much older patient or a diagnosis on the other side, of ischemic optic neuropathy, in a much younger patient, unless they have really clear features that push me in that direction. Dr Smith: I wonder if maybe you could talk a little bit about features that would push you away from optic neuritis, because, I mean, people who are over fifty do get optic neuritis- Dr De Lott: They do. Dr Smith: -and people who get ischemic optic neuropathies who are younger. So, what features would push you away from optic neuritis and towards… let's be broad, just a different type of optic neuropathy? Dr De Lott: Sure. We know that most patients with optic neuritis do have pain, but that pain is accompanied---within a few days, typically---with vision loss. So, pain alone going on for a number of days without any visual symptoms or any of those other things I listed, like the afferent papillary defect, the visual field defect, would push me away from optic neuritis. But in general, yes, most optic neuritis is indeed painful. So, the presence of optic disc edema is unfortunately one of those things that an optic neuritis may be present, may not be present, but in somebody with ischemia that is anterior---and that's the most common type of ischemic optic neuropathy, would be anterior ischemic optic neuropathy---they have to have optic disc edema for us to be able to make that diagnosis, and that is a diagnosis of NAION, or nonarteritic ischemic optic neuropathy. An APD in this case, again, that's just a feature of an optic neuropathy. It doesn't really help you to distinguish, individual field defects are going to be relatively similar between them. So then in patients, I'm also looking, like I said, at their history. So, in a patient where I'm entertaining a diagnosis of ischemic optic neuropathy, I want to make sure that they have vascular risk factors or that I'm actually doing things like measuring their blood pressure in the office if they haven't seen a physician recently or checking a lipid panel, hemoglobin A1c, those kinds of things, to look for vascular risk factors. One of the other features on exam that might push me more- again, in a patient with ischemic optic neuropathy, where it might suggest ischemia over optic neuritis, would be some other features on exam like a crowded optic disc that we sometimes will see in patients with ischemic optic neuropathy. I feel like that was a bit of a convoluted answer. Dr Smith: I thought that was a great answer. And when you say crowded optic disc, that's the- is that the “disc at risk”? Dr De Lott: That is the “disk at risk,” yes. So, crowded optic disk is really a disk that is smaller than what we see in the average population, and the average cup to disk ratio is 0.3. So, I think that's where 30% of the disk should be. So, this extra wiggle room, as I sometimes will explain to my patients. Dr Smith: And then, I wonder if you could talk a little bit about more- just more about exam, right? You raised the importance of recognizing optic disc edema. Are there aspects of that disc edema that really steer you away from optic neuritis and towards ischemia-like hemorrhages or whatnot? And then a similar question about the importance of careful visual field testing? Dr De Lott: So, on the whole, optic disc edema is optic disc edema. And you can have very severe optic neuritis with hemorrhages, cotton wool spots, which is essentially just an infarction of the retinal nerve fiber layer either overlying the disc or other parts of the retina. And ischemia, you can have some of the same features. In patients who have giant cell arteritis, which is just one form of anterior ischemic optic neuropathy, patients can have a pallid optic disc edema where the optic disc is swollen and white-looking. But on the whole, swelling is swelling. So, I would caution anyone against using the features of the optic nerve swelling to make any type of, sort of, definitive kind of diagnosis. It's worth keeping in mind, but I just- I would caution against using specific features, optic nerve swelling. And then for visual field testing, there are certain patterns that sometimes can be helpful. I think as I mentioned earlier, in patients with ischemic optic neuropathy, we'll often see an altitudinal defect where either the top half or, more commonly, the bottom half of the vision is lost. And that vision loss in the field corresponds to the area of swelling on the disk, which is really rewarding when you're actually able to see sectoral swelling of the disk. So, say the top half of the disk is swollen and you see a really dense inferior defect. And other types of optic neuropathy such as hereditary optic neuropathies, toxic and nutritional optic neuropathies, they often cause more central field loss. And in patients who have optic neuropathies from elevated intracranial pressure, so papilladema, those folks often have more subtle visual field loss in an arcuate pattern. And it's only once the optic nerves have sustained a pretty significant injury that you start to see other patterns of field loss and actual decline in visual acuity in those patients. I do think a detailed visual field assessment can often be pretty helpful as an adjunct to the rest of the exam. Dr Smith: So, we haven't talked a lot about neuroimaging, and obviously, neuroimaging is really important in patients who have optic neuritis. But how about an older patient in whom you suspect ischemic optic neuropathy? Do those patients all need a MRI scan? And if so, is it orbits and brain? How do you- how do you protocol it? Dr De Lott: You're asking such a good question, totally controversial in in some ways. And so, in patients with ischemic optic neuropathy, if you are confident in your diagnosis: the patient is over the age of fifty, they have all the vascular, you know, they have vascular risk factors. And those vascular risk factors are things like diabetes, hypertension, high blood pressure, hyperlipidemia, obstructive sleep apnea. They have a “disc at risk” in the fellow eye. They don't have pain, they don't have a cancer history. Then doing an MRI of the orbits is probably not necessary to rule out another cause. But if you aren't confident that you have all of those features, then you should absolutely do an MRI of the orbit. The MRI of the brain probably doesn't provide you with much additional information. However, if you are trying to distinguish between an ischemic optic neuropathy and, say, maybe an optic neuritis, in those patients we do recommend MRI orbits and brain imaging because the brain does provide additional information about other CNS demyelinating disorders that might be actually the cause of a patient's optic neuritis. Dr Smith: I wonder if you could talk a little bit about posterior ischemic optic neuropathy. That's much less common, and you mentioned earlier that those patients don't have optic disk edema. So, if there's a patient who has vision loss that- in a similar sort of clinical scenario that you talked about, how do you approach that and under what circumstances do we see patients who have posterior ischemic optic neuropathy? Dr De Lott: So, you're going to most often see patients with posterior ischemic optic neuropathy who, for example, have undergone a recent surgery. These are often associated with things like spinal surgeries, cardiac surgeries. And there are a number of risk factors that are associated with it. Things like blood pressure, drain surgery, the amount of blood loss, positioning of patient. And this is something that the surgeons and anesthesiologists are very sensitive to at this point in time, and many patients are often- this can be part of the normal informed consent process at this point in time since this is something that is well-recognized for specific surgeries. In those patients, though… again, unless you're really certain, for example, maybe the inpatient neurology attending and you've been asked to consult on a patient and it's very clear that they went into surgery normal, they came out of surgery with vision loss, and all the rest of the features really seem to be present. I would recommend that in those cases you think about orbital imaging, making sure you're not missing anything else. Again, unless all of the features really are present- and I think that's one of the themes, definitely, throughout this article, is really the importance of neuroimaging in helping us to distinguish between different types of optic neuropathy. Dr Smith: Yeah, I think one of the things that Eric Eggenberger talks about in his article is the need to use precise nomenclature too, which I plan on talking to him about. But I think having this very structured approach- and your article does it very well, I'll tell our listeners who haven't seen it there's a series of really great tables in the article that outline a lot of these. I wonder, Lindsey, if we can switch to talk about arteritic optic neuropathy. Is that okay? Dr De Lott: Sure. Yeah, absolutely. Dr Smith: How do you sort that out in an older patient who comes in with an ischemic optic neuropathy? Dr De Lott: Yeah. In patients who are over the age of fifty with an ischemic optic neuropathy, we always need to be thinking about giant cell arteritis. It is really a diagnosis we cannot afford to miss. If we do miss it, unfortunately, patients are likely to lose vision in their fellow eye about 1/3 to 1/2 the time. So, it is really one of those emergencies in neuro-ophthalmology and neurology. And so you want to do a thorough review systems for giant cell arteritis symptoms, things like headache, jaw claudication, myalgias, unintentional weight loss, fevers, things of that nature. You also want to check their inflammatory markers to look for evidence of an elevated ESR, elevated C-reactive protein. And then on exam, what you're going to find is that it can cause an anterior ischemic optic neuropathy, as I mentioned earlier. It can cause palette optic disc swelling. But giant cell arteritis can also cause posterior ischemic optic neuropathy. And so, it can be present without any swelling of the optic disc. And in fact, you know, you mentioned one of my mentors, John Trobe, who used to say that in a patient where you're entertaining the idea of posterior ischemic optic neuropathy, who is over the age of fifty with no optic disc swelling, you should be thinking about number one, giant cell arteritis; number two, giant cell arteritis; number three, giant cell arteritis. And so, I think that is a real take-home point is making sure that you're thinking of this diagnosis often in our patients who are over the age of fifty, have to rule it out. Dr Smith: I'll ask maybe a simple question. And presumably just about everyone who you see with a presumed ischemic optic neuropathy, even if they don't have clinical features, you at least check a sed rate. Is that true? Dr De Lott: I do. So, I do routinely check sedimentation rate and C-reactive protein. So, you need to check both. And the reason is that there are some patients who have a positive C-reactive protein but a normal sedimentation rate, so. And vice versa, although that is less common. And so both need to be checked. One other lab that sometimes can be helpful is looking at their CBC. You'll often find these patients with giant cell arteritis have elevated platelet counts. And if you can trend them over time, if you happen to have a patient that's had multiple, you'll see it sort of increasing over time. Dr Smith: I'm just thinking about how you sort things out in the middle, right? I mean, so that not all patients with GCF, sky-high sed rate and CRP…. And I'm just thinking of Dr Trobe's wisdom. So, when you're in an uncertain situation, presumably you go ahead and treat with steroids and move to biopsy. Maybe you can talk a bit about that pathway? Dr De Lott: Yeah, sure. Dr Smith: What's the definitive diagnostic process? Do you- for instance, the sed rate is sky-high, do you still get a biopsy? Dr De Lott: Yes. So, biopsy is still our gold-standard diagnosis here in the United States. I will say that is not the case in all parts of the world. In fact, many parts of Europe are moving toward using other ancillary tests in combination with labs and exam, the history, to make a definitive diagnosis of giant cell arteritis. And those tests are things like temporal artery ultrasound. We also, even though we call it temporal artery ultrasound, we actually need to image not only the temporal arteries but also the axillary arteries. The sensitivity and specificity is actually greater in those cases. And then there's high-resolution imaging of the vessels and the- both the intracranial and extracranial distributions. And both of those have shown some promise in their predictive values of patients actually having giant cell arteritis. One caution I would give to our listeners, though, is that, you know, currently in the US, temporal artery biopsy is still the gold standard. And reading the ultrasounds and the MRIs takes a really experienced radiologist. So, unless you really know the diagnostic accuracy at your institution, again, temporal artery biopsy remains the gold standard here. So, when you are considering giant cell arteritis, start the patient on steroids and- that's high dose, high dose steroids. In patients with vision loss, we use high dose intravenous methylprednisolone and then go ahead and get the biopsy. Dr Smith: Super helpful. And are there other treatments, other than steroids? Maybe how long do you keep people on steroids? And let's say you've got a patient who's, you know, diabetic or has other factors that make you want to avoid the course of steroids. Are there other options available? Dr De Lott: So, in the acute phase steroids are the only option. There is no other option. However, long term, yes, we do pretty quickly put patients on tocilizumab, which is really our first-line treatment. And I do that in conjunction with our rheumatology colleagues, who are incredibly helpful in managing and monitoring the tocilizumab for our patients. But when you're seeing the patients, you know, whether it's in the emergency room or in the hospital, those patients need steroids immediately. There are other steroid-sparing agents that have been tried, but the efficacy is not as good as tocilizumab. So, the American College of Rheumatology is really recommending tocilizumab as our first line steroid-sparing agent at this point. Dr Smith: Outstanding. So again, I will refer our listeners to your article. It's just chock-full of great stuff. This has been a great conversation. Thank you so much for joining me today. Dr De Lott: Thank you, Dr Smith. I really appreciate it.  Dr Smith: The pleasure has been all mine, and I know our listeners will be enjoying this as well. Again, today I've been interviewing Dr Lindsey De Lott about her article on optic neuropathies, which appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum Audio episodes from this and other issues. I already mentioned Dr Eggenberger and I will be talking about optic neuritis, which will be a great companion to this discussion. Listeners, thank you for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Another great, and deep, Coffee Time Wednesday!  Send us your question at social@theprairiefarm.com to hopefully get your question answered and get free native seed mix.   hokseynativeseeds.com (for all your native seed, CRP,  hunting mixes need)

Dive deep into Richard Rappley's exciting journey toward buying his first farm, insider tips from NRCS work, and turkey hunting tales, all with a side of conservation chat. Get inspired by Richard's hands-on approach to wildlife habitat and how it may kindle your homesteading ambitions. Don't miss savvy insights on CRP programs and heritage tree hunting. Tune in for a blend of wisdom and wit! • Real talk on CRP and EQUIP programs • The joys and challenges of homesteading • Insights on buying your first farm • Tips for turkey hunting with new gear • Strategies for wildlife habitat improvement https://www.whitetailmasteracademy.com Use code 'HOFER' to save 10% off at www.theprairiefarm.com Massive potential tax savings: ASMLABS.Net -Moultrie: https://bit.ly/moultrie_ -Hawke Optics: https://bit.ly/hawkeoptics_ -OnX: https://bit.ly/onX_Hunt -Painted Arrow: https://bit.ly/41ZtK5i 

Colchicine

Jackie and Chase Burns, with Land Guys, join us to discuss how to help bring back the community and benefits of rural America's lifestyle.    hokseynativeseeds.com (for all your native seed needs and native pasture mixes and CRP mixes)

The SOUL trial

In this episode of the Health Upgrade podcast, we dive into the world of wearable health devices and their potential to revolutionize personal wellness. We explore critical metrics like heart rate variability (HRV) and continuous glucose monitoring, highlighting how these tools help us better understand the autonomic nervous system and metabolic health.We also discuss the importance of tracking sleep quality and blood pressure, and how these insights can paint a more complete picture of our overall well-being. Wearables, in our view, are powerful tools that can empower individuals to take control of their health journey.Rather than using this data to compare ourselves to others, we advocate for self-experimentation and personalization—finding what truly works for each unique body. We even dream a little, imagining future wearables and in-home biomarker tests for CRP and omega ratios, bringing health optimization within reach for everyone.If you're passionate about optimizing your health or curious about how wearable tech can support your wellness goals, this episode is for you. Tune in for practical insights and empowering strategies to help you take charge of your health evolution—and upgrade your life, one metric at a time.-----Truvaga Discount $30 offLink: truvaga.com/upgrade-----Contact info:Dr. Navaz HabibEmail: podcast@healthupgraded.comFacebook: https://www.facebook.com/DrNavazHabib/Instagram: https://www.instagram.com/drnavazhabib/LinkedIn: https://ca.linkedin.com/in/drnavazhabibJP ErricoLinkedIn: https://www.linkedin.com/in/jp-errico-097629aa

This episode challenges the dental industry's casual approach to gingivitis and reframes bleeding gums as a severe systemic health warning that demands attention! Melissa and Tabitha reveal why making gingivitis identification compelling to patients is crucial for oral and overall health outcomes. Link to Meissa's Post mentioned in the episode:  https://www.instagram.com/reel/DG0LnVGsrnT/?utm_source=ig_web_copy_link&igsh=MzRlODBiNWFlZA== Key Topics Covered

In this episode of the Metabolic Freedom Podcast, Ben Azadi sits down with Jason Theobald—fitness coach, IFBB Pro, and founder of Scooby Health—to deliver a masterclass on building lean muscle, optimizing fat loss, and improving metabolic health. Jason shares his top five exercises for maximum results, why muscle mass is critical for longevity, and how stress, inflammation, and poor insulin sensitivity affect fat loss. They also dive into lab testing, fat-burning supplements, keto cycling, and the power of recovery, mindset, and gratitude. Whether you're a beginner or seasoned lifter, this conversation is packed with practical tools to level up your physique and health.

Dr. Shilpa Sayana is a triple board-certified MD in Internal Medicine, Obesity Medicine, and Functional Medicine with a deeply compassionate, science-backed approach to women's health. She's been helping women in perimenopause and menopause reclaim their energy, balance hormones, and feel like themselves again—even when they've been told everything looks "normal." Her Sayana Medical Road Map goes beyond symptom management to address the full picture of what's going on inside, and her work has earned both peer and patient recognition, including the Best Doctors Women's Choice Award.We break down the real reasons your bones begin to weaken—hint: it's not just about calcium or age. Estrogen, cortisol, and inflammation are central players, and Dr. Sayana explains how they work together to either support or sabotage your bone strength. She also shares what most conventional doctors miss, including the power of Dutch hormone testing, inflammatory markers like CRP, and how you can finally get answers that connect the dots. You are in control of your body and your bones.Key TakeawaysEstrogen Is a Bone Builder – Dr. Sayana explains how the drop in estrogen during menopause removes the natural protection our bones need, contributing to osteoporosis and increased fracture risk.Stress Creates Hidden Bone Loss – Chronic cortisol weakens bone structure, even in women who “look healthy” on the outside.Inflammation Drives Bone Breakdown – Inflammation acts like a slow burn that quietly erodes your bone strength.Look Beyond the DEXA Scan – A clear DEXA doesn't mean your bones are resilient. Bone quality matters just as much as density.Functional Testing Gives You Answers – Tools like the Dutch test and CRP bloodwork show the deeper story behind your symptoms.Your Lifestyle Is the Foundation – Managing stress, eating anti-inflammatory foods, and supporting your hormones can rebuild bone from the inside out.Where to Find Our GuestDr. Sayana's Instagram: https://www.instagram.com/sayanamedicalDr. Sayana's Website: https://www.sayanamedical.comLinks & ResourcesStronger Bones Lifestyle CommunityJoin a supportive space to strengthen your bones naturally with live sessions and masterclasses. Start your 10-day free trial now at https://debirobinson.com/the-stronger-bones-lifestyle-communityHealthy Gut Healthy Bones ProgramDiscover a self-paced course to build stronger bones and better gut health. Enroll now at https://debirobinson.com/healthy-gut-healthy-bones-program-v2/Free Download: Common Root Causes of OsteoporosisGet a free guide on osteoporosis causes and actionable solutions. Download now at https://debirobinson.com/#7rootcausesMasterclass: Stronger Bones Stronger YouWatch an on-demand masterclass for natural bone health strategies. Start here: https://debirobinson.com/bone-health-masterclass-signup-1/Healthy Gut Healthy Bones QuizAssess your bone health and discover personalized solutions. Take the quiz now at https://debirobinson.com/healthy-gut-healthy-bones-quiz-landing-page/Newsletter SubscriptionStay updated with exclusive bone health insights and tips. Subscribe at https://debirobinson.com/#newsletter-signup

Cancer rates are rising rapidly—especially in young adults. With 1 in 2 men and 1 in 3 women being diagnosed with cancer, proactively preventing cancer is an absolute must in our modern world. Today, Dr. Leigh Erin Connealy shares what she's learned in the last few decades treating cancer with an integrative approach. We also answer your questions about root causes of cancer, red flags in labs, how parasites, autoimmunity, and hormone issues can contribute to cancer, and what's worth your time and effort when it comes to reducing overall risk. Timestamps:[3:28] Welcome Dr. Leigh Erin Connealy[3:40] Why do you think cancer rates are continuing to rise even though we have more information than ever? [13:15] Do you think the current standard of care is actually helping people when it comes to cancer?[16:01] What's an ideal C reactive protein and are the standards on labs adequate? [19:00] Is there a significant cause to ovarian and colon cancers because they're becoming more prevalent in younger people?. [24:32] Are parasites connected to cancer?[30:05] If someone is coming in and they already have cancer, are you looking for these underlying root causes and can you treat cancer that way?[33:52] Do you see there being any connection to cancer with long withstanding hormonal imbalances? [38:00] Is there any cancer link with birth control? [39:10] Does autoimmunity and immune suppressive drugs increase cancer risk and if so what can we do to keep risk as low as possible?[41:30] If you could tell people to start incorporating three to five things that would help them make a preventative approach to cancer, what would they be?[50:51] What is the best type of diet for preventing cancer and what should we be focusing on once diagnosis? [55:27] What do you think about routine mammograms and colonoscopies? Do you recommend them and how are we detecting cancer safely? [1:00:48] What are some more cutting edge alternative therapies that you're working into your cancer treatment that is showing promising results that you wish more people would do?Episode Links:Visit Dr. Leigh Erin Connealy's websiteThe Cancer Revolution: A Groundbreaking Program to Reverse and Prevent Cancer Follow Dr. Leigh Erin Connealy on InstagramIdeal lab tests:Fasting blood sugar: 85 (70, too low, 95 and up, too high)SGOT and SGPT: 20-22Ferritin: 50 HA1C: under 5.7 CRP:  0.5Sponsors:Go to wellminerals.us/creatine and use code WELLFED to get 10% off your order.Go to blissy.com/wellfed and use code WELLFED for 30% off your purchase!Go to drinklmnt.com/wellfed and use code WELLFED to get a free 8-pack with any drink mix purchase!Go to http://mdlogichealth.com/immuno and use coupon code WELLFED for 10% off.

Giant Cell Arteritis (GCA) is one of the most dreaded diagnoses in ophthalmology; not only can it cause vision loss, but it can also be life threatening.  So what is the threshold for going down the 'GCA diagnostic path'? When should one order an ESR and CRP?  When is the concern high enough to warrant a temporal artery biopsy, and when should steroids be started?  How is temporal artery biopsy changing our diagnostic alogirthm.  Dr. Andrew Lee joins the podcast. This episode of the podcast is sponsored by Thea Pharma Canada - https://www.theapharma.caBecome a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.

"A study that was done in 2022, it looked at over 4,000 adults over a 26-year span, and it found that just a 5-gram increase in fiber led to a lot less inflammation in the body. And they measured inflammation by C-reactive protein, which you can ask your doctor about when you get your next blood test to measure your CRP, or C-reactive protein, to see how inflamed you are. And when you have lower inflammation, this also lowers your heart attack risk. So, higher fiber in your diet can lower your heart attack risk by as much as 30%. Who knew, right?" -Alexandra Paul Today, we're diving into the power of fiber—how it fuels gut health, reduces inflammation, and why most people aren't getting enough. Alexandra breaks down the different types of fiber, why variety matters, and easy ways to boost your intake. Then, Jason shares his experience with heavy metal detox, revealing how hidden toxins affect your health, where they come from, and the best foods for natural chelation. Plus, we explore the surprising link between nutrition and gray hair. So, whether you want better digestion, detox support, or vibrant hair, this episode is a must-listen! Podcast sponsor: Vedge Vegan Collagen: vedgenutrition.com – use code S4G for 30% off your order. - https://www.vedgenutrition.com/ What we discuss in this episode: Why fiber is essential for overall health and how it supports the body. How short-chain fatty acids reduce inflammation and lower blood pressure.  How much fiber you should be eating daily for optimal health. Alexandra's favorite method for tracking daily fiber intake. The polyphenol with anti-aging effects and where to find it. How chelation works to remove heavy metals and the best foods to support this process. Common sources of heavy metal exposure and how they accumulate in the body. Symptoms of heavy metal toxicity and how to identify potential risks. The link between animal protein consumption and toxin exposure. Resources: Luteolin, an antioxidant in vegetables, may contribute to the prevention of hair graying | ScienceDaily https://pmc.ncbi.nlm.nih.gov/articles/PMC11673595/ Dietary Strategies for the Treatment of Cadmium and Lead Toxicity - PMC Phytochemicals Involved in Mitigating Silent Toxicity Induced by Heavy Metals - PMC Click the link below to support the FISCAL Act https://switch4good.org/fiscal-act/ Share the website and get your resources here https://kidsandmilk.org/ Send us a voice message and ask a question. We want to hear from you! Switch4Good.org/podcast Dairy-Free Swaps Guide: Easy Anti-Inflammatory Meals, Recipes, and Tips https://switch4good.org/dairy-free-swaps-guide SUPPORT SWITCH4GOOD https://switch4good.org/support-us/ ★☆★ JOIN OUR PRIVATE FACEBOOK GROUP ★☆★  https://www.facebook.com/groups/podcastchat ★☆★ SWITCH4GOOD WEBSITE ★☆★ https://switch4good.org/ ★☆★ ONLINE STORE ★☆★ https://shop.switch4good.org/shop/ ★☆★ FOLLOW US ON INSTAGRAM ★☆★ https://www.instagram.com/Switch4Good/ ★☆★ LIKE US ON FACEBOOK ★☆★ https://www.facebook.com/Switch4Good/ ★☆★ FOLLOW US ON TWITTER ★☆★ https://twitter.com/Switch4GoodOrg ★☆★ AMAZON STORE ★☆★ https://www.amazon.com/shop/switch4good ★☆★ DOWNLOAD THE ABILLION APP ★☆★ https://app.abillion.com/users/switch4good

In episode 87, Kathryn and Theresa dive into the Critical Response Process (CRP) with Mallory Alekna, Assistant Professor of Music, Human Development, and Learning at Augsburg University. Mallory shares how this four-step feedback framework, developed by choreographer Liz Lerman, can transform music classrooms by fostering meaningful dialogue and empowering students to take ownership of their learning. Through CRP, students learn to articulate their observations, ask thoughtful questions, and engage in constructive, permission-based feedback. By integrating this process into music education, teachers can create more equitable, student-centered environments that encourage creativity, agency, and collaborative learning.Music teachers will leave this episode with practical strategies for implementing CRP in their classrooms, whether through peer feedback on student compositions, discussions about performance techniques, or even broader conversations about musicianship as an ongoing journey. If you're looking for ways to shift from a traditional top-down approach to one where students feel truly heard and valued, this episode is packed with insights and actionable takeaways to help you get started.Connect with Mallory and learn more: Contact MalloryLearn about the Critical Response Process Connect with an Expert Facilitator More about Pass the Baton:Website Join the Coffee Club Support Pass the Baton Amplify student voice with Exit Tickets for Self Reflection

BUFFALO, NY — March 26, 2025 — A new #research paper was #published in Aging (Aging-US) on January 29, 2025, in Volume 17, Issue 2, titled “Diet, lifestyle and telomere length: using Copula Graphical Models on NHANES data.” Researchers Angelo M. Tedaldi, Pariya Behrouzi, and Pol Grootswagers from Wageningen University and Research used data from the National Health and Nutrition Examination Survey (NHANES) to explore how diet and lifestyle affect telomere length, a key marker of cellular aging. They found that inflammation—rather than diet, exercise, or smoking—had the strongest and most consistent association to telomere shortening. The findings suggest that reducing inflammation may be more effective than dietary changes in slowing down the aging process at the cellular level. Telomeres are protective caps at the ends of chromosomes that get shorter as we age. When they become too short, cells lose the ability to divide properly, which can contribute to aging and age-related diseases. Previous studies suggested that healthy habits might protect telomeres, but many focused on a small number of factors and did not account for important elements like inflammation or differences in blood cell composition. This study aimed to take a more complete, data-driven approach. The research team analyzed health data from over 7,000 U.S. adults collected between 1999 and 2002. Using a method called Copula Graphical Modeling, they examined more than 100 variables—such as diet, physical activity, smoking, and blood biomarkers—across three age groups: Young (20–39 years), Middle (40–59 years), and Old (60–84 years). They found that telomere length was most strongly associated to age, levels of C-reactive protein (CRP)—a common marker of inflammation—and gamma-tocopherol, a form of vitamin E found in the blood. Higher CRP levels were consistently associated with shorter telomeres, especially in younger and middle-aged adults. The results suggest that while lifestyle factors like diet and exercise still play a role, their impact on aging may be indirect—mainly through their influence on inflammation. This finding shifts the focus toward managing chronic inflammation as a potentially more effective way to preserve telomere length and promote healthy aging. “The central role played by CRP and the marginal role of antioxidants suggests that telomeres are particularly vulnerable not to oxidative stress, but to inflammation; and they should be protected against it.” The study challenges earlier research that looked at individual lifestyle factors isolated. By using a more advanced and inclusive method, this analysis offers a clearer picture of how health behaviors, biological markers, and aging are connected. Although this research cannot prove a cause-and-effect relationship, it strongly supports the idea that inflammation plays a key role in cellular aging. The authors recommend further long-term studies to better understand how inflammation affects telomere length over time. In the meantime, reducing chronic inflammation may be one of the most important steps to help support healthy aging and reduce the risk of age-related diseases. DOI - https://doi.org/10.18632/aging.206194 Corresponding author - Angelo M. Tedaldi - angelomt1999@gmail.com Video short - https://www.youtube.com/watch?v=C2yXfF7iY6c Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Please visit our website at https://www.Aging-US.com​​ and connect with us: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

Since joining our RA Coaching Program in 2023, Elaine has normalized her CRP levels and dropped major disease-modifying drugs: she is now symptom-free, and today she shares her story with us. Book Your RA Reversal Strategy Session Here https://www.rheumatoidsolutions.com/book-a-call 1. Learn how you can reverse your RA symptoms here: https://www.rheumatoidsolutions.com/training-2024 2. Follow me on Instagram to get daily pain-reduction insights: www.instagram.com/paddisonprogram

I this episode Colin is joined by Curt Rogers, Owner of Rogers Natural Resources. Curt discusses the equipment he uses for forestry mulching and what he has learned over the years from mulching in many different situations.Colin talks about how him and Curt have worked together to get a lot done on client properties when being at the same property. Curt and Colin talk about planting warm season grasses and the major differences between CRP blends and blends that are more based for whitetails and have a low percentage of grass in them. Curt talks about managing invasives and what solutions he uses to treat and control many common invasives very easily. Colin and Curt talk about the top equipment they both use and recommend for guys starting in habitat management on their property. https://www.instagram.com/legendary_habitat/https://www.facebook.com/LegendaryHabitat/https://www.youtube.com/channel/UCbIsv6Orm9cD025IBFx8DWAhttps://www.legendaryhabitat.com/https://splitbrowhabitat.com/

We discuss the evaluation of and treatment options for acute back pain. Hosts: Benjamin Friedman, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Acute_Back_Pain.mp3 Download Leave a Comment Tags: Musculoskeletal, Orthopaedics Show Notes **Please fill out this quick survey to help us develop additional resources for our listeners: Core EM Survey** Clinical Evaluation: Primary Goal: Distinguish benign musculoskeletal pain from serious pathology. Red Flags: Look for indicators of spinal infection, spinal bleed, or space-occupying lesions (e.g., tumors, large herniated discs). Assessment: A thorough history and neurological exam (strength testing, gait) is essential. Additional Tools: Use bedside ultrasound for post-void residual assessment in suspected cauda equina syndrome Imaging Guidelines: Routine Imaging: Generally not indicated for young, healthy patients without red flags. ACEP Recommendations: Avoid lumbar X-rays in patients under 50 without risk factors, as they do not change management and may increase costs and ED time. Advanced Imaging: Reserve MRI for patients with red flags, neurological deficits, or suspected cauda equina syndrome; CRP may be a part of your calculus when evaluating for infectious causes of back pain Treatment Options: Evidence-Based First-Line: NSAIDs offer modest benefit.

Join host Carol Pankow as she dives into the complexities of Order of Selection (OOS) in vocational rehabilitation with two expert guests: Theresa Kolezar, Director of Indiana Combined, and Chris Pope, Director of the State Monitoring and Program Improvement Division at RSA. In this episode, they break down: ·      Why agencies implement OOS due to financial and staffing constraints ·      Key regulatory requirements and compliance considerations ·      Strategies for managing and eventually lifting OOS ·      Indiana VR's data-driven approach to decision-making and communication ·      RSA's insights on fiscal forecasting and policy compliance If you're in the VR field, you won't want to miss this insightful conversation on planning, stakeholder engagement, and using data to overcome challenges.   Listen Here   Full Transcript:   {Music} Chris: As you know, we have 78 VR agencies and only eight of them have a closed priority category, and only one of those eight have all priority categories closed.   Carol: So by going back and saying hey you gotta look at this other side of the house and really analyze what's happening. It will give you the full picture, than what is playing into what's happening over here on the fiscal side of the house.   Theresa: For the majority of folks. They were maybe even having somewhat of a positive impact because we were able to get them processed, get them in sooner. And you know, there's obvious benefits that go along with lower case load sizes.   Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.   Carol: Well, welcome to the manager minute. Joining me in the studio today is Theresa Kolezar, director of Indiana Combined. And Chris Pope, director of the State Monitoring and Program Improvement division at the Rehabilitation Services Administration. So, Theresa, how are things going with you in Indiana?   Theresa: Oh, we're doing well. Thanks. So happy to be here.   Carol: Thanks for being here. And, Chris, how are things going for you in D.C.?   Chris: Things are cold in D.C. at the moment, Carol, but we're hanging in there.   Carol: Yeah, not as cold as Minnesota.   Chris: I knew you were going to say that.   Carol: Yeah. I'm like, wow, we're 14 below people. Well, there has been a lot happening with the VR program over the past decade, and we certainly have had our ebbs and flows with funding and staffing. And as of late, the fiscal pendulum has been swinging, VR programs have been experiencing a tightening of the belt, so to speak, and discussions about the order of selection have been ramping up. And so for our listeners, order of selection is a process required under the VR regulations. When a VR agency does not have enough resources, whether it's funding staff or both, to serve all eligible individuals, and it's designed to prioritize services for those with the most significant needs. But over the years, order of selection really has sparked a lot of tension. And for some it's seen as just another layer of government red tape adding to the stigma around bureaucracy. Others argue that it undermines the very spirit of the rehab act by limiting access to services instead of promoting inclusion. Critics point out that it can widen service gaps. It leaves individuals with moderate disabilities without support, even though they still face serious barriers to employment.   And for our counselors, order of selection can bring its own challenges, including the emotional burden of explaining to clients why they can't receive immediate services. And for clients, being placed on a waitlist can feel disheartening and frustrating. And at the same time, agencies are grappling with a harsh reality. There's limited resources. Tough decisions have to be made. So how do we balance fairness, inclusion and the constraints of funding? And that is the question at the heart of today's conversation on order of Selection. So, Theresa, I've been a fan of yours for a long time. I think you bring a really thoughtful approach to almost every difficult situation in VR, and you been around a while, so I definitely want to pick your brain about your thoughts and approach on the topic. And Chris, I'm really count on you to bring the facts from an RSA perspective on what needs to happen with the Order of Selection. So let's dig in. So, Theresa, can you just tell us to start out with a little bit about yourself and your journey into VR?   Theresa: Sure. I probably have the least interesting journey, but maybe the most classic. I went from straight from undergrad to graduate school to get my masters in rehabilitation, got my CRC that same summer, and I entered the rehab field initially with a nonprofit, CRP, before coming to Indiana VR in 2004. So I've been with the VR program for a little over 20 years. Made my journey starting from a VR counselor and now director with, as you can imagine, a lot of other roles along the way. And I think I'm a fairly tenured VR director with almost nine years under my belt in this role.   Carol: Yeah, definitely you would be. Because I remember being told when I left, I had six years, you know, and people were telling me usually the lifespan of a VR director is about five years because the job is tough. So you're definitely one of our longer term folks. So, Chris, how about you? How did you venture into the VR world?   Chris: Thanks, Carol. Well, similar to Theresa, my graduate degree in rehab counseling, I became a CRC and began my career as a VR counselor with the State of New York in the general agency at the time, for about four years. And I've been with RSA now for a lucky 13. Just had my 13th anniversary. And in that time have served in a variety of roles. So, yeah, really happy to be here and now leading the division that's responsible for all of our formula grant.   Carol: Yeah, it's super cool. It's been fun to watch your career, Chris, as  you have grown. I remember one of the very first conferences you presented at, and I believe you were still, you know, more kind of on the staff level. And I thought, who's this guy? You were up there, you just had such a great presence about you. And I'm like, he's going somewhere. And you have, it's come true.   Chris: Thanks, Carol.   Carol: So let's talk about the realities of Order of Selection. It's not something that can be implemented at the snap of a finger. And so I want to start with you. What are those factors via our leaders need to take into account.   Theresa: Yeah. You know it's hard I feel like I sort of came to terms with it because it's it didn't feel so much like something we had to choose or decide upon, but more something we had to do. if your circumstances are such that you don't have the resources to serve everyone. So in Indiana, we enter the order in 2017, and I believe that was the first time in our history, as far as I know, it came after years of trying other things, you know, implementing strategies to improve our capacity, stretch our resources. And just a few examples. Implementing efficiencies, changing to our staffing structure, changing our minimum VRC qualifications to a bachelor's degree, and a whole lot more. And those strategies were definitely focused for us at that time around staffing resources. But there were also some fiscal unknowns or concerns because right around that time, the 15 earmark requirement was also, you know, kind of hitting us. And we were trying to figure out how to shift those resources. So the strategies we did pre they were definitely helpful. They were effective, but we still were left with a deficit. You know, we still had high caseload sizes. It was taking way too long for new referrals to get an intake appointment. Our VRC turnover rate was much higher than is optimal. Ultimately led us to identify that we were not able to provide the full range of ER services to everyone who was eligible, and therefore we needed to enter the Order of Selection.   So we started planning for that probably around nine months prior to. The implementation and when I was making my talking points, there's a lot that you have to do, right, to prepare for Order of selection. So discussion with our internal leadership, our VR council, our stakeholders, our staff conversation with RSA, drafting that state plan amendment, getting that out for public comment. We took a couple extra steps and met with our other workforce partners because we thought, hey, they may get more referrals here. We may want to tell them why and what's going on over here and what this means. And then we of course, you have to develop written procedures, adapt your case management system. And then we also wanted to be really careful with our messaging to applicants. So we drafted some materials that we wanted our intake counselors to share and get that consistent message out there and, of course, training our counselors. So I think the nine month runway was probably a fast track Approach, thinking about all those steps. You want to do it right? You want to be planful. But at the same time, once you identify that this is a need, you usually need it to happen pretty quickly.   Carol: Absolutely. I know for me, when I was a new director in Minnesota, I actually faced this. And Minnesota Blind had not been on an order for many, many, many, many, many, many years. And being a little naive, you know, coming into VR going, we have this situation, you know, I'm thinking this all can happen super fast. It does not. But I found for me, really getting grounded in understanding our data was so important because I see these things all going on. But you had to put all the pieces together, get your fiscal side of the house and what's going on and how you're making expenditures and investments in different things and what's happening with that. But what also is happening programmatically, the people that are coming in and the characteristics of your caseload and all those different things, you had to put it all together to really get the complete picture. And for me, I know I had to do that rather quickly. So it becomes super important to have people around you. If you are not that person you know, that can pull all that data and present it in a way so you can really see the picture of what is happening and kind of unfolding in the state.   I think it just so foundationally because I know I have this little list at my desk of people that have called me looking at needing to go on order selection or thinking they're going to need to. And we have over a dozen states that have outreached in the last two months. And part of my advice to them has been back, you know, you have to get grounded to and what was your data telling you? Because you can't just base this all in sort of an assumption or something. You've got to be grounded. So I always think that that's a really important piece to start with. Now, Chris, I know from a regulatory perspective there are items that are absolutely critical for VR to have in place when you were considering Order Selection. Can you help us with that? Because I want to make sure people aren't making a mistake, you know, as they're kind of thinking through the process.   Chris: Definitely. There are several regulatory requirements, and before we address those, I thought I could provide just a little bit of context at the moment of where we're at with Order selection across the country. As you know, we have 78 VR agencies and only eight of them have a closed priority category, and only one of those eight have all priority categories closed. So this is significant progress over the past several years, I'd say since the passage of WIOA in 2014, in the past, as many as a fourth of our VR agencies had at least one closed priority category. And I can say that when RSA meets with congressional committees and other stakeholders, they often ask us for a status check on Order of Selection, and I can tell you that they respond really positively when we share that very few VR agencies are unable to serve all eligible individuals. Further, since RSA and our federal partners approved, the latest state plan would be the 2024 to 2027 state plans, RSA has approved one VR agency's new order of selection, and at the moment, we have 2 to 3 VR agencies that have submitted paperwork and are pending implementation.   Carol: You might have a few more. Chris now coming because I have I have my list of people calling. I mean really we do have 12 now on the list, so I expect maybe some more outreach.   Chris: Yep. So in terms of all of those regulatory requirements, like you said, VR agencies need to have a few things in place as they consider implementation. These include a comprehensive fiscal forecast, cost containment policies if necessary, and assessment of staff resources. And as Theresa talked about, consultation with the State Rehabilitation Council, so that fiscal forecast needs to address six data points. Average case costs, the projected number of new IPEs, the current number of IPEs, the projected number of applicants and the cost of any assessment services that might be needed to determine them eligible for the program. Projected increase or decrease in the cost of providing VR services to these groups of people, and projected income, or in any other budget resources that may become available. The fiscal forecast produces that data, Carol, that you were talking about, that demonstrates whether or not the VR agency can do the following four things. Whether the agency can continue to provide services to all individuals currently receiving services under their plans. Provide assessment services to all those individuals expected to apply to the program over the next fiscal year. Provide services to all individuals who are expected to be determined eligible in the next fiscal year. And finally, that fiscal forecast needs to include data that demonstrates that the VR program will continue to meet all of the various program requirements, like that 15% reserve requirement that Theresa discussed. So in terms of creating an Order of Selection policy, there are about five things that the VR agency needs to include in that actual policy.   First is it's priority categories, including the regulatory definition of what significant disability means, how the VR agency will determine which individuals have the most significant disabilities. And that definition must build on that regulatory definition of significant disability. The policy needs to address whether the agency has elected to serve individuals outside of the order of selection, who may require specific services or equipment to maintain their job or to keep employment, was one of those new requirements. The policy must indicate how the VR program will provide information and referral services to individuals who may be placed on a waiting list. And finally, the policy needs to describe how the agency will carry out the order, how it will be implemented so, in effect, how the waitlist will be managed and how the VR agency will decide when to open all of those other priority categories. I was happy that Theresa also mentioned that VR agencies need to ensure that their case management system can fulfill the administration of the order. And we like to see in the policy some discussion of what tracking mechanisms VR agencies will use to account for such things as cost, staff time and caseload sizes. So in other words, sort of that real time data analysis that That informs whether the order continues to be necessary or whether it can be lifted.   Carol: Awesome. I'm sure people are probably, as they're listening, taking copious notes. So folks need to know that there also is always a transcript that goes along with the podcast. So if your wrist just broke, you will be able to just take a look at the notes and get all those things. That is super helpful. Chris, I wanted to ask as a follow up, so that people that have outreached so far, those states that have outreached are you seeing? Is it a fiscally related issue? Is it a staffing? You know how sometimes the states are really struggling with having appropriate staffing? I know it's only been a few, but do you know kind of what that looks like if it's based on more of the fiscal end of things, or is it they don't have capacity because they don't have any staff?   Chris: It's been a combination of all of those things, Carol. So we're seeing agencies with limited fiscal resources, whether that be state appropriated funds, their inability to kind of fully leverage the federal award. It may be retention and recruitment of VR counselors. It could also be sort of capacity of providers, whether those are community rehab providers or contractors who provide VR services. And oftentimes it's other things that kind of just contribute to those as well. And what we're hoping to see in those justifications that VR agencies submit is a real data informed discussion of those factors, like real time data in terms of both fiscal data and performance data. So the money and the people.   Carol: Yeah, I can't underscore that enough, because I know the folks that have reached out to us a lot of times they tend to talk about, you know, their hair is on fire about this thing. And then I'm always bringing  back. So if they're all focused just on the fiscal. But I said, what's happening in your program, what's going on? And that has been very interesting as people are talking about. And then they call us back. They go, you know, the characteristics of the individuals coming in the case characteristics, kind of pre-COVID to now is different. And so we're finding clientele coming in has many more needs, and so the cost of the case are so much greater. And they hadn't realized it until they went back in. They just knew something was going on with the people, but they didn't understand what. So by going back and saying, hey, you got to look at this other side of the house and really analyze what's happening. It will give you the full picture. And then what is playing into what's happening over here on the fiscal side of the house. So I think for, you know, we've all said it, the data is super important. I just want to underscore that. So Theresa, tell us a little bit about your journey with Order Selection in Indiana and your current picture what's happening?   Theresa: I echo the data conversation, that's critical, and you really have to justify the need for the order. So we did all of that really before we even probably got to that, that nine month runway that I spoke of. But from there, our next step was to get our internal leadership approval. And there were hesitancies, which is understandable. We really had to work to articulate and help them understand the challenges that we were facing. Again, justifying using that data that we were not able to provide the full range of services to everyone, while also meeting the range of other expectations, you know, timeliness, getting people in the door in a reasonable period of time. And we really had to work to articulate the negative impact of having these ongoing high caseload sizes and the cycle that we were in with staff turnover. It just felt like we were getting deeper and deeper into right into a hole and further and further away from optimal capacity. So ultimately, we presented the Order of Selection as one something that is federally required for our agencies, you know, not able to provide that full range of services. And then two, a lever of sorts that would enable us to maybe pause or slow some of that growth in participants, giving us the space to get out of that cycle to rebuild our foundation, which for us primarily at that time, was fixing our long standing staffing capacity challenges. But for those experiencing fiscal deficits, of course, that focus would look very different. Once we got leadership support, we moved as quickly as humanly possible. And now on the other side of it. I'm thrilled to share that we have now opened all of our priority categories. We released the last 200 or so from our waitlist just this past October, so we were in and out of the order in about a seven year period in Indiana.   Carol: I love that. I like that you said you want to project, you know, the ways to get kind of out of the order to open the categories and do that. I know for states that have contacted us, that's one of the pieces of advice I've been giving. I'm like, okay, you're thinking about the right now, but you also have to think about the future because that is everyone's biggest worry. You're going to do this thing and it's never going to go away. People are going to be in a waitlist forever. You're never putting strategies in place to come out on the other side of that. And I know for me in Minnesota, that was very much part of what I had to do. And given the circumstances we had at that time, I had this plan and I said, if you all can hang with me, I believe by about 2018 or so, end of 17-18, we're going to be on the other side of this, which actually ended up playing out and coming true. And so you've got to not only like react to your current situation, but you want to be thinking thoughtfully about what are those things that you can put in play so that you aren't just going to stay there? This is the lever we're pulling and we're going to be here forever. So I really like that you said that. I know, Theresa, when you and I talked earlier, Order selection can often be treated like a bad word in the VR world, and it is loaded with a lot of stigma and frustration. But at its core, you know, when you and I were chatting and, you know, you just boil it down, it really is a mechanism. It's a tool required by law to prioritize services when resources are limited. And so if we can't do everything for everyone, it's a system that outlines how to make those tough decisions. What are your thoughts about Order of Selection and how we can maybe shift the conversation to reduce the stigma and see it for what it is? It can be this necessary lever to balance fairness amongst those limited resources.   Theresa: Yeah, that's probably one of the trickiest parts in communication. Communication, right. Communication. Communicating with stakeholders about Order Selection will probably always be challenging. It's a challenging thing, but I think there's a couple of things that were really helpful. And one is sharing a game plan to address the underlying resource challenges. Is a helpful approach, right. Making sure that there's game plan. This isn't the end result, right? This is going to enable us to make this shift and again kind of get out of the cycle. We also found it helpful to share the federal requirements. So just very factually, if you can't serve all you have to prioritize certain populations first. And the Order of Selection is the prescribed process for complying with that. And I think it's a good process for doing that. It's effective at making sure the prioritization happens. Additionally, we also share data throughout our process on the percent of eligible individuals who were impacted. And what that showed is that the majority of individuals were actually not impacted. You know, relatively speaking, a pretty small percent of folks ultimately went on a wait list. And, you know, you could even argue, and I think we did a couple of times that for the majority of folks, they were maybe even having somewhat of a positive impact because we were able to get them processed, get them in sooner.   And, you know, there's obvious benefits that go along with lower case load sizes. So we often relay that only about 10% of eligible individuals were going on a wait list, and 90% were meeting that criteria for those with a most significant disability, which was our open category for a good bit of our seven years. I will say people were a little wary of that stat. They kind of had a hard time believing that, and I think that it's because that term MSD or most significant disabilities, it definitely has meaning. But also we found it could be a little bit misleading. You know, people thought, oh, to be MSD, someone must look like this, right? And we actually found that those meeting that MSD criteria were really a more inclusive group than maybe that term people would perceive that term to imply. And that was just another educational opportunity for our stakeholders and our referral sources.   Carol: I like that you talked about the communication piece around all this, because that really is important. It's almost as important as all of the plans you're putting in place. All the things that Chris told us about that need to go in developing that communication plan, that goes along with how you discuss this out amongst all the stakeholders and such, is super important. I know, Chris, do you have any insights on this part, on the stigma or anything you wanted to share?   Chris: I guess I just had a couple thoughts on like the element of fairness that you talked about in dealing with fairness and at the same time limited resources. So I guess I would just say that order of selection is only one of the cost containment measures afforded to VR agencies through the law and through regulations. And there are other things, too, that VR agencies may want to consider, and that's comparable services and benefits. How we inform people and refer them to other workforce development programs. Those may be our partners or others. How we balance what VR Agencies by in terms of services and what we provide in-house in the cost kind of associated with both strategies. One of the other things that RSA often considers VR agencies to look at when we're talking about implementing an order is kind of carefully evaluating the need to require additional assessments when the law allows and promotes the use of existing information. So sort of not overdoing that eligibility determination process because that often comes with cost. Right. And then finally VR agencies should also be reassessing sort of their routine practices and policies that result in increased cost. That may not always be necessary. So we're really looking at kind of the entire fiscal picture of the program, not just those VR service costs that are provided to eligible individuals.   Carol: That's good. I'm glad you brought all of that up, because we often do talk about these other factors. And I asked people, are you also looking at what are you getting bang for your buck? And not that we're trying to bang on vendor communities, but do you have vendors where people never like they're never done with service, they never graduate, they never get to the end? I mean, maybe it's looking back at that and going are the ways in which their training really working for your clientele? Maybe not. Maybe you need to circle back and work with them or have a parting of the ways and think about that. I also like the thinking about really leveraging our partners. I mean, the whole rehab act, when it was redone, you know, and we had the 2014 WIOA comes out of that. We always had partners, but I don't think we were very good at leveraging what things are they doing. And I feel like some of this stuff is duplicative. You know, why are we offering these same sort of trainings that are now at the one stop that people can access and go to those courses or whatever, you know, types of things that they're offering. So it does force you to take a look at that and really actually live in to WIOA and leveraging the partnerships and the funds across all these systems. I like that. Thank you Chris, for saying that. Order Selection also has to be a super thoughtful process. And so, Chris, I know you talked about the data points that folks should look at. Theresa, what are the data points you look at regularly? And I like it because some directors talk about kind of they're reading the tea leaves to complete your fiscal forecasting, or there's some other things that you like to do.   Theresa: Oh gosh, yeah, We could talk all day on fiscal forecasting. But to just kind of be brief, you have to look beyond just what did we spend last year and apply that and assume that. And I think if you don't have programs talking to fiscal sometimes that is the fiscal assumption. Right. By fiscal staff being made. So with the pendulum swings that we tend to see in VR, which of course are highly driven by trends and applicant and participant counts, you really need to have a very layered approach to forecasting. This is where, again, that program knowledge and fiscal knowledge, it's essential that they're paired up. Just a few things to consider would be beyond the basics right. What is your data show? What are your trends? Show. But what's in your state plan? What are the goals? What are the initiatives that you have in place? There may be a fiscal impact to those, right? There may be a staff resource impact to those. So for instance, a very obvious example in our state plan, we have some goals around increasing enrollment in post-secondary training. There's some fiscal impact there. We need to know what that is, how to apply that, and then really have an understanding of our ability to sustain that goal into the subsequent years.   Again, the applicant and participant growth trends are super important. So keep your eye on and then any impact of any other outreach or collaborative partnerships that might be contributing to some of that program growth. You know, more people served generally is going to mean more expenses. And then just quickly, from kind of a fiscal standpoint, something that might be a little bit unique beyond, again, all the basic essentials of fiscal forecasting is we really have to account for carrying over a certain portion of our dollars. And that really comes down to making sure we don't have, you know, disruptions and services and can comply with this period of performance requirements. So we find in Indiana that, you know, carrying over like 20 to 25% works well for us, ensures that we can continue authorizations past 9/30 and not have that challenge of waiting until ten/1, you know, to encumber new funds. And that just keeps the flow of services going. So I'll just add that as maybe a nuance that others aren't always thinking about.   Carol: Yeah, I appreciate that because I think that having that strategy I did too, as a director, wanting you have your sweet spot of what you like to have in that carry over, because it really does promote that consistency when you have that hard start and stop, and especially in an era of continuing resolutions, you know your whole strategy with how you're flowing into the next year and how all that's going to work. You need to think about that piece for sure. Now, I know a big problem has existed around priority categories and the most significant disability designation. And many programs have three categories, but almost 90% of the customers are in category one, which makes it difficult, you know, when you're implementing an Order of Selection. How did you address that in Indiana?   Theresa: Yeah, that's exactly what we saw. And we balanced this by a couple of key strategies. One is that we did not release anyone from the waitlist until a little over two years into our process. That's  kind of how we, how bad of a cycle we were in. And again, it's a lever. It's  that dial. We had some targets like caseload sizes, retention rate that we were tracking as a gauge to when we could start moving people off that waitlist. So just for example, average caseload size is getting to under 100, turnover being less than 20%. So those were some indicators to watch to start releasing folks. Another strategy that was really helpful is that we opted to do larger releases each quarter instead of kind of smaller, more frequent releases. And this gave us the opportunity to really have our staff know that it was coming the same time each quarter. They could carve out time because it is a lift on top of the day to day, right? You've got to reach out to folks multiple times. You've got to schedule them for meetings. You've got to get IPEs in place. And then with those reviews of the, you know, again, we might look at like 2 to 300 people to see, can we take 300? Can we take 200? Is it somewhere in the middle? How does that break down across your 26 offices? And inevitably each quarter, one office got hit with a high number. And then there were a few that had very little. So we also had to weigh that and see where we could balance our resources to make those work. You know, at the end of the day, you ultimately have to release more people from the waitlist than new people who came in as eligible that quarter in order to get ahead of it. So that was another data point that we looked at.   Carol: Did you find that actually learning kind of through Covid, a lesson, you know, with working remotely and all of that, did that help as you're looking at distributing across the 26 areas? Because you can I mean, and I've talked to other directors about this now you can work with people. Maybe you're in this part of the state, but you can work with other folks as well to keep them moving. So maybe there isn't this huge one off, it's just got 200 people and the other offices get one, you know, they don't have any. Did you find some ability to flex that around the state?   Theresa: Absolutely. That's exactly what we did. So those offices that were hit hard, of course, they were also the offices with the highest number of vacancies. It just seemed to be how it fell every quarter. So absolutely, our region managers really did it. We have five of those five regions. They really did an excellent job troubleshooting that, you know, we helped where needed. But they for sure did that looking across offices in their region and even across the state. We also have about 7 or 8 working lead counselors, kind of floater counselors. So we were able to deploy them to the areas with the highest need. And then as we progressed through the order, we had a pretty robust outreach process. As we were getting ready to release folks, we ended up centralizing that a little bit to take some of that load off of our field staff as well. So, you know, you kind of have to adjust as you go. Move your resources where you can. But absolutely, we found that to be a great strategy.   Carol: Chris, you have any thoughts on that about the priority categories and the most significant disability? I just wondered because I know folks struggle with that. You were looking contemplative, so I thought maybe you might have something to add.   Chris: My philosophy with a lot of things, Carol, has always been less is more. And you mentioned that most of our agencies have three priority categories. And if I were able to say this is a requirement, that would probably be what I would say. But, you know, VR agencies have flexibility to develop more than three. I would just caution that as you get more complicated, things get more complicated for applicants to understand and for VR counselors to implement. So again, I would just say that the law requires that the significant disability category be identical to what's in the rehab act and the regs, and that that most significant category needs to build upon that. So we often see agencies talking about more functional limitations, more services being needed, more time needed to help the person reach their employment goal. So the more specificity there, the better is. I think that helps VR counselors kind of understand where to place people when they're determined eligible.   Carol: Yeah, that's really good advice. Now I know, Theresa, also, you have talked about wanting to bust the myth that nobody gets off the waitlist. And how can we better do that?   Theresa: I can't tell you how many times I've heard that in Indiana, and that was part of the a lot of the grief is that there was this thought that we'll never get out. So we know that's not true. The facts are there. You know, there are many states. And Chris shared, you know, 25% down to less than ten. So less than ten states. So we know it happens. There are states who've done it. I don't know if we do enough to highlight that to kind of our stakeholders, you know, at large and celebrate that. So maybe that's part of the answer. You know, we have those actual examples. That's an important part of the communication to internal and external stakeholders. The other piece here is outlining the conditions that need to be in place to progress, to opening more categories, to ending the order, and then people can see you hitting those target milestones. They may start believing that, oh wow, there's some actual notable objective progress here. We are getting closer to the end. This does seem doable.   Carol: Yeah, I think going back to that communication strategy for sure can help. I know with our SRC, and I had laid out the plan like I had all these points that we needed to do to kind of get through our struggle. And as things were met or we were able to achieve other savings in certain areas without impacting, you know, a quality of a service. Man ,it was great. Like no stone was unturned as we did that. But I wanted to be super transparent. Here's all the things. And I kept a little chart, like, here was this savings, or here we met this thing so people could see we were actively working a process all the way through, versus okay, we are pulling the lever and the lever is just staying closed down. That's it. They don't see the other end. All that work that's being done behind. So what is your best advice for state directors contemplating pulling the lever?   Theresa: Well, we definitely looked at it as that lever or that dial, and we felt that that gave us an opportunity. We really would not otherwise have had to take action on addressing a really significant foundation or core issue while slowing down that incoming train a little bit and refocusing our resources, staffing and fiscal building adequate resources and capacity. It's an ongoing effort. It never ends. It's one of the more difficult things, probably, that we do, but it's so critical to carrying out services in general, let alone good quality services. And it requires a very thoughtful plan and a lot of simultaneous strategies. You know, all the strategies we implemented from salary adjustments to, you know, creating those working lead counselors I mentioned, we developed a layer of case coordinators to take on some of the case management aspects. I think some states call them rehab techs. Lots of gaining of technology, you know, modernization and efficiencies and then some. Right. It ultimately helped us with two really big systemic needs. And one was getting cancer caseload sizes to manageable levels and reducing our VRC turnover. I mean, those things are gold when it comes to staff capacity.   Carol: Now, Chris, I don't want to steal your thunder, but what I'm going to say to folks too is call RSA. Like, reach out to your liaison and talk to them about your situation. You want to start those conversations because the worst thing I would think is you're a state liaison at RSA and you just get this boom, we want to do it. We need to go on March 1st and today is January, you know, 24th. You want to have that partnership all the way along. And I know, Chris, you can speak a little more to that for sure.   Chris: Carol, you know, we often talk about with clients early and sustained engagement. And I would encourage VR agencies to take the same approach with us at RSA. Reach out early and keep that conversation going. The order of selection approval process is going to be iterative. In 99% of times, RSA will have feedback and will have questions, and we'll want to see justifications be made as strong as possible. So to your point, Carol, our ability to approve orders of selection overnight is not possible. Theresa talked about sort of a nine month on ramp. I wouldn't say it's going to take that long on our end, but it will take at least a couple of weeks. And the stronger the justification we receive, the better. Again, I would just say that consider all of the flexibilities that the Rehab Act offers to VR agencies when it comes to managing the program, in addition to implementing an order. And we talked about some of those before, but they could mean cost containment from financial participation to preferences to instate services, to looking at the administrative costs that you might pay for providing services, your staffing capacity, and really leveraging the ability of your SRC. To advocate for the program, we often talk about the return on investment of the VR program, and it really is unlimited. Our program offers a lot of flexibility to be creative, to help people meet their career goals, and that's kind of the best thing we have going for us to argue for the sustainability of the program moving forward.   Carol: Yeah. Excellent points. The SRC can do so much more than we can do, really, and a lot of venues and have a different voice and a seat with the governor. You know, they're appointed by the governor. They have a different mode of communication that they can use that we cannot. So we definitely don't want to forget about them. All right guys, so we're coming to a conclusion. Any last parting thoughts from either of you for our listeners?   Theresa: Well, I'll just add, I think we've touched on a lot of great lessons learned in communication. Number one, really important. And we've hit on some ideas and strategies around that. And then the second, having that game plan, it's  critical so that we're all viewing Order of selection, not as that end result right, or that indefinite status, but as that lever or that dial that can be adjusted to address the situation at hand and then get back on track, get out of the order, be able to serve everyone who needs those services.   Carol: Awesome. I really appreciate you both and appreciate having this conversation. And for our listeners who were taking notes, because I know you guys read the transcript because that will help you with all of that. You can go back through and highlight the things you need to do. Thanks so much for being here today. Appreciate you.   Theresa: Thank you.   Chris: Thanks, Carol.   {Music} Outro Voice: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!

Originally uploaded December 26, re-edited February 19th. Jeffrey Mosher welcomes back Teri Sand, SHRM-CP, PHR, CBSP, CRP, Business Services Manager, Capital Area Michigan Works!, Lansing, MI, but serving Ingham Eaton, and Clinton Counties THEME: Capital Area Michigan Works! Business Services Manager Teri Sand discusses the importance of Registered Apprenticeships, particularly in the healthcare field, and how CAMW! supports the development of healthcare apprenticeships in the region. Question: What are Registered Apprenticeships and what challenges do they help address in the workforce? Registered Apprenticeships are structured, industry-driven career pathways that provide individuals with classroom instruction and a nationally recognized credential that demonstrates their skills and qualifications. They are a valuable alternative to traditional education routes like college degrees, as they provide a direct route to meaningful careers and provide on-the-job learning in a variety of career fields. They also allow individuals to develop specialized skills while earning a paycheck and gaining work experience, unlike other forms of education. Registered Apprenticeships address multiple challenges in the workforce including talent shortages, increasing demand for services, workforce retention, staffing and skill gaps. They help improve employee retention by offering workers a clear career path and the skills needed for advancement. This is especially critical in healthcare, where high turnover and burnout can significantly affect the quality of care. Many employers in evolving industries face challenges in closing skill gaps — the difference between the skills needed for positions and the skills job seekers possess. Apprenticeships are a critical talent pipeline for organizations because they provide targeted training to equip workers with specific, up-to-date skills. Question: Why is there a growing need for Registered Apprenticeships in the healthcare field? There are many factors that pose workforce challenges in the healthcare field. Employment in healthcare is projected to grow faster than the average for all occupations through 2032, with 1.8 million openings per year, creating a significant demand for skilled workers. Talent shortages, burnout among healthcare workers and increasing skill demands have made it difficult for employers to keep pace with growing demand. Question: What is the current state of Registered Apprenticeships in the healthcare industry and how are they helping address workforce challenges and meet growing skill demands? Employers are increasingly turning towards registered apprenticeships as they allow them to recruit a diverse workforce, reduce turnover and instill their company culture more effectively. In 2023, the number of registered apprentices in the healthcare field reached 24,492, marking a 169% increase over the past five years. Question: How does CAMW! collaborate with local healthcare businesses to implement apprenticeship opportunities and what are some examples of apprenticeship programs CAMW! supports? CAMW! works closely with businesses to tailor apprenticeship opportunities that align with industry demands, ensuring that both employers and apprentices benefit from a structured, hands-on training experience. Question: Where can people go if they want to learn more about health apprenticeships in the Lansing region? More information about healthcare apprenticeships can be found under the “explore career options” tab on CAMW!'s website, www.camw.org.

Welcome to Life in the Leadership Lane where I am talking to leaders making a difference in the workplace and in our communities. How did they get to where they are and what are they doing to stay there! Buckle up and get ready to accelerate in the Leadership Lane! This week, I am talking with Caroline Cook, CRP, Director Business Development at CWS Corporate Housing and 2025CMARC President (Charlotte Metro Area Relocation Council President) How did Caroline get started in her career? What ledher to Corporate Housing and Leadership? What does Caroline share about relocating to different places while growing up? What does Caroline share about collaboration, creation, and growth? What does Caroline share about 2025 CMARC SpringConference? What does Caroline share about some of the educational topics during conference? What does Caroline share about sponsorships and getting involved? What does Caroline share supporting CMARC charitable organization “Nourish Up” during conference? What does Caroline share about making people feelwelcome at CMARC? …and more as we spend “Time to Accelerate” with afew more questions. Interview resources:Favorite quote from Caroline:“It's a beautiful experience knowing your competitors arefriends.” Connect with Caroline on LinkedInEmail CarolineLearn more about CMARCVisit Conference Website to Register and/or SponsorLearn more about the podcast host Bruce WallerCheck out Bruce's books Drive With Purpose: Move Your Career from Success toSignificance (#1 New Released book on Amazon) Life in the Leadership Lane; Moving Leaders to Inspire and Change the Workplace Find Your Lane; Change your GPS, Change your Career (“Book Authority” Best Books) Milemarkers; A 5 Year Journey …helping you record daily highlights to keep you on track.Subscribe to Bruce's Blog “Move to Inspire” Connect with Bruce on LinkedIn Connect with Bruce on TwitterConnect with Bruce on InstagramConnect with Bruce on FacebookGet relocation support for your next household goods orcommercial office move across the US by reaching out to Bruce at bwaller@goarmstrong.com or visit The Armstrong Company

Originally uploaded November 26, re-edited February 18th. Jeffrey Mosher welcomes back Teri Sand, SHRM-CP, PHR, CBSP, CRP, Business Services Manager, Capital Area Michigan Works!, Lansing, MI, but serving Ingham Eaton, and Clinton Counties. THEME: In light of Veteran's Day, Capital Area Michigan Works! Business Services Manager Teri Sand gives an overview of the veteran support services CAMW! provides and the importance of aiding veterans in their job searches. Question: What barriers might veterans face when looking for a job? ● The shift from military to civilian life can be challenging, as veterans may struggle to translate military skills into civilian job qualifications or find jobs they feel a meaningful connection to. ○ According to the U.S. Department of Veterans, some barriers veterans may experience when reentering the workforce include: ■ Learning how to look for, apply or interview for a civilian job, especially if they have never done so before. Question: Why is it important to specifically support veterans in their job search? ● It is important to support veterans in obtaining employment not only because of the sacrifices they have made for our country but also because they bring valuable experience and skills that, though developed in a military setting, equip them for success in the workforce. Question: What services does CAMW! provide to directly support veterans in seeking employment? ● One resource CAMW! offers to support veterans is access to Veterans' Career Advisors (VCAs). ○ Located within Michigan Works! American Job Centers, VCAs provide intensive, individualized support to veterans and their spouses, including comprehensive assessment interviews, career guidance services and individual employment plans. Question: You mentioned that CAMW! frequently connects veterans to InvestVets for employment resources. Could you elaborate on the services InvestVets offers and its role in supporting veterans? ● INVESTVets focuses on bridging the military-civilian cultural gap, which as we've discussed, is one of the most significant barriers to veterans' employment. Question: Where can veterans go to learn more about the services CAMW! offers? ● To learn more about the services CAMW! offers, veterans can visit our website at camw.org. Under the "Career Seekers" tab, there is a dedicated page titled “Veteran Employment Services.”

Meet Brendan Reid, author of "The Fat Ginger Nerd," who transformed his life by losing 110 pounds in just 15 months after decades of struggling with conventional dietary advice. In this episode, Brendan shares how he went from being a skeptical follower of traditional guidelines to finding success through a methodical approach to low-carb eating, ultimately maintaining his weight loss for over 8 years.KEY POINTSReid lost 35-40% of his body weight (110 pounds) in 15 months by adopting a low-carb diet, despite initial skepticismSystematic analysis of food labels and setting a 10g carbs per 100g limit helped create a sustainable approachInflammation markers (CRP) dropped dramatically from 140 to single digits within a year of dietary changesTraditional dietary guidelines in New Zealand strongly discouraged low-carb approaches, leading to years of failed attempts with conventional adviceRESOURCESBook: "The Fat Ginger Nerd" by Brendan ReidWebsite: thefatgingernerd.comSocial Media: Follow "The Fat Ginger Nerd" on Facebook, X, and YouTubeTIMESTAMPS00:05:00 - Introduction and childhood experiences with weight 00:15:20 - The turning point to try low-carb eating 00:28:45 - Health improvements and biomarker changes 00:42:30 - Writing the book and analyzing dietary guidelinesBIOBrendan Reid is a New Zealand-based IT professional turned health advocate who transformed his life through low-carb eating. After maintaining his 110-pound weight loss for eight years, he authored "The Fat Ginger Nerd" and is now pursuing a degree in public health to help others achieve similar success.KISMETWhile most weight loss stories focus on willpower and motivation, Reid's IT background led him to approach weight loss like debugging software - systematically analyzing food labels and treating low-carb as a technical challenge rather than a battle of willpower. This unique perspective helped him succeed Send Dr. Ovadia a Text Message. (If you want a response, include your contact information.) Joburg MeatsKeto/Carnivore-friendly meat snacks. Tasty+Clean. 4 ingredients. Use code “iFixHearts” to save 15%. Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier. So take action right now. Book a call with Dr. Ovadia's team. One small step in the right direction is all it takes to get started. --------------Stay Off My Operating Table on X: Dr. Ovadia: @iFixHearts Jack Heald: @JackHeald5 Learn more: Stay Off My Operating Table on Amazon. Take Dr. Ovadia's metabolic health quiz: iFixHearts Dr. Ovadia's website: Ovadia Heart Health Jack Heald's website: CultYourBrand.com Theme Song : Rage AgainstWritten & Performed by Logan Gritton & Colin Gailey(c) 2016 Mercury Retro RecordingsAny use of this intellectual property for text and data mining or computational analysis including as training material for artificial intelligence systems is strictly prohibited without express written consent from Dr. Philip Ovadia.

Dive into a blend of habitat insights and land market trends with Steve Hanson on the Land Podcast. From electric fences to auction tactics, Steve shares a treasure trove of expertise that can transform your hunting game and investment strategies. Catch real-life stories and pro tips that'll make you a land connoisseur in no time! • Steve's approach on land buying and selling • CRP and its impact on land value • Importance of proper habitat management • Hunting strategies and buck encounters • Innovations in land access and food plots https://www.whitetailmasteracademy.com Use code 'HOFER' to save 10% off at www.theprairiefarm.com Massive potential tax savings: ASMLABS.Net CONNECT: https://linktr.ee/TheLandPodcast 

1. NEJM Article (2024): A 30-year study of 27,939 U.S. women found that high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) independently predicted cardiovascular risk. Higher levels of these biomarkers increased the risk of major cardiovascular events, emphasizing the need for early screening and prevention in women. 2. BrJSportsMed Article (2024): A study of 13,018 women found that even 1–3 minutes/day of vigorous intermittent lifestyle physical activity (VILPA) significantly reduced cardiovascular risk. Women engaging in 3.4 minutes/day had a 45% lower MACE risk and 67% lower heart failure risk, highlighting VILPA as a simple yet effective prevention strategy.

How to lower chronic inflammation naturally. Here are 17 things that either have been shown to work or don't work. Chronic inflammation, that low-grade inflammation that occurs, even though you are not sick, is implicated in diseases ranging from arthritis, diabetes, cancer and heart disease. The term “Inflamm-aging” is a reference to how inflammation is linked to the aging process.   ·      What is chronic inflammation ·      Diseases associated with chronic inflammation, including Inflammaging ·      How to test for inflammation: C-reactive protein (CRP) and Interleukin 6 (IL-6) ·      Effects of Weight loss on inflammation markers CRP, IL-6 and TNF alpha (TNF alpha) ·      Cholesterol, LDL and chronic inflammation ·      How exercise affects inflammation ·      what foods raise systemic inflammation? ·      Health conditions associated with pro-inflammatory eating. ·      Chronic inflammation telomere effects ·      Foods that reduce inflammation & Advanced glycation end products ·      Fiber and the microbiome. Short-chain fatty acids (Butyrate) ·      Skin moisturizing ·      Curcumin and turmeric ·      Ginger ·      Garlic and garlic powder &  Aged Garlic Extract ·      Vitamin B12, B6, Folic Acid & Homocysteine ·      Nattokinase ·      Homotaurine ·      Fish oil ·      Resveratrol & NF-kB (Nuclear Factor-kB) ·      Vitamin D ·      Vitamin C and Orange juice ·      What is the best way to reduce chronic inflammation (most return on investment)   Supplement Facts Coffee Mug: https://joecannon.creator-spring.com/listing/supplement-facts-mug   Consultations  https://supplementclarity.com/private-consultations/     Get My Rhabdo Book   Education is the best defense against getting rhabdomyolysis. I've been teaching about rhabdo for over 10 years. If you are in the US, you can order my book directly from me. Purchase My Rhabdo Book Order on Amazon       Connect With Me Joe-Cannon.com SupplementClarity.com YouTube    About Me   For over 30 years I've been sorting nutrition facts from fiction, busting myths and helping people understand dietary supplements using clinical research as my litmus test.    I have an MS in exercise science and a BS in biology & chemistry. I've written several books, including Rhabdo, the first book about exercise-induced rhabdomyolysis.   Disclaimer   Episodes are for information only. I'm NOT a medical doctor. NO medical advice is given or implied. ALWAYS consult your physician for the best health advice for you. I participate in the Amazon Associates program which means if you click on a link to amazon and make a purchase, I may make a small commission at no extra cost to you.    

About two years ago, we released a podcast with Dr. Thomas Wadden of the University of Pennsylvania describing work on a new generation of medications to treat diabetes and obesity. They were really taking the field by storm. Since then, much more is known since many additional studies have been published and so many people have been using the drugs. So many, in fact, the market value of the Danish company, Novo Nordisk, one of the two major companies selling the drugs, has gone up. It is now greater than the entire budget of the country of Denmark. This single company is responsible for about half of Denmark's economic expansion this year. So, a lot of people are now taking the drugs and this is a great time for an update on the drugs. And we're fortunate to have two of the world's leading experts join us: Dr. Wadden, Professor of Psychology and Psychiatry at the University of Pennsylvania School of Medicine and the inaugural Albert J. Stunkard Professor of Psychiatry at Penn. Joining us as well as Dr. Robert Kushner, a physician and professor of medicine at Northwestern University and a pioneer in testing treatments for obesity. Interview Summary Tom, you and I were colleagues at Penn decades ago. And I got frustrated the treatments for obesity didn't work very well. People tended to regain the weight. And I turned my attention to prevention and policy. But you hung in there and I admired you for that patience and persistence. And Bob, the same for you. You worked on this tenacious problem for many years. But for both of you, your patience has been rewarded with what seems to me to be a seismic shift in the way obesity and diabetes can be treated. Tom, I'll begin with you. Is this as big of a deal as it seems to me? Well, I think it is as big of a deal as it seems to you. These medications have had a huge impact on improving the treatment of type 2 diabetes, but particularly the management of obesity. With older medications, patients lost about 7 percent of their starting weight. If you weighed 200 pounds, you'd lose about 15 pounds. That was also true of our best diet and exercise programs. You would lose about 7 percent on those programs with rigorous effort. But with the new medications, patients are now losing about 15 to 20 percent of their starting body weight at approximately one year. And that's a 30-to-40-pound loss for a person who started at 200 pounds. And with these larger weight losses, we get larger improvements in health in terms of complications of obesity. So, to quote a good friend of mine, Bob Kushner, these medications have been a real game changer. Thanks for putting that in perspective. I mean, we're talking about not just little incremental changes in what treatments can produce, which is what we've seen for years. But just orders of magnitude of change, which is really nice to see. So, Bob what are these medications that we're talking about? What are the names of the drugs and how do they work? Well, Kelly, this transformation of obesity really came about by finding the target that is really highly effective for obesity. It's called the gut brain axis. And when it comes to the gut it's starting off with a naturally occurring gut hormone called GLP 1. I think everyone in the country's heard of GLP 1. It's released after we eat, and it helps the pancreas produce insulin, slows the stomach release of food, and reduces appetite. And that's where the obesity story comes in. So pharmaceutical companies have taken this hormone and synthesized it, something similar to GLP 1. It mimics the action of GLP 1. So, you could actually take it and give it back and have it injected so it augments or highlights this hormonal effect. Now, that same process of mimicking a hormone is used for another gut hormone called GIP that also reduces appetite. These two hormones are the backbone of the currently available medication. There's two on the market. One is called Semaglutide. That's a GLP 1 analog. Trade name is Wegovy. Now, it's also marketed for diabetes. Tom talked about how it is used for diabetes and increases insulin. That trade name is Ozempic. That's also familiar with everyone around the country. The other one that combined GLP 1 and GIP, these two gut hormones, so it's a dual agonist, the trade name for obesity is called Zep Bound, and the same compound for diabetes is called Mounjaro. These are terms that are becoming familiar, I think, to everyone in the country. Tom mentioned some about the, how much weight people lose on these drugs, but what sort of medical changes occur? Just to reiterate what Tom said, I'll say it in another way. For Semaglutide one third of individuals are losing 20 percent of their body weight in these trials. For Tirzepatide, it even outpaces that. And I got a third of individuals losing a quarter of their body weight. These are unheard of weight losses. And with these weight losses and these independent effects from weight, what we're seeing in the trials and in the clinic is that blood pressure goes down, blood sugar goes down, blood fats like triglyceride go down, inflammation in the body goes down, because we marked that with CRP, as well as improvement in quality of life, which we'll probably get to. But really interesting stuff is coming out over the past year or two or so, that it is improving the function of people living with congestive heart failure, a particular form called a preserved ejection fraction. We're seeing improvements in sleep apnea. Think of all the people who are on these CPAP machines every night. We're seeing significant improvements in the symptoms of sleep apnea and the apneic events. And lastly, a SELECT trial came out, that's what it was called, came out last year. Which for the very first time, Kelly, found improvements in cardiovascular disease, like having a heart attack, stroke, or dying of cardiovascular disease in people living with obesity and already have cardiovascular disease. That's called secondary prevention. That, Tom, is the game changer. Bob, I'd like to go back to Tom in a minute but let me ask you one clarifying question about what you just said. That's a remarkable array of biological medical benefits from these drugs. Just incredible. And the question is, are they all attributable to the weight loss or is there something else going on? Like if somebody lost equal amounts of weight by some other means, would these same changes be occurring? Those studies are still going on. It's very good. We're thinking it's a dual effect. It's the profound amount of weight loss, as Tom said. Fifteen to 21 to even 25 percent of average body weight. That is driving a lot of the benefits. But there also appear to be additional effects or weight independent effects that are working outside of that weight. We're seeing improvements in kidney function, improvement in heart disease, blood clotting, inflammation. And those are likely due to the gut hormone effect independent of the weight itself. That still needs to be sorted out. That's called a mitigation analysis where we try to separate out the effects of these drugs. And that work is still underway. Tom, one of the most vexing problems, over the decades that people have been working on treatments for obesity, has been long term results. And I'm curious about how long have people been followed on these drugs now? What are the results? And what was the picture before then? How do what we see now compared to what you saw before? The study that Bob just mentioned, the SELECT trial followed people for four years on Semaglutide. And patients achieve their maximal weight loss at about one year and they lost 10 percent of their weight. And when they were followed up at four years still on treatment, they still maintained a 10 percent weight loss. That 10 percent is smaller than in most of the trials, where it was a 15 percent loss. But Dr. Tim Garvey showed that his patients in a smaller trial lost about 15 percent at one year and while still on medication kept off the full 15 percent. I think part of the reason the weight loss in SELECT were smaller is because the study enrolled a lot of men. Men are losing less weight on this medication than women. But to your question about how these results compare to the results of earlier treatment, well with behavioral treatment, diet, and exercise back in the 70s beyond, people lost this 7 or 8 percent of weight. And then most people on average regain their weight over one to three years. And the same was true of medication. People often stopped these earlier medications after 6 to 12 months, in part because they're frustrated the losses weren't larger. Some people were also worried about the side effects. But the long and short is once you stop taking the medication, people would tend to regain their weight. And some of this weight regain may be attributable to people returning to their prior eating and activity habits. But one of the things we've learned over the past 20 years is that part of the weight regain seems to be attributable to changes in the body's metabolism. And you know that when you lose weight, you're resting metabolic rate, which is the number of calories your body burns at rest to maintain basic bodily functions. Your resting metabolic rate decreases by 10 to 15 percent. But also, your energy expenditure, the calories you burn during exercise decreases. And that may decrease by as much as 20 to 30 percent. So, people are left having to really watch their calories very carefully because of their lower calorie requirements in order to keep off their lost body weight. I think one thing these new drugs may do is to attenuate the drop both in resting metabolic rate and energy expenditure during physical activity. But the long and short of it is that if you stay on these new medications long term, you'll keep off your body weight. And you'll probably keep it off primarily because of improvements in your appetite, so you have less hunger. And as a result, you're eating less food. I'd like to come back to that in a minute. But let me ask a question. If a person loses weight, and then their body starts putting biological pressure on them to regain, how come? You know, it's disadvantageous for their survival and their health to have the excess weight. Why would the body do that? Well, our bodies evolved in an environment of food scarcity, and our physiology evolved to protect us against starvation. First, by allowing us to store body fat, a source of energy when food is not available. And second, the body's capacity to lower its metabolism, or the rate at which calories are burned to maintain these basic functions like body temperature and heart rate. That provided protection against food scarcity. But Kelly, you have described better than anybody else that these ancient genes that regulate energy expenditure and metabolism are now a terrible mismatch for an environment in which food is plentiful, high in calories, and available 24 by 7. The body evolved to protect us from starvation, but not from eating past our calorie needs. And so, it's this mismatch between our evolution and our appetite and our body regulation in the current, what you have called toxic food environment, when you can eat just all the time. I guess you could think about humans evolving over thousands of years and biology adapting to circumstances where food was uncertain and unpredictable. But this modern environment has happened really pretty rapidly and maybe evolution just hasn't had a chance to catch up. We're still existing with those ancient genes that are disadvantageous in this kind of environment. Bob back to the drugs. What are the side effects of the drugs? Kelly, they're primarily gastrointestinal. These are symptoms like nausea, diarrhea, constipation, heartburn, and vomiting. Not great, but they're generally considered mild to moderate, and temporary. And they primarily occur early during the first four to five months when the medications are slowly dose escalated. And we've learned, most importantly, how to mitigate or reduce those side effects to help people stay on the drug. Examples would be your prescriber would slow the dose escalation. So. if you're having some nausea at a particular dose, we wait another month or two. The other, very importantly, is we have found that diet significantly impacts these side effects. When we counsel patients on these medications, along with that comes recommendations for dietary changes, such as reducing fatty food and greasy food. Reducing the amount of food you're consuming. Planning your meals in advance. Keeping well hydrated. And very importantly, do not go out for a celebration or go out to meals on the day that you inject or at least the first two days. Because you're not going to tolerate the drug very well. We use that therapeutically. So, if you want to get control on the weekends, you may want to take your injection on a Friday. However, if weekends are your time out with friends and you want to socialize, don't take it on a Friday. Same thing comes with a personal trainer, by the way. If you're going to have a personal trainer on a Monday where he's going to overwork you, don't take the injection the day before. You'll likely be nauseated, you're not eating, you're not hydrating. So actually, there's a lot that goes into not only when to take the dose and how to take the dose, but how to take it to the best ability to tolerate it. Two questions based on what you said. One is you talked about these are possible side effects, but how common are they? I mean, how many people suffer from these? Well, the trials show about 25 to 45 percent or so of individuals actually say they have these symptoms. And again, we ask them mild, moderate, severe. Most of them are mild to moderate. Some of them linger. However, they really do peak during the dose escalation. So, working with your prescriber during that period of time closely, keeping contact with them on how to reduce those side effects and how you're doing out of medication is extremely important. And the second thing I wanted to ask related to that is I've heard that there's a rare but serious potential side effect around the issue of stomach paralysis. Can you tell us something about that? I mentioned earlier, Kelly, that these medications slow gastric emptying. That's pretty much in everybody. In some individuals who may be predisposed to this, they develop something called ileus, and that's the medical term for gastric paralysis. And that can happen in individuals, let's say who have a scleroderma, who have longstanding diabetes or other gastrointestinal problems where the stomach really stopped peristalsis. In other words, it's moving. That's typically presented by vomiting and really unable to move the food along. We really haven't seen much of that. We looked at the safety data in a SELECT trial that Tom mentioned, which was 17,000 individuals, about 8,000 or so in each group. We really did not see a significant increase in the ileus or what you're talking about in that patient population. Okay, thanks. Tom had alluded to this before, Bob, but I wanted to ask you. How do you think about these medicines? If somebody takes them, and then they stop using the medicines and they gain the weight back. Is that a sign that the medicine works or doesn't work? And is this the kind of a chronic use drug like you might take for blood pressure or cholesterol? That's a great way of setting up for that. And I like to frame it thinking of it as a chronic progressive disease, just like diabetes or hypertension. We know that when you have those conditions, asthma could be another one or inflammatory bowel disease, where you really take a medication long term to keep the disease or condition under control. And we are currently thinking of obesity as a chronic disease with dysfunctional appetite and fat that is deposited in other organs, causing medical problems and so on. If you think of it as a chronic disease, you would naturally start thinking of it, like others, that medication is used long term. However, obesity appeared to be different. And working with patients, they still have this sense 'that's my fault, I know I can do it, I don't want to be on medication for the rest of my life for this.' So, we have our work cut out for us. One thing I can say from the trials, and Tom knows this because he was involved in them. If we suddenly stop the medication, that's how these trials were definitely done, either blindly or not blindly, you suddenly stop the medication, most, if not all of the participants in these trials start to regain weight. However, in a clinical practice, that is not how we work. We don't stop medication suddenly with patients. We go slowly. We down dose the medication. We may change to another medication. We may use intermittent therapy. So that is work that's currently under development. We don't know exactly how to counsel patients regarding long term use of the medications. I think we need to double down on lifestyle modification and counseling that I'm sure Tom is going to get into. This is really work ahead of us, how to maintain medication, who needs to be on it long term, and how do we actually manage patients. Tom, you're the leading expert in the world on lifestyle change in the context of obesity management. I mean, thinking about what people do with their diet, their physical activity, what kind of thinking they have related to the weight loss. And you talked about that just a moment ago. Why can't one just count on the drugs to do their magic and not have to worry about these things? Well, first, I think you can count on the drugs to do a large part of the magic. And you may be surprised to hear me say that. But with our former behavioral treatments of diet and exercise, we spent a lot of time trying to help people identify how many calories they were consuming. And they did that by recording their food intake either in paper and pencil or with an app. And the whole focus of treatment was trying to help people achieve a 500 calorie a day deficit. That took a lot of work. These medications, just by virtue of turning down your appetite and turning down your responsiveness to the food environment, take away the need for a lot of that work, which is a real blessing. But the question that comes up is, okay, people are eating less food. But what are they eating? Do these medications help you eat a healthier diet with more fruits and vegetables, with lean protein? Do you migrate from a high fat, high sugar diet to a Mediterranean diet, or to a DASH like diet? And the answer is, we don't know. But obviously you would like people to migrate to a diet that's going to be healthier for you from a cardiovascular standpoint, from a cancer risk reduction standpoint. One of the principal things that people need to do on these medications is to make sure they get plenty of protein. And so, guidance is that you should have about 1 gram of dietary protein for every kilogram of body weight. If you're somebody who weighs 100 kilograms, you should get 100 grams of protein. And what you're doing is giving people a lot of dietary protein to prevent the loss of bodily protein during rapid weight loss. You did a [00:20:00] lot of research with me back in the 80s on very low-calorie diets, and that was the underpinning of treatment. Give people a lot of dietary protein, prevent the loss of bodily protein. The other side of the equation is just physical activity, and it's a very good question about whether these medications and the weight loss they induce will help people be more physically active. I think that they will. Nonetheless for most people, you need to plan an activity schedule where you adopt new activities, whether it's walking more or going to the gym. And one thing that could be particularly helpful is strength training, because strength training could mitigate some of the loss of muscle mass, which is likely to occur with these medications. So, there's still plenty to learn about what is the optimal lifestyle program, but I think people, if they want to be at optimal health will increase their physical activity and eat a diet of fruits and vegetables, leaner protein, and less ultra processed foods. Well, isn't it true that eating a healthy diet and being physically active have benefits beyond their impact on your ability to lose the weight? You're getting kind of this wonderful double benefit, aren't you? I believe that is true. I think you're going to find that there are independent benefits of being physical activity upon your cardiovascular health. There are independent benefits of the food that you're eating in terms of reducing the risk of heart attack and of cancer, which has become such a hot topic. So, yes how you exercise and what you eat makes a difference, even if you're losing weight. Well, plus there's probably the triple one, if you will, from the psychological benefit of doing those things, that you do those things, you feel virtuous, that helps you adhere better as you go forward, and these things all come together in a nice picture when they're working. Tom, let's talk more about the psychology of these things. You being a psychologist, you've spent a lot of time doing research on this topic. And of course, you've got a lot of clinical experience with people. So as people are losing weight and using these drugs, what do they experience? And I'm thinking particularly about a study you published recently, and Bob was a coauthor on that study that addressed mental health outcomes. What do people experience and what did you find in that study? I think the first things people experience is improvements in their physical function. That you do find as you've lost weight that you've got less pain in your knees, you've got more energy, it's easier to get up the stairs, it's easier to play with the children or the grandchildren. That goes a long way toward making people feel better in terms of their self-efficacy, their agency in the life. Big, big improvement there. And then, unquestionably, people when they're losing a lot of weight tend to feel better about their appearance in some cases. They're happy that they can buy what they consider to be more fashionable clothes. They get compliments from friends. So, all of those things are positive. I'm not sure that weight loss is going to change your personality per se, or change your temperament, but it is going to give you these physical benefits and some psychological benefits with it. We were happy to find in the study you mentioned that was conducted with Bob that when people are taking these medications, they don't appear to be at an increased risk of developing symptoms of depression or symptoms of suicidal ideation. There were some initial reports of concern about that, but the analysis of the randomized trials that we conducted on Semaglutide show that there is no greater likelihood of developing depression or sadness or suicidal ideation on the medication versus the placebo. And then the FDA and the European Medicines Agency have done a full review of all post marketing reports. So, reports coming from doctors and the experience with their patients. And in looking at those data the FDA and the European Medicines Agency have said, we don't find a causal link between these medications and suicidal ideation. With that said, it's still important that if you're somebody who's taking these medications and you start them, and all of a sudden you do feel depressed, or all of a sudden you do have thoughts like, maybe I'd be better off if I weren't alive any longer, you need to talk to your primary care doctor immediately. Because it is always possible somebody's having an idiosyncratic reaction to these medications. It's just as possible the person would have that reaction without being on a medication. You know, that, that can happen. People with overweight and obesity are at higher risk of depression and anxiety disorders. So, it's always going to be hard to tease apart what are the effects of a new medication versus what are just the effects of weight, excess weight, on your mood and wellbeing. You know, you made me think of something as you were just speaking. Some people may experience negative effects during weight loss, but overall, the effects are highly positive and people are feeling good about themselves. They're able to do more things. They fit in better clothes. They're getting good feedback from their environment and people they know. And then, of course, there's all the medical benefit that makes people feel better, both psychologically and physically. Yet there's still such a strong tendency for people to regain weight after they've lost. And it just reinforces the fact that, the point that you made earlier, that there are biological processes at work that govern weight and tendency to regain. And there really is no shame in taking the drug. I mean, if you have high blood pressure, there's no shame in taking the drug. Or high cholesterol or anything else, because there's a biological process going on that puts you at risk. The same thing occurs here, so I hope the de-shaming, obesity in the first place, and diabetes, of course, and then the use of these medications in particular might help more people get the benefits that is available for them. I recommend that people think about their weight as a biologically regulated event. Very much like your body temperature is a biologically regulated event, as is your blood pressure and your heart rate. And I will ask people to realize that there are genetic contributors to your body weight. just as there are to your height. If somebody says, I just feel so bad about being overweight I'll just talk with them about their family history of weight and see that it runs in the family. Then I'll talk to them about their height. Do you feel bad about being six feet tall, to a male? No, that's fine. Well, that that's not based upon your willpower. That's based upon your genes, which you received. And so, your weight, it's similarly based. And if we can use medications to help control weight, cholesterol, blood pressure, blood sugar, let's do that. It's just we live in a time where we're fortunate to have the ability to add medications to help people control health complications including weight. Bob, there are several of the drugs available. How does one think about picking between them? Well, you know, in an ideal medical encounter, the prescriber is going to take into consideration all the factors of prescribing a medication, like any other medication, diabetes, hypertension, you name the condition. Those are things like contraindication to use. What other medical problems does the patient have that may benefit the patient. Patient preferences, of course and side effects, safety, allergies, and then we have cost. And I'll tell you, Kelly, because of our current environment, it's this last factor, cost, that's the most dominant factor when it comes to prescribing medication. I'll have a patient walk in my room, I'll look at the electronic medical record, body mass index, medical problems. I already know in my head what is going to be the most effective medication. That's what we're talking about today. Unfortunately, I then look at the patient insurance, which is also on the electronic medical record, and I see something like Medicaid or Medicare. I already know that it's not going to be covered. It is really quite unfortunate but ideally all these factors go into consideration. Patients often come in and say, I've heard about Ozempic am I a candidate for it, when can I get it? And unfortunately, it's not that simple, of course. And those are types of decisions the prescriber goes through in order to come to a decision, called shared decision making with the patient. Bob, when I asked you the initial question about these drugs, you were mentioning the trade name drugs like Mounjaro and Ozempic and those are made by basically two big pharmaceutical companies, Novo Nordisk and Eli Lilly. But there are compounded versions of these that have hit the scene. Can you explain what that means and what are your thoughts about the use of those medications? So compounding is actually pretty commonly done. It's been approved by the FDA for quite some time. I think most people are familiar with the idea of compounding pharmacies when you have a child that must take a tablet in a liquid form. The pharmacy may compound it to adapt to the child. Or you have an allergy to an ingredient so the pharmacy will compound that same active ingredient so you can take it safely. It's been approved for long periods of time. Anytime a drug is deemed in shortage by the FDA, but in high need by the public, compounding of that trade drug is allowed. And that's exactly what happened with both Semaglutide and Tirzepatide. And of course, that led to this compounding frenzy across the country with telehealth partnering up with different compounding pharmacies. It's basically making this active ingredient. They get a recipe elsewhere, they don't get it from the company, they get this recipe and then they make the drug or compound it themselves, and then they can sell it at a lower cost. I think it's been helpful for people to get the drug at a lower cost. However, buyer beware, because not all compounded pharmacies are the same. The FDA does not closely regulate these compounded pharmacies regarding quality assurance, best practice, and so forth. You have to know where that drug is coming from. Kelly, it's worth noting that just last week, ZepBound and Mounjaro came off the shortage list. You no longer can compound that and I just read in the New York Times today or yesterday that the industry that supports compounding pharmacies is suing the FDA to allow them to continue to compound it. I'm not sure where that's going to go. I mean, Eli Lilly has made this drug. However, Wegovy still is in shortage and that one is still allowed to be compounded. Let's talk a little bit more about costs because this is such a big determinant of whether people use the drugs or not. Bob, you mentioned the high cost, but Tom, how much do the drugs cost and is there any way of predicting what Bob just mentioned with the FDA? If the compounded versions can't be used because there's no longer a shortage, will that decrease pressure on the companies to keep the main drug less expensive. I mean, how do you think that'll all work out? But I guess my main question is how much these things cost and what's covered by insurance? Well first how much do the drugs cost? They cost too much. Semaglutide, known in retail as Wegovy, is $1,300 a month if you do not have insurance that covers it. I believe that Tirzepatide, known as ZepBound, is about $1,000 a month if you don't have insurance that covers that. Both these drugs sometimes have coupons that bring the price down. But still, if you're going to be looking at out of pocket costs of $600 or $700 or $800 a month. Very few people can afford that. The people who most need these medications are people often who are coming from lower incomes. So, in terms of just the future of having these medications be affordable to people, I would hope we're going to see that insurance companies are going to cover them more frequently. I'm really waiting to see if Medicare is going to set the example and say, yes, we will cover these medications for anybody with a BMI of 40 or a BMI of 35 with comorbidities. At this point, Medicare says, we will only pay for this drug if you have a history of heart attack and stroke, because we know the drug is going to improve your life expectancy. But if you don't have that history, you don't qualify. I hope we'll see that. Medicaid actually does cover these medications in some states. It's a state-by-state variation. Short of that, I think we're going to have to have studies showing that people are on these medications for a long time, I mean, three to five years probably will be the window, that they do have a reduction in the expenses for other health expenditures. And as a result, insurers will see, yes, it makes sense to treat excess weight because I can save on the cost of type 2 diabetes or sleep apnea and the like. Some early studies I think that you brought to my attention say the drugs are not cost neutral in the short-term basis of one to two years. I think you're going to have to look longer term. Then I think that there should be competition in the marketplace. As more drugs come online, the drug prices should come down because more will be available. There'll be greater production. Semaglutide, the first drug was $1,300. Zepbound, the second drug Tirzepatide, $1,000. Maybe the third drug will be $800. Maybe the fourth will be $500. And they'll put pressure on each other. But I don't know that to be a fact. That's just my hope. Neither of you as an economist or, nor do you work with the companies that we're talking about. But you mentioned that the high cost puts them out of reach for almost everybody. Why does it make sense for the companies to charge so much then? I mean, wouldn't it make sense to cut the price in half or by two thirds? And then so many more people would use them that the company would up ahead in the long run. Explain that to me. That's what you would think, for sure. And I think that what's happened right now is that is a shortage of these drugs. They cannot produce enough of them. Part of that is the manufacturing of the injector pens that are used to dispense the drug to yourself. I know that Novo Nordisk is building more factories to address this. I assume that Lilly will do the same thing. I hope that over time we will have a larger supply that will allow more people to get on the medication and I hope that the price would come down. Of course, in the U. S. we pay the highest drug prices in the world. Fortunately, given some of the legislation passed, Medicare will be able to negotiate the prices of some of these drugs now. And I think they will negotiate on these drugs, and that would bring prices down across the board. Boy, you know, the companies have to make some pretty interesting decisions, don't they? Because you've alluded to the fact that there are new drugs coming down the road. I'm assuming some of those might be developed and made by companies other than the two that we're talking about. So, so investing in a whole new plant to make more of these things when you've got these competitor drugs coming down the road are some interesting business issues. And that's not really the topic of what we're going to talk about, but it leads to my final question that I wanted to ask both of you. What do you think the future will bring? And what do you see in terms of the pipeline? What will people be doing a year from now or 2 or 5? And, you know, it's hard to have a crystal ball with this, but you two have been, you know, really pioneers and experts on this for many years. You better than anybody probably can answer this question. Bob, let me start with you. What do you think the future will bring? Well, Kelly, I previously mentioned that we finally have this new therapeutic target called the gut brain axis that we didn't know about. And that has really ushered in a whole new range of potential medications. And we're really only at the beginning of this transformation. So not only do we have this GLP 1 and GIP, we have other gut hormones that are also effective not only for weight loss, but other beneficial effects in the body, which will become household names, probably called amylin and glucagon that joins GLP 1. And we not only have these monotherapies like GLP 1 alone, we are now getting triagonists. So, we've got GIP, GLP 1, and glucagon together, which is even amplifying the effect even further. We are also developing oral forms of GLP 1 that in the future you could presumably take a tablet once a day, which will also help bring the cost down significantly and make it more available for individuals. We also have a new generation of medications being developed which is muscle sparing. Tom talked about the importance of being strong and physical function. And with the loss of lean body mass, which occurs with any time you lose weight, you can also lose muscle mass. There's drugs that are also going in that direction. But lastly, let me mention, Kelly, I spend a lot of my time in education. I think the exciting breakthroughs will not be meaningful to the patient unless the professional, the provider and the patient are able to have a nonjudgmental informative discussion during the encounter without stigma, without bias. Talk about the continuum of care available for you, someone living with obesity, and get the medications to the patient. Without that, medications over really sit on the shelf. And we have a lot of more work to do in that area. You know, among the many reasons I admire the both of you is that you've, you've paid a lot of attention to that issue that you just mentioned. You know, what it's like to live with obesity and what people are experiencing and how the stigma and the discrimination can just have devastating consequences. The fact that you're sensitive to those issues and that you're pushing to de-stigmatize these conditions among the general public, but also health care professionals, is really going to be a valuable advance. Thank you for that sensitivity. Tom, what do you think? If you appear into the crystal ball? What does it look like? I would have to agree with Bob that we're going to have so many different medications that we will be able to combine together that we're going to see that it's more than possible to achieve weight losses of 25 to 30 percent of initial body weight. Which is just astonishing to think that pharmaceuticals will be able to achieve what you achieve now with bariatric surgery. I think that it's just, just an extraordinary development. Just so pleased to be able to participate in the development of these drugs at this stage of career. I still see a concern, though, about the stigmatization of weight loss medications. I think we're going to need an enormous dose of medical education to help doctors realize that obesity is a disease. It's a different disease than some of the illnesses that you treat because, yes, it is so influenced by the environment. And if we could change the environment, as you've argued so eloquently, we could control a lot of the cases of overweight and obesity. But we've been unable to control the environment. Now we're taking a course that we have medications to control it. And so, let's use those medications just as we use medications to treat diabetes. We could control diabetes if the food environment was better. A lot of medical education to get doctors on board to say, yes, this is a disease that deserves to be treated with medication they will share that with their patients. They will reassure their patients that the drugs are safe. And that they're going to be safe long term for you to take. And then I hope that society as a whole will pick up that message that, yes, obesity and overweight are diseases that deserve to be treated the same way we treat other chronic illnesses. That's a tall order, but I think we're moving in that direction. BIOS Robert Kushner is Professor of Medicine and Medical Education at Northwestern University Feinberg School of Medicine, and Director of the Center for Lifestyle Medicine in Chicago, IL, USA. After finishing a residency in Internal Medicine at Northwestern University, he went on to complete a post-graduate fellowship in Clinical Nutrition and earned a Master's degree in Clinical Nutrition and Nutritional Biology from the University of Chicago. Dr. Kushner is past-President of The Obesity Society (TOS), the American Society for Parenteral and Enteral Nutrition (ASPEN), the American Board of Physician Nutrition Specialists (ABPNS), past-Chair of the American Board of Obesity Medicine (ABOM), and Co-Editor of Current Obesity Reports. He was awarded the ‘2016 Clinician-of-the-Year Award' by The Obesity Society and John X. Thomas Best Teachers of Feinberg Award at Northwestern University Feinberg School of Medicine in 2017. Dr. Kushner has authored over 250 original articles, reviews, books and book chapters covering medical nutrition, medical nutrition education, and obesity, and is an internationally recognized expert on the care of patients who are overweight or obese. He is author/editor of multiple books including Dr. Kushner's Personality Type Diet (St. Martin's Griffin Press, 2003; iuniverse, 2008), Fitness Unleashed (Three Rivers Press, 2006), Counseling Overweight Adults: The Lifestyle Patterns Approach and Tool Kit (Academy of Nutrition and Dietetics, 2009) and editor of the American Medical Association's (AMA) Assessment and Management of Adult Obesity: A Primer for Physicians (2003). Current books include Practical Manual of Clinical Obesity (Wiley-Blackwell, 2013), Treatment of the Obese Patient, 2nd Edition (Springer, 2014), Nutrition and Bariatric Surgery (CRC Press, 2015), Lifestyle Medicine: A Manual for Clinical Practice (Springer, 2016), and Obesity Medicine, Medical Clinics of North America (Elsevier, 2018). He is author of the upcoming book, Six Factors to Fit: Weight Loss that Works for You! (Academy of Nutrition and Dietetics, December, 2019). Thomas A. Wadden is a clinical psychologist and educator who is known for his research on the treatment of obesity by methods that include lifestyle modification, pharmacotherapy, and bariatric surgery. He is the Albert J. Stunkard Professor of Psychology in Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and former director of the university's Center for Weight and Eating Disorders. He also is visiting professor of psychology at Haverford College. Wadden has published more than 550 peer-reviewed scientific papers and abstracts, as well as 7 edited books. Over the course of his career, he has served on expert panels for the National Institutes of Health, the Federal Trade Commission, the Department of Veterans Affairs, and the U.S. House of Representatives. His research has been recognized by awards from several organizations including the Association for the Advancement of Behavior Therapy and The Obesity Society. Wadden is a fellow of the Academy of Behavioral Medicine Research, the College of Physicians of Philadelphia, the Obesity Society, and Society of Behavioral Medicine. In 2015, the Obesity Society created the Thomas A. Wadden Award for Distinguished Mentorship, recognizing his education of scientists and practitioners in the field of obesity.

Topics this week: Meat Substitutes Linked to 42% Higher Depression Risk in Vegetarians - Big Dru talks about the recent research that indicates vegetarians who consume plant-based meat alternatives (PBMAs) may face a 42% higher risk of depression compared to those who avoid these products. Study Overview: Participants: The study analyzed data from over 3,300 vegetarians, including vegans, from the UK Biobank. HEALTHLINE Findings: Vegetarians consuming PBMAs exhibited: -A 42% increased risk of depression. -Higher levels of C-reactive protein (CRP), indicating increased inflammation. -Slightly elevated blood pressure. -Lower levels of apolipoprotein A, associated with HDL ("good") cholesterol. -Conversely, a 40% reduced risk of irritable bowel syndrome (IBS). Therapy of the Week: 10% OFF ALL #TitanMedical Center Weight Loss Therapies Special! DON'T MISS THIS AMAZING SPECIAL!!! Let our #TitanMedical weight loss therapies help you lose weight & feel great! You get to choose from any of our great weight loss therapies and get 10% off each one! All of our therapies come from U.S. licensed pharmacies straight to you! Semaglutide ECA Stack Plus Titan Trim (Tesofensine) Tirzepatide AOD 9604 L-Carnitine Titan Complete Prometheus Fat Burning Cream *********** This special ends 1/3/2024!!! -------------- Get On Email List! Text: titanmedical To: 22828 About Titan Medical Center: We offer Hormone Replacement Therapy, Medical Weight Loss, Injectable Vitamin & Amino Therapies, Relationship, Bedroom Enhancing Therapies, On-Site or Nationwide Blood Work Testing, Peptide Therapies, In-House IV Therapy, & Primary Care. We are based in Tampa, Florida but YES we service NATIONWIDE! We can help you enhance your life and performance while operating at optimal health levels. We have medical doctors and start with blood work testing to get you on the right track! Some of our therapies are available without blood work testing. Call Titan Medical Center to learn how you can have a healthier, stronger life. We offer telemedicine (via FaceTime or Skype) from the comfort of your own home where you will see a licensed medical provider. Our Titan therapies are doctor prescribed & shipped directly to your doorstep from a licensed US pharmacy!

Welcome to another insightful episode of PICU on Call, a podcast dedicated to current and aspiring intensivists. In this episode, our hosts, Dr. Pradip Kamat, Dr. Rahul Damania, and their colleague, Dr. Jordan Dent, delve into the complexities of managing pneumonia in pediatric patients. The discussion is anchored around a clinical case involving a 10-year-old girl presenting with difficulty breathing and a fever, suggestive of pneumonia. We will break down the key themes and insights from the case, providing a comprehensive guide to understanding and managing pediatric pneumonia.Case PresentationThe episode begins with a detailed case presentation:Patient: 10-year-old girl, 28-week preemie with chronic lung disease.Symptoms: Progressive respiratory distress over eight days, worsening cough, increased work of breathing, hypoxemia (oxygen saturation in the low 80s despite supplemental oxygen).Findings: Chest X-ray reveals bilateral lower lobe infiltrates and a left-sided pleural effusion. Lab results show elevated CRP and a positive respiratory PCR for a bacterial pathogen.This case sets the stage for an in-depth discussion on the various aspects of pediatric pneumoRisk Factors for PneumoniaUnderstanding the risk factors for pneumonia is crucial for early identification and prevention. These risk factors can be categorized into three main groups:Host FactorsIncomplete Immunization Status: Children who are not fully vaccinated are at higher risk.Young Age: Infants and young children have immature immune systems, making them more susceptible.Lower Socioeconomic Status: Limited access to healthcare and poor living conditions can increase risk.Environmental FactorsExposure to Tobacco Smoke: Secondhand smoke can damage the respiratory tract and impair immune function.Seasonal Variations: Pneumonia cases peak during fall and winter due to increased circulation of respiratory viruses.Contact with Other Children: Daycare settings and schools can facilitate the spread of infections.Healthcare-Associated FactorsProlonged Mechanical Ventilation: Increases the risk of ventilator-associated pneumonia (VAP).Nasogastric Tube Placement: Can introduce pathogens into the respiratory tract.Neuromuscular Blockade: Impairs the ability to clear secretions.Inadequate Humidification: Dry air can damage the respiratory mucosa.Pathogenesis of PneumoniaPneumonia occurs when pathogens invade the lower respiratory tract, triggering an inflammatory response. This leads to fluid...

Want to add a healthy habit to your daily routine that is absolutely free and incredibly effective? Looking to reduce insulin resistance and lose visceral fat? Want to boost mental health and improve cognitive function? Look no further than walking! Tune in to hear us unpack the myriad of research-supported benefits.   In this episode, we discuss the incredible benefits of walking, from lowering blood pressure to improving heart rate variability to reducing stress and so much more. Learn about the magic number when it comes to step count, our thoughts on walking in nature vs. on a treadmill, and get practical tips for getting those steps!    Also in this episode:  Naturally Nourished Teas are buy 3 get 1 FREE, use code FREETEA Gift cards at Naturally Nourished Detox Masterclass 1/8 Keto Masterclass 1/15 Walking Pad C2 use code ALIMILLERRD for savings Health Benefits of Walking Lowers Blood Pressure Hypertension: Brisk walking for 30 minutes, five days a week reduces blood pressure (Hypertension, 2020). Improves Cholesterol Levels Cholesterol: Effects on LDL and HDL cholesterol (Journal of the American Heart Association, 2021). Lipid Profiles: Walking improves triglycerides and HDL (Atherosclerosis, 2021). Reduces the Risk of Coronary Artery Disease Coronary Artery Disease Risk: 150 minutes of walking weekly (Circulation, 2022). Enhances Cardiorespiratory Fitness Reduces Systemic Inflammation Systemic Inflammation: Walking lowers CRP and IL-6 (Arteriosclerosis, Thrombosis, and Vascular Biology, 2020). Systemic Inflammation: Walking reduces inflammatory cytokines (The Journal of Endocrinology, 2022). Helps Maintain Healthy Weight and Prevent Obesity Improves Heart Rate Variability Heart Rate Variability: HRV improvement with regular walking (Heart, 2022). Prevents Peripheral Artery Disease Peripheral Artery Disease: Walking improves circulation and function in PAD patients (Journal of Vascular Surgery, 2021). Reduces Resting Heart Rate Enhances Endothelial Function Supports Recovery After Cardiac Events Improves Insulin Sensitivity Insulin Sensitivity: Improvements with post-meal walks (Diabetes Care, 2021). Enhances Glucose Regulation Boosts Fat Oxidation Fat Oxidation: Brisk walking boosts fat metabolism (Journal of Applied Physiology, 2022). Reduces Visceral Fat Reduction of visceral fat after 10,000 steps/day (Obesity, 2021). Promotes Energy Balance Energy Balance: 12,000 steps/day for maintaining weight (Medicine & Science in Sports & Exercise, 2020). Regulates Hormones Related to Metabolism Increases Mitochondrial Efficiency Improves Metabolic Flexibility Prevents Metabolic Syndrome Helps Manage Type 2 Diabetes Mental health Stress Reduction: Nature walks lower cortisol more than treadmill (Environmental Research, 2022). Stimulates Neurogenesis and Brain Plasticity Brain Connectivity: Walking improves default mode network activity (Journal of Aging Research, 2021). Enhances Neurotransmitter Balance Supports Autonomic Nervous System Regulation Improves Sensory Integration Vestibular Function: Enhancing balance and stability with walking (Frontiers in Neuroscience, 2021). Strengthens Cognitive Function Neurogenesis and Cognitive Function: Exercise-induced brain growth (Nature Neuroscience, 2021). Promotes Myelination and Nerve Health Enhances Emotional Regulation via the Vagus Nerve Reduces Neurological Disease Risk Synchronizes the Nervous System Through Rhythmic Movement Improves Sleep and Circadian Rhythm Bone and Joint Health Immune System Support Longevity and Reduced Mortality Gut Health Gut Health: Positive effects on microbiota diversity (Gut Microbes, 2020). The Science of Step Counts Thoughts on Nature vs. Treadmill Walking Cognitive Benefits: Nature walking improves attention restoration (Nature Neuroscience, 2021). Proprioception: Benefits of uneven terrain in natural settings (Journal of Sports Medicine, 2023). Motivation: Outdoor walkers maintain habits better than treadmill users (Behavioral Medicine, 2022). Immune Boosting: Increased NK cell activity in forest walkers (International Journal of Environmental Health Research, 2021).   Sponsors for this episode:  According to extensive research by the Environmental Working Group, virtually every home in America has harmful contaminants in its tap water. That's why you've got to check out AquaTru. AquaTru purifiers use a 4-stage reverse osmosis purification process, and their countertop purifiers work with NO installation or plumbing. It removes 15x more contaminants than ordinary pitcher filters and are specifically designed to combat chemicals like PFAS in your water supply. Naturally Nourished Podcast listeners can use code ALIMILLERRD at AquaTru.com to save 20% off. 

⟡ 支持蒼藍鴿產出Podcast ➤ https://open.firstory.me/join/bluepigeon0810 ⟡ 信箱 ➤ bluepigeonn@gmail.com --- 【各段重點】 00:00 鴿的碎碎唸時間 00:35 抗生素被發明之前的人類壽命 05:01 長壽要面臨的議題 07:19 如何維持血管健康 09:51 抽血常見指標：發炎指數（CRP） 12:32 抽血常見指標：低密度膽固醇（LDL） 16:09 抽血常見指標：脂蛋白A（Lp(a)） 20:06 減重門診 意外發現糖尿病 #健檢 #健康檢查 #心血管健康 #發炎 #感染 #抗生素 #超級細菌 #細菌感染 #壽命 #人類壽命 #長壽 #血管健康 #三高 #高血壓 #高血脂 #高血糖 #糖尿病 #中風 #洗腎 #肥胖 #心臟病 #心肌梗塞 #長照 #臥床 #抽血 #發炎指數 #CRP #低密度膽固醇 #膽固醇 #脂蛋白A #蒼藍鴿 #蒼嵐健康美學診所 #蒼嵐診所 --- ⟡ 更多醫學知識： 蒼藍鴿著作 ➤ https://ppt.cc/ffUrkx Instagram ➤ https://reurl.cc/ygvba8 Youtube ➤ https://reurl.cc/gm6bb7 Line Voom ➤ https://ppt.cc/fW8IVx Tik Tok ➤https://ppt.cc/fBehOx Powered by Firstory Hosting

In this episode, CardioNerds Dr. Gurleen Kaur and Dr. Akiva Rosenzveig are joined by Cardio-Rheumatology experts, Dr. Brittany Weber and Dr. Michael Garshick to discuss treating inflammation, delving into the pathophysiology behind the inflammatory hypothesis of atherosclerotic cardiovascular disease and the evolving data on anti-inflammatory therapies for reducing ASCVD risk, with insights on real-world implementation. Show notes were drafted by. Dr. Akiva Rosenzveig. This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Lexicon Pharmaceuticals. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Treating Inflammation Our understanding of the pathophysiology of atherosclerosis has undergone a few iterations from the incrustation hypothesis to the lipid hypothesis to the response-to-injury hypothesis and culminating with our current understanding of the inflammation hypothesis. Both the adaptive and innate immune systems play instrumental roles in the pathogenesis of atherosclerosis. After adequately controlling classic modifiable risk factors such as blood pressure, dyslipidemia, glucose intolerance, and obesity, systemic inflammation as assessed by CRP can be ascertained as CRP is associated with ~1.8-fold increased risk of cardiovascular events Although the most common side effect of colchicine is gastrointestinal intolerance, colchicine can induce lactose intolerance, so a lactose free diet may help ameliorate colchicine-induced GI symptoms. Anti-inflammatory therapeutics have shown promise in reducing cardiovascular risk but much more is to be learned with ongoing and future basic, translational, and clinical research. Show notes - Treating Inflammation What are the origins of the inflammatory hypothesis? The first hypothesis as to the pathogenesis of atherosclerosis was the incrustation hypothesis by Carl Von Rokitansky in 1852. He suggested that atherosclerosis begins in the intima with thrombus deposition.In 1856, Rudolf Virchow suggested the lipid hypothesis whereby high levels of cholesterol in the blood lead to atherosclerosis. He observed inflammatory changes in the arterial walls associated with atherosclerotic plaque growth, called endo-arteritis chronica deformans.In 1977, Russell Ross suggested the response-to-injury hypothesis, that atherosclerosis develops from injury to the arterial wall.In the 1990's the role of inflammation in ASCVD became more recognized. Both the adaptive and innate immune system are critical in atherosclerosis. Lipids and inflammation are synergistic in that lipid exposure is required but they translocate through damaged endothelium which occurs by way of inflammatory cytokines, namely within the NLRP3 inflammasome (IL-1, IL-6 etc.).Smooth muscle cells are also involved. They migrate to the endothelial region and secrete collagen to create the fibrous cap. They can also transform into macrophage-like cells to take up lipids and become foam cells. T, B, and K cells are also part of this milieu. In fact, neutrophils, macrophages and monocytes make up only a small portion of the cells involved in the atherosclerotic process. What are ways to individually optimize one's ASCVD risk?Ensure the patient is on appropriate antiplatelet therapy, lipid lowering therapy, blood pressure is well controlled, and the Hemoglobin A1c is well controlled. Smoking cessation is pivotal.If the patient has an elevated Lipoprotein (a), pursue more aggressive lipid lowering therapy. Targeted therapies may become available in the future. Assess the patient's systemic inflammatory risk as measured by C-Reactive Protein (CRP)

In this episode, Dr. Paul Ridker, a pioneer in the field of cardiovascular inflammation, joins the CardioNerds (Dr. Gurleen Kaur, Dr. Richard Ferraro, and Dr. Nidhi Patel) to discuss the evolving landscape of inflammation as a key factor in cardiovascular risk reduction. The discussion dives into the importance of biomarkers like high-sensitivity C-reactive protein (hs-CRP) in guiding treatment strategies, the insights gleaned from landmark trials like the JUPITER and CANTOS studies, and the future of targeted anti-inflammatory therapies in cardiology. Show notes were drafted by Dr. Nidhi Patel. Audio editing by CardioNerds academy intern, Grace Qiu.  This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Lexicon Pharmaceuticals. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Targeting Inflammation for Cardiovascular Risk "If you don't measure it, you can't treat it”: Incorporate hs-CRP into routine practice for patients at risk of cardiovascular events, as it provides crucial information for risk stratification and management. Recognize the dual benefits of statins in lowering both LDL and inflammation, particularly in patients with elevated hs-CRP. Encourage patients to adopt heart-healthy habits, as lifestyle changes remain foundational in reducing both cholesterol and inflammatory risk. Reminder that most autoimmune or inflammatory diseases, from psoriasis to Addison's disease to lupus to scleroderma to inflammatory bowel disease, have been shown to have elevated cardiovascular risk Ongoing randomized trials including ZEUS, HERMES, and ARTEMIS will inform whether novel targeting of IL-6 can safely lower cardiovascular event rates or slow renal progression Show notes - Targeting Inflammation for Cardiovascular Risk Why is it important to measure both LDL and hs-CRP, and what factors increase hs-CRP? Inflammation and hyperlipidemia are synergistic in promoting atherosclerosis. They interact to exacerbate plaque formation and instability, increasing the risk of cardiovascular events. Just like we measure blood pressure and LDL to know what to treat, we should measure hs-CRP to guide targeted therapy. Clinical Example: in Ms. Flame's case, despite achieving target LDL levels with statins, her elevated hs-CRP indicates ongoing inflammation and residual cardiovascular risk that should be assessed. Residual inflammatory risk should be assessed in both primary and secondary prevention. Increased BMI1, smoking2, a sedentary lifestyle3, and genetics4 (such as a higher risk of metabolic disease in South Asians) all raise hs-CRP levels. SGLTi5 and GLP-1 agonists6 have also been shown to decrease hs-CRP levels. What data do we have to support measuring hs-CRP?  Women's Health Study7: an early study showing that hs-CRP predicted risk at least as well as LDL cholesterol and that models incorporating hs-CRP in addition to lipids were significantly better at predicting risk than models based on lipids alone. JUPITER Trial8 (Primary Prevention): Among patients with normal LDL but elevated hs-CRP there was a 44% reduction in major cardiovascular events (>50% in MI and stroke) and a 20% reduction in all-cause mortality in patients treated with statins. These results led to changes in guidelines in recognizing the need to measure and treat inflammation. CANTOS Trial9 (Secondary Prevention): Randomized >10K patients with previous MI and hs-CRP ≥ 2mg/L and found that canakinumab reduced hs-CRP level from baseline in a dose-dependent manner, without reduction in the LDL, ApoB, TG, or blood pressure. What are the guidelines and supportive data on using Colchicine?