Podcasts about crps

In this episode, Kimberley Dondo is joined by Ilana Miller from Royal London about centralised retirement propositions (CRPs): what they are, why firms are adopting them, and how Royal London published a fully worked, editable example to help firms create consistent, client-centred retirement frameworks. The conversation highlights behavioural research showing fear and false confidence shape retirement choices, explains why CRPs should treat retirement as a journey (not a single decision), and offers practical steps firms can take to align principles, client needs, income strategies and ongoing support.

Imagine going into business with a partner who tells you upfront: at the end of every year, I'll decide how much of the profits I keep. You'd never agree to that. But Ira Work says millions of Americans already did the day they opened a traditional IRA.That's one of several hard truths Ira Work, a 42-year financial industry veteran, addresses head-on in his new book and in this conversation. After 17 years working for firms like Smith Barney and Shearson Lehman Brothers, Ira walked away from the traditional brokerage model — not because he failed, but because he saw how it was failing clients.In this episode, Ira breaks down four persistent myths that quietly erode investor wealth, explains why tax-deferred retirement accounts may carry more risk than most people realize, and makes the case for financial coaching over traditional advising. Listeners will walk away with a clearer picture of what questions to ask, what costs to watch for, and what it actually means to have a financial plan built around their life and not just their portfolio.About Ira WorkIra Work is an Investor Coach and founder at First Financial Coaching, Inc., with over 42 years of experience in the financial industry. He holds multiple advanced designations including ChFC, RFC, AIF, AAMS, CASL, and CRPS. After spending his first 17 years at major wirehouses, Ira transitioned to independent financial coaching focused on investor education, behavioral science, and evidence-based investing. He is the author of The Investor's Coach: How You Can Rise Above Wall Street's Myths and Build Real Wealth.What We CoverWhy stock picking and market timing feel logical in the moment but fail investors over timeThe real reason 10-year fund track records are nearly meaningless for picking investmentsHow hidden trading costs inflate what investors actually pay beyond the stated expense ratioThe IRA tax trap: why deferring taxes today could mean paying far more tomorrow if rates riseThe one question Ira asks every new client that most advisors never think to raiseThe difference between a financial advisor and a financial coach, and why one asks about your life while the other asks about your moneyResources MentionedThe Investor's Coach by Ira Work — available on AmazonCome Back America by David Walker (U.S. Comptroller General) — referenced in the tax trap discussionNavigating the Fog of Investing — documentary film featuring Morningstar's CEO on fund ratingsConnect with Ira WorkWebsite: irawork.com / firstfinancialcoach.comEmail: irawork@firstfinancialcoach.comSupport the show

C'est dans les coulisses de la MJC, à Rodez, que je vous donne rendez-vous aujourd'hui. Les loges sont pleines à craquer, il y a de l'agitation dans tous le sens : ce soir-là, le Théâtre des Deux Points affiche presque complet pour le concert des Squatteurs du blues.Ces Squatteurs avaient la maladie mentale en commun : tous ont été, à un moment de leur vie, accompagnés par le CRPS, comprenez le centre de réhabilitation psycho-sociale du centre hospitalier Sainte-Marie. Mais ce qui les rassemble aujourd'hui dépasse tous les symptômes et toutes les pathologies : à travers la musique, et l'écriture de leurs propres textes qu'ils jouent sur scène, les Squatteurs du blues déjouent le tout-tracé chemin médical pour y faire entrer la création artistique comme allié thérapeutique. Après la création du groupe en 2017 et la sortie d'un premier CD en 2021, les Squatteurs racontent aujourd'hui sur scène, dans le spectacle « Maudit blues », leurs histoires, des premiers signes de la maladie jusqu'au rétablissement.Secouer la pulpe Guidés par un musicothérapeute, Francis Esteves alias Cisco, et l'expertise de l'association Prodiges qu'il a créée, les Squatteurs comptent aussi dans leurs rangs l'infirmier psy Olivier Rabereau et le médecin psychiatre Pierre Kivits, à la basse et à la guitare. De plus en plus autonomes, à la tête de l'association qu'ils ont créée, les Squatteurs espèrent désormais faire des émules et devenir, à leur tour, des pair-aidants afin d'accompagner  ceux que l'écriture pourrait révéler. En les rencontrant, j'ai compris que tout est question d'une pulpe, restée au fond de la bouteille, qu'il s'agirait d'agiter à nouveau. Vous comprendrez en écoutant ce nouvel épisode de la collection « Dans ta bande ». Une collection de Finta ! pensée pour expérimenter des podcasts plus collectifs, en immersion, laissant la place à des sujets qui nous lient et des tranches de vie qui nous rassemblent. Bonne écoute !

Some seasons change you. This one did.Season 4 of The Pain Game Podcast — The Aftermath — was built around a question Lyndsay has been living with for a decade: what happens to the people left standing after the unimaginable? Not the headlines. The human beings behind them. The survivors, the families, the professionals who carry these stories inside their bodies long after the cameras are gone.In this season finale, Lyndsay closes out The Aftermath with a reflection on everything this limited series uncovered — and everything it confirmed. That behind every crime, every loss, every headline is a pain that deserves purpose. That healing is not linear. And that the only way out is through.This episode is also home to some big news. After four seasons, The Pain Game Podcast is becoming The Giving Pain Purpose Podcast — because that's exactly what this show has always been. The mission hasn't changed. The conversations haven't changed. The name finally caught up.If you're new here, this episode is your entry point to everything Season 4 had to offer. If you've been here all along — thank you. You made this season what it was.Season 5 of The Giving Pain Purpose Podcast is coming. Don't miss it.Episode Highlights:(00:00) Introduction and Lyndsay's Journey with CRPS(00:51) Living in Trauma and Finding Resilience(02:17) The Purpose of the Series and Human Stories Behind Trauma(03:41) Season Highlights: True Crime and Trauma Survivors(05:38) Stories of Sex Trafficking, Grief, and Advocacy(07:34) Healing, Trust, and Reprogramming the Mind(08:56) Personal Stories: Annie Lisa and the Power of Connection(10:21) The New Name and Mission: Giving Pain Purpose(11:48) Community, Merch, and Upcoming InitiativesFind The Pain Game Podcast Online Here:Website: thepaingamepodcast.comInstagram: @thepaingamepodcastFacebook: The Pain Game PodcastLinkedIn: Lyndsay SopranoYouTube: The Pain Game PodcastSubscribe on YouTube | Merch Shop is OPEN!! | COMING SOON: The Pain Hub - A Women's Healing Community. Subscribe Now!Unfiltered convos. Dark humor. Real healing.This is where pain meets purpose — and you're not doing it alone.++Want to be a guest on The Pain Game Podcast with Lyndsay Soprano? Send her a message on PodMatch, here: Be a Guest on The Show

Remember his name: Jeffrey Panik, MSFS, CFP, CRPS. He's received the Five Star Wealth Manager Award for ten years running is the Managing Principal, Financial Advisor at Balance Wealth Partners. Jeff knows his job is to help clients strike a balance between living well today and planning for the future. In fact, Jeff Panik founded Balance Wealth Partners with a simple goal in mind: to create tailored plans for intentional living. He is the author of two Books: Your Future is Now (An Introductory Guide to Managing Your Finances) and Your Future Is Now (Your Blueprint for Solving your Retirement Puzzle). balancewealthpartners.com Sageintl.com or 800-254-5779

A re-release from 2017 but still valid. I've worked with people with CRPS since the early 1980's If you want to discuss treatment options to help book a conversation  Check out my website there is a page about specialist help for persistent and complex pain conditions I work with https://jillwigmore-welsh.com/specialist-chronic-pain   Complex Regional Pain Syndrome, CRPS Chronic Pain & Body Image Treatment in Reading, London and UK wide via webcam  I'm in the UK and provide treatment in the UK and for UK registered residents but who travel all around the world.  I also provide movement lessons around the world, these are educational and not therapeutic, they provide you with tools to begin safely and kindly reconnecting with your body. If you have CRPS you are welcome to contact me for help, I am particularly interested in working with neurodivergent individuals interested in lifestyle and behaviour change, neuroscience, improving sleep, reducing inflammation, managing anxiety, and improving quality of life.    When you have CRPS, or Chronic Pain your body image will be different from the way it was before you began having problems   So what is Body Image?   Body image is the perception you have of your physical self.   This podcast introduces key aspects of body image.   Redevelopment of your body image is a very important and all rehabilitation and recovery programs include improving body image because body image is important for day to day self use.  

A re-release from 2017 but still valid. I've worked with people with CRPS since the early 1980's If you want to discuss treatment options to help book a conversation  Check out my website there is a page about specialist help for persistent and complex pain conditions I work with https://jillwigmore-welsh.com/specialist-chronic-pain   Complex Regional Pain Syndrome, CRPS Chronic Pain & Choosing a Practitioner Treatment in Reading, London and UK wide via webcam  I'm in the UK and provide treatment in the UK and for UK registered residents but who travel all around the world.  I also provide movement lessons around the world, these are educational and not therapeutic, they provide you with tools to begin safely and kindly reconnecting with your body. If you have CRPS you are welcome to contact me for help, I am particularly interested in working with neurodivergent individuals interested in lifestyle and behaviour change, neuroscience, improving sleep, reducing inflammation, managing anxiety, and improving quality of life. 

A re-release from 2017 but still valid. This one addresses CRPS and children, it's always distressing when children develop CRPS and I've seen many with very limiting problems.   I've first worked with people with CRPS in the early 1980's when it was called RSD, reflex sympathetic dystrophy, and the key to my success then, and now, isn't just the evidence and approach I take, but my ability to create a really strong therapeutic alliance with my clients, and nowhere is that more important than when working with children.   If you want to discuss treatment options to help book a conversation  Check out my website there is a page about specialist help for persistent and complex pain conditions I work with https://jillwigmore-welsh.com/specialist-chronic-pain   Complex Regional Pain Syndrome, CRPS Chronic Pain & Body Image Treatment in Reading, London and UK wide via webcam  I'm in the UK and provide treatment in the UK and for UK registered residents but who travel all around the world.  I also provide movement lessons around the world, these are educational and not therapeutic, they provide you with tools to begin safely and kindly reconnecting with your body. If you have CRPS you are welcome to contact me for help, I am particularly interested in working with neurodivergent individuals interested in lifestyle and behaviour change, neuroscience, improving sleep, reducing inflammation, managing anxiety, and improving quality of life. 

A re-release from 2017 but still valid. I've worked with people with CRPS since the early 1980's If you want to discuss treatment options to help book a conversation  Check out my website there is a page about specialist help for persistent and complex pain conditions I work with https://jillwigmore-welsh.com/specialist-chronic-pain   Complex Regional Pain Syndrome, CRPS Chronic Pain, Early Stages Treatment in Reading, London and UK wide via webcam  I'm in the UK and provide holistic evidence informed treatment in the UK and for UK registered residents but who travel all around the world.  I also provide movement lessons around the world, these are educational and not therapeutic, they provide you with tools to begin safely and kindly reconnecting with your body. If you have CRPS you are welcome to contact me for help, I am particularly interested in working with neurodivergent individuals interested in lifestyle and behaviour change, neuroscience, improving sleep, reducing inflammation, managing anxiety, and improving quality of life. 

Most people experience grief as an ending. Annie Lisa walked into hers and found a beginning.After her sister, Dr. Teresa Sievers, was brutally murdered in 2015, Annie left a 20-year career in marketing. She opened her practice, Annie Lisa Life — a space rooted in the science of the subconscious mind. She sits down with Lyndsay to talk about the day the call came, the signs and messages that started arriving from her sister afterward, and PSYCH-K®, the modality she now uses to help clients rewrite the patterns running 95% of their lives.This conversation doesn't stay in the dark. Annie and Lyndsay get into the work of Bruce Lipton and Greg Braden, the question almost no one wants to sit with: who would you actually be without your pain? And why energy medicine isn't woo, it's the physics most of us were never taught. They dig into secondary gain, epigenetics, signs from departed loved ones, and the quiet subconscious loops that keep the same chapter playing on repeat.Who murdered Dr. Teresa Sievers? You will have to buy the book to find out the rest of her story!Episode Highlights:(00:00) Introduction to the Pain Game Podcast(01:43) Personal Loss and Grief(03:55) The Impact of Trauma on Healing(09:52) The Subconscious Mind and Its Influence(17:16) Changing Subconscious Programs for Healing(24:07) Understanding Chronic Pain and Subconscious Influence(28:53) The Fear of Letting Go of Pain(33:54) The Power of the Subconscious Mind(37:07) Energy Medicine: The Science Behind Healing(40:56) Collective Responsibility for Change(44:30) The Journey of Healing and TransformationFind Annie Lisa Online Here:Website: annielisalife.comInstagram: @annielisalifeFacebook: AnnielisalifeLinkedIn: Annie LisaTikTok: AnnieLisaLifeYouTube: Annie LisaBook: What My Sister Told Me After She Was MurderedFind The Pain Game Podcast Online Here:Website: thepaingamepodcast.comInstagram: @thepaingamepodcastFacebook: The Pain Game PodcastLinkedIn: Lyndsay SopranoYouTube: The Pain Game PodcastSubscribe on YouTube | Merch Shop is OPEN!! | COMING SOON: The Pain Hub - A Women's Healing Community. Subscribe Now!Unfiltered convos. Dark humor. Real healing.This is where pain meets purpose — and you're not doing it alone.++Want to be a guest on The Pain Game Podcast with Lyndsay Soprano? Send her a message on PodMatch, here: Be a Guest on The Show

In this conversation, Dr. Ruchir Gupta shares his unconventional journey from established anesthesiologist to successful pain medicine entrepreneur. After 10 years of practicing anesthesia, he made the bold decision to return for a pain fellowship at Mayo Clinic, where he was older than most of his attendings.Dr. Gupta's story shows how strategic career reinvention can create competitive advantages in medicine. By combining his decade of anesthesia experience with pain medicine fellowship training, he identified a market opportunity that others overlooked: IV ketamine therapy for chronic pain patients. While other pain physicians were hesitant to offer ketamine infusions due to unfamiliarity with anesthetic protocols, Dr. Gupta's background made him uniquely qualified to bridge this gap.You'll hear about how his specialized fibromyalgia protocols achieves 80% success rates, his insights about monitoring standards including the "fifth vital sign" of proper patient follow up, and practical business advice about overcoming analysis paralysis.Dr. Gupta's journey from zero to building Mountain View Headache and Spine Institute offers valuable lessons for any medical professional considering practice ownership or career reinvention. His approach challenges common physician assumptions about entrepreneurship and shows how leveraging existing skills can lead to practice success.What You'll Learn in This Episode· Career reinvention strategy: how Dr. Gupta leveraged his anesthesia background to differentiate his pain practice and why returning to fellowship training became a competitive advantage rather than a setback· Physician entrepreneurship barriers: why medical professionals create mental obstacles around private practice that dentists, chiropractors, and other healthcare providers don't experience, and how to overcome this mindset· Clinical monitoring standards: detailed recommendations for ketamine infusion monitoring, including the importance of continuous EKG, pulse oximetry, and blood pressure monitoring for longer pain protocols· The "fifth vital sign" concept: why proper patient follow up and outcome measurement are essential for maintaining medical credibility and avoiding the "med spa" trap in ketamine therapy· Business development approach: practical strategies for practice growth including LinkedIn networking, physician education sessions, and building referral relationships with skeptical providers· Cross-disciplinary medicine benefits: why Dr. Gupta believes future physicians should combine multiple specialties or degrees to offer integrated approaches and differentiated services· Pain and mood disorder integration: clinical insights about treating patients with concurrent chronic pain and depression, including combination Spravato and ketamine protocols

Early bird discounts for the San Francisco World's Fair, the biggest AIE gathering of the year, end today - prices will go up by ~$500 tonight so do please lock in ASAP!From near-universal AI tool adoption inside Shopify to internal systems for ML experimentation, auto-research, customer simulation, and ultra-low-latency search, Mikhail Parakhin joins us for a deep dive into what it actually looks like when a 20-year-old, $200B software company goes all-in on AI. We cover why Shopify has become much more vocal about its internal stack, what changed after the December model-quality inflection, and why the real bottleneck in AI coding is no longer generation, but review, CI/CD, and deployment stability.We also go inside Tangle, Tangent, SimGym, which are three major AI initiatives that Shopify is doing to make experimentation reproducible, optimization automatic, customer behavior simulatable, and search and catalog intelligence faster and cheaper at scale. Along the way, Mikhail explains UCP, Liquid AI, and why token budgets are directionally right but often measured badly, why AI-written code can still increase bugs in production, what makes Shopify's customer simulation defensible, and what he learned from the Sydney era at Bing.We discuss:* Mikhail's path from running a major Microsoft business unit spanning Windows, Edge, Bing, and ads to becoming CTO of Shopify* Why Shopify is talking more publicly about AI now, and why staying at the frontier has become necessary for the company* Shopify's internal AI adoption curve, the December inflection, and why CLI-style tools are rising faster than traditional IDE-based tools* Why Jensen Huang is directionally right on token budgets, but raw token count is still the wrong way to evaluate engineering output* Why the real unlock is not more agents in parallel, but better critique loops, stronger models, and spending more on review than generation* Why AI coding can still lead to more bugs in production even if models write cleaner code on average than humans* Why Shopify built its own PR review flow, and why Mikhail thinks most off-the-shelf review tools miss the point* How PR volume, test failures, and deployment rollback are becoming the real bottlenecks in the agent era* Why Git, pull requests, and CI/CD may need a new metaphor once code is written at machine speed* What Tangle is, and how Shopify uses it to make ML and data workflows reproducible, collaborative, and production-ready from the start* Why Tangle is different from Airflow, and why content-addressed caching creates network effects across teams* What Tangent is, and how Shopify is using auto-research loops to optimize search, themes, prompt compression, storage, and more* Why Tangent is becoming a democratizing tool for PMs and domain experts, not just ML engineers* Why AutoML finally feels real in the LLM era, and where auto-research still falls short today* Why Tangle, Tangent, and SimGym become much more powerful when combined into one system* What SimGym is, why simulated customers only work if you have real historical behavior, and why Shopify's data gives it a moat* How SimGym evolved from comparing A/B variants to telling merchants what to change on a single live storefront to raise conversions* Why customer simulation is so expensive, from multimodal models to browser farms to serving and distillation costs* How Shopify models merchant and buyer trajectories, runs counterfactuals, and thinks about interventions like discounts, campaigns, and notifications* Why category-level behavior is so different across commerce, and why ideas like Chinese Restaurant Processes are showing up again in practice* Shopify's new UCP and catalog work, including runtime product search, bulk lookups, and identity linking* Why Shopify is using Liquid AI, and why Mikhail sees it as the first genuinely competitive non-transformer architecture he has used in practice* Where Liquid already works inside Shopify today, from low-latency query understanding to large-scale catalog and Sidekick Pulse workloads* Whether Liquid could become frontier-scale with enough compute, and why Shopify remains pragmatic and merit-based about model choice* Who Shopify is hiring right now across ML, data science, and distributed databases* The Sydney story at Bing, why its personality was not an accident, and what Mikhail learned from deliberately shaping AI character early onMikhail Parakhin* LinkedIn: https://www.linkedin.com/in/mikhail-parakhin/* X: https://x.com/MParakhinTimestamps00:00:00 Introduction: Mikhail Parakhin, Microsoft, and Shopify00:01:16 Why Shopify Is Talking More About AI00:02:29 Internal AI Adoption at Shopify and the December Inflection00:06:54 Token Budgets, Jensen Huang, and Why Usage Metrics Can Mislead00:10:55 Why Shopify Built Its Own AI PR Review System00:12:38 AI Coding, More Bugs, and the Real Deployment Bottleneck00:14:11 Why Git, PRs, and CI/CD May Need to Change for Agents00:18:24 Tangle: Shopify's Reproducible ML and Data Workflow Engine00:21:19 Why Tangle Is Different from Airflow00:26:14 Tangent: Auto Research for Optimization and Experimentation00:30:07 How Tangent Democratizes Experimentation Beyond ML Engineers00:33:06 The Limits of Auto Research00:36:36 Why Tangle, Tangent, and SimGym Compound Together00:37:20 SimGym: Simulating Customers with Shopify's Historical Data00:42:47 The Infra Behind SimGym00:46:00 Why SimGym Gets Better with Real Customer History00:47:30 Counterfactuals, HSTU, and Modeling Merchant Trajectories00:51:55 CRPs, Clustering, and Category-Level Customer Behavior00:53:30 UCP, Shopify Catalog, and Identity Linking00:55:07 Liquid AI: Why Shopify Uses Non-Transformer Models00:59:13 Real Shopify Use Cases for Liquid01:03:00 Can Liquid Scale into a Frontier Model?01:09:49 Hiring at Shopify: ML, Data Science, and Databases01:10:43 Sydney at Bing: Personality Shaping and AI Character01:13:32 Closing ThoughtsTranscript[00:00:00] swyx: Okay. We're here in the studio, a remote studio, with Mikhail Parakhin, CTO of Shopify. Welcome.[00:00:08] Mikhail Parakhin: Thank you. Welcome.[00:00:10] swyx: I don't even know if I should introduce you as CTO of Shopify. I feel like you have many identities. Uh, you led sort of the, the Bing ML team, I guess, uh, uh, or ads team. I, I don't know, I don't know, uh, you know, it's, uh, people va-variously refer you as like CEO or, or, uh, I don't know what that, that, that said previous role at Microsoft was.[00:00:29] Mikhail Parakhin: Uh, that was... Yeah, my previous role w- at Microsoft was the-- I actually was the CEO of one of Microsoft's business units, which included, as I, you know, as we discussed, all the things that people like to laugh about, uh, including Windows and Edge and Bing and ads and everything.[00:00:47] swyx: Yeah, yeah. What a, what a, what a wild time.You've obviously, uh, done a lot since you landed at Shopify. Uh, one of the reasons I reached out was because you started promoting more sort of internal tooling, uh, primarily Tangle, but also a lot of people have seen and adopted Tobi's QMD, uh, and obviously, I think, uh, Shopify has always been sort of leading in terms of, uh, engineering.I think more-- it's just more recent that you guys have been more vocal about your sort of AI adoption. Is that, is that true?[00:01:16] Mikhail Parakhin: Well, I think AI tools in general are fairly recent development, uh, and we've-- Shopify, you know, at this stage of its development, we're developing AI in-in-house and other, uh, building tools that use AI and, you know, interfacing with the wider AI community, uh, you know, are on the sort of the, uh, runaway trajectory.So it just did by sort of natural byproduct. We, we talk about it more also. We just, uh, just even yesterday, Andrej Karpathy was famous in tweeting about, oh, are there some, uh, ways, uh, that, that you can organize your agents to store the data and then, uh, look up the data so that you don't have to research or, or lose context every- Yestime. And a little bit tongue in cheek, I tweeted that, “Hey, we've, we've done it much earlier, and we even have different approaches, Tobi and I.” Tobi, of course, is a big fan of QMD, and I'm more of a SQL, SQLite fan. But, uh, yeah, very similar things that we've already done here. The point is, yeah, we're very dynamic, you know, explosively growing company, and we have to be at the forefront of AI adoption, obviously.[00:02:29] swyx: Yeah. Yeah. Um, you, your team kindly prepared some slides actually that we were gonna bring up on to, uh, the screen. I think I can, I can screen share, and then we can kind of go through some of the shocking stats that maybe, maybe put some numbers to what exactly is going on. So here we have, uh- An internal AI tool adoption chart.What are we looking at here? What ?[00:02:54] Mikhail Parakhin: Yeah, this is very interesting statistics. Uh, this is number of daily active workers, you know, think of, uh, DAO, basically the active users of-[00:03:05] swyx: Yeah ...[00:03:05] Mikhail Parakhin: AI tool as a percentage of all the people in the company, right? And then- Yeah ... different AI tools. And, uh, you could see two things here is that one is the green is total.Uh, green is just total. So you could see that it approaches really % by now. It's hard not to do your job now without interacting deeply, at least with one tool. You could see another interesting thing is just as many people commented in December was the phase transition when suddenly models gotten good enough that, that everything took off and started growing.Uh, it, it was many people noticed that the thing is that small improvements accumulated into this big change in Sep- December roughly timeframe.[00:03:52] swyx: Yeah.[00:03:52] Mikhail Parakhin: The other thing I would claim you could see is that, uh, CLI-based tools and tools that don't require you to look at the code becoming more popular, and you could see, yeah, various versions of, uh, Cloud Code and Codex and Pi and internal development tools taking off.Uh, exactly, yeah, uh, and blue is our River, just internal agent for coding, where tools, uh, that require IDEs such as, uh, GitHub, Copilot or Cursor, they're not exactly shrinking, but they're not growing as fast. Like, uh, red, red line is, is the IDE kind of tools. So you could see that they're, they're not experiencing as, as fast of a growth.[00:04:37] swyx: As I understand it, basically, every employee has their choice, right? Of choose whatever tool you use, and then you're just kind of doing a, a daily sur-survey or something.[00:04:47] Mikhail Parakhin: Exactly. And, uh, we- Yeah ... the, the push is to get your job done, you can use any tool, and we effectively fund unlimited tokens for everybody.Uh, we, we do, we do try to control the models that, uh, people use, but from the bottom, not from top. Like we basically say, “Hey, please don't use anything less than Opus four point six.”[00:05:09] swyx: Oh .[00:05:10] Mikhail Parakhin: Some people, some people end up using GPT five point four extra high. Some people use Opus four point six. Um, uh, you know, uh, there are some, uh, there are plus and minuses in going for full one million context window versus not.But, uh, we try to discourage people from using anything less than that.[00:05:28] swyx: Yeah, yeah. Got it, got it. Uh, I mean, uh, that's, you know... The, the next chart here, it really kind of shows the expansion and the sort of December twenty twenty-five inflection, right? That, uh, people are using a lot of tokens. I think it's also really interesting that no one was kind of abusing it in twenty twenty-five.Like it was- Had comparatively, uh, to this year, there was almost no growth. I mean, it's still like, you know, probably, probably gave fifty percent.[00:05:56] Mikhail Parakhin: Yeah. This is just a different scale. It's still exponential- Yeah, yeah ...growth at just a different- ...rate of expansion. Uh, there was inflection point, and Sean, I would claim the, the super interesting part here is that you could see that the distribution becoming more and more skewed.Yes. The top percentiles grow faster. So that means- Yeah ...the people in the top ten percentile, they, their consumption grows faster than seventy-five and so forth. So, uh, the distribution skews more and more towards the highest users, which is... I don't know what it tells me. It's like it feels not ideal, to be honest.Or maybe it's okay. We'll see.[00:06:36] swyx: Why does it feel not ideal? Is, is it because of, um, quantity over quality, or what's the concern?[00:06:42] Mikhail Parakhin: Because take it to the limit. That means, you know, if, if this rate of separation continued- Ah, yes ...a year, there will be one person consuming all the tokens. So it's just, it's kinda strange.[00:06:54] swyx: Yeah, I mean, um, uh, I, I think internal like teaching and all that, uh, will, will help sort of distribute things more widely. But in, in the early days, of course, the people who are sort of more AI-pilled will obviously find more ways to use it than the people who are less AI-pilled. Maybe let's, let's call it that.I'll just, I'll just kinda quickly, uh, pause from the, the... You know, we will go back to the rest of the slides, but I just wanna, um, review, you know, there are a lot of CTOs of, of large companies like yourself where they're all considering some kind of token budget, right? Like I think it's something, something that Jensen Huang has been talking about, where like if your 200K engineer is not using 100K of tokens every year, like they're, they're underutilizing coding agents.Of course, Jensen Huang would say that, but like it seems a very quantity over quality approach and like some, some people are basically saying like, well, is this comparable to judging engineer quality by lines of code, right? Which we also know is like kind of flawed, but better than nothing. So I, I don't know if you have like a sort of management take here on, on how to view this kind of, uh, metrics.[00:08:02] Mikhail Parakhin: Well, I mean, you're, you're baiting me. I, I like... This is my favorite topic. Uh, if you let me, I'll probably talk for two hours on just this. I have a lot of things to say. Like I do think Jensen gotten a lot of bad press saying, “Oh, of course you're, you know, this, uh, the- ...the cake seller says you don't need enough cakes.”You know? Like, of course. Uh, but, uh, I actually, uh, think that's undeserved. I think he, he's actually right. Uh, I do think- He,[00:08:33] swyx: he's directionally correct.[00:08:35] Mikhail Parakhin: Yeah. Yeah. He's directionally correct for sure. Uh-[00:08:37] swyx: Who knows what the right number is? Yeah.[00:08:39] Mikhail Parakhin: The thing that I do Uh, want to say, and this is something that we learned through trial and error and very important is like two things.One is that it's not about just consuming tokens. Uh, you can consume tokens and, and in fact, the anti-pattern is running multiple agents, too many agents in parallel that don't communicate with each other. That's almost useless, uh, compared to just fewer agents and burns tokens very efficiently. Uh, setting up the right critique loop, especially with the high quality models, where one agent does something, the other one, ideally with a different model, critiques it, uh, suggests ways to improve it, the agent redoes it with this critique and, and so it takes much longer.So people don't like it because latency goes up. You know, they, they have to wait until this debate is happening. But, uh, the quality of the code is much higher. And another thing, just since you mentioned like, look, uh, uh, yeah, the overall budget is just like, uh, lines of codes. Lines of codes are exploding for everybody right now, or partially because AI is really mover balls, but partially just because AI can write a lot more code, you know, doesn't get tired.And so you have to have to have a very strong narrow waist during PR review. Otherwise, just the number of bugs will go through the roof. It's, uh, it's this unexpected consequence of the just volume trumping everything. I would claim by now good model writes code on average with fewer bugs than, than the average human.But since they write so much more of it, like more of it will make it into production. So you have to- You still[00:10:26] swyx: have[00:10:26] Mikhail Parakhin: more bugs. Yeah. Have to have a very rigorous PR reviews, also automated of course. But, uh, yeah, that to spend a lot budget there. Like this, this for me, for me, actually, the important metric is the ratio of budget spent during code generation versus, uh, spent, uh, expensive tokens like GPT, uh, five point four Pro or, uh, uh, Deep Think from Gemini, you know, checking on PR reviews.[00:10:55] swyx: Yeah, totally. Uh, I noticed in your chart you didn't have any review tools. Do you just use like, like let's say a Claude code to review tools? Or do you have another set of review tools like the Greptiles, the Code Rabbits, uh, Devin Reviews has a review tool. I don't know if you've had those specialist review tools.[00:11:13] Mikhail Parakhin: You are a little bit jumping on my store tool right now because the graphs I was only showing public tools. Uh, uh, the-- I haven't found a good PR review tool that, that does what I think should be done. And, uh, partially my, my thinking is because it's so... It just goes against both what people feel like emotionally they prefer and, uh, some of the, uh, you know, frankly Even business models that, that the companies run.At peer review tool, uh, time, you want to run the largest models. That means, I don't know, Codex or, or, uh, Cloud Code is not gonna cut it. You need to have pro-level models if you really want to, uh, stand the tide of bots from going into production. And you need us to spend a lot of time, the models taking turns, but you don't want, like, a big swarm of, uh, of, uh, agents.So in fact, you end up in a different dual-dualistic world where you generate not that many tokens. You, in fact, generate few tokens, but it takes f-a long time because these are expensive models taking turns rather than many, many agents trying to do many things in parallel. So that's, that's why I feel like I haven't found good tools, so we are using our own for peer review for now.[00:12:33] swyx: Yeah. Yeah. I mean, uh, I think a lot of companies are building their own, uh, especially to their needs, right?[00:12:38] Mikhail Parakhin: Mm-hmm.[00:12:38] swyx: Um, I, uh, you also have a chart here going back to the slides on, uh, PR merge growth, where we're now at thirty percent, uh, month on month rather than ten percent. Uh, and also the, the estimated complexity is going up.You know, this is productivity, right? ‘Cause y- presumably there's more stuff going into the code base and more, more features getting worked on. I'm curious about the backlog, right? Like the, the, the-- I actually don't mind a pro-level model taking an hour or two hours to review my PR, because I've dealt with humans who take a week to review my PR, right?And I keep pinging them on Slack, “Hey, hey, review my PR.” So, you know, I think there's some trade-off here where, like, it still doesn't make sense.[00:13:18] Mikhail Parakhin: Exactly. That, that's exactly m-my point. Uh, that on one hand, you can tolerate longer latencies at, uh, PR. On the other hand, like right now, the real problem is not in spending time waiting for PR.It's real problem is since there's so much more code than- Yeah ... uh, probability of at least some tests failing going up, and then you, like, keep de-failing, then you have to find the offending PR, evict it, retest it without that PR, and so deployment cycle becomes much longer. Uh, so it actually, in terms of the overall time to deploy, it's total time savings if you spend more time on a longer model, like thinking for an hour, because then, then you, you don't have to spend all that time during testing and rolling, you know, rolling back the deployment.[00:14:03] swyx: Yeah, totally. That's still worth it. You know, you don't look at the individual, look at the aggregate, and look at the, the, the change in the aggregate system.[00:14:11] Mikhail Parakhin: Exactly.[00:14:11] swyx: I'm kind of curious if, like, there's this PR mentality and, like, c-- the, the, the CICD paradigm will be changed eventually. Some people are like, obviously a lot of people want new GitHub, but I even wonder if, like, Git is the problem, right?Like, is that the bottleneck? Is the concept of a PR a bottleneck? Do you guys use stack diffs? I don't know if, uh, that's a, like, a merge queue stack diff type of thing.[00:14:34] Mikhail Parakhin: We, we use, we use Stacks, we u- we use Graphite. We worked with, uh, Graphite a lot. Uh, so we use Stack, uh, PRs. I think, uh, like that's clearly the overall CICD in general, and the interaction with the code repository right now is the, clearly the sort of the, the main issue and the bottleneck for us, uh, and highest top of mind.I would say we probably need a different metaphor or different whole design of how to process it in new agentic world. I haven't seen anything dramatically better yet. I, I think everybody right now is just trying to keep their head above the water ‘cause, ‘cause there, there's so many PRs and then everybody's CICD pipelines start creaking, the, the times are increasing, the number of bugs slipping by increasing, and you have to, have to clap on down.And so we are a little bit in this situation when we need to first stabilize that story and then start thinking, hey, what, what it could be a completely different and new world, which I haven't... I know some people working on it. I haven't seen something, like anything super compelling yet, but clearly the old thing were designed for humans will need to be morphed into something new.[00:15:53] swyx: One of the thing that I, I think about is kind of like the merge conflict is basically a global mutex on the whole system, right? And in, in hu- in human organizations, we do have something like that. It's the company standup. But like, other than that, it's like it's actually fitting for us to be somewhat decentralized, somewhat plugged into one stream of information source, but somewhat lossy.Like it's okay, you know, that, that not every delivery is like atomic consistency. Like we're not dealing with a database sometimes.[00:16:27] Mikhail Parakhin: This is a very good point, uh, because since humans don't write code too fast, you know that global mutex is not too bad. Once you-[00:16:36] swyx: Yes ...[00:16:37] Mikhail Parakhin: start writing code at the speed of machine, it becomes the, you know, the bottleneck.Then what do you do? Maybe, and I can't believe I'm saying this because I, I'm long-- lifelong opponent of, uh, microservices, and I always thought that was, like, a really bad idea. And now that you're saying it, like, maybe in new guys like microservices will make a comeback, you know, because then you, you can ship things independently in tiny things and, and the managing all that complexity automatically will be much easier.I don't know. Like, we'll s-- we'll have to see.[00:17:10] swyx: Yeah. I mean, I don't know what the Microsoft or, or Shopify thing is, but I, I read this paper from Google where they have a monorepo that deploys into microservices, right? And then, uh, the other concept that I think about a lot is the Chaos Monkey concept from, from Netflix.Being able to create, like, this robust system where, um, uh, you know, you, you have the service discovery, you have the, uh, the independent, independent microservices discovery and, and, uh, you know, probably going to be a fair amount of duplication. That's how an organic system sort of scales, uh, that, that you have that...I don't know how you call it. Slack? Robustness? Depend-- uh, d-duplication. I, I, I forget the-- I, I'm-- And this-- those-- these are not exactly the terms- Hmm ... I'm looking for, but I c-can't really think of the words. Okay. I was gonna go into Tangent and Tangle. Uh, so, uh, we, we sort of discussed the overall stats that, uh, Shopify has.Uh, but, you know, I, I think some, some pretty cool stuff that you guys are working on is your ML experimentation, uh, and your, your sort of auto tr-research training pipeline. Presumably you're much closer to this one because it's, it's a sort of personal hobby of yours. How, how would you explain them in, together?I thought we have a slide that, like, uh, has the s- the system diagram.[00:18:24] Mikhail Parakhin: Yeah. Tangle first and then Tangent as a-[00:18:27] swyx: Yeah ...[00:18:28] Mikhail Parakhin: as a thing on top of Tangle. And, uh, Tangle is the third generation, I claim, of, uh, systems of, uh, running any data processing, but a bit with a skew for ML experiments, but not necessarily. Any sort of data processing tasks where you need to iterate, share, and you have scale so that you want maximum efficiency.You know how, like, normally you would work, you would-- Imagine you're a data scientist or an ML practitioner, you would get Jupiter notebooks or, or maybe you would get, uh, you know, Pyth- your Python scripts, and you would manage the data, and you produce those TSV files, and you put them in some JFS or something.Then you would notice that, oh, it has this, uh, weird missing values. You go and write another script that, uh, goes and replaces them with, uh-[00:19:20] swyx: Ah ...[00:19:21] Mikhail Parakhin: dash S. And then, then you, then you run some, some, uh, “Oh, I need to filter bots.” And so you run some light GBM model that, uh, removes the bots. And then, then you like-- And then you, you kind of like get into shape, and then you start experimenting, and you run multiple experiments, and then you're like, “Oh my God,” like, “this experiment is worse.”You undo, and you cannot get to previous result. And like, “Ah, what did I do?” Like that. Again, then, then you finally like get everything working. Then you like start throwing it over the fence to production. You, you replicate it, those things don't work, and then sometimes you like don't notice that you forgot some feature naming and the, the features don't match.But then, like imagine you, you did everything, and then six months later you're like, have to repeat it because now there's more data, or you wanted to do another pass, and you're like, “What, what did I do?” Or like, or like, “This script crashes now,” or the, “the path has changed.” And then, then you're trying to, like you spend another month just doing ar- digital archeology on your own, you know, history, right?Now multiply that by many, many teams. Now imagine you got an intern that you wanna ramp up. Now you have to show that intern, “Oh, you know, look, here's the folder, there's the scripts, you know, ask your cloud agent to do, and then, uh, to, to figure it out.” And then cloud agent does something, and then you're, “Ah, yeah, right, right, it was the wrong folder.I forgot to tell you, I actually have this other thing I forgot myself.” And, and that's, that's the, like, the daily life we all, uh, all know it, uh, if, if you're a data scientist, machine practitioner, ma- machine learning practitioner or, uh, or even like any data managing, uh, person.[00:21:00] swyx: Yeah. So I, I used to do this, uh, f- uh, on the quant finance side, uh, in, in my hedge fund.So we did this before Airflow, and then, uh, obviously Airflow came along and, uh, then more recently Dagster, uh, I would say is like, in my mind, what I would use for that shape of problem, uh, where you had to materialize assets and create a pipeline.[00:21:19] Mikhail Parakhin: And that's, that's very good segue because... So Airflow is great, but Airflow is more about you, you have something and you wanna repeatedly run it in production on schedule.It's less about you as a team developing things and being able to share, and you grabbing the standard pipeline and saying, “Hey, I wanna change this tiny little component in the huge sea of data processing, and I don't wanna-- I wanna run ten experiments on this, and I wanna do hyperparameter optimization.”All that is very hard to do with Airflow. It's very easy to do with Tango. Tango is m- more about, it's everything about group of people Running experiments, it might be agents too nowadays. Uh, running experiments cheaply, collaborating, sharing results. Uh, you don't need to understand fully. You, you grab-- you clone somebody else's experiment or somebody else's pipeline, uh, run, uh, change small piece, run it, be, like, get it to production state, and then ship in one click.So then the... You don't have to port it into any other system to, to run in production. You can just run the same experiment. It's, it's fully production ready. And, and it's, uh, it has lots of... Again, as I said, it's third generation system. The original one was, I would claim there was Ether and then, uh, at least in my career, Ether was the first, first, uh, that pioneered this type of approach.And then there was, uh, Nirvana, which, uh, uh, at Yandex, which did kind of sec-second take on this. And now this one aggregates the, the learnings from all of those and, and Airflow as well to, to get to the state where you try it, it, it feels kind of magical. Uh, ‘cause now everything is based on content, uh, hashes.So even if the version changed, but if the output didn't change, nothing is being rerun. It's very efficient. If you... Multiple people start experiment that needs the same sort of data preprocessing, it's not repeated multiple times. It's automatically done only once. If you start ten experiments that all require, you know, some, some data preparation first as the first step, and you don't have to coordinate for that.Like, you don't have to know that other people are starting it. You now, it's very easy compos-, uh, composability, any language you can u- uh, you wanna use, and it's very visual. So you can see immediately, you can edit it easily, you can assemble small things with just even mouse clicks if you want to, and, uh, share, clone.And everybody knows also it's fully kind of static in the sense that we rerun it second time, it will exactly have the same results. Like, you will never have to do digital archeology. So full versioning and everything is also there.[00:24:06] swyx: Uh, so, so people can, uh... It's open source. Go to the GitHub repo and, and, uh, check it out.Uh, and it is also a really good, uh, blog post about it. I think all these is, like, really appealing. The, the, the, the thing that I think sells me the most about it is that, um, sort of development to production transition, right? Which I think, um, a lot of people haven't really solved that, uh, strictly, right?Like, we develop really, really well in, in Python notebooks, but then, you know, that's obviously not a sort of production ready process. I think that, like, any way in which that is solved, I think is, is very appealing. Then the other thing that you mentioned, which also raised my eyebrows, was content-based caching, which you mentioned is, is, um, you know, is ve-very much, uh, um, a sort of efficiency measure about, uh, you know, just like recalculation only on, on sort of content addressing Which I think makes sense.Uh, it surprised me that the savings could be this much, but maybe I just haven't worked at your scale where there's so much duplication, uh, that people just rerun because they change a single ID upstream.[00:25:10] Mikhail Parakhin: It does, yeah. But it's not only you rerun. The, the main savings are coming from the fact that you ran it, you got your job done, and you moved on.Then- Yeah ... somebody else in some department you don't know existed runs the same task, but on a newer version.[00:25:27] swyx: Yeah.[00:25:27] Mikhail Parakhin: Like right now, you can't, in, in most of the organizations, you can't even find out about it so that you can't even measure that you're spending that time twice, right? Here- Yeah ... if everybody's on Tango, that's detected automatically and detected that the output is the same.And then for that person, all it looks like is like experiment just suddenly moved, jumped forward, right? Uh, uh- Yeah ... so that's because, because the, there's network effect of multiple people helping each other.[00:25:51] swyx: Yeah. This is one of those things where it's designed to be a platform from the beginning rather than an individual developer's tool from the beginning, right?And, and everything's gonna streams down from there. That is the sort of Tango, uh, orchestrator, and it's, it manages jobs. We've seen a few versions of this, and this is obviously, uh, uh, the sort of, uh, unique approaches that you guys have, have, uh, figured out. And then there's Tangent.[00:26:14] Mikhail Parakhin: Yeah. And Tangent is basically an automatic auto research loop that can help and kind of do your work for you.Uh- ... you know, uh, effectively, effectively, Andrej Karpathy recently popularized it with auto research. Yes. Remember he said like he was, uh, speed running this, uh... Yeah, uh, you know the story. The, here we're basically bringing the same capability into Tango so that, uh, the, uh, Tangent can analyze it. It's just an agent that can run multiple experiments, figure out what can be changed, and keep on rerunning it, keep on modifying until, uh, maximizing some goal, some loss function, whatever you need to, to achieve.And in general, I would say if you're not using auto research-like approach in whatever you do, like literally whatever you do, then you're missing out. We saw at Shopify that taking like a wildfire, anything where you can put measurements can be done dramatically better. Our-[00:27:19] swyx: Mm-hmm ...[00:27:20] Mikhail Parakhin: uh, speed of, uh, templatization HTML, uh, completely new UX tem- uh, templatization of, uh, reducing latency for liquid themes.Uh, we-- Our, uh, search, uh, recently we moved from It's hard even, uh, quote from eight hundred QPS to forty-two hundred QPS with the same quality just by pure optimizations and not a research loop that kept running and changing code in our index serve on the same number of machines, just increasing the throughput.We, we managed to improve the quality of gisting and machine learning process. Uh, you know, gisting is the prompt compression technique that[00:27:59] swyx: allows for[00:28:00] Mikhail Parakhin: lower latency and, and lower and, uh, actually higher quality slightly. So like literally whatever different walks of life, and it doesn't have to be AI related.Uh, we, we had a reduction in, uh, storage because the agents would go and find data sets that clearly are derivative, uh, and then you don't need to store things twice. You know, we, we, we found somewhat embarrassingly that it was one of the largest tables was hashing random IDs into another random ID, and we literally- Oofput only one. So it was translating, yeah, two random IDs hashed[00:28:36] swyx: into[00:28:37] Mikhail Parakhin: each. So, so[00:28:37] swyx: it has access to the code as well, so it can, it can check the, like what, what the hell is it doing?[00:28:42] Mikhail Parakhin: So there, there cou- it could be run in two levels. You, uh, you know, at the superficial level, it could just use ex-existing components and, uh, reshuffle them.Uh, you know, like you can grab- Yeah ... uh, XGBoost, and you can grab some, some Py- PyTorch module, and then can grab some, you know, grab another tools and, and combine them. At a deeper level, since Tangle is all sort of CLI based underneath you, every, every component is a wrapped really CLI, uh, call and a YAML file, it can analyze code and create new components and, and, uh, keep on iterating as well.So, so you can, you can both have quick modifications of existing t- uh, pipelines with the, with components that are already there pre-baked, or you can create new components, uh, and-[00:29:29] swyx: Yeah ...[00:29:29] Mikhail Parakhin: keep iterating on those. So auto research is, again, this is probably the, the thing I was excited the most in the last two months happening, and we see it taking like, like totally like a wildfire.Just, uh, everybody, every day, every... well, every day, every minute, I would, uh, have somebody Slack message saying, “Oh, look how much better I made it.” And, uh, it's all throughout the research.[00:29:53] swyx: Is this democratized in some way in, in the sense that like is it your ML, uh, engineers and researchers doing this, or is it your regular PMs and software engineers also have the ability to auto-- to use Tangent?[00:30:07] Mikhail Parakhin: This is an awesome question. Like, Tango in general and Tangent in particular are extremely democratizing. Like they- Yeah ... they are the main tools for- ‘Cause I don't[00:30:15] swyx: need the details.[00:30:16] Mikhail Parakhin: Yeah. Exactly. Initially used by ML and AI engineers, but then literally, as you said, PMs are like the highest user right now is one of PMs on our org, uh, Sartak and he was, he was number one by, by usage of, of this ‘cause they're just, uh, energetic and knowledgeable, and now it, it unlocks a lot of capability where you don't have to co-change code manually.[00:30:39] swyx: I mean, I mean, because it kind of cuts out the ML, ML engineer from the process because the, the, the PMs have the domain knowledge and the ability to think about, uh, from first principles about, okay, what, what results do I want? And they can-- they even have the access to the data that, that needs to go in.So it's like in some ways, like this is the magic black box that we've always wanted for, for training and, and for, uh, I guess, uh, uh, hill climbing, whatever.[00:31:04] Mikhail Parakhin: It's basically cloud code for your AI development- ... uh, situation, right? Like now, now you don't have to know exactly how algorithms work. You can just, uh, bring your domain knowledge and expertise and product knowledge and iterate within Tangent until you've gotten the results that you need.[00:31:21] swyx: In my previous roles, every time that someone has pitched AutoML, you know, I've always been like, “Uh, this is not, this is not gonna work. It's, you know, it's, it's always gonna be a flop.” Somehow it's working now. I mean, presumably the answer is now we have LLMs and it's good enough, right? It's, it's an emergent property that we can do auto research, but like, it doesn't feel that satisfying that how come we didn't do this before, right?Like we just did like parameter search and like, I don't know. That's maybe that's it.[00:31:48] Mikhail Parakhin: Yeah. Bayesian optimization and hyperparameter optimization was, was the one that, or facet of AutoML that was used very actively, which incidentally also built into, uh, Tango. But, you know, I know Patrice Simard very well, and, uh, he was such a, uh, such a proponent of AutoML, and he put, like literally spent careers trying to democratize it.Without LLMs, it just turned out to be very hard. Like it, you, you would have flexibility within certain narrow domain, but it was hard to wider scale, and now with LLMs suddenly it's like magic wand, and so suddenly everybody- ... is an AutoML expert.[00:32:28] swyx: Yeah, I, I think it's multiple things, right? Like I'm, I'm just gonna bring up the, the, the chart again, right?Like LLMs can do the monitoring very well. That is the very potentially unbounded, super unstructured. It can do the analysis very well, it can do the... Uh, and basically it is much more intelligence poured into every single step. Uh, there's maybe nothing structurally changed about AutoML, but this is just m-more intelligent and more unstructured.[00:32:53] Mikhail Parakhin: Exactly.[00:32:54] swyx: Any flaws that you've run into? Like everyone is like drinking the Kool-Aid, oh my God, time savings, uh, you know, performance improvements. Like what, what, uh, issues have you have, uh, come up?[00:33:06] Mikhail Parakhin: This is really cool. It's not a solution to all the world's problems for sure. The limitations are usually the ones I-- And this is where we get into a bit of a subjective territory.Uh, I can only share what I've, I've seen so far, and I'm sure the situation, uh, is changing, and, you know, maybe after I say it, like many people will reach out and say, “Hey, what about this?” And you don't know that, and then, then we'll be probably right. But what I've seen is auto research is very good at doing kind of obvious things that you don't have bandwidth to do or you didn't notice or maybe you're not aware of like the-- some standard practices.It is not good at doing something completely out of distribution, something that, you know, you have to think for, for multiple days, uh, and, and do something like none of this. So, so it's, uh, I, uh, set an experiment once, uh, on, on my sort of, uh, hobby thing, and I let it run for, uh, ended up, uh, several weeks run, uh, you know, it's like full production kind of scale, so it, you know, slow runs and, and it ex-- it performed in the end, uh, over four hundred experiments, and only one was successful.I'm like, “Okay, that's, that's good.” But-[00:34:18] swyx: But it saved time.[00:34:19] Mikhail Parakhin: Yeah, I saved time. Like it, it was the, that thing. Yeah, if I, if I were doing four hundred experiments myself, my betting average, as I said, would have been much higher, I'm sure. But also, first of all, it would take me like three years to do four hundred experiments.And, uh, I didn't have to do them. Like the machines were just, uh, the price of electricity did that. So, and I got one improvement, uh, that in, uh, my, my-- Honestly, when I was starting that experiment, my thinking was to go and show that, “Hey, Andre, maybe you just don't know how to optimize.” And I was super smart because in, in my pro-problem, it was optimized for many years, and it was like fully improved.Uh, and I didn't expect it, you know, auto research to find anything at all. Yet it did. So instead of making fun of Andre, I ended up, uh, a big, big supporter. Yeah, that's exactly the tweet. Yes.[00:35:10] swyx: You and Toby really, really go back and forth on-online a lot, which is really funny. Uh, think of it as, as an eval for the optimalness of the code it's running on.Uh, it's almost like it reminds me of like a Kolmogorov complexity thing, but, uh, I guess it's-- there's some optimal thing that you're trying to sort of reduce down to, I guess. Um, and so, so you, you, you know, you should congratulate yourself that you had, uh, you know, uh, ninety-nine percent, uh, optimality.[00:35:36] Mikhail Parakhin: Exactly, yeah. I think Andre really deserves a lot of credit for popularizing this approach. This is, uh, this is incredibly, I think, powerful and cool and You know, the, uh, even him, him just mentioning it led to a lot of gains in a lot of places in the industry, so we should be thankful.[00:35:56] swyx: Yeah. I think he also has a just...I don't know what it is. Like, um, you know, it, it is a simple self-contained project that people can take and apply to other things, which is, is, is one thing, but also just the name. Just like somehow no one, no one managed to call their thing auto research. It's just naming things is very important. I think that that is mostly, uh, our coverage of Tango and, and, uh, Tangents.I think obviously, you know, there's a lot of, uh, ML infra at, at Shopify that people can, uh, dive into. We're about to go into SimGym, but before I do that, any, any other sort of broader comments around this whole effort? Like where is it, where is it leading to?[00:36:36] Mikhail Parakhin: As a segue to SimGym, like all those things start composing strongly.And, uh, you could see a huge unlock when you can look at each one of the tools and, and you see, oh, they're extremely useful. Uh, Tango is useful by itself. Auto Research is useful by itself. SimGym is useful by itself. If you combine all three, you create like synergetic effect. I think that's why we wanted to even, uh, cover them today is because this is something that if you go back even, you know, five years ago, would've been unthinkable.Uh, replicating that, uh, would, would be either incredibly costly or impossible, right? With probably thousands of people are required.[00:37:20] swyx: Well, we have serverless human, uh, serverless intelligence, right? Like, uh, so yes, you do have thousands of hu-- of, of intelligences, not just, not humans. And that's, that's close enough, right?Even if they're not AGI, they're, they're close enough to do the, the task that you need them to do. And, and, you know, that's, there's plenty for, for a lot of routine work, knowledge work. Okay, let's get into SimGym. Um, this is one of those things I, I was surprised to see actually it's apparently your, uh, one of your most popular launches, and I think something that, uh, I think Sim AI, I think Yunjun Park, who did the Smallville thing, there's a very small cottage industry of people trying to do like the simulate customer thing.I think a lot of people maybe don't super trust this yet because they're like, well, obviously they would just do what you prompt them to do, right? But maybe just think, uh, tell us about the sort of inspiration or origin story.[00:38:10] Mikhail Parakhin: That's exactly actually the thing I wanted to cover, because if you don't have the historical data, all you can do is prompt a-agents in a vacuum, and they will do exactly what you prompt them to do.In fact, when I first proposed it, and this is a bit of, um, my brainchild initially, if I, I can boast, even Toby said like, “But wouldn't they, they just repeat what, what you tell them?” And, uh, but I'm like, “Yes, except Shopify has decades of history of how people made changes and what there is, uh, there, what it resulted in terms of sales.”So now what we can do is we can-- we have this... It's not, it's a noisy data. There's a small, usually websites, uh, you know, like things, things are never in isolation. It's almost never AB experiment. It's always AA experiment when there's has two meanings, but basically, you know, in different time you run two different things.But if you aggregate in general, uh, like everything together, and you apply, uh, denoising and collaborative filtering like approach, you can extract a very clear signal. And then you can optimize your agents. And that's why it took so long. It took almost a year of that optimization of just us sitting and fiddling, and, and we had this internal goals of correlation of hitting-- internal goal was to hit zero point seven correlation with, uh, add to cart events, for example.Like that, that if we run real AB test experiment, that it should, it should go and, and rep-uh, replicate, uh, same sort of success that, that humans had or lack thereof. And it, it took forever, and I don't think that's easily replicatable because, uh, like who else would have that data? You have to have this historic, you know, decades, uh, worth of data.And now, now the, like the other thing you need is in-infrastructure and the scale, right? Because, uh, w- again, what we found, uh, stat sig results, you need to run a lot of simulations, a lot of agents, and, and it's-- Those are expensive things. Like you're, you're making actions in the browser because you want a real friction.You want to, to be able to get the image like of what humans will see because you wanna, uh, detect effects like, “Hey, if I make my images larger, will I have more sales or l- uh, fewer sales?” And like usually people's intuition here, by the way, is that I increase my images, I will have more because they look nicer.You know, designers all look sparse and big images. Like usually your sales tank, right? But, but, uh, you know, from HTML, all the characters look the same only the, the size tag looks different, right? So it's very hard. So you have to take visual information, you have to run this in simulated browser environment on the big farm and, and of course, you have to have, uh, like very, very expensive model, good model with multi-model model.So all this it's-- is what's taken so long and, uh, to share my personal fail a little bit there, Sean, is like, you know, we always had this bias to-- for like large company bias. You know, we always, uh, whenever you-- we do, we're like, “Hey, we'll run an experiment,” right? We make, make a change, and we will run an experiment and then, uh, see, uh, see which one's better or like, “No, this is worse,” and most of them are worse, so you discard it and keep iterating, hill climbing.And we're like, “Oh, like smaller merchants, they cannot get stat sig results. They cannot really run experiments simply because, you know, in a week there would be not enough data for them.” So we thought from this perspective. What we didn't realize is that most people don't have A and B, they just have one thing, and they need suggestions of What A and B should be.So, uh, we first build this, hey, we run simulation on two separate teams and, and, uh, say, “Hey, which one is better?” We then morphed it into, and very recently just released it, when you have just your site, your theme, we run over it and we say, “Hey, here's what predicted values of, of, uh, uh, conversions are, and here's how we think you should modify it to increase your conversions.”And then circling back to what you started with, the proof is in the pudding. Like, if we are not correlating with reality, like, people will not be using it. And, uh, thankfully, we see literally every day more users than the previous day. So, so right now, uh, right now- It's working. Yeah. I'm-- Right now my problem is how to pay for it all because the so our major thing is how to optimize the LLMs, do distillation, how to run the headless browsers, uh, and handful browsers, uh, uh, cheaper so that we can accommodate the increase in traffic.[00:42:47] swyx: Yeah. I, I understand that you, uh, you published a lot of technical detail at GTC, so I was just gonna bring it up a little bit. I think s- was this in, in con-conjunction with some kind of GTC presentation? Or something like that, right?[00:42:59] Mikhail Parakhin: Well, we, yeah, we, we did it in several place, but yeah, we had the engineering- Yeahblog, uh, as well. Yeah.[00:43:05] swyx: Yeah. So you're running, uh, GPT OSS. Uh,[00:43:08] Mikhail Parakhin: the, this is an older version. You know, now we run multimodal model. But yeah- Yeah ... GPT OSS, we still run GPT OSS as well for[00:43:15] swyx: And then you have the VMs, and you also have browser-based. I really like this one where it you said, “It violates almost every assumption that standard LLM serving is designed for.”And then you had like, basically orders of magnitude differences between everything.[00:43:29] Mikhail Parakhin: Exactly. Which is, which, uh, which was, you know, a bit of a challenge to implement, like when, like even simple things. Uh, be- since it violates all the assumptions, for example, multi-instance GPUs, like MIGs don't work as well.But we needed, uh, to get MIG to work because, ‘cause otherwise it's way too expensive. And so we had to deal with the, yeah, with, uh, lots of infrastructure and, and, uh, work with, uh, uh, Fireworks and CentML, uh, you know, to help with optimizations and browser-based, as you mentioned. Yeah, like, takes a village.[00:44:04] swyx: Okay. So there's a lot of like, I guess, experimentation in the infrastructure so far, and you've published more or less what you have here. I guess I'm, I'm less familiar with CentML. I, I don't do, uh, that much work in this, this part of the stack. But why was it the sort of preferred instance platform?[00:44:22] Mikhail Parakhin: There are really three probably top companies. There used to be, uh, uh- Three top companies, uh, at least I was aware of that did, uh, LM optimization. You know, together Fireworks and Santa ML, not necessarily in that order. Santa ML recently got acquired by NVIDIA. Uh, what they did is if you have a model and you want to optimize it to a specific prof-- uh, profile of usage, uh, they would go and do it.And, uh, we work with, with those companies, uh, this was work particularly in with Santa ML and NVIDIA to get them the best possible results out of it. And, and sometimes you, you have to retune depending on, like sometimes you want the maximum throughput, sometimes you want minimal latency, sometimes you want like the cheapest, right?And, yeah, or some combination. And so yeah, these are people who would come and help you.[00:45:14] swyx: I see. I see. Yeah, yeah. I'm familiar with these people for the LLM, you know, autoregressive stack. But the other interesting category of these optimizers is also the diffusion people, whereas like Fel and, you know, uh, Pruna recently has come up a lot as well, which I think is like really underappreciated, uh, at least by myself, because I, I thought, oh, all the workload would be LLMs, but actually there's a lot of diffusion as well.[00:45:38] Mikhail Parakhin: Exactly.[00:45:38] swyx: There's a lot here, so I, I, I... it's, it's, uh, it's, it's, it's hard to cover. But I, I do think like people underappreciate the importance of customer simulation, basically. I think this is something that I'm candidly still getting to terms with. Uh, you know, uh, you also-- your team also like prepared this, like, really nice diagram.Uh, I, I assume this is AI generated.[00:46:00] Mikhail Parakhin: Yeah, it looks-[00:46:01] swyx: Maybe it's not.[00:46:01] Mikhail Parakhin: Yeah, it looks, uh, Gemini-ish. Yeah, but, uh, uh, honestly, I, I don't know where, where the hell they generated. It looks, look, uh, looks like it's, uh, Google. But the interesting part, John, that, that, uh, we haven't covered, but I, I wanted to mention is if your store had previous customers, rather than it's a new store, you're like new merchant just launching things, it helps tremendously in just correlation and forecast.Yeah, we take your previous, uh, customer's behavior, and we create agents that replicate those specific distribution of, of customers that you get, and then we a- we apply those to your changes, and then that, that raised raw, you know, the re-- uh, just correlation with the add to cart events or to-- with conversion or whatever it, it, it may be, uh, quite dramatically.So, uh, replicating humans in general seems like an interesting, cool challenge.[00:46:58] swyx: As a shareholder, I think this is the-- like if people are Shopify shareholders, they should really deeply understand this because this is basically the moat. The, the more you use Shopify, the more it will just automatically improve, right?Like you're, you're doing the job for them.[00:47:13] Mikhail Parakhin: Yeah, that's what we started with. Like, uh- ... uh, otherwise, if you're just a startup, I wouldn't do it if, uh, you know, if it was my startup because Without the data, it, yeah, as, as you said, it's, it's exactly the case that, uh, whatever you say in prompt, that's, that's what the agents will be doing.[00:47:30] swyx: The statistician in me wants to like really satisfy the sort of, um, statistical intuition, I guess. Um, to me it's kind of, uh, the, the word that comes to mind is, um, ergodicity. Uh, so let's say a, a customer takes this path, customer takes this path, customer takes this path, right? Um, the... In my mind, the way I explain it is like, okay, here, here's the ninety-five percentile, here's the five percentile, and here's the median, right?Um, but to me, what SimGym is potentially doing is that it can, uh, modify... It can sort of model the sort of in-between sort of journeys as well, that, that maybe are dependent on the previous states. This may be like a very RL-type conclusion where like basically the summary statistics, if you only did naive AB testing, you only have the, the statistics at, at, at a certain point, and you only judge based on the sort of overall summary statistics.But here you can actually model trajectories. Does that make sense? Or-[00:48:31] Mikhail Parakhin: That makes total sense because like, well, that, that makes even more sense that maybe even you realize bec- because-[00:48:38] swyx: Okay. Please,[00:48:38] Mikhail Parakhin: please. Yes ... we do-- Yeah. The, so internally, uh, we have this system, we talked about it briefly once at NeurIPS.We have a huge HSTU-based system that models the whole companies, uh, and their possible paths. And like- Yeah ... what you are, what you are showing, like actually at any point of time, you can either model the user's behavior or you mo- can also think about, uh, the whole merchant as a company, as the entity that acts in the world.You can model that as well. And then you can do, can do counterfactuals. In your graph, like in your blue graph, uh, if you're... Imagine in the center there, uh, somewhere in the middle, you would have an intervention. I give that person a coupon, or I don't know, I send a personal thank you card, or give a discount in some- somewhere.And then you can, uh, then you can do forward rollouts from that counterfactual. So what would have happened with that intervention or without the intervention? And you can even ch- change where that intervention, uh, in time can happen, right? Like some- where, where in this journey. So we, we do this at the Shopify scale for our merchants, and then if we notice that something that they can be fixing, like there's a strong counterfactual, like we have Shopify policy, they basically get a notification like, “Hey, we think your...something is wrong with your-” I don't know, Canadian sales. Like, uh, it looks like it's misconfigured. Here's what you need to do. Or do you think like, uh, you have to set up this campaign with these parameters? And we do that at the buyer level to literally offer discounts or cashback or, or things to buyers.So this is-- I'm getting very excited. Like this is my sort of area of, uh, interest, I guess, and, and hobby. But being able to m-model something complex as human beings or companies and model counterfactuals on it, where you can have interventions in the future and optimize when to make intervention, what kind inter-- uh, what kind of intervention to make.It's such an unlock that previously was completely impossible. Like the-- it was, it was always dreamed of, but never... Like how would you even simulate it without LLMs or HTUs? I think very, very exciting times.[00:50:59] swyx: I just wanted to, uh, to maybe illustrate this. I, I'm not the best illustrator, but I, I am a conceptual statistics guy.And y-you know, you cannot just do this. Like this is a dimensionality AB test doesn't do, right? Like, uh, because it doesn't have the, the, the change over time, uh, stochastic nature, uh, and it doesn't have the sort of contextual like... Here's all the context to this point. Um, okay, cool. Um, that's SimGym.You're, you're gonna burn a lot of tokens on this thing. But you're, you're one of the, the only scale platforms in the world that can, uh, that can do this across a huge variety of workloads, right? I'm even curious on a sort of human, uh, research level of like, well, do, does retail behave d-differently from like clothing sales?D-does that behave differently from electronic sales? I, I don't know. I don't know what else you guys... The Kardashian shoppers, do they differ from like people who buy, uh, I don't know, cars and, uh, whatever.[00:51:55] Mikhail Parakhin: Well, very different, and different sensitivities and different modes of, uh, shopping and, and different levels of what's important.Now, to-totally, you can do aggregations at, uh, at a store level. You can do aggregations at a different, uh, category level. I don't know if, uh, you know, for our statisticians among us, I couldn't believe, but we-- recently we're looking at it, and we had to bring back, uh, CRPs, you know, Chinese restaurant process.It's a, like, way of aggregating and, like, naturally grow clustering. So across... Specifically to answer questions that, uh, like you were just posing on how, how if, if buyers behave different categories. And I'm like, “I haven't seen CRP since two thousand and one.” It's[00:52:37] swyx: so What? It's so- What is... No, I haven't, I haven't seen this.No. This is not in my training. Uh,[00:52:44] Mikhail Parakhin: but, but yeah, it, uh, uh, it actually, like the, the-- there was a very popular kind of theory, popular neurips HTML circles in early two thousands, uh, kind of nice. And now, now it has practical applications, uh- Yeah ... that we were resurrecting.[00:53:03] swyx: Yeah, amazing. Uh, I, I can see, I can see how this is like a, uh, a fun job for you where you get to apply all these things.Um, yeah, yeah, so super cool. Super cool. So, okay, so, so anyone who, who knows what CRPs are and has always wanted to use them at work, uh, they should, they should definitely join Shopify. Okay, so w-we have a lot and but I, I'm, I'm being mindful of the time. I, I do wanted to, to sort of cover some other things.Um, I-I'll give you a choice, UCP or Liquid?[00:53:30] Mikhail Parakhin: Liquid. I think, I think on UCP, you know, like UCP is very important for us and, and it just we are-- UCP, we have a structured, uh, discussions, and you can read about them, and we have, uh, blog posts, and we have a big release this week, in fact, like with our catalog.Oh,[00:53:46] swyx: okay.[00:53:46] Mikhail Parakhin: Uh, yeah,[00:53:46] swyx: but- Le-I mean, we, we can, we can discuss the, the, the release briefly because we'll release this after the-- after it's already announced so whatever. There's a catalog that you guys are doing?[00:53:55] Mikhail Parakhin: Yeah. So we are, we are- Okay ... we are bringing in capabilities of a whole, uh, Shopify catalog.Basically, you now you can search for products, you can do lookups by specific ID, you can do bulk lookups when you need to bring m-multiple products. You don't need to know in ad-in advance what you're trying to show or to sell or check out. Like, you can now, you can now have this decided at, at runtime, and this big area for investment for us for both non-personalized and personalized searches, trying to provide basically a win-window into whole universe of products that are being sold everywhere in the world.And Shopify is really not exactly, but almost like a super set of any-anything being sold. Now we are bringing it into UCP and, uh, and, uh, identity linking is another big thing for us, uh, so that you, you can use, uh, like Google or whatever, whatever identity you have, uh, they're minimizing friction.[00:54:56] swyx: Yeah. So[00:54:57] Mikhail Parakhin: yeah, big release for us.But Liquid AI of course we never talk about, and the problem might be more, more aligned with what we d-discussed previously on this chat.[00:55:07] swyx: Sure. The main thing that everyone understands about Liquid is that it is inspired by Worm, and I still don't know why. I'm curious on your explanation. I think you, you, uh, you can make things very approachable.And also I think like what is the potential of like the, the level of efficiency that you get out of Liquid?[00:55:23] Mikhail Parakhin: You- we all familiar with transformer architectures. And, uh, for the longest time, there was a competing architecture, it's called the state space models. So, so Sams, uh, you know, Chris, Chris Reyes, one of the pioneers and, and lots of startups, uh, trying to make those realities.They have, uh, significant benefits being main being, uh, being much faster and, uh, lower footprint and not quadratic in length, you know, sort of, uh, linear in, in, uh, in your context length. But with state space models- They never quite made it. Like they're used-- They have, uh, certain niches when they thrive, their hybrid architectures are useful, but they never quite made it.And liquid neural networks are, you can think of them as a next step, like, uh, sort of, uh, state-space model square. It's non-transformer architecture that's more complicated than sta-state space and really difficult to code if you-- if I'm being honest. But it's, um, very efficient. It's, uh, subline-- sub, uh, quadratic in, in length of your context.Uh, it's very compact way to represent things, and that's a liquid AI company. They... Their goal is to productize it, and very often you have this need, uh, when you need to have long context and small model, and you want to have low latency. Like in general, it's basically on par with transformers, and if you do hybrids with transformers, it's, it's even better.That's why we at Shopify, when we tried multiple and we constantly try multiple models, multiple companies, we found that for small, particularly with low latency applications, when you have low latency and/or if you need longer context lengths, liquid was the best. And so we still use the whole zoo and always like obviously test and use everything, uh, every open source model and, you know, it feels l

After 25 years of experience as a financial advising professional, my phone-in guest today is Jeffrey Panik, MSFS, CFP, CRPS who's received the Five Star Wealth Manager Award for ten years running is the Managing Principal, Financial Advisor at Balance Wealth Partners. Jeff knows his job is to help clients strike a balance between living well today and planning for the future. In fact, Jeff Panik founded Balance Wealth Partners with a simple goal in mind: to create tailored plans for intentional living. He is the author of two Books: Your Future is Now (An Introductory Guide to Managing Your Finances) and Your Future Is Now (Your Blueprint for Solving your Retirement Puzzle). balancewealthpartners.com Sageintl.com or 800-254-5779

If you've ever felt stuck in patterns you can't explain, this episode will hit home. In this conversation, Lyndsay Soprano sits down with Matt Johnson to unpack how much of our lives are actually being run by the subconscious mind and how trauma quietly shapes the way we think, feel, and respond.Matt shares how tools like NLP and hypnosis can help uncover and release emotional baggage that's been sitting beneath the surface for years. They talk about the real reason willpower alone doesn't work, how the body holds onto past experiences, and what it takes to actually create lasting change.This isn't about surface-level mindset shifts. It's about understanding the root of your behaviors and learning how to work with your mind instead of against it. They also touch on the importance of self-care, especially for those who are constantly showing up for others, and how small shifts in awareness can start to change everything.If you're dealing with chronic pain, emotional overwhelm, or patterns that keep repeating, this episode offers a different way to look at healing—one that starts from the inside out.Tune in to this bonus episode if you're ready to stop feeling stuck and start understanding what's really driving your life.Episode Highlights:(00:00) Introduction to The Pain Game Podcast(08:25) Rethinking PTSD Beyond Just Soldiers(11:40) What NLP (Neuro-Linguistic Programming) Actually Is(15:53) How the Subconscious Influences Chronic Pain(21:02) 95% of Daily Behavior is Subconscious(26:39) Healing Unresolved Trauma at the Root(32:08) The Body Keeps the Score and Its Impact(34:10) Insights from a Berkeley Study on Mental Health(36:08) The Ongoing Work of Healing(37:09) Transformation is Possible When You Refuse to Give UpFind Matt Johnson Online Here:Website: mattjohnsonnlp.comInstagram: @mattjohnson7455Facebook: Matt JohnsonLinkedIn: Matt JohnsonYouTube: Rewire and Rise with NLPFind The Pain Game Podcast Online Here:Website: thepaingamepodcast.comInstagram: @thepaingamepodcastFacebook: The Pain Game PodcastLinkedIn: Lyndsay SopranoYouTube: The Pain Game PodcastSubscribe on YouTube | Merch Shop is OPEN!! | This Is More Than a PodcastUnfiltered convos. Dark humor. Real healing.This is where pain meets purpose — and you're not doing it alone.++Want to be a guest on The Pain Game Podcast with Lyndsay Soprano? Send her a message on PodMatch, here: Be a Guest on The Show

Send us Fan MailWe connect an Easter-season question to a real anesthesia fact: propofol is formulated with egg lecithin from egg yolk, and that doesn't automatically mean people with egg allergies can't receive it. We also break down why propofol safety depends on monitoring and dosing, then pivot to a listener question on CRPS and a practical look at multimodal pain control and long-term opioid risks. Have a question for Dr. Brian Schmutzler? Submit them to any of the social media pages below or on his website at https://www.drbrianschmutzler.com/Facebook: https://www.facebook.com/drbrianschmutzlerInstagram: https://www.instagram.com/drbrianschmutzlerTikTok: https://www.tiktok.com/@drbrianschmutzler?lang=enProvider or Medical Student?? Subscribe to his Patreon Page to get exclusive content and access to Medical Blocks:https://www.patreon.com/user?u=89356957&utm_medium=clipboard_copy&utm_source=copyLink&utm_campaign=creatorshare_creator&utm_content=join_linkThanks to our show sponsor: Butterfly Networkhttps://store.butterflynetwork.com/us/en/?rsCode=BRIAN25Get $750 off the latest iQ3 at ButterflyNetwork.comSupport the show

In this episode, I had a pre-conversation with Melody Woolf, whose journey with chronic pain and becoming an advocate for plant and herbal treatments to help people with chronic pain. Her story of how she went from having pain in her hand to not being in pain, to the point of being temporarily paralyzed for eight years, to now being able to walk again with less pain.  She went from using multiple prescription drugs to using a plant called Kratom that has helped her with chronic pain. She spoke about how she became an advocate for kratom as far as being used to help people with chronic pain, MS, CRPS, and more. With over a decade dedicated to advancing consumer rights in the botanicals sector, Melody's path is both personal and pragmatic. After spending eight years bedridden with chronic pain, her recovery through plant-based solutions propelled her into legislative advocacy for medical choice and government accountability. Melody's recent role as the key patient-advocate speaker for the U.S. HHS & FDA press conference on botanical safety, sharing the stage with figures such as Secretary Robert F. Kennedy Jr. and FDA Commissioner Dr. Marty Makary, highlights how her lived experience intersects with national policy. She has testified at a U.S. Congressional briefing on kratom, been a featured presenter at the National Conference of State Legislatures, and engages weekly with legislative bodies and health councils across the country. With practical knowledge backed by ongoing collaborations with policymakers and scientific experts. She is now tackling the rising barrier of social media censorship in public health discussions. She talked about Kratom, as far as the pros and cons of the plant, as well as why the FDA won't approve the plant to be used in America. I learned a lot in the pre-conversation about Kratom, and I had to post this conversation. I can't wait for her, and I do the actual podcast conversation.Become a supporter of this podcast: https://www.spreaker.com/podcast/a-happier-you-leads-to-a-healthier-you--5161886/support.This episode includes AI-generated content.

Long-Term Effects of Brainstem Stroke: The Hidden Deficits No One Talks About Ty Hawkins was taking engagement photos with his wife the same day he was admitted to the ICU. That sentence alone captures something essential about brainstem stroke, and about the particular cruelty of its long-term effects. On the outside, Ty looked like a young man in love, celebrating a milestone. On the inside, his vision was blurring, his balance was failing, and one side of his face had begun to droop. By nightfall, he was in the hospital being told they had found a mass on his brain. That was June 2019. Ty was in his mid-twenties, working in sales at Verizon, playing competitive basketball, and building a life with the woman he was about to marry. The stroke caused by a bleed from a cavernous malformation in his brainstem carried a 25% survival rate. Of those who survived, only 10% made a significant recovery. Ty is now approaching year seven. He returned to work. He speaks publicly. He shares his story with a global audience that finds him through social media and reaches out to tell him he helped them keep going. And every single day, he still wakes up managing deficits that most people around him cannot see. What the Brainstem Controls — And Why Its Damage Lingers The brainstem is not a dramatic structure in the way the cortex is. It doesn't govern language, memory, or personality in ways that are immediately visible to an observer. What it governs is more fundamental: breathing, heart rate, digestion, balance, coordination, and the relay of sensory signals between the brain and the body. When a bleed occurs in the brainstem, as it did for Ty through a cavernous malformation, a cluster of abnormally formed blood vessels, the damage disrupts those foundational systems. The effects can be wide-ranging, deeply personal, and stubbornly persistent. They can also be almost entirely invisible to anyone who isn't living inside that body. For Ty, the long-term effects of his brainstem stroke include ataxia, double vision, gastroparesis, CRPS, and left-sided numbness and weakness. None of these are visible when he walks into a room. All of them shape his daily experience in ways that most people, including many in the medical system, never fully appreciate. Gastroparesis After Stroke: The Deficit Nobody Mentions Of all the long-term effects Ty lives with, gastroparesis is perhaps the least discussed in stroke recovery conversations and one of the most disruptive to daily life. Gastroparesis is a condition in which the stomach empties too slowly or incompletely, caused by disrupted communication between the brain and the vagus nerve. For Ty, this means the digestive signals that most people take for granted, hunger, fullness, and discomfort, are unreliable. He can eat three bites and feel as though he has finished a six-course meal. He can go hours without a hunger signal and needs to eat by clock rather than by sensation. When his nervous system is overwhelmed, his digestive system slows or stalls entirely. Gastroparesis after stroke is not a fringe experience. The brainstem governs the vagus nerve, which in turn governs gut motility. A brainstem stroke can interrupt that pathway in ways that create persistent digestive dysfunction, yet it rarely features in the standard conversations about stroke recovery. Survivors can spend years not understanding why their digestion is erratic, not connecting it back to the stroke, and not receiving targeted support. Ty found that movement and routine helped regulate his system. A morning sauna, regular exercise, and starting the day with warm tea and light fruit rather than a heavy meal gave his digestive system conditions in which it could function more predictably. These are not medical solutions, they are adaptive strategies built through seven years of learning his own body. CRPS and Ataxia: When the Nervous System Won't Stand Down “My daily pain level is a four or five. Someone not used to chronic pain would call it an eight or a nine.” — Ty Hawkins Complex Regional Pain Syndrome (CRPS) was misdiagnosed in Ty for several years as neuropathy. It presents as the brain becoming stuck in a fight-or-flight pain loop, sending persistent, amplified pain signals in response to stimuli that should not be painful at all. For Ty, this means clothing fabric can register as pain. Cold bed sheets can spike his discomfort through the roof. Water on his skin can hurt. Ataxia compounds this by disrupting muscle coordination when his nervous system becomes overwhelmed. His gait changes. His shoulder shakes when lifting overhead. Coordination that was once automatic, honed through years of competitive basketball, becomes unreliable when fatigue, overstimulation, or stress tips his nervous system past a threshold. Both conditions are neurological in origin. Both are invisible to the outside observer. Both require constant, conscious management. The Athletic Mindset as Recovery Infrastructure What gave Ty the internal architecture to manage all of this? He credits his coaches. Years of athletic training being pushed past comfort, being held to a standard of effort regardless of natural talent, learning that showing up and doing the work was non-negotiable, built in Ty a psychological framework that translated directly into rehabilitation. In the inpatient facility, he was wheeling himself to therapy sessions before the nurses came to collect him. After the first week, they stopped coming. They knew he would already be there. As the doctors noted during his rehabilitation: he was recovering faster than expected, and they attributed it directly to his athletic background. Not his talent. His work ethic. The Emotional Cost of Looking Fine Perhaps the most underappreciated long-term effect of Ty's brainstem stroke is the one least visible of all: the emotional toll of presenting as healthy while carrying a daily invisible burden. For years, Ty's type-A, athletic identity kept him moving forward, but it also kept him from fully acknowledging what he was carrying. It took until years three or four before he genuinely engaged with psychotherapy. Once he did, the progress he experienced was significant. He now starts every Monday with a therapy session. The shift that mattered most was learning to honour how he actually felt rather than how he wanted to feel. For male survivors in particular, the cultural conditioning to tough it out is deeply ingrained and actively harmful in the context of long-term stroke recovery. Emotional suppression does not make the load lighter. It makes it invisible to everyone, including the person carrying it. Recovery Has No Expiry Date Ty's most direct message to survivors is straightforward: don't limit your recovery to the first year. The brain does not set a deadline on neuroplasticity. He is approaching year seven and still noticing improvements. The triumph of this story is not that Ty is symptom-free. The triumph is that he has built a life of genuine meaning and contribution around an ongoing physical reality without pretending that reality doesn't exist. He's reached people on every continent with a message that is simple, honest, and badly needed: You can survive the statistics. You can carry the hidden weight. And you can keep getting better years after everyone else assumes the story is over. If you are navigating your own stroke recovery early or years in, Bill's book is a practical and honest companion for the journey: recoveryafterstroke.com/book And if the Recovery After Stroke community has been part of your path, consider supporting the show on Patreon: patreon.com/recoveryafterstroke This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. Ty Hawkins: Six Years After a Brainstem Stroke, Still Fighting the Battles You Can't See He survived a 25% chance brainstem stroke. Nearly 7 years on, Ty Hawkins reveals the hidden deficits that never made the headlines until now. Instagram Facebook LinkedIn Highlights: 00:00 Introduction: Long-Term Effects of Brainstem Stroke 05:54 The Day of the Stroke 11:35 Hospital Experience and Diagnosis 15:44 Mindset and Recovery 21:46 Therapy and Rehabilitation 24:25 Long-Term Effects of Brainstem Stroke 32:58 The Importance of Exercise in Recovery 38:21 Living with CRPS: A Daily Challenge 50:29 Emotional Resilience and Mental Health 01:01:28 Lessons Learned: Recovery Insights for Stroke Survivors Transcript: Introduction: Long-Term Effects of Brainstem Stroke Ty Hawkins (00:00) as I’m sleep. have a dream and It’s just I’m in a dark place and I just hear a voice and it says do you trust me and? I said well Absolutely, it said okay. Well, we have to go and I immediately wake up and I tap my wife and I say hey we should go to the hospital now and Then I go to the hospital so by day I’m taking engagement photos and by night. I’m in ICU immediately taken to the for a CAT scan and chest x-rays. Bill Gasiamis (00:30) Before we get into today’s conversation, I wanna take a moment to acknowledge something that I think a lot of people in this community quietly live with. The feeling that your looks finished to everyone else, but you know the real story. You’re still managing things every single day that nobody around you can see. If that’s you, this episode is going to hit home. My guest today is Ty Hawkins. Ty had a brainstem stroke in June, 2019. caused by a cavernous malformation, a bleed that carries a 25 % survival rate. He made it, he went back to work, he plays basketball, he looks great, and he is still nearly seven years later managing gastroparesis, CRPS, ataxia, and daily chronic pain that he rates at four or five, which he says most people would call an eight or nine. This is a triumphant story, not because every deficit is gone, but because Ty built a life of purpose and meaning around the ones that stayed. We’ll get into all of that in just a moment. Now turn2.ai is your AI health sidekick that keeps you up to date with personalized stroke recovery information each week. There are literally over 800 new things published every week on stroke. Turn2 searches everything new from the past week and sends you what’s most relevant, research, patient discussions. expert comments, trials and events. You can try for free and get 10 % off by scanning the QR code on the screen or clicking the link in the description below. And if you haven’t picked up a copy of my book yet, it’s available now at recoveryafterstroke.com/book. And now let’s get into the conversation Ty. Bill Gasiamis (02:13) Ty Hawkins, welcome to the podcast. Ty Hawkins (02:15) Thank you for having me. Bill Gasiamis (02:17) Thank you for being here. This is the second time we’ve tried to connect and have you on the show. Last time, if I recall correctly, you won an award or you graduated from somewhere. Ty Hawkins (02:30) I believe I had one either had a speaking engagement or I won an award where I wasn’t able to attend our our interview Bill Gasiamis (02:42) Yeah, what was the award? Do you recall? Ty Hawkins (02:47) That was a few years back. I don’t really recall offhand. I know there was a lot going on with me mentally at that time too. So I don’t really recall what it was. drawing a blank right now on that one. Bill Gasiamis (03:01) Yeah, fair enough. I do remember it was at least 12, maybe 18 months ago that we tried to connect. But that’s cool that you’re here now, man. Thanks for reaching out again. I was just going to ask like, what was your life like before the stroke? What were you up to? What was your regular day like? Ty Hawkins (03:21) So for me what I was up to both prior to my stroke I was really locked in and focused on my career. So I graduated college or university in 2015 and I was well into my career with Verizon here in the States and So my my day-to-day look pretty much like work and I was spending a lot of time just playing basketball because I played in college. So I was trying to, you know, ⁓ still keep up with the athletic side of me while getting my career off the ground. Bill Gasiamis (04:01) What kind of work did you do for Verizon? Ty Hawkins (04:05) So his Verizon, was at that time while I’m still in sales currently, but at that time I had just started my sales role and immediate like right prior to I was a sales manager, prior immediately prior to my stroke. Bill Gasiamis (04:21) huh. What was it like the day of the stroke? Or actually just before you answer that question, was there any signs that you were unwell, that there was potentially something looming, you know, anything give it away before the stroke that now you think that was probably a sign? Ty Hawkins (04:40) Absolutely. So looking back and now having the education and the awareness of stroke, know I remember just having numbness in my left foot ⁓ that started and felt like a little pebble in my left shoe. And I would take my shoe off and shake it out and nothing came out. And I had no idea that it was actually like the feeling in my foot. and it started to move up my leg and eventually ⁓ from my foot up to my shin, actually I felt pins and needles ⁓ and my foot was actually numb and I experienced a lot of headaches ⁓ immediately prior to the stroke. So for weeks I was having, I would have little headaches that I just thought was stress related from work. Bill Gasiamis (05:38) to the, what you just explained about your foot. That’s exactly what happened to me. My left, my big left toe went numb and then my entire left leg went numb, but it took me a week to get to the hospital. By then my entire left side had gone numb. So how long was it before you decided to do something about your numb foot and shin? The Day of the Stroke Ty Hawkins (05:54) Mm-hmm. So ⁓ it may have been a few weeks, honestly. So I just pushed through and thought it was because of work and just stress related to work. it took about a week or so till it actually moved, till actually my leg went numb. And I remember one day vividly my wife tickled my foot, my feet, I was ticklish. And she went to tickle my, she tickled, tickle my feet and I jumped when she tickled the right foot but I didn’t budge at all when she tickled the left foot and so that was a sign I still pushed through and I went to play basketball and I took a shot that it was routine for me and I missed very bad and there were guys at the gym I thought I had vertigo maybe some something in her ear and the guys at the gym like hey man Something seems off with you. I want you to get checked out before we play again in a few weeks. And so I decided to make an appointment to see my neurologist or not neurologist, my primary care physician. And I went through a routine checkup and everything kind of cleared. And so I had a decision to make that I want to tell her what was going on with my body though my vitals were good. And so I told her and she ran some tests like poked poked my foot and just was touching my leg with different ⁓ textures and eyes open eyes closed and I can only I only knew that she was touching me if I could see her. So when I closed my eyes and she touched me, I didn’t I had no idea. And so she sent me to for MRI and before or not for MRI, she sent me to a neurologist. And the neurologist scheduled me for MRI for the next week and I was in the hospital the very next day. Bill Gasiamis (08:04) Wow, man. You had a brainstem stroke from a cavernous malformation. I had a stroke caused by a arteriovenous malformation, which is very similar kind of issue with the way that the blood vessels have formed. My one popped and then started to bleed like really, really slowly. It sounds like yours did something similar. So Ty Hawkins (08:17) AVM, correct? Bill Gasiamis (08:33) you’re going through this for a couple of weeks, you go and see the neurologist and the next day you’re in hospital, how dramatically did it escalate between the neurologist appointment and the next day? Ty Hawkins (08:44) ⁓ So it escalated very very fast so the next day I woke up and it was that my engagement photo shoot so what a day right and Bill Gasiamis (08:57) Wow. Ty Hawkins (08:58) I’ll go to the bank I take a five-minute drive from my house to the bank and what happened on my way back is just off I couldn’t explain what was going on I just had an all feeling so I told my wife I wasn’t able to drive to any of the other appointments that I had that day prior to our shoot and on the way to our photo shoot so things progress by minute by minute hour by hour So I started the day she noticed a facial droop and we had no ideas of the sign She looked at me. She said are you okay? Cuz your face and I looked in the mirror and it was it was slight but So didn’t really think much of it and I was excited for our shoot So I just pushed through and on our way the photo shoot location was at our University where we met and that’s about 40 minute drive from our house so as we’re progressing through the drive my vision starts to get blurry and I can’t I can barely make out the vehicles that are around us I can only make out the color and the color of the license plate so I know that something’s there but it’s so blurry that I can’t even couldn’t tell you what kind of what kind of vehicle it was we actually get to the location for the shoot I get out the car and I can barely stand upright so ⁓ I Remembered trying to move and I was just so all balance and and dizzy and We did the shoot somehow some some way I made it through the shoot and I remember changing my clothes and ⁓ As I look back now I went into the bathroom to change my clothes and I was alone and I could I kept Tilted to the right while was trying to put my clothes on and my shoes and as I think back I’m so lucky I’ll say I’m so blessed to have made it out of that bathroom you know I’m back to the group and We finished the shoot and I go we drop home So my wife says do you want to go to the hospital or I said no, I won’t go home and I just want to rest ⁓ so She goes and picks us up some food. I’m at home. I remember taking maybe two, three bites of the food and just feeling so nauseous. Like, man, I can’t even, I’m not even hungry anymore. And so I say, I’m gonna go and take a nap. If I wake up and I feel the same as I do now, we can go to the hospital. And this is where the story really gets. Hospital Experience and Diagnosis It’s going because in my dream or as I’m sleep. have a dream and It’s just I’m in a dark place and I just hear a voice and it says do you trust me and? I said well Absolutely, it said okay. Well, we have to go and I immediately wake up and I tap my wife and I say hey we should go to the hospital now and Then I go to the hospital so by day I’m taking engagement photos and by night. I’m in ICU immediately taken to the back with them saying whatever the stroke they felt that the stroke code was or what they call it in the hospital. And I was immediately taken back for a CAT scan and chest x-rays. Bill Gasiamis (12:31) Wow, man, that is a crazy story. ⁓ Firstly, how did the photos turn out? Ty Hawkins (12:39) photos they turned out good I would say in spite of the circumstances but if you look at the photos in as you know as well as we understand stroke you can look at my face and see the the facial droop in my top lip so as I’m trying to smile you my smile wasn’t wasn’t aligned it was it droops slightly so the right side of my face was impacted so I had a juke going to the right But I would say they turned out well despite the circumstances for what the circumstances were Bill Gasiamis (13:17) All things considered. Yeah. That is unbelievable. This dream like who now this is going to get trippy. I know like who was that in your dream that gave you that information. Ty Hawkins (13:30) So for me, at that time, I mean even now, I say it was God for me, speaking to me and letting me know that I needed to get to the hospital. And then at the hospital, when the doctor came in to give the news that they found what they thought was a mass on my brain, I remember hearing seeing a figure in the corner of my room and hearing that same voice say remember that I’m going to protect you and so from there you know I just tied it that that was God with me through through the stroke Bill Gasiamis (14:12) I love it that that was God with you, man. Why not? That is amazing. And that the person or that spirit or the being was in the room with you as well. Reassuring you. Wow. Ty Hawkins (14:22) Yes. Yeah, it was was crazy. remember so it’s time almost simultaneous the the doctor was coming in to give the news and he was The door was off-center to my left. So I see he he came in and The figure was in the corner to the right So as he comes in my wife is looking like he has bad he looks like he has a face of bad news so he mentions that there’s They found a mess and Simultaneously, heard me remember I’m going to protect you so as the doctor leaves I look at my wife and I say I don’t know how to explain this but I’m going to be okay and You know as destroyed as she was You know, that’s what I could say to her I couldn’t really explain it in that moment But I told her and ⁓ I knew that I was going to be fine Bill Gasiamis (15:25) Wow, man. So I had some moments when they gave me the news. I was at the hospital alone. It was probably 11 p.m. at night. It was a Saturday night. No, it was a Friday night. I’d sent my wife and the kids home because I didn’t want them to wait for hours and hours to find out the news, go home and rest and look after the kids. They were young teenagers, both of them at the time. And I was… Mindset and Recovery I got the news it was there’s a mass on your brain or a shadow on your brain that appeared in the scan. It could be a brain bleed. It could be a tumor and that tumor could be benign. It could be cancerous. That’s the way they broke the news. And I remember being kind of like, ⁓ okay, whatever. And I was so. I was so nonchalant about it. He says to me, do you have any questions? And I said, no, not at this stage. And I left it at that. And I basically just took the news, went to bed, had a bit of a sleep because the next morning I was going to wake my wife, her to come to hospital. I had to tell her the news and I did that. She came. And after I told her the look on her face was the first time that I kind of got a little bit scared. And then I had to ring. my client and tell my client I’m not coming into work today ⁓ because I’m in hospital and there’s something wrong with my brain I don’t know what it is and I start crying. But even through all of the drama, the three brain bleeds over two and a half years, brain surgery, walking, even through all of that and all the problems that it caused us, me, my family, my work, it never crossed my mind that I wouldn’t get through this or wouldn’t get over it or beyond it. Now I am still dealing with it. I still have a podcast that I have to do. because if I don’t do, I don’t get my therapy every week. But do you know, I’m moving through it, beyond it, overcoming it. I never believed for one moment that it would be the thing that stops me, defines me, even though I’ve had dark days, dark weeks, dark months, I always expected that it would shift and something would come out from the other side. I don’t know whether… ⁓ I would ⁓ allocate that to God or something else, but I truly deeply believe that like it was within me and maybe it was kind of God like type of experience, but I love how you’re in technically like the worst day of your life health wise, it could go one way or another and you’re just thinking I’m going to tell my wife everything is going to be fine and ⁓ We’ll just get through this. I think that is something that sort of set the foundation for how you were going to approach the whole entire recovery after that, this experience that you had. Ty Hawkins (18:40) Yes, I think that definitely set the tone. Having that experience and not… I never felt in danger. I knew that the journey, this process, wasn’t going to be easy. But I never felt that I was in danger. That my life was in jeopardy. the diagnosis and the statistics that show if you have a bleed in your brain stem that the percentage of survival is 25. So that’s one in four people that based on statistics that experience what I do one in four people survive. And then of those that do survive, they say that 10 % just make a significant recovery. And I never felt. that I was battling against those statistics each day that from the moment I got the news it was a cool calm collected call my mom, my brother and that’s what my wife did and you know I just tried to stay as composed as possible ⁓ because I never felt in danger and I didn’t want them to worry too much ⁓ you know I knew it was going to be be difficult because I went from One day running up and down the basketball court to being bedridden and barely could function. I couldn’t write. I lost the perception on size of writing. I couldn’t walk. ⁓ I forgot how to walk, though my body forgot how to walk. I could mentally think, hey, I want to take these steps and get up out of bed, but I needed help. So I spent a week in the hospital. I spent three weeks in an inpatient rehab facility. So as I mentioned It was the day of our engagement shoot so our wedding was set for three months later And that’s all I could really think about was I have to get ready for this wedding I have to get ready for our wedding. I have to get ready for our wedding. So every day I woke up ⁓ You know my athletic mind is up for the challenge ⁓ You know, God told me that I was going to be okay. And I knew that I had to show up and do the work when I was taught on the basketball court and just in life, you just have you show up and you, you, you battle back against adversity. And I decided that yes, like you, didn’t want this to define me. I didn’t feel that this was going to be the end of, of my life. ⁓ I knew that it was going to be a chapter that I would never forget, but I knew that I was up for the challenge. Therapy and Rehabilitation Bill Gasiamis (21:40) I love that athletic mindset, right? Your coach probably drilled you for years, know, like get up, get going, keep going, keep moving, push through, overcome, ⁓ try harder, you know, be more strategic, whatever, like the whole athletic mindset applied to stroke recovery. I reckon it’s such a massive, ⁓ like it’s such a massive benefit to have that going into a diversity, like recovering from a significant health. ⁓ situation because I know that there are players on the field who are not the best players but they are the most impactful because they do the most work and they get given labels like he’s a natural or ⁓ he’s gifted or stuff like that and it’s like dude I couldn’t I couldn’t walk straight when I was a young kid. The only reason why I appear gifted or natural is because I work all day every day. You classic Michael Jordan ⁓ kind of approach where Jordan talks about being ⁓ always training, always shooting hoops, always ⁓ on the basketball court more than anybody, even though he was Ty Hawkins (22:52) you Bill Gasiamis (23:00) Appearing to be kind of naturally gifted because of his body shape because of his athleticism because of his height But it meant nothing if he didn’t do the work every single day Ty Hawkins (23:12) Yes, yes, and even you know from a spiritual perspective There’s the saying that faith without works is is dead And so for me I had the faith and I knew that I needed that there was work work required of me I think even after ⁓ my experience of so as I mentioned I spent three weeks in the inpatient facility once I understood the magnitude and how much my Long-Term Effects of Brainstem Stroke mindset really helped me through. I reached out to a lot of my coaches and you don’t understand when you’re young how they’re, man they’re pushing me so hard, they’re pushing me so hard and I’m like well I’m glad that they pushed me this hard because because of that I felt prepared for the adversity that I faced in June of 2019 so you know I remember reaching out and just saying thank you for being as hard on me as you were because it helped me through this. Who would have known that years later that discipline that you were, that I thought as a young adult would, you know, thinking that you’re just being tough on me and it’s really building characters, building a mindset. And I grew to appreciate that as I started to reflect back on, you know, on my journey because a lot of the doctors said, You’re I feel that you’re recovering so fast because you were an athlete in I wasn’t just an athlete I worked hard my I took pride in like you said that Michael being in the gym and Just really working hard. It was one thing I said hey You might be better than me, but it’s one thing that you’re not gonna you might have more talent than me But you’re not going to outwork me and you know, that was my mindset Bill Gasiamis (25:03) Hmm. Ty Hawkins (25:06) with recovery, it’s every day. Once I understood what therapies that I would have to do. ⁓ So I remember in the inpatient facility, my first week there, the nurses would come clip my schedule to my wheelchair and they would come get me for therapy. After the first week, they would come clip my schedule to the wheelchair and they’d never, they wouldn’t come to get me because they knew that I was going to be wheeling myself down the hallway to get to whatever session, OT, occupational therapy, physical therapy, or speech therapy that I knew what time I needed to be there and I was going to be there because I was determined to get better. Bill Gasiamis (25:52) I to ask for permission to walk back to the therapy room ⁓ on my own because they were afraid I was going to fall and it was fair enough because my left side wasn’t really working well after about two and a half, three weeks I was on my feet but I still was quite unstable and they said, look, we’re not gonna let you walk alone. We’ll come, but we won’t help you like we have been helping you. We’ll just watch you walk. I was like, yes, do that. I felt safe, but also I had the ability to just get myself there. They had handrails down the hallway and everything that I could hold onto. But of course I went near them, tried not to hold on, held on when I needed to. I did everything I could to be on my feet on my own so I can get the brain getting used to being on this weird left side of my body, which is numb, tingly. and not receiving information that the foot was on the ground. Like the brain wasn’t being told your foot’s on the ground, man, you know, like step or tension muscle or do the stride or whatever. So I remember going through that and I remember complaining because I was spending too much time in my bed. And I was like, guys, like, what am I doing here? This is boring. And I need to get into a session. I need to do something. And they were, well, You know, we have to have lunch and we have to have other things that we attend to after I write reports on you and all that kind of stuff. You can’t be eight hours a day just in the gym or in the therapy room or whatever. And I’m like, ⁓ okay. I didn’t realize there was other technical things that happened in the background that wasn’t that was related to me, but not the as part of the physical stuff. So in, so instead what I did is I Ty Hawkins (27:38) Thanks, Ted. physical, yes. Bill Gasiamis (27:49) imagined myself exercising, I imagined myself walking, I imagined what it would look like when I was on my feet, etc. Because it rewires the same part of your brain as if you’re actually doing it. So I thought, right, if you’re not going to be with me, ⁓ taking me for the actual therapy, I’m going to imagine myself doing the therapy. Ty Hawkins (28:11) No, I was the same so For me, I didn’t so I couldn’t really Walk in the big the first the first week I spent a lot of a lot of the duration of my three weeks I spent in the in a wheelchair there, but I was able to in The first week I needed a lot of help moving from the bed to the wheelchair But after a while I could get myself out of bed into the wheelchair, will to therapy. That’s why they didn’t come because I wasn’t necessarily walking. But when I did walk, I would have a walker and they would use, somebody would be with me. And I was the same way. I’m like, man, I’m in bed a lot. I’m only in therapy for an hour and a half each session. neural fatigue really, could appreciate my breaks because I was so, that hour took a lot out of me. But as my body reacclimated to the workload that it was receiving, ⁓ I was able to stay awake a lot better and my mom would then take me outside to do extra things. We would play toss for my hand. ⁓ She would toss the tennis ball. It would help me walk outside a little bit. Bill Gasiamis (29:11) Yeah, same. Ty Hawkins (29:37) But just, you would help, RMOF would help as much as they could for me to get extra, ⁓ some extra time and extra movement in outside of just the hour and a half that I was in the therapy session. Bill Gasiamis (29:52) Yeah, I love that. My parents came along as well. said to my wife and everyone came past and I spent time outside with them, you know, having some time in the sun, a meal, a coffee, something like that. That was really helpful. I think you and I also both benefited from the fact that the bleeds, although really serious, were not catastrophic bleeds and we had a lot of time to react. to our situation that we found ourselves in. I took seven days, you took weeks. And I think that was just pure, utter luck that the bleed was a little small enough to start impacting us in a very small way that we thought was not significant and not at risk of our health. And also we both benefit from looking like we haven’t had a stroke. No one can tell that you would have or I’ve had a stroke, but you are. Ty Hawkins (30:23) Please hit. Yes. Bill Gasiamis (30:47) also still though like me living with deficits right and you’ve got a few of them let me just read out the list you’ve got left-sided numbness and tingling which i have and weakness which i have but you’ve also got ⁓ a taxia which you’ll tell me about in a minute double vision ⁓ you’re going to also tell me about gastroparesis and crps so for someone that is so upbeat Ty Hawkins (30:51) Yes. Bill Gasiamis (31:16) looks like you do ⁓ like you haven’t had a strike, etc. You are experiencing some ongoing deficits years out. So first, tell me a little bit about a taxia. What’s that? Ty Hawkins (31:24) Yes. So ataxia is, impacts the muscle coordination. So when my nervous system gets overwhelmed, it almost scrambles my coordination. So sometimes it’ll impact my gait specifically. It really like impacts. Again my left side so I was impacted in the brain stem right side of face left side of body So it impacts a lot of and I’m left side dominant. So as I’m trying to lift weights or play basketball ⁓ I’ll have a I’ll feel what someone miscoordinated and so my coordination isn’t ⁓ Isn’t smooth once I get overwhelmed or My nervous system isn’t sending the signals properly then it impacts my running so then ⁓ doesn’t send the signals for all the muscles to fire in the proper chain and then it impacts Yeah, like my shoulder so we’re trying to like lift things overhead ⁓ then it’ll get shaky ⁓ But yeah, it’s pretty much just a lack of coordination for like to simplify things The Importance of Exercise in Recovery Bill Gasiamis (32:52) Okay, cool. Interesting. So I have a very minor version of that. My left side, probably not as coordinated as my right side anyway, because I’m right side dominant. But now my left side is just a little bit out, you know, and when I get tired, my balance goes off. And ⁓ I find myself leaning in one direction. I lean into the doorway, you know, when I’m really tired, getting out of bed in the morning, I need to make sure that my foot is on the ground so I don’t lose my balance. that kind of stuff. So tell me about gastroparesis. That’s one I haven’t come across a lot. Ty Hawkins (33:27) So, ⁓ just from having the brain stem is in control ⁓ of a lot of your, not basic functions, but your essential functions. So breathing, heart rate, digestion. So what gastroparesis is, is there’s ⁓ a lack of communication between my brain and the vagus nerve. which will then lead to my digestive system either pausing or moving slow, moving a lot more slowly. And so what that can lead to is a lot of stomach discomfort where I can have three bites of food and feel like I had a six or six course meal. ⁓ you know, and then when that system isn’t functioning properly, it leads to issues with like my skin and things like that. But Gastroparesis from my understanding is just either like a slowdown or paralysis of your digestive system. Bill Gasiamis (34:33) I hear you. Unexpected, ⁓ unexpected side effect of a stroke, right? People hear stroke, they, they know it’s associated to the head, but gastrointestinal issues become a massive problem for some people after stroke because the two are linked. And, you know, you can heal your brain by healing your gut. And when I say heal your brain, you can improve how it functions by healing your gut. ⁓ And like if you stop eating the standard American diet, standard Australian diet, same thing. If you stop eating that, you improve the gut conditions and that improves your brain, but also your other organs. But here you’ve got like a neurological disconnect sometimes when you’re overwhelmed by the vagus nerve that stops the standard basic functioning of your gut digestion. Like I imagine Ty Hawkins (35:29) Yes. Bill Gasiamis (35:31) you have a meal and it takes longer to digest or and therefore it causes discomfort therefore you are you avoiding food because of that? Ty Hawkins (35:41) Some days some days ⁓ You know and that it this one really my wife it’s you need to have you need to eat you need to have your meals and Like I’m not really hungry. It’s ⁓ is a lot of times I’m confused because I have such a discomfort in my stomach that I don’t know if I’m full or if is discomfort from you know, just just everything neurologically So I’ll have to try and guess like hey ⁓ Am I am I fool what did I eat yesterday? What did I have today already? So some days I found myself avoiding food Just because I think that if I do I’ll give my system time to either catch up or slow down ⁓ So simply put I do as I’m thinking about it. I do avoid foods at times Bill Gasiamis (36:35) Hmm. Yeah, it makes sense that you would. And I met a guy many years ago, we’re talking about maybe 10 years ago, who had a similar thing to you, but a little more dramatic in that he didn’t get hunger messages at all. So he had to eat only when other people were eating as a reminder that it’s time to eat. if he didn’t do that, he wouldn’t ever get the message that you have to eat. You haven’t eaten for four days or five days. Ty Hawkins (37:15) I’ll get you know I think that sometimes that that may happen where I’m just not getting the signal and but I’m aware that hey I know I need to eat I’m aware that maybe it’s been a day or I have a workout coming up that I know I need to eat for and sometimes it can just be I can have a banana and It feels like I had a full a steak dinner with potatoes and a vegetable and like wow just from a banana and a glass of water and then some days my appetite is normal where I think once I find you know my routine I found a routine of sitting in a sauna and working out and ⁓ eating regimen so in the morning I would have I’ll have a cup of warm tea Living with CRPS: A Daily Challenge And if I’m not overly hungry or have a gym session, I’ll just have some fruit like a fruit salad and I’ll feel light and my digestive system appreciates that. And then ⁓ my body responds well to the heat. So I’ll try to sit in the sauna or exercise to get myself to sweat. And that seems to help my systems kind of stay in syncing and rhythm. So when I do that, my appetite is pretty normal, but when I find myself either overwhelmed, just neurologically or from the stresses of the day, then systems just start to go out of whack. Bill Gasiamis (38:55) I hear you. Exercise is so important. Like doesn’t matter what condition you’re in after stroke, you got to find a way to move your body as much as possible. And it causes so many positive cascades in your body that you, the bang for buck by exercising that your brain and body gets, it’s just unmeasurable. You cannot measure it. It’s so, so important. ⁓ And I love that you experienced direct benefits that you’re aware of. when you exercise. Ty Hawkins (39:27) Yes, and that’s that’s the physical benefits and it’s also been very Beneficial mentally to mentally emotionally because a lot of people don’t Really when you hear a stroke and you think a recovery is just hey the physical recovery and hey you look great tie and like I Do look great, but internally some days I don’t and mentally some days I don’t but I know that When I get, when I go to the gym and I work out, my mood is, it’s night and day when I don’t and when I do. And so I committed to, ⁓ working out as much, even if it’s just going outside for a in the neighborhood, getting outside, fresh air, it’s, have to move my body because if I don’t, that’s when things, you know, physically, mentally, and emotionally just start to break down. Bill Gasiamis (40:23) Yeah, we are meant to be moving. We’re moving creatures, you we’re meant to be moving, not sitting down too much, you know, driving desk work, all that kind of stuff is not normal. And we’re to be doing the, the physical version of getting somewhere like walking somewhere or, you know, running or, riding a bike. And if you can’t get on a bike, get a one of those sit down three wheeler bikes. If you need a walker, walk with a walker. you know, whatever the situation is, find a way around it because exercising is hard, not exercising is hard, but like far harder. Ty Hawkins (41:11) Yes, yes, I just I made a video about that and I posted it Maybe two days ago about the gym and I woke up I was a little tired and I still got up and I went to the gym and after I said that same thing that Though I got the hard work done. The work was hard, but not moving is hard too. It may not be immediately hard but it’s hard on your body not moving it adds up over time and ⁓ it’s what kept me I think not I think I know it’s what kept me the movement that I did early on paid off you know the doctors every session it was a lot of movement ⁓ and even now I’m just conscious of I may reach in the cabinet to get a cup but I’m You know extending my arm more more than the one time to get the cup because that’s that’s therapy You know a lot of people have this ⁓ Miss conception that therapy is just that one hour in the therapy environment I try to find everything to be therapy Reaching for a cup reaching for a plate eating ⁓ You know the steps that I take around the house ⁓ even just dancing you know I’m not I don’t have the, I have a little rhythm, but I’m not the best dancer, but music and moving my body just as I feel was something that was very, you know, beneficial for me. And it took me back to think when we were children and we’re kids, we just have these, what we think as adults is random movements. We’re folding ourselves like pretzels and spinning in circles. And it’s like, hey, this is what, body is meant to be freely moving and we kind of lose track of that once we get to work or school sit at a desk for eight hours sit in a vehicle for long long drives and you know so on and so forth then we forget that we take for granted you know moving the ability to move our bodies until you know our bodies show us like hey you know this is the repercussions sometimes of you not moving your body. Bill Gasiamis (43:34) I love that. That’s a beautiful way to wrap that up is by saying the repercussions of not moving your body. It’s exactly what it is. They occur. Your hips get tight, your joints change in their ability to handle stress. Your bones get ⁓ thinner. You know, like so many things change in a negative way. You got to move even if you’re doing a real, you know, if you have a real challenging stroke experience and stroke. ⁓ deficits, you just got to move as much as you can. I love I love that ⁓ that approach. So you also are now dealing with CRPS. Now I’ve heard of that before, but describe that and what it’s like for you. Ty Hawkins (44:18) ⁓ So it was misdiagnosed for some years as just neuropathy Which is the numbness and tingling on my left side? So if I if you were to look at me and draw a straight line down My right side feels What do you know the ⁓ normal person would feel you know? ⁓ It’s just freely flowing it feels normal right and my left side is just You know, constant daily pain. You know, I feel something, ⁓ whether it’s in, you know, my leg, my arm, ⁓ you know, ⁓ it can be even having clothes on like this jacket right now is sending signals to my brain that ⁓ my arm is in pain and I’m not in pain clearly, but my brain is sending signals that me having this jacket on this material brushing up against my arm. ⁓ It’s painful water hitting my skin painful and my paint but That you know depending on the temperature you know if they’re cool at the bed sheets are cold of Pain level rises through the roof. ⁓ Yeah, it hurts But you know a lot of you know my mindset Bill Gasiamis (45:23) What about the big shades? What about big shades? Yeah. Ty Hawkins (45:44) I don’t know. just I don’t complain about it and it’s like hey, you know, this is what I have to deal with So it’s constant like times. I feel it deep within my abdomen. I’ll feel it in my shoulder ⁓ You know, but CRPS it attacks ⁓ It’s essentially your brain just signaling that it is your brain stuck in a fight-or-flight cycle and it’s constantly Signaling that there’s some it’s a threat or some kind of pain is happening. So From putting the sneaker on, it’s really been attacking, as of lately, my left ankle and my left foot. certain shoes, I can feel the pain deep in the bones in my foot. And then sometimes I’ll just feel like ⁓ a very deep ache in my shoulder. Or if the temperature gets cold enough, it’ll feel like somebody’s just grabbing, know, just has a hold on my rib cage. and ⁓ you know so that’s Lightly to put CRPS what I think for me because I’m so used to the pain now is that my I always say daily I have a pain level of ⁓ four four to five where somebody that’s not used to chronic pain would say it’s eight or a nine and ⁓ Some days it’s frustrating Some days it’s tiring, know, the sensation varies. It’s a numbness and tingling to a deep bone-jarring ache to almost a burning sensation at times, like depending on how much I’m moving. Like, so if I were to move with this jacket right now, as I move my arm, then there’s a deep pain in my tricep and then a very deep pain from the wrist to my fingertips. And sometimes it’ll make me, like people, I’ll stand and I’ll just be squeezing my hands and people may think that I’m just, you know, just holding my hands, but I’m trying to let my body know that it’s okay. So I’m, you know, massaging or rubbing and ⁓ sometimes that helps or sometimes I just have to, you know, take a nap or close off other sensors to calm the brain down. Bill Gasiamis (48:11) my wife gets in trouble when she touches my left hand and she’s being gentle. If she’s being gentle, it’s like, dude, do not do that. She’s like, what do you mean? I’m being gentle. being rough. Don’t just be gentle with it. It hurts too much. It’s hurting now. And I’m in an enclosed room with no wind, no anything, but my left arm feels like it’s cold. Ty Hawkins (48:16) Mm-hmm. Yeah. Yeah. Bill Gasiamis (48:38) freezing while my right side is perfectly fine. You know, it’s a very mild, beautiful day outside. ⁓ the wind, when I go outside, if I’m wearing shorts and a t-shirt, the wind makes it hurt. And if I go to the beach, I have to wear, ⁓ what we call runners, trainers, joggers in the water because the little pebbles of sand, they feel like they’re, I just stepped on like a thousand pins. Ty Hawkins (49:01) Mm-hmm. Bill Gasiamis (49:07) or something, it’s just ridiculous. And then I sleep on my left side so that I can, like you do with your hand, you just squeeze it to just let it know like it’s okay. I sleep on my left side so the sheets don’t rub on my left side and I don’t get woken up by my sheets in the middle of the night. That’s how I kind of get around it. And I would say that my pain is around a three to a four, mostly. Ty Hawkins (49:08) you Go. Emotional Resilience and Mental Health Bill Gasiamis (49:37) kind of closer to a three. And when we go for a long walk, sometimes I’ll go for a long walk with my wife. If we’re visiting a city that we’ve never been to before, we love to see the city on foot the whole time. And we might be walking for four, five, six hours through the whole day after, you know, stopping for a coffee or something to eat or whatever. And my left side will be going, we are not doing this anymore. We’re completely done. And I will have to have a conversation in my head with my left side and say, you’re coming along for the ride because you are overreacting. The right side is perfectly fine, which means that I haven’t done anything to hurt my body. haven’t over exerted ourselves. So you’re just overreacting. Be quiet and let’s get on with it. And believe it or not, man, that works. That quietens things down. and then we just get on with the job of walking and seeing what we need to see. Ty Hawkins (50:38) Yes, yes, so the two things my wife, ⁓ so she likes to pick at my skin sometimes whether she sees a little pimple or something and I’m like, please not today. It’s days that I can tolerate it, but it’s days where, and in the beginning she didn’t understand. I didn’t either and I’m like, am I just overreacting? I’m like, no, this really hurts. And so as I started to understand my diagnosis, I explained it to her and she’s been. Bill Gasiamis (50:49) you Ty Hawkins (51:07) you know more aware and I’ll let her know if it’s like hey I’m fine today it’s good so you’re good to go and two I remember ⁓ she loves Disney so we went to Disney World for her birthday and that’s a lot of walking a lot of people so ⁓ and when I get overstimulated then sometimes I get a little irritable So we’re walking and then, you know, I’m like, have to control my emotions. And then like you have a conversation with myself, like, Hey, my right side is not tired at all. My right side, we can go, we can go. And I’m like, Hey, we are, ⁓ we are okay. We’re, we are totally fine. This is a walk in the park. It’s a lot of people. Yes, but we are okay. We are safe and I wouldn’t do, I let my body know it’s nothing that I’m not putting you in any harm’s way. We’re just walking. And we may have to slow the pace down a little bit. But then as I get back in rhythm, then I found myself, okay, we’re back. We’re back to speed. And I really think that, like you say, it’s you having that mindset and then telling yourself. So day two in Disney, day one, I didn’t know what to expect. But day two is like, hey, we’re having this pep talk before we even go outside. We’re not, we’re cooperating today. We’re going for a walk and it’s going to be a long day. So. let’s go and as long as I have comfortable shoes and I think you know and I walk take breaks and able to sit down at times and you know my body then it’s like starts to trust in a lot that he’s going to take care of me so you know I have those conversations too in those same experiences. Bill Gasiamis (52:58) I relate to that so much, man. I get stuck. You know that feeling that you get in your hand? I get it in the ball of my left foot. It just becomes really, really tight. Like it feels, it doesn’t close up or anything, but it becomes really, really tight. And I can’t do anything to… undo it, you know, so I’ve got to like sit there, massage it, massage it, just try and get the tendons and all of that stuff to move into work. That’s kind of like the only way that I can, that I can get through it, but I have to get regular massages. get a massage every once every about 10 days on my left side to loosen everything up. Otherwise it just puts my right side out as well, because then it starts impacting the other side of my body. Ty Hawkins (53:35) Mm-hmm. Yeah, because you start to overcompensate. Yeah, I do the same while I start going for those kind of weird here’s movement, movement recovery. So I do a lot of things to move my body stretch recovery and things like that. I actually have an appointment tomorrow afternoon to do that. Bill Gasiamis (53:45) Hmm. Yeah, it’s so important. ⁓ Little, little things that kind of help you get through the next 10 days or two weeks or whatever it is, make such a difference if you can make it to a massage or if you can get your body look at that. It really helps. I find it helps me mentally more than anything because it eases all of those ⁓ discomforts and then my brain can just feel a little bit relaxed, you know, for a few days. Ty Hawkins (54:20) Yes. Bill Gasiamis (54:28) four days, 10 days, whatever it is, you whatever I get out of it. ⁓ And some days I feel like, man, need to see that. I need to see somebody right now. And I can’t get an appointment, but then by the time I get to the next day, it’s settled. Ty Hawkins (54:38) Mm-hmm. Yes. Bill Gasiamis (54:45) So sometimes the cycle requires me to just sort of stop, rest and not push through and just allow it to settle down. Ty Hawkins (54:54) No, yeah, I definitely think that allowing some days for the body to just rest and you know kind of catch up and recover does does the brain and body very well? ⁓ You know, I think I know for myself I was so Engulfed in I have to do something every day every day and keep my body moving that I wasn’t allowing it to rest in I remember even on the basketball court, had a day off from practice. it’s, I have to allow my body time to rest and also my brain. you know, when we’re constantly thinking how can I improve, that’s actually putting, you know, some stress on our brain. ⁓ You know, that I started to learn to try to limit and just say, hey, I’m taking a day off. I don’t even want to. think about what I may have to do. I just want to be here in the moment. I just want to enjoy a movie today or just spend time with the family and not think about anything recovery related. Bill Gasiamis (56:00) Yeah, it’s so important to you. You need time out, man. I hear you. ⁓ So you’re you’re being a few through a few tests and you’ve had some challenges to overcome. You’ve made it through your generally very positive, upbeat, glass half full kind of guy. But there probably was some dark times and difficult moments. How did you? Like how did you deal with them? How do you kind of navigate when it gets really tough and challenging emotionally and mentally? Ty Hawkins (56:34) Before I used to just try to keep myself busy at first not realizing that that was almost making it worse in a sense because I was never dealing with the emotion of What I experienced I never allowed myself allowed myself to fully understand and feel it until recently and so recently I started Started talk therapy psychotherapy. ⁓ that’s been tremendous. And then also just really taking time to reflect, I’ll do yoga, I’ll meditate, and you know, I’ll just get more vulnerable about my story I share with people, and I think that allows me to make it through just being honest with myself. I think that the type A athletic mind that I have, it was like, hey, you’re fine, you’re fine, you’re fine, you’re okay, and I never allowed myself to say, you’re not okay. Once I did I think that was when I started to see more progress because I was honoring how I truly felt versus how I wanted to feel And it was hey some days I told my just recently maybe maybe two days ago. So my mom, know was it was a rough day and I was like hey this sucks mom and She was like, know, yes you you have to honor and it’s okay to say that that it It does suck, but know it’s you show gratitude that you’re still alive to experience have the experience of life But understand you know you have to honor how you feel in the moment, and it’s for me. I’m able to Shift quicker out of those moments now because it’s like hey I honor it this sucks may have a little cry then immediately after it better then have a little laugh and like hey, okay, you know so I just Understand that there’s the range of emotions in its waves. So instead of going against the tide I just roll with the waves these days and you know is if I’m sad I just sit with it in the moment I talk to whoever I need to talk to and you know, let them know hey today is a bit harder of a day rather than you’re okay. You’re okay. You’re strong and I eliminated that ego and just honored how I feel because I think especially as men, we’re we’re taught to, you know, just tough it out, get up and dust it off. And it’s like, hey, we’re human at the end of the day and we all have So I think it’s better to honor your emotions. You know, we all have them for a reason, ⁓ you know, so it’s okay to cry. It’s okay to feel sad, you know, and work through that and you’ll eventually, hopefully we’ll see happiness, enjoy on the other side. Bill Gasiamis (59:30) Yeah, there is always a, what’s it like a reward on the other side of the hard time. Like you might not know when you’re going through the hard time, but it always leads to a positive outcome on the other side. You just got to give a time to get there. You know, got to just go through the ride and I’m similar to you talk therapy, man. Well, what a difference that’s made in my life. It just is so tremendous that you find somebody by the way, who you like to go and talk to. ⁓ So you might have to try a couple of different therapists, but like it is next level. You go there, you could talk about anything you want. Nobody’s judging you. You know, don’t have to share that with your loved ones. You can just be yourself and a different version of yourself in that room. that again, it just takes more weight off your shoulders. It creates more lightness. So I’m fully behind that. Ty Hawkins (1:00:26) Yes, yes, it’s been, it’s made a tremendous difference for me and I see, you know, this is, moving into year seven and early on I refused to go to therapy and, ⁓ you know, I think it wasn’t, it wasn’t until year three or four that I really decided to see, really dig in and understand therapy and realize that, it’s not just, I talk about the stroke less and less now. and just about life. It helps me every Monday. It’s a great start to my week. Bill Gasiamis (1:01:03) Man amazing start to your week. Well done. I love it that it’s every Monday Your where are you doing this recording from now, where are you? Lessons Learned: Recovery Insights for Stroke Survivors Ty Hawkins (1:01:14) Actually, I’m actually at work. ⁓ so I was able to return to work. ⁓ Fortunately, so I’m back with with Verizon ⁓ You know Emma in my sales role, so I was able to return to my career and In addition to my career being able to speak and do things like that. But currently I’m at work We’re getting ready to close up shop soon But they gave me the time because they they are very accommodating and understanding how important this is to me and they support me here on my journey. Bill Gasiamis (1:01:48) Wow. This episode is not sponsored by Verizon, but thank you Verizon for allowing this to happen, man. Yeah. We love it. All right. I really appreciate that. ⁓ sounds like the stroke incident has shaped your life in a meaningful way. Ty Hawkins (1:02:08) Yes, yes it has. would say I was a very selfish person before and I don’t mean that like ⁓ in a bad context. was I just thought about myself and my goals and not how my life could impact others. And after the stroke, just being, you know, given this story and seeing how I had no idea that me sharing that I had a stroke and My recovery would lead to a social media following and people looking to me for, you know, hope and inspiration that it was like, wow, you know, I’m actually am somebody that can impact. now it’s, you know, I live to help others. That’s why I continue to share almost seven years later and stay in touch with, with people and help try to provide resources that, you know, You know, just be a resource for people that go through this or loved ones, you know, to anybody who goes through this or any adversity, just to show, my story is a testament that, you know, adversity does hit, but you can make it through. You know, it starts with a mindset and a great community. And, you know, I’m very proud of my story and, know, where I am now and the person that I have become despite, you know, that unfortunate circumstance and event. Bill Gasiamis (1:03:37) Yeah, I’m with you, man. I love what you said about like, how you you’re impacting, you know, you’re aware of how you can impact people, we impact people all the time, negative, positive, whatever it is all the time, you may as well focus the needle towards positive. If you become aware of it, you know, it’s way better. You get much more reward than just being about yourself. I mean, what a Ty Hawkins (1:03:54) Yes. Bill Gasiamis (1:04:03) And I was the same, like we all kind of start there. You know, it’s about how do I succeed? How do I make the next dollar? How do I do this? How do I do that? And then at some point you shift. And for me, the catalyst was the strokes for you. It seems like it was the same thing. And the reward that I never thought I would get from shifting the needle towards helping other people has been way, way greater than anything I ever ⁓ focused on before. because it’s more of a global reward. It’s less of a focused, narrow reward, which is, know, money, car, house, you know, vacation. It’s now. a feedback loop from other people and I get messages on the podcast every single day on YouTube, emails, people going this episode really has made a difference to my life or I loved hearing that story from that person, know, the comments make it so worth doing. It is amazing. Ty Hawkins (1:05:03) Yes, yes, yeah, for me the message is hey, you know, your story helped me make it through or it helps me you serve as the inspiration and I don’t do it for that but it just helps. You know, it’s just good, a good feeling knowing that, you know, this isn’t in vain and that I’m able to impact people, especially in places that I’ve never

In this deeply moving episode, Lyndsay Soprano sits down with Erika Mahoney for a conversation that cuts to the heart of what it means to survive the unimaginable. They talk candidly about chronic pain, grief, and the emotional wreckage left in the wake of gun violence—specifically the loss of Erika's father in a mass shooting.Together, they explore what healing really looks like when the trauma is layered and ongoing. Erika opens up about life after tragedy and how storytelling and letter writing became tools for processing the pain. It's a conversation rooted in truth, compassion, and the shared human experience of suffering.They touch on how resilience doesn't always look like toughness—it can also appear as softness, such as showing up when you don't want to, and giving yourself and others grace along the way. Lyndsay and Erika remind us that community support isn't just helpful, it's necessary. And that in speaking about grief, we help others feel just a little less alone in theirs.Tune in for an episode that makes space for loss, honors the complexity of healing, and shows us that sometimes the most powerful thing we can do is write it down and speak it aloud.Episode Highlights:(00:00) Introduction and Content Warning(00:23) Living with Chronic Pain and Trauma(02:52) Introducing Erica Mahoney and Her Story(04:11) The Day of the Tragedy(09:27) The Aftermath of Loss(13:07) Navigating Grief and Community Support(20:15) The Impact of Gun Violence(27:30) Finding Purpose Through Pain(33:39) The Healing Power of Writing(45:44) Reflections on Resilience and HealingFind Erika Mahoney Online Here:Website: www.erikamahoney.com Instagram: @erika_mahoney_LinkedIn: Erika MahoneyYouTube: Erika MahoneyPodcast: Senseless with Erika Mahoney on Lemonada MediaFind The Pain Game Podcast Online Here:Website: thepaingamepodcast.comInstagram: @thepaingamepodcastFacebook: The Pain Game PodcastLinkedIn: Lyndsay SopranoYouTube: The Pain Game PodcastSubscribe on YouTube | Merch is Coming (Finally) | This Is More Than a PodcastUnfiltered convos. Dark humor. Real healing.This is where pain meets purpose — and you're not doing it alone.++Want to be a guest on The Pain Game Podcast with Lyndsay Soprano? Send her a message on PodMatch, here: Be a Guest on The Show

Link for CME Credit Coming Soon! Holly Wayment welcomes grand rounds speaker  Dr. Maged Mina on chronic pediatric pain, presented by University Health's Women's and Children's Hospital and UT Health San Antonio. Dr. Mina reviews his background in anesthesiology and pain management and his long-standing work with children. The episode covers recognition and diagnosis of chronic pediatric pain (>3 months), common presentations (headaches, recurrent abdominal pain, musculoskeletal pain, CRPS, cancer- and sickle cell–related pain), and the importance of a multidisciplinary approach focused on functional restoration. Physical therapy (including aquatic therapy), behavioral therapies, hypnosis, acupuncture, and virtual reality are emphasized alongside family collaboration and school reintegration. Pharmacologic and interventional options are presented as adjuncts: basic analgesics, gabapentinoids, tricyclics, melatonin, cautious opioid use when necessary, and procedures such as nerve blocks, epidural catheters, Botox, and emerging neuromodulation (peripheral nerve and dorsal root ganglion stimulation). Barriers such as cost, access, and the need for patience and team-based care are also highlighted.

Season four of The Pain Game Podcast opens with a shift. Lyndsay Soprano returns to the mic to share where she's been, what this podcast has meant to her, and why this next chapter is taking a new direction.This season moves into the world of true crime, but not in the way you might expect. The focus isn't on shock or spectacle. It's on the people left behind. The survivors. The professionals who sit with trauma every day. The families whose lives are split into before and after.Lyndsay reflects on personal milestones, the growth of the podcast community, and the deeper purpose behind this new season. The heart of The Pain Game Podcast remains the same: giving pain purpose and holding space for the stories that shape us.Throughout Season 4, listeners will hear from survivors, investigators, advocates, and experts who understand what happens after tragedy. These are conversations about grief, resilience, justice, and the long road back to living.This is not just a new season. It is a new lens.Tune in to the Season 4 opener and step into a season of truth, resilience, and the stories that refuse to be forgotten.Episode Highlights:(00:00) Introduction and Season 4 Preview(00:47) Reflecting on Season 3 Highlights(02:09) Personal Milestones and Gratitude(04:04) Building Resilience and Setting Boundaries(05:51) Shifting Focus to True Crime and Trauma(07:17) Exploring Human Resilience and Healing(08:44) Community Engagement and Season 4 Goals(09:12) Closing Remarks and Call to ActionFind The Pain Game Podcast Online Here:Website: thepaingamepodcast.comInstagram: @thepaingamepodcastFacebook: The Pain Game PodcastLinkedIn: Lyndsay SopranoYouTube: The Pain Game PodcastSubscribe on YouTube | Merch is Coming (Finally) | This Is More Than a PodcastUnfiltered convos. Dark humor. Real healing.This is where pain meets purpose — and you're not doing it alone.++Want to be a guest on The Pain Game Podcast with Lyndsay Soprano? Send her a message on PodMatch, here: Be a Guest on The Show

What happens when the life you built… disappears overnight?In this deeply honest and moving conversation, host Teresa Reiniger sits down with author Patti Sauer to talk about the kind of grief we don't often name—the loss of identity that comes with chronic illness.After nearly two decades as a middle school teacher, Patti was forced to step away from the career she loved due to Chronic Regional Pain Syndrome (CRPS)—a rare and debilitating neurological condition known as one of the most painful diseases in the world. What followed was not just physical suffering, but a profound identity crisis. Who are you when the titles fall away? Through therapy, journaling, and unexpected encouragement, Patti rediscovered a long-buried part of herself: the writer. Her poetry collection, Brave Bird, was born from grief—but grew into something much bigger.This episode is for anyone navigating chronic illness, career loss, depression, identity shifts, or the quiet grief of becoming someone new.

“Personalization” has become one of the most overused words in wealth management and one of the hardest promises to actually deliver. Clients want portfolios that reflect their goals, values, tax realities, and life events. Firms want scale, efficiency, and fewer operational landmines. Too often, those two goals collide. In this episode of The WealthStack Podcast, host Shannon Rosic sits down with Joshua Allen, CEO of TCP Asset Management, to unpack what real portfolio personalization looks like inside a fast-growing RIA and why most firms underestimate the operational cost of getting it wrong. Josh shares how TCP moved beyond model-only workflows, where automation actually helps (and where it doesn't), and why saying no to most technology is critical to scaling personalization without creating an ops headache. Key takeaways: How hiring a director of advisory services strengthened tech integration Why deeper use of existing tech beats adding more tools to the stack How personalized portfolios are driving referrals across generations Why most “personalized portfolios” still feel identical to clients What's real vs hype when it comes to AI in portfolio management Resources: Listen to WealthStack on Wealth Management Subscribe and listen to WealthStack on Apple Podcasts Subscribe and listen to WealthStack on Spotify Connect with Shannon Rosic: Shannon Rosic WealthStack website Wealth Management Connect with Joshua Allen: LinkedIn: TCP Asset Management Website: TCP Asset Management About Our Guest: As a founding Partner and  Chief Executive Officer of TCP Asset Management, Josh Allen is charged with leading a team of wealth advisors in practice management, business development, and innovative planning solutions. These solutions have provided our clients with the resources and flexibility needed to deliver a personalized financial planning experience that is fluid and dynamic. Josh and his team have developed and refined a process that is comprehensive in nature and ties together: investment management, risk management, retirement income planning, estate planning, business and family legacy planning, and philanthropy. This exclusive process allows them to put together all the pieces of the financial puzzle for their clients as their lives unfold and be engaged when their needs evolve. Josh received a Bachelor of Science degree from The Ohio State University in Family Resource Management. He also received a certificate in Financial Planning from Boston University. Upon completion of the education, examination and experience requirements, Josh obtained the Certified Financial Planner, CRPC® and CRPS® designations. His securities licenses include the series 7,9,10 and 66 and State of Ohio insurance license. Josh is married to Branda, who is also one of his business partners. They together have three children, two dogs and two cats. As a family they love the outdoors, whether it is on the beach or in the mountains, they are always up for an adventure.

Pain has a way of demanding your attention, but it doesn't get to decide who you become. Lyndsay Soprano's life has been shaped by layers of trauma, abuse, chronic illness, and a diagnosis of Complex Regional Pain Syndrome, one of the most painful conditions known. Yet instead of letting pain define her, Lyndsay made a conscious decision to give it purpose. This episode explores what it means to reclaim your power when your body hurts, your past weighs heavy, and healing feels overwhelming. Through honesty, humor, and radical gratitude, Lyndsay shares how facing trauma head-on, questioning broken systems, and choosing presence over despair changed everything. Her story is not about fixing pain,  it's about learning how to live fully in spite of it. Guest Bio Lyndsay Soprano is the founder and host of The Pain Game Podcast and a bold advocate in the chronic pain and trauma recovery space. Diagnosed with Complex Regional Pain Syndrome (CRPS) in 2017, Lyndsay is also a survivor of sexual, emotional, and physical abuse, infertility, depression, anxiety, and divorce. After years of misdiagnosis and failed treatments, she chose a trauma-informed, integrative approach to healing and turned her lived experience into a platform that helps others feel seen, understood, and less alone. Her guiding belief is simple but uncompromising: the only way out is through.   You'll hear About How early trauma quietly shaped Lyndsay's coping mechanisms Living with CRPS and navigating life in constant physical pain The moment she chose gratitude over despair Why Western medicine alone failed her — and what she did differently Turning pain into purpose through conversation, advocacy, and voice   Chapters 00:00 Welcome and Episode Introduction 02:00 Lyndsay's Early Trauma and Childhood Coping 05:00 Uncovering Repressed Memories and Their Impact 08:00 Living With CRPS and Daily Pain Decisions 12:00 Gratitude as a Survival Skill 15:30 The Night Everything Had to Change 18:30 Reclaiming Power From Medication and Misdiagnosis 22:30 Functional and Integrative Healing Approaches 26:30 Advocacy, Self-Trust, and Taking Control of Care 30:00 Why Pain Does Not Get to Define Identity 33:30 Creating The Pain Game Podcast 37:30 Writing, Forgiveness, and Letting Go 41:00 Lyndsay's Message to Anyone Feeling Hopeless 45:00 Chuck's Closing Reflections Chuck's Challenge This week, notice where pain or frustration is trying to take your power. Pause before reacting. Ask yourself how you can meet that moment with curiosity, compassion, or gratitude instead. Even small shifts can change the entire direction of a day. Connect with Lyndsay Soprano Website: thepaingamepodcast.com Email: talktoher@thepaingamepodcast.com Connect with Chuck Check out the website: https://www.thecompassionateconnection.com/ Linked In: https://www.linkedin.com/in/chuck-thuss-a9aa044/ Follow on Instagram: @warriorsunmasked Join the Warriors Unmasked community by subscribing to the show. Together, we're breaking stigmas and shining a light on mental health, one story at a time

The management of complex regional pain syndrome (CRPS) continues to challenge clinicians—especially when conservative and interventional strategies fall short. This episode of RAPM Focus, hosted by RAPM Editor and Social Media Editor Ryan D'Souza, MD, explores these challenges in managing CRPS with Daniël van der Spek, MD, and Frank Huygen, MD, PhD, FIPP, FFPMCAI, following the August 2025 publication of their original research paper, “Long-term outcomes of amputation in patients with complex regional pain syndrome (CRPS): a mixed-methods study.” In rare and severe cases, amputation has been proposed as a last resort intervention, but the topic remains completely controversial. How does one weigh the potential relief of unrelenting pain against the risk of further complications and disability from an amputation? This episode explores a fascinating, mixed-method study into the long-term outcomes of patients with CPRS undergoing limb amputation in hopes of pain relief, despite risks of residual pain or phantom limb pain. Dr. Daniël van der Spek is a medical doctor and PhD candidate at the Erasmus University Medical Center under the supervision of Professor Huygen his research focus is on CPRS with a particular emphasis on interventional pain management. Dr. Frank Huygen is an anesthesiologist and pain physician serving as the head of the Department of Pain Medicine at Erasmus University Medical Center, and has been a full professor since 2009. His expertise focuses on CPRS and neuromodulation. He leads multiple national and international research projects, and maintains close collaborations with CRPS patient organizations, in both the Netherlands and the United States. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

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 Brandon McCormick, CFP, AIF, CRPS, CPFA, Partner and Advisor, Prime Capital Financial, and2026 DallasHR President.How did Brandon get started in his career and whatled him to finance and leadership?What does Brandon share about the finance market?hat does Brandon share about “finding his lane”?What does Brandon share about building trust?What does Brandon share about goals and risktolerance? What does Brandon share about volunteer leadership?What does Brandon share about certification value?What advice does Brandon share to help others in theworkplace? …and more as we spend “Time to Accelerate” with afew more questions. Interview resources:Favorite quote from Brandon:“Keep moving forward. When you look back, you'll realize how far you have come.”Connect with Brandon on LinkedInVisit Prime CapitalVisit DallasHRLearn 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; MovingLeaders to Inspire and Change the Workplace Find Your Lane; Change yourGPS, Change your Career (“Book Authority” Best Books)Milemarkers; A 5 Year Journey …helping you record daily highlights to keep you on track.Connect with Bruce on LinkTreeSubscribe to Bruce's Blog “Move to Inspire” Get 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

In today's episode CesarEspino.com brings to yout a special guest to You Can Overcome Anything! Podcast Show.Alex Crowther is the CEO of Pain Coach Academy, a former global advertising executive, and now a Reiki Master and initiated Shaman who transformed an incurable pain condition (CRPS) into a purpose-driven mission to help others heal. After three decades leading international ad agency organizations, Alex's life changed dramatically when he was diagnosed with Complex Regional Pain Syndrome, one of the most painful diseases known to man. That experience became his greatest teacher, leading him to study the neuroscience of pain, trauma, and healing. Today, Alex blends science, spirituality, and human connection to reframe how people understand and manage pain. Through his talks and work at Pain Coach Academy, he helps individuals and organizations rediscover meaning, resilience, and purpose, proving that true power lies not in control but in surrender and alignment.To Connect with Alex Crwother go to:alex@828.media2487613366To Connect with CesarRespino go to:

In this solo episode, Dr. Linda Bluestein brings on her producers to help unpack the hidden complications that can follow seemingly routine medical procedures. From the lingering effects of breast surgery to the controversial use of nitrous oxide, Dr. Bluestein explores how standard treatments can backfire, especially for patients with EDS, MCAS, or complex regional pain syndrome (CRPS). She also dives into the surprising risks of cervical collars, and why something that feels stabilizing may actually worsen pain over time. If you've ever been told your symptoms “shouldn't be happening,” this episode might finally connect the dots. Takeaways Dr. Bluestein explains how this commonly used sedative can trigger or worsen neurological symptoms in vulnerable patients and why you might want to avoid it. From scar sensitivity to chronic nerve pain, Dr. Bluestein explores the challenges many face but few anticipate. You'll learn when collars are truly helpful and when they might prolong instability, weakness, and pain. This condition affects the nervous system in ways most clinicians miss. Dr. Bluestein breaks down how to recognize early signs and advocate for better care. Dr. Bluestein reveals the disconnect between standard protocols and what EDS/MCAS patients actually experience in the OR and during recovery. Want more Dr. Linda Bluestein, MD? Website: https://www.hypermobilitymd.com/ YouTube: https://www.youtube.com/@bendybodiespodcast Instagram: ⁠⁠⁠⁠https://www.instagram.com/hypermobilitymd/⁠⁠⁠⁠ Facebook: ⁠⁠⁠⁠https://www.facebook.com/BendyBodiesPodcast⁠⁠⁠⁠ X: ⁠⁠⁠⁠https://twitter.com/BluesteinLinda⁠⁠⁠⁠ LinkedIn: ⁠⁠⁠⁠https://www.linkedin.com/in/hypermobilitymd/⁠⁠⁠⁠ Newsletter: ⁠⁠⁠⁠https://hypermobilitymd.substack.com/ Shop my Amazon store ⁠⁠⁠ https://www.amazon.com/shop/hypermobilitymd Dr. Bluestein's Recommended Herbs, Supplements and Care Necessities: https://us.fullscript.com/welcome/hypermobilitymd/store-start Thank YOU so much for tuning in. We hope you found this episode informative, inspiring, useful, validating, and enjoyable. Join us on the next episode for YOUR time to level up your knowledge about hypermobility disorders and the people who have them. Join YOUR Bendy Bodies community at ⁠⁠https://www.bendybodiespodcast.com/⁠⁠. YOUR bendy body is our highest priority!⁠⁠ Learn more about Human Content at ⁠⁠⁠http://www.human-content.com⁠⁠⁠ Podcast Advertising/Business Inquiries: ⁠⁠⁠sales@human-content.com⁠⁠⁠ Part of the Human Content Podcast Network FTC: This video is not sponsored. Links are commissionable, meaning I may earn commission from purchases made through links Learn more about your ad choices. Visit megaphone.fm/adchoices

In this solo episode, Dr. Linda Bluestein brings on her producers to help unpack the hidden complications that can follow seemingly routine medical procedures. From the lingering effects of breast surgery to the controversial use of nitrous oxide, Dr. Bluestein explores how standard treatments can backfire, especially for patients with EDS, MCAS, or complex regional pain syndrome (CRPS). She also dives into the surprising risks of cervical collars, and why something that feels stabilizing may actually worsen pain over time. If you've ever been told your symptoms “shouldn't be happening,” this episode might finally connect the dots. Takeaways Dr. Bluestein explains how this commonly used sedative can trigger or worsen neurological symptoms in vulnerable patients and why you might want to avoid it. From scar sensitivity to chronic nerve pain, Dr. Bluestein explores the challenges many face but few anticipate. You'll learn when collars are truly helpful and when they might prolong instability, weakness, and pain. This condition affects the nervous system in ways most clinicians miss. Dr. Bluestein breaks down how to recognize early signs and advocate for better care. Dr. Bluestein reveals the disconnect between standard protocols and what EDS/MCAS patients actually experience in the OR and during recovery. Find the episode transcript here. Want more Dr. Linda Bluestein, MD? Website: https://www.hypermobilitymd.com/ YouTube: https://www.youtube.com/@bendybodiespodcast Instagram: ⁠⁠⁠⁠https://www.instagram.com/hypermobilitymd/⁠⁠⁠⁠ Facebook: ⁠⁠⁠⁠https://www.facebook.com/BendyBodiesPodcast⁠⁠⁠⁠ X: ⁠⁠⁠⁠https://twitter.com/BluesteinLinda⁠⁠⁠⁠ LinkedIn: ⁠⁠⁠⁠https://www.linkedin.com/in/hypermobilitymd/⁠⁠⁠⁠ Newsletter: ⁠⁠⁠⁠https://hypermobilitymd.substack.com/ Shop my Amazon store ⁠⁠⁠ https://www.amazon.com/shop/hypermobilitymd Dr. Bluestein's Recommended Herbs, Supplements and Care Necessities: https://us.fullscript.com/welcome/hypermobilitymd/store-start Thank YOU so much for tuning in. We hope you found this episode informative, inspiring, useful, validating, and enjoyable. Join us on the next episode for YOUR time to level up your knowledge about hypermobility disorders and the people who have them. Join YOUR Bendy Bodies community at ⁠⁠https://www.bendybodiespodcast.com/⁠⁠. YOUR bendy body is our highest priority!⁠⁠ Learn more about Human Content at ⁠⁠⁠http://www.human-content.com⁠⁠⁠ Podcast Advertising/Business Inquiries: ⁠⁠⁠sales@human-content.com⁠⁠⁠ Part of the Human Content Podcast Network FTC: This video is not sponsored. Links are commissionable, meaning I may earn commission from purchases made through links Learn more about your ad choices. Visit megaphone.fm/adchoices

In a stunning legal reversal that's shaking the true crime and justice world, the Florida appellate court has overturned the $213.5 million verdict in the Maya Kowalski case — one of the most emotionally charged courtroom battles in recent memory. Former FBI agent and true crime analyst Jennifer Coffindaffer sits down with legal expert Dave Ehrenberg to dissect what went wrong and what comes next in this explosive new episode of Break the Case. For those unfamiliar, Maya Kowalski suffered from a rare pain condition known as CRPS. While hospitalized, her mother, Beata Kowalski, was accused by doctors of suffering from Munchausen by proxy — a form of abuse involving fabricating or inducing illness in a child. When Beata was prevented from seeing Maya for more than 80 days, the distraught mother fell into a deep depression and ultimately took her own life, leaving behind a note pleading for her daughter's release. A Florida jury later awarded the Kowalski family over $200 million in damages, holding Johns Hopkins All Children's Hospital accountable for false imprisonment, emotional distress, and wrongful death. But now, the Second District Court of Appeals has vacated that verdict entirely, citing major errors by the trial judge — particularly around Florida's “mandatory reporter” immunity laws. The appellate court ruled that hospital staff, acting as mandatory reporters of suspected abuse, were shielded by law and acted in good faith when they contacted child protection authorities. This means a new trial will move forward, but only for a limited set of claims: battery, medical negligence, and intentional infliction of emotional distress on behalf of Maya herself. Beata's death, which once anchored the case's emotional gravity, may only be referenced as context. The decision not only erases a massive verdict but also sets a crucial precedent for hospitals and medical professionals across Florida. Coffindaffer and Ehrenberg's discussion peels back the layers of this controversial ruling — a reminder that even in the pursuit of justice, emotion and law often collide. This is more than a case; it's a tragedy, a legal reckoning, and a lesson in how far institutions will go to protect themselves under the letter of the law. #TrueCrime #MayaKowalski #BeataKowalski #JohnsHopkinsHospital #LegalAnalysis #BreakingNews #JusticeForMaya #CourtAppeal #FloridaLaw #InvestigativeNews Want to comment and watch this podcast as a video? Check out our YouTube Channel. https://www.youtube.com/@hiddenkillerspod Instagram https://www.instagram.com/hiddenkillerspod/ Facebook https://www.facebook.com/hiddenkillerspod/ Tik-Tok https://www.tiktok.com/@hiddenkillerspod X Twitter https://x.com/tonybpod Listen Ad-Free On Apple Podcasts Here: https://podcasts.apple.com/us/podcast/true-crime-today-premium-plus-ad-free-advance-episode/id1705422872

In a stunning legal reversal that's shaking the true crime and justice world, the Florida appellate court has overturned the $213.5 million verdict in the Maya Kowalski case — one of the most emotionally charged courtroom battles in recent memory. Former FBI agent and true crime analyst Jennifer Coffindaffer sits down with legal expert Dave Ehrenberg to dissect what went wrong and what comes next in this explosive new episode of Break the Case. For those unfamiliar, Maya Kowalski suffered from a rare pain condition known as CRPS. While hospitalized, her mother, Beata Kowalski, was accused by doctors of suffering from Munchausen by proxy — a form of abuse involving fabricating or inducing illness in a child. When Beata was prevented from seeing Maya for more than 80 days, the distraught mother fell into a deep depression and ultimately took her own life, leaving behind a note pleading for her daughter's release. A Florida jury later awarded the Kowalski family over $200 million in damages, holding Johns Hopkins All Children's Hospital accountable for false imprisonment, emotional distress, and wrongful death. But now, the Second District Court of Appeals has vacated that verdict entirely, citing major errors by the trial judge — particularly around Florida's “mandatory reporter” immunity laws. The appellate court ruled that hospital staff, acting as mandatory reporters of suspected abuse, were shielded by law and acted in good faith when they contacted child protection authorities. This means a new trial will move forward, but only for a limited set of claims: battery, medical negligence, and intentional infliction of emotional distress on behalf of Maya herself. Beata's death, which once anchored the case's emotional gravity, may only be referenced as context. The decision not only erases a massive verdict but also sets a crucial precedent for hospitals and medical professionals across Florida. Coffindaffer and Ehrenberg's discussion peels back the layers of this controversial ruling — a reminder that even in the pursuit of justice, emotion and law often collide. This is more than a case; it's a tragedy, a legal reckoning, and a lesson in how far institutions will go to protect themselves under the letter of the law. #TrueCrime #MayaKowalski #BeataKowalski #JohnsHopkinsHospital #LegalAnalysis #BreakingNews #JusticeForMaya #CourtAppeal #FloridaLaw #InvestigativeNews Want to comment and watch this podcast as a video? Check out our YouTube Channel. https://www.youtube.com/@hiddenkillerspod Instagram https://www.instagram.com/hiddenkillerspod/ Facebook https://www.facebook.com/hiddenkillerspod/ Tik-Tok https://www.tiktok.com/@hiddenkillerspod X Twitter https://x.com/tonybpod Listen Ad-Free On Apple Podcasts Here: https://podcasts.apple.com/us/podcast/true-crime-today-premium-plus-ad-free-advance-episode/id1705422872

In a stunning legal reversal that's shaking the true crime and justice world, the Florida appellate court has overturned the $213.5 million verdict in the Maya Kowalski case — one of the most emotionally charged courtroom battles in recent memory. Former FBI agent and true crime analyst Jennifer Coffindaffer sits down with legal expert Dave Ehrenberg to dissect what went wrong and what comes next in this explosive new episode of Break the Case. For those unfamiliar, Maya Kowalski suffered from a rare pain condition known as CRPS. While hospitalized, her mother, Beata Kowalski, was accused by doctors of suffering from Munchausen by proxy — a form of abuse involving fabricating or inducing illness in a child. When Beata was prevented from seeing Maya for more than 80 days, the distraught mother fell into a deep depression and ultimately took her own life, leaving behind a note pleading for her daughter's release. A Florida jury later awarded the Kowalski family over $200 million in damages, holding Johns Hopkins All Children's Hospital accountable for false imprisonment, emotional distress, and wrongful death. But now, the Second District Court of Appeals has vacated that verdict entirely, citing major errors by the trial judge — particularly around Florida's “mandatory reporter” immunity laws. The appellate court ruled that hospital staff, acting as mandatory reporters of suspected abuse, were shielded by law and acted in good faith when they contacted child protection authorities. This means a new trial will move forward, but only for a limited set of claims: battery, medical negligence, and intentional infliction of emotional distress on behalf of Maya herself. Beata's death, which once anchored the case's emotional gravity, may only be referenced as context. The decision not only erases a massive verdict but also sets a crucial precedent for hospitals and medical professionals across Florida. Coffindaffer and Ehrenberg's discussion peels back the layers of this controversial ruling — a reminder that even in the pursuit of justice, emotion and law often collide. This is more than a case; it's a tragedy, a legal reckoning, and a lesson in how far institutions will go to protect themselves under the letter of the law. #TrueCrime #MayaKowalski #BeataKowalski #JohnsHopkinsHospital #LegalAnalysis #BreakingNews #JusticeForMaya #CourtAppeal #FloridaLaw #InvestigativeNews Want to comment and watch this podcast as a video? Check out our YouTube Channel. https://www.youtube.com/@hiddenkillerspod Instagram https://www.instagram.com/hiddenkillerspod/ Facebook https://www.facebook.com/hiddenkillerspod/ Tik-Tok https://www.tiktok.com/@hiddenkillerspod X Twitter https://x.com/tonybpod Listen Ad-Free On Apple Podcasts Here: https://podcasts.apple.com/us/podcast/true-crime-today-premium-plus-ad-free-advance-episode/id1705422872

In this episode, Antonia and Andrew discuss the November 5, 2025 issue of JBJS, along with an added dose of entertainment and pop culture. Listen at the gym, on your commute, or whenever your case is on hold!   Link: JBJS website: https://jbjs.org/issue.php   Sponsor: This episode is brought to you by JBJS Clinical Classroom.   Subspecialties: Spine, Knee, Hip, Basic Science, Pediatrics, Pain Management, Rehabilitation, Orthopaedic Essentials, Education and Training Chapters (00:00:03) - JBJS: Cases on Hold(00:02:05) - Case on Hold(00:02:53) - This Week's Orthopedic News(00:04:37) - The Broken Wing Sign(00:09:32) - Broken Wing Sign test, sensitivity and specificity(00:14:45) - Does BMI change after total hip and knee arthroplasty?(00:21:48) - Knee and hip replacement: Does this particular study change my practice(00:27:06) - Mayo Clinic orthopedic care: Future of weight loss(00:28:27) - Vitamin C and CRPS after total knee replacement(00:37:40) - Vitamin C pre-cancer screening(00:38:41) - Honorable Mention(00:39:48) - The pelvic inclination angle in congenital cervical scoliosis

DMSO is an "umbrella remedy" capable of treating a wide range of challenging ailments due to its combination of therapeutic properties (e.g., reducing inflammation, improving circulation, and reviving dying cells). It also rapidly transports substances dissolved in it through the skin and throughout the body These benefits are also seen when DMSO is combined with a variety of natural therapies – in many cases, allowing the mixture to treat challenging conditions neither could treat alone DMSO is commonly combined with proven nutraceuticals, such as vitamins and antioxidants These combinations effectively treat a myriad of diseases, including skin cancer, prostate enlargement, cataracts, CRPS, fatigue, lost smell or hearing, osteoarthritis, COPD, and tinnitus This article will review the basics of botanical DMSO combinations, the literature supporting it, and show how these mixtures can be used to treat many additional challenging medical conditions

What Defense Attorneys Need to Know about CRPS with Dr. Jeffrey SummersIn this podcast, we hear a conversation from our live event with Dr. Jeffrey Summers, a pain management physician, regarding complex regional pain syndrome (CRPS). Dr. Summers discusses the making the diagnosis of complex regional pain syndrome under the AMA Guides and the Budapest criteria and the differences in those methods. He discusses his thoughts on how some physicians have over-diagnosed the condition and gives some useful ideas in how to verify or rule out the diagnosis.  Listen as Jennifer White, Shane Dawson, and Steve Armstrong interview Dr. Summers with questions posed to him by our live audience.To learn more about DRI and the Workers' Compensation Committee visit www.DRI.org.#DRILawyer#DRICommunity

Abdominal pain in EDS can be a puzzle with countless hidden pieces. In this episode, Dr. Linda Bluestein welcomes back Dr. Pradeep Chopra for part two of their exploration into gastrointestinal problems. Together, they uncover overlooked causes of abdominal pain, from drooping intestines and tethered spinal cords to mast cell activation and nerve entrapment. Listeners will hear surprising connections between the spine, bladder, ribs, and gut, with insights that could explain symptoms often dismissed or misunderstood. Takeaways: How intestines “dropping” into the pelvis complicate digestion and bladder function. Why tethered cord surgery may relieve unexpected symptoms, including GI issues. The overlooked role of mast cell activation in abdominal pain and food intolerances. How abdominal pain can actually begin in the ribs, nerves, or pelvic floor. Why abdominal migraines and CRPS challenge traditional medical thinking. Find the episode transcript here. Want more Dr. Pradeep Chopra? Website: ⁠⁠https://www.painri.com/⁠⁠Contact Dr. Chopra's Office: ⁠⁠⁠snapa102@gmail.com Want more Dr. Linda Bluestein, MD? Website:  ⁠⁠⁠https://www.hypermobilitymd.com/⁠⁠⁠. YouTube: ⁠⁠⁠⁠youtube.com/@bendybodiespodcast⁠⁠⁠⁠  Instagram: ⁠⁠⁠⁠https://www.instagram.com/hypermobilitymd/⁠⁠⁠⁠  Facebook: ⁠⁠⁠⁠https://www.facebook.com/BendyBodiesPodcast⁠⁠⁠⁠  X: ⁠⁠⁠⁠https://twitter.com/BluesteinLinda⁠⁠⁠⁠  LinkedIn: ⁠⁠⁠⁠https://www.linkedin.com/in/hypermobilitymd/⁠⁠⁠⁠  Newsletter: ⁠⁠⁠⁠https://hypermobilitymd.substack.com/⁠⁠⁠⁠ Shop my Amazon store ⁠⁠⁠⁠https://www.amazon.com/shop/hypermobilitymd⁠⁠⁠ To check out all of my favorite products, please click on this link: ⁠⁠https://www.hypermobilitymd.com/productswelove⁠ Thank YOU so much for tuning in. We hope you found this episode informative, inspiring, useful, validating, and enjoyable. Join us on the next episode for YOUR time to level up your knowledge about hypermobility disorders and the people who have them. Check out the following episodes to learn more: Find previous Bendy Bodies episodes featuring Dr. Pradeep Chopra here:https://www.bendybodiespodcast.com/guests/dr-pradeep-chopra/Find previous Bendy Bodies episodes featuring Dr. Theoharis Theoharides here:https://www.bendybodiespodcast.com/guests/theoharis-theoharide/Hidden Causes of Pain ‘Down There' with Dr. Andrew Goldstein (Ep 148):https://www.bendybodiespodcast.com/hidden-causes-of-pain-down-there-with-dr-andrew-goldstein-ep-148/Hidden Causes of Painful Sex with Dr. Irwin Goldstein & Sue Goldstein (Ep 130): https://www.bendybodiespodcast.com/hidden-causes-of-painful-sex-ep-130/Slipping Rib Surgery in EDS with Adam Hansen, MD: https://www.bendybodiespodcast.com/videos/84-slipping-rib-surgery-in-eds-with-adam-hansen-md/Testosterone is Essential for Women with Dr. Kelly Casperson (Ep 131) https://www.bendybodiespodcast.com/testosterone-is-essential-for-women/Signs of Tethered Cord You Shouldn't Ignore with Dr. Petra Klinge (Ep 137): https://www.bendybodiespodcast.com/signs-of-tethered-cord-you-shouldnt-ignore-with-dr-petra-klinge-ep-137/Why Do Some GI Problems Hide from Every Test? with Dr. Zachary Spiritos (Ep 153): https://www.bendybodiespodcast.com/why-do-some-gi-problems-hide-from-every-test-ep-153/ Join YOUR Bendy Bodies community at ⁠⁠⁠https://www.bendybodiespodcast.com/⁠⁠⁠. YOUR bendy body is our highest priority!⁠⁠⁠⁠ Learn more about Human Content at ⁠⁠⁠⁠http://www.human-content.com⁠⁠⁠⁠ Podcast Advertising/Business Inquiries: ⁠⁠⁠⁠sales@human-content.com⁠⁠⁠⁠ Part of the Human Content Podcast Network FTC: This video is not sponsored. Links are commissionable, meaning I may earn commission from purchases made through links Learn more about your ad choices. Visit megaphone.fm/adchoices

Abdominal pain in EDS can be a puzzle with countless hidden pieces. In this episode, Dr. Linda Bluestein welcomes back Dr. Pradeep Chopra for part two of their exploration into gastrointestinal problems. Together, they uncover overlooked causes of abdominal pain, from drooping intestines and tethered spinal cords to mast cell activation and nerve entrapment. Listeners will hear surprising connections between the spine, bladder, ribs, and gut, with insights that could explain symptoms often dismissed or misunderstood. Takeaways: How intestines “dropping” into the pelvis complicate digestion and bladder function. Why tethered cord surgery may relieve unexpected symptoms, including GI issues. The overlooked role of mast cell activation in abdominal pain and food intolerances. How abdominal pain can actually begin in the ribs, nerves, or pelvic floor. Why abdominal migraines and CRPS challenge traditional medical thinking. Find the episode transcript here. Want more Dr. Pradeep Chopra? Website: ⁠⁠https://www.painri.com/⁠⁠Contact Dr. Chopra's Office: ⁠⁠⁠snapa102@gmail.com Want more Dr. Linda Bluestein, MD? Website:  ⁠⁠⁠https://www.hypermobilitymd.com/⁠⁠⁠. YouTube: ⁠⁠⁠⁠youtube.com/@bendybodiespodcast⁠⁠⁠⁠  Instagram: ⁠⁠⁠⁠https://www.instagram.com/hypermobilitymd/⁠⁠⁠⁠  Facebook: ⁠⁠⁠⁠https://www.facebook.com/BendyBodiesPodcast⁠⁠⁠⁠  X: ⁠⁠⁠⁠https://twitter.com/BluesteinLinda⁠⁠⁠⁠  LinkedIn: ⁠⁠⁠⁠https://www.linkedin.com/in/hypermobilitymd/⁠⁠⁠⁠  Newsletter: ⁠⁠⁠⁠https://hypermobilitymd.substack.com/⁠⁠⁠⁠ Shop my Amazon store ⁠⁠⁠⁠https://www.amazon.com/shop/hypermobilitymd⁠⁠⁠ To check out all of my favorite products, please click on this link: ⁠⁠https://www.hypermobilitymd.com/productswelove⁠ Thank YOU so much for tuning in. We hope you found this episode informative, inspiring, useful, validating, and enjoyable. Join us on the next episode for YOUR time to level up your knowledge about hypermobility disorders and the people who have them. Check out the following episodes to learn more: Find previous Bendy Bodies episodes featuring Dr. Pradeep Chopra here:https://www.bendybodiespodcast.com/guests/dr-pradeep-chopra/Find previous Bendy Bodies episodes featuring Dr. Theoharis Theoharides here:https://www.bendybodiespodcast.com/guests/theoharis-theoharide/Hidden Causes of Pain ‘Down There' with Dr. Andrew Goldstein (Ep 148):https://www.bendybodiespodcast.com/hidden-causes-of-pain-down-there-with-dr-andrew-goldstein-ep-148/Hidden Causes of Painful Sex with Dr. Irwin Goldstein & Sue Goldstein (Ep 130): https://www.bendybodiespodcast.com/hidden-causes-of-painful-sex-ep-130/Slipping Rib Surgery in EDS with Adam Hansen, MD: https://www.bendybodiespodcast.com/videos/84-slipping-rib-surgery-in-eds-with-adam-hansen-md/Testosterone is Essential for Women with Dr. Kelly Casperson (Ep 131) https://www.bendybodiespodcast.com/testosterone-is-essential-for-women/Signs of Tethered Cord You Shouldn't Ignore with Dr. Petra Klinge (Ep 137): https://www.bendybodiespodcast.com/signs-of-tethered-cord-you-shouldnt-ignore-with-dr-petra-klinge-ep-137/Why Do Some GI Problems Hide from Every Test? with Dr. Zachary Spiritos (Ep 153): https://www.bendybodiespodcast.com/why-do-some-gi-problems-hide-from-every-test-ep-153/ Join YOUR Bendy Bodies community at ⁠⁠⁠https://www.bendybodiespodcast.com/⁠⁠⁠. YOUR bendy body is our highest priority!⁠⁠⁠⁠ Learn more about Human Content at ⁠⁠⁠⁠http://www.human-content.com⁠⁠⁠⁠ Podcast Advertising/Business Inquiries: ⁠⁠⁠⁠sales@human-content.com⁠⁠⁠⁠ Part of the Human Content Podcast Network FTC: This video is not sponsored. Links are commissionable, meaning I may earn commission from purchases made through links Learn more about your ad choices. Visit megaphone.fm/adchoices

On this episode, we are joined by Tara Packham, an occupational therapist who has worked for many years in upper extremity rehabilitation and is now educating the next generation of occupational therapists. Tara recognizes the impact social media has had on knowledge mobilization and she shares with us how clinicians, researchers and educators are utilizing social media and other digital platforms to educate their colleagues, patients and students. Guest Bio: Tara Packham, PhD, OTReg(Ont) is an occupational therapist with over 25 years of clinical experience in hand and upper limb rehabilitation, and an associate professor in the School of Rehabilitation Sciences at McMaster University in Hamilton Ontario Canada. Tara's program of research focuses on assessing and addressing persistent pain, and continuing to advance the global field of hand rehabilitation. She is passionate about moving evidence into practice and helping therapists to adopt and apply new research to advance clinical care. Tara has published and presented extensively for both hand rehabilitation and pain management audiences on persistent pain conditions impacting the upper extremity. She currently serves on the executive committee of the Special Interest Group for CRPS at the International Association for the Study of Pain, on the editorial board of the Journal of Hand Therapy, and as Editor-in-Chief at Hand Therapy (official journal of the British Association for Hand Therapists and European Federation of Societies for Hand Therapy). The views and opinions expressed in the Hands in Motion podcast are those of the guests and do not necessarily reflect the official policy or position of ASHT. Appearance on the podcast does not imply endorsement of any products, services or viewpoints discussed.

Very pleased to welcome back independent wrestling personality Black Dahlia to Wrestling with Heart! On episode 221, we discussed her journey in the business, lessons learned from her trainers, CRPS awareness, and more. You can find more about Black Dahlia here: https://www.facebook.com/profile.php?... https://twitter.com/black_dahlia47 https://www.instagram.com/blackdahlia47/ https://onlyfans.com/blackdahlia47 Are you a pro wrestler and have done community service and/or charity work? E-mail the podcast at wrestlingwithheart@yahoo.com and tell us if you would be interested in being interviewed. Follow us on: Facebook: Wrestling with Heart with Stanley Karr Bluesky: @wrestlingwithheart.bsky.social Instagram: @wrestlingwithheart Threads: @wrestlingwithheart Hear Wrestling with Heart on Apple Podcasts: https://podcasts.apple.com/us/podcast... Hear Wrestling with Heart on Spotify: https://open.spotify.com/show/46cviL5... Hear Wrestling with Heart on iHeartRadio: https://www.iheart.com/podcast/269-wr... Donate to my Patreon and subscribe to my content here: https://www.patreon.com/user?u=84502525 Learn more about your ad choices. Visit megaphone.fm/adchoices

A diagnosis doesn't mean you have to hit pause on your purpose. In this episode, Lyndsay Soprano sits down with Deb Krier—a powerhouse entrepreneur, stage four breast cancer survivor, and proof that you can still show up and lead, even when life throws its worst.They talk about what it really takes to keep moving forward while living with chronic pain, illness, and the emotional weight of it all. Deb shares how she built her “battle plan” with doctors, used humor as fuel, and leaned into empathy—not just to survive cancer, but to keep thriving in business and in life.This episode isn't about pretending it's easy. It's about choosing to rise anyway. It's for anyone who's ever felt like their diagnosis defined them, or who's been told to slow down when every part of them still wants to show up.Deb reminds us that empowerment starts from within—but it's amplified when we use it to lift others. Because thriving isn't about ignoring the hard stuff. It's about carrying it with purpose.Tune in if you're ready to reclaim your ambition—regardless of what you're carrying.Find Deb Krier Online Here:Website: tryingnottodie.liveWebsite: debkrier.comFacebook Group: Trying Not to DieLinkedIn: Deb KrierPodcast: The Business Power Hour with Deb KrierFind The Pain Game Podcast Online Here:Website: thepaingamepodcast.comInstagram: @thepaingamepodcastFacebook: The Pain Game PodcastLinkedIn: Lyndsay SopranoYouTube: The Pain Game PodcastEpisode Highlights:(00:00) Introduction to Chronic Pain and Trauma(02:29) Living with Chronic Pain: Personal Experiences(05:32) Courage in the Face of Cancer(08:16) Managing Pain and Emotional Support(11:02) Balancing Work and Health(14:06) Advocating for Yourself in Healthcare(19:35) Seven Courageous Steps to Face Cancer(28:13) Conclusion and Call to Action

Building strong financial foundations isn't just about numbers, it's about nurturing relationships and leaving a legacy. How can financial advisors inspire trust and empower the next generation? What role does education play in creating lasting client relationships? In this episode, Referral Coach Bill Cates interviews Jeff Panik, CFP®, MSFS, CRPS, Principal of Balanced Wealth Partners, … Continue reading #92 Connecting Generations Through Financial Literacy with Jeff Panik, CFP®, MSFS, CRPS →

If you're tired, wired, and in pain—this one's for you. Insomnia, stress, and chronic discomfort often show up together, and we tend to treat them like separate problems. But what if they all stem from something simple… and fixable?Lyndsay Soprano talks with Natalie Jurado, founder of Rooted In, about the quiet power of magnesium. Not the kind in chalky pills or powders that mess with your gut—but in a cream your body can actually absorb. Natalie shares how magnesium supports everything from sleep and anxiety to inflammation, energy, blood pressure, and even mood swings.They dig into how magnesium deficiency flies under the radar, why it's often misdiagnosed, and how most of us—kids included—aren't getting enough. From ADHD to weight loss to workout recovery, magnesium plays a starring role in our well-being. And the truth is, food isn't always enough.This conversation is equal parts science and real talk. It's about understanding your body, getting ahead of burnout, and giving your nervous system the support it's been quietly begging for.Tune in if you've tried everything for your pain, sleep, or stress—and nothing's worked. This might be the missing piece.Find Natalie Jurado Online Here:Website: berootedin.comInstagram: @berootedinFacebook: Rooted InLinkedIn: Natalie JuradoFind The Pain Game Podcast Online Here:Website: thepaingamepodcast.comInstagram: @thepaingamepodcastFacebook: The Pain Game PodcastLinkedIn: Lyndsay SopranoYouTube: The Pain Game PodcastEpisode Highlights:(00:00) Introduction to Chronic Pain and Healing(01:16) The Connection Between Insomnia, Pain, and Stress(02:41) Exploring Magnesium for Relief(03:38) Understanding Magnesium: The Essential Mineral(07:13) Personal Journeys with Insomnia and Anxiety(12:24) Creating Effective Magnesium Products(15:37) Benefits of Magnesium for Health(19:12) Magnesium and Cholesterol Management(20:21) Safe Usage and Dosing of Magnesium Cream(27:01) Magnesium's Role in Diabetes and Blood Sugar(28:05) Magnesium for Pain Relief(30:31) Final Thoughts and Encouragement

Welcome to Pain-Bytes, a bite-sized extension of The Pain Game Podcast! Hosted by our wild and crazy, Lyndsay Soprano, these drop every Friday and serve up small but mighty dose of real talk. Whether it's chronic pain, emotional chaos, unexpected wins, or everything in between—this is the space to say it out loud and be heard. Each Pain-Byte lets you in on a moment (or meltdown) from your week—because pain “bytes” but also…life bites back.  Lyndsay is also calling on YOU—our VIPs—to submit your wins, losses, struggles, celebrations, and everything in between. Whether it's a DM, email, or voice memo, let's share the load and spread some light. Because here, you are seen, heard, and held—even if it's just for a byte.

"I told my husband he could leave—I had just been diagnosed with an incurable pain disease less than a year into our marriage… but he stayed. And that's when I decided I was going to fight, not just for me, but for everyone like me." On this episode of Celebrate Your Story, I sit down with Beth Stillitano, a former teacher whose life was turned upside down at just 24 years old after a seemingly minor fall led to a diagnosis of Complex Regional Pain Syndrome (CRPS), a rare and excruciating neurological disease often called “the suicide disease.” Beth shares her emotional journey through years of relentless pain, misdiagnoses, and opioid dependency, and how she eventually found healing through therapy, mindfulness, and community. But her story doesn't end with survival, it's about purpose. Beth went on to co-found Fight the Flame, a national nonprofit supporting CRPS patients, caregivers, and medical professionals. Her mission: to make sure no one faces this invisible illness alone. This is a story about pain, resilience, and the power of showing up for yourself, your family, and the millions who suffer in silence.

⚠️ Content Warning: This episode contains a discussion around suicidal thoughts. Please take care while listening and seek support if you need it.Living with Complex Regional Pain Syndrome (CRPS) isn't just painful—it's punishing. It hijacks your body, messes with your mind, and turns everyday tasks into uphill battles. In this episode, Lyndsay Soprano sits down with Jeannette Tashjian for a brutally honest conversation about what it really means to live with relentless, unpredictable pain.They talk about the parts most people don't see: the mental spiral, the isolation, the weight of explaining yourself over and over, and the moments when giving up feels like the only option. But they also talk about what keeps them going—connection, infrared sauna therapy, self-advocacy, and the power of simply being heard.This episode doesn't sugarcoat anything. From navigating life with a disability to confronting the stigma around suicidal thoughts, Jeannette and Lyndsay lay it all out. They speak from the gut—about grief, about resilience, and about finding pieces of joy in a body that feels like it's working against you.If you've ever felt like no one understands what you're going through—or if you love someone who lives with chronic pain—this conversation will hit home.Tune in for the truth behind CRPS, and the reminder that you're not alone in this fight.Find Jeanette Tashjian Online Here:Website: www.burbankinfraredsauna.comInstagram: @burbankinfraredsaunaPast Guest Episode 6: The Pain Game Podcast Episode 6Find The Pain Game Podcast Online Here:Website: thepaingamepodcast.comInstagram: @thepaingamepodcastFacebook: The Pain Game PodcastLinkedIn: Lyndsay SopranoYouTube: The Pain Game PodcastIF YOU'RE IN CRISIS:USA – Call or text 988 (24/7)Canada – Call: 1-833-456-4566 (24/7) | Text: 45645 (4 PM–12 AM EST)Episode Highlights:(00:00) Introduction to Chronic Pain and Trauma(03:12) Understanding Complex Regional Pain Syndrome (CRPS)(06:01) Personal Stories of Pain and Trauma(08:52) The Role of Infrared Sauna in Pain Management(12:11) Navigating Life with CRPS(14:58) Acceptance and Coping Mechanisms(18:07) The Importance of Community and Support(23:42) Finding Freedom in Acceptance(30:43) Navigating the Pain Journey(31:12) Addressing Suicidal Thoughts(43:45) The Importance of Hope and Support

We're rereleasing an episode from our original coverage of the Kowalski case that was published on 11/7/2023. *** With a verdict in the case days away, host Andrea Dunlop unpacks some of what's happened so far in the Kowalski v Johns Hopkins All Childrens trial with lawyer and trial consultant Jonathan Leach. They analyze the dueling opening statements, consider what each side is likely to look for in jurors, and which of the charges—if any—might be most viable.   Andrea shares insights on the lawyers after watching their interactions in court. She also weighs in on the extensive medical testimony so far, including a major revelation about the origins of Maya's controversial CRPS diagnosis. We also share a chilling account of Maya's ketamine coma that was shared in court via missives written by Beata herself.   As both sides begin their closing arguments Andrea weighs the merits of what each side has told the jury and considers what the ramifications of the imminent verdict might be.  *** To support the show, subscribe on ⁠Apple Podcast⁠s or go to ⁠Patreon.com/NobodyShouldBelieveMe⁠ where you can listen to exclusive bonus content and access all episodes early and ad-free, including weekly recaps of the Kowalski trial.   Follow host Andrea Dunlop on Instagram for behind-the-scenes photos: ⁠@andreadunlop⁠  Buy Andrea's ⁠books here⁠.  For more information and resources on Munchausen by Proxy, please visit ⁠MunchausenSupport.com⁠  Download the ⁠APSAC's practice guidelines here⁠.  ***  Click ⁠here⁠ to view our sponsors. Remember that using our codes helps advertisers know you're listening and helps us keep making the show! Learn more about your ad choices. Visit podcastchoices.com/adchoices

Dr. Jack Cush reviews the news, journal reports and lupus highlights from the past week on RheumNow.com. Triple positivity, the gut and CRPS, and hope for better outcomes with Vitamin D therapy.

In the first part of our four part Case Files series diving into the upcoming lawsuit against Rady Children's in San Diego, Andrea and Dr. Bex start with looking into preteen Madison Meyer's string of diagnoses like Ehlers-Danlos syndrome, POTS, CRPS, and more. They break down what these conditions are and why they - coupled with Madison's rapid decline - raised red flags.  *** Follow Dr. Bex on instagram: @secretdoctorbex Order Andrea's new book The Mother Next Door: Medicine, Deception, and Munchausen by Proxy.  Click here to view our sponsors. Remember that using our codes helps advertisers know you're listening and helps us keep making the show!   Subscribe on YouTube where we have full episodes and lots of bonus content.  Follow Andrea on Instagram: @andreadunlop Buy Andrea's books here.  For more information and resources on Munchausen by Proxy, please visit MunchausenSupport.com The American Professional Society on the Abuse of Children's MBP Practice Guidelines can be downloaded here. Learn more about your ad choices. Visit podcastchoices.com/adchoices