Podcasts about cts

CTS 6 YEAR ANNIVERSARY EPISODE

Many clinical decision rules exclude elderly patients from the derivation cohorts. So the question remains unanswered do all elderly patients need cervical spine CTs in the setting of trauma? What if they have no symptoms? This recap of a journal club article explores the incidence of significant cervical spine fractures in elderly patients.

Anissa Polverari, the business development leader for non-profit NEMT service model CTS joins Enterprise Radio. She will discuss the efforts to connect with leading … Read more The post Transportation, Healthcare and the Underserved: Eliminating Transportation “Deserts” appeared first on Top Entrepreneurs Podcast | Enterprise Podcast Network.

Dr. Nathan Pennell and Dr. Cheryl Czerlanis discuss challenges in lung cancer screening and potential solutions to increase screening rates, including the use of AI to enhance risk prediction and screening processes. Transcript Dr. Nate Pennell: Hello, and welcome to By the Book, a monthly podcast series for ASCO Education that features engaging discussions between editors and authors from the ASCO Educational Book. I'm Dr. Nate Pennell, the co-director of the Cleveland Clinic Lung Cancer Program and vice chair of clinical research for the Taussig Cancer Center. I'm also the editor-in-chief for the ASCO Educational Book.  Lung cancer is one of the leading causes of cancer-related mortality worldwide, and most cases are diagnosed at advanced stages where curative treatment options are limited. On the opposite end, early-stage lung cancers are very curable. If only we could find more patients at that early stage, an approach that has revolutionized survival for other cancer types such as colorectal and breast cancer.  On today's episode, I'm delighted to be joined by Dr. Cheryl Czerlanis, a professor of medicine and thoracic medical oncologist at the University of Wisconsin Carbone Cancer Center, to discuss her article titled, "Broadening the Net: Overcoming Challenges and Embracing Novel Technologies in Lung Cancer Screening." The article was recently published in the ASCO Educational Book and featured in an Education Session at the 2025 ASCO Annual Meeting. Our full disclosures are available in the transcript of this episode.  Cheryl, it's great to have you on the podcast today. Thanks for being here. Dr. Cheryl Czerlanis: Thanks, Nate. It's great to be here with you. Dr. Nate Pennell: So, I'd like to just start by asking you a little bit about the importance of lung cancer screening and what evidence is there that lung cancer screening is beneficial. Dr. Cheryl Czerlanis: Thank you. Lung cancer screening is extremely important because we know that lung cancer survival is closely tied to stage at diagnosis. We have made significant progress in the treatment of lung cancer, especially over the past decade, with the introduction of immunotherapies and targeted therapies based on personalized evaluation of genomic alterations. But the reality is that outside of a lung screening program, most patients with lung cancer present with symptoms related to advanced cancer, where our ability to cure the disease is more limited.  While lung cancer screening has been studied for years, the National Lung Screening Trial, or the NLST, first reported in 2011 a significant reduction in lung cancer deaths through screening. Annual low-dose CT scans were performed in a high-risk population for lung cancer in comparison to chest X-ray. The study population was comprised of asymptomatic persons aged 55 to 74 with a 30-pack-year history of smoking who were either active smokers or had quit within 15 years. The low-dose CT screening was associated with a 20% relative risk reduction in lung cancer-related mortality. A similar magnitude of benefit was also reported in the NELSON trial, which was a large European randomized trial comparing low-dose CT with a control group receiving no screening. Dr. Nate Pennell: So, this led, of course, to approval from CMS (Centers for Medicare and Medicaid Services) for lung cancer screening in the Medicare population, probably about 10 years ago now, I think. And there are now two major trials showing an unequivocal reduction in lung cancer-related mortality and even evidence that it reduces overall mortality with lung cancer screening. But despite this, lung cancer screening rates are very low in the United States. So, first of all, what's going on? Why are we not seeing the kinds of screening rates that we see with mammography and colonoscopy? And what are the barriers to that here? Dr. Cheryl Czerlanis: That's a great question. Thank you, Nate. In the United States, recruitment for lung cancer screening programs has faced numerous challenges, including those related to socioeconomic, cultural, logistical, and even racial disparities. Our current lung cancer screening guidelines are somewhat imprecise and often fail to address differences that we know exist in sex, smoking history, socioeconomic status, and ethnicity. We also see underrepresentation in certain groups, including African Americans and other minorities, and special populations, including individuals with HIV. And even where lung cancer screening is readily available and we have evidence of its efficacy, uptake can be low due to both provider and patient factors. On the provider side, barriers include having insufficient time in a clinic visit for shared decision-making, fear of missed test results, lack of awareness about current guidelines, concerns about cost, potential harms, and evaluating both true and false-positive test results.  And then on the patient side, barriers include concerns about cost, fear of getting a cancer diagnosis, stigma associated with tobacco smoking, and misconceptions about the treatability of lung cancer. Dr. Nate Pennell: I think those last two are really what make lung cancer unique compared to, say, for example, breast cancer, where there really is a public acceptance of the value of mammography and that breast cancer is no one's fault and that it really is embraced as an active way you can take care of yourself by getting your breast cancer screening. Whereas in lung cancer, between the stigma of smoking and the concern that, you know, it's a death sentence, I think we really have some work to be made up, which we'll talk about in a minute about what we can do to help improve this.  Now, that's in the U.S. I think things are probably, I would imagine, even worse when we leave the U.S. and look outside, especially at low- and middle-income countries. Dr. Cheryl Czerlanis: Yes, globally, this issue is even more complex than it is in the United States. Widespread implementation of low-dose CT imaging for lung cancer screening is limited by manpower, infrastructure, and economic constraints. Many low- and middle-income countries even lack sufficient CT machines, trained personnel, and specialized facilities for accurate and timely screenings. Even in urban centers with advanced diagnostic facilities, the high screening and follow-up care costs can limit access. Rural populations face additional barriers, such as geographic inaccessibility of urban centers, transportation costs, language barriers, and mistrust of healthcare systems. In addition, healthcare systems in these regions often prioritize infectious diseases and maternal health, leaving limited room for investments in noncommunicable disease prevention like lung cancer screening. Policymakers often struggle to justify allocating resources to lung cancer screening when immediate healthcare needs remain unmet. Urban-rural disparities exacerbate these challenges, with rural regions frequently lacking the infrastructure and resources to sustain screening programs. Dr. Nate Pennell: Well, it's certainly an intimidating problem to try to reduce these disparities, especially between the U.S. and low- and middle-income countries. So, what are some of the potential solutions, both here in the U.S. and internationally, that we can do to try to increase the rates of lung cancer screening? Dr. Cheryl Czerlanis: The good news is that we can take steps to address these challenges, but a multifaceted approach is needed. Public awareness campaigns focused on the benefits of early detection and dispelling myths about lung cancer screening are essential to improving participation rates. Using risk-prediction models to identify high-risk individuals can increase the efficiency of lung cancer screening programs. Automated follow-up reminders and screening navigators can also ensure timely referrals and reduce delays in diagnosis and treatment. Reducing or subsidizing the cost of low-dose CT scans, especially in low- or middle-income countries, can improve accessibility. Deploying mobile CT scanners can expand access to rural and underserved areas.  On a global scale, integrating lung cancer screening with existing healthcare programs, such as TB or noncommunicable disease initiatives, can enhance resource utilization and program scalability. Implementing lung cancer screening in resource-limited settings requires strategic investment, capacity building, and policy interventions that prioritize equity. Addressing financial constraints, infrastructure gaps, and sociocultural barriers can help overcome existing challenges. By focusing on cost-effective strategies, public awareness, and risk-based eligibility criteria, global efforts can promote equitable access to lung cancer screening and improve outcomes.  Lastly, as part of the medical community, we play an important role in a patient's decision to pursue lung cancer screening. Being up to date with current lung cancer screening recommendations, identifying eligible patients, and encouraging a patient to undergo screening often is the difference-maker. Electronic medical record (EMR) systems and reminders are helpful in this regard, but relationship building and a recommendation from a trusted provider are really essential here. Dr. Nate Pennell: I think that makes a lot of sense. I mean, there are technology improvements. For example, our lung cancer screening program at The Cleveland Clinic, a few years back, we finally started an automated best practice alert in our EMR for patients who met the age and smoking requirements, and it led to a six-fold increase in people referred for screening. But at the same time, there's a difference between just getting this alert and putting in an order for lung cancer screening and actually getting those patients to go and actually do the screening and then follow up on it. And that, of course, requires having that relationship and discussion with the patient so that they trust that you have their best interests. Dr. Cheryl Czerlanis: Exactly. I think that's important. You know, certainly, while technology can aid in bringing patients in, there really is no substitute for trust-building and a personal relationship with a provider. Dr. Nate Pennell: I know that there are probably multiple examples within the U.S. where health systems or programs have put together, I would say, quality improvement projects to try to increase lung cancer screening and working with their community. There's one in particular that you discuss in your paper called the "End Lung Cancer Now" initiative. I wonder if you could take us through that. Dr. Cheryl Czerlanis: Absolutely. "End Lung Cancer Now" is an initiative at the Indiana University Simon Comprehensive Cancer Center that has the vision to end suffering and death from lung cancer in Indiana through education and community empowerment. We discuss this as a paradigm for how community engagement is important in building and scaling a lung cancer screening program.  In 2023, the "End Lung Cancer Now" team decided to focus its efforts on scaling and transforming lung cancer screening rates in Indiana. They developed a task force with 26 experts in various fields, including radiology, pulmonary medicine, thoracic surgery, public health, and advocacy groups. The result of this work is an 85-page blueprint with key recommendations that any system and community can use to scale lung cancer screening efforts. After building strong infrastructure for lung cancer screening at Indiana University, they sought to understand what the priorities, resources, and challenges in their communities were. To do this, they forged strong partnerships with both local and national organizations, including the American Lung Association, American Cancer Society, and others. In the first year, they actually tripled the number of screening low-dose CTs performed in their academic center and saw a 40% increase system-wide. One thing that I think is the most striking is that through their community outreach, they learned that most people prefer to get medical care close to home within their own communities. Establishing a way to support the local infrastructure to provide care became far more important than recruiting patients to their larger system.  In exciting news, "End Lung Cancer Now" has partnered with the IU Simon Comprehensive Cancer Center and IU Health to launch Indiana's first and only mobile lung screening program in March of 2025. This mobile program travels around the state to counties where the highest incidence of lung cancer exists and there is limited access to screening. The mobile unit parks at trusted sites within communities and works in partnership, not competition, with local health clinics and facilities to screen high-risk populations. Dr. Nate Pennell: I think that sounds like a great idea. Screening is such an important thing that it doesn't necessarily have to be owned by any one particular health system for their patients. I think. And I love the idea of bringing the screening to patients where they are. I can speak to working in a regional healthcare system with a main campus in the downtown that patients absolutely hate having to come here from even 30 or 40 minutes away, and they'd much rather get their care locally. So that makes perfect sense.  So, under the current guidelines, there are certainly things that we can do to try to improve capturing the people that meet those. But are those guidelines actually capturing enough patients with lung cancer to make a difference? There certainly are proposals within patient advocacy communities and even other countries where there's a large percentage of non-smokers who perhaps get lung cancer. Can we expand beyond just older, current and heavy smokers to identify at-risk populations who could benefit from screening? Dr. Cheryl Czerlanis: Yes, I think we can, and it's certainly an active area of research interest. We know that tobacco is the leading cause of lung cancer worldwide. However, other risk factors include secondhand smoke, family history, exposure to environmental carcinogens, and pulmonary diseases like COPD and interstitial lung disease. Despite these known associations, the benefit of lung cancer screening is less well elucidated in never-smokers and those at risk of developing lung cancer because of family history or other risk factors. We know that the eligibility criteria associated with our current screening guidelines focus on age and smoking history and may miss more than 50% of lung cancers. Globally, 10% to 25% of lung cancer cases occur in never-smokers. And in certain parts of the world, like you mentioned, Nate, such as East Asia, many lung cancers are diagnosed in never-smokers, especially in women. Risk-prediction models use specific risk factors for lung cancer to enhance individual selection for screening, although they have historically focused on current or former smokers.  We know that individuals with family members affected by lung cancer have an increased risk of developing the disease. To this end, several large-scale, single-arm prospective studies in Asia have evaluated broadening screening criteria to never-smokers, with or without additional risk factors. One such study, the Taiwan Lung Cancer Screening in Never-Smoker Trial, was a multicenter prospective cohort study at 17 medical centers in Taiwan. The primary outcome of the TALENT trial was lung cancer detection rate. Eligible patients aged 55 to 75 had either never smoked or had a light and remote smoking history. In addition, inclusion required one or more of the following risk factors: family history of lung cancer, passive smoke exposure, history of TB or COPD, a high cooking index, which is a metric that quantifies exposure to cooking fumes, or a history of cooking without ventilation. Participants underwent low-dose CT screening at baseline, then annually for 2 years, and then every 2 years for up to 6 years. The lung cancer detection rate was 2.6%, which was higher than that reported in the NLST and NELSON trials, and most were stage 0 or I cancers. Subsequently, this led to the Taiwan Early Detection Program for Lung Cancer, a national screening program that was launched in 2022, targeting 2 screening populations: individuals with a heavy history of smoking and individuals with a family history of lung cancer.  We really need randomized controlled trials to determine the true rates of overdiagnosis or finding cancers that would not lead to morbidity or mortality in persons who are diagnosed, and to establish whether the high lung detection rates are associated with a decrease in lung cancer-related mortality in these populations. However, the implementation of randomized controlled low-dose CT screening trials in never-smokers has been limited by the need for large sample sizes, lengthy follow-up, and cost.  In another group potentially at higher risk for developing lung cancer, the role of lung cancer screening in individuals who harbor germline pathogenic variants associated with lung cancer also needs to be explored further. Dr. Nate Pennell: We had this discussion when the first criteria came out because there have always been risk-based calculators for lung cancer that certainly incorporate smoking but other factors as well and have discussion about whether we should be screening people based on their risk and not just based on discrete criteria such as smoking. But of course, the insurance coverage for screening, you have to fit the actual criteria, which is very constrained by age and smoking history. Do you think in the U.S. there's hope for broadening our screening beyond NLST and NELSON criteria? Dr. Cheryl Czerlanis: I do think at some point there is hope for broadening the criteria beyond smoking history and age, beyond the criteria that we have typically used and that is covered by insurance. I do think it will take some work to perhaps make the prediction models more precise or to really understand who can benefit. We certainly know that there are many patients who develop lung cancer without a history of smoking or without family history, and it would be great if we could diagnose more patients with lung cancer at an earlier stage. I think this will really count on there being some work towards trying to figure out what would be the best population for screening, what risk factors to look for, perhaps using some new technologies that may help us to predict who is at risk for developing lung cancer, and trying to increase the group that we study to try and find these early-stage lung cancers that can be cured. Dr. Nate Pennell: Part of the reason we, of course, try to enrich our population is screening works better when you have a higher pretest probability of actually having cancer. And part of that also is that our technology is not that great. You know, even in high-risk patients who have CT scans that are positive for a screen, we know that the vast majority of those patients with lung nodules actually don't have lung cancer. And so you have to follow them, you have to use various models to see, you know, what the risk, even in the setting of a positive screen, is of having lung cancer.  So, why don't we talk about some newer tools that we might use to help improve lung cancer screening? And one of the things that everyone is super excited about, of course, is artificial intelligence. Are there AI technologies that are helping out in early detection in lung cancer screening? Dr. Cheryl Czerlanis: Yes, that's a great question. We know that predicting who's at risk for lung cancer is challenging for the reasons that we talked about, knowing that there are many risk factors beyond smoking and age that are hard to quantify. Artificial intelligence is a tool that can help refine screening criteria and really expand screening access. Machine learning is a form of AI technology that is adept at recognizing patterns in large datasets and then applying the learning to new datasets. Several machine learning models have been developed for risk stratification and early detection of lung cancer on imaging, both with and without blood-based biomarkers. This type of technology is very promising and can serve as a tool that helps to select individuals for screening by predicting who is likely to develop lung cancer in the future.  A group at Massachusetts General Hospital, represented in our group for this paper by my co-authors, Drs. Fintelmann and Chang, developed Sybil, which is an open-access 3D convolutional neural network that predicts an individual's future risk of lung cancer based on the analysis of a single low-dose CT without the need for human annotation or other clinical inputs. Sybil and other machine learning models have tremendous potential for precision lung cancer screening, even, and perhaps especially, in settings where expert image interpretation is unavailable. They could support risk-adapted screening schedules, such as varying the frequency and interval of low-dose CT scans according to individual risk and potentially expand lung cancer screening eligibility beyond age and smoking history. Their group predicts that AI tools like Sybil will play a major role in decoding the complex landscape of lung cancer risk factors, enabling us to extend life-saving lung cancer screening to all who are at risk. Dr. Nate Pennell: I think that that would certainly be welcome. And as AI is working its way into pretty much every aspect of life, including medical care, I think it's certainly promising that it can improve on our existing technology.  We don't have to spend a lot of time on this because I know it's a little out of scope for what you covered in your paper, but I'm sure our listeners are curious about your thoughts on the use of other types of testing beyond CT screening for detecting lung cancer. I know that there are a number of investigational and even commercially available blood tests, for example, for detection of lung cancer, or even the so-called multi-cancer detection blood tests that are now being offered, although not necessarily being covered by insurance, for multiple types of cancer, but lung cancer being a common cancer is included in that. So, what do you think? Dr. Cheryl Czerlanis: Yes, like you mentioned, there are novel bioassays such as blood-based biomarker testing that evaluate for DNA, RNA, and circulating tumor cells that are both promising and under active investigation for lung cancer and multi-cancer detection. We know that such biomarker assays may be useful in both identifying lung cancers but also in identifying patients with a high-risk result who should undergo lung cancer screening by conventional methods. Dr. Nate Pennell: Anything that will improve on our rate of screening, I think, will be welcome. I think probably in the future, it will be some combination of better risk prediction and better interpretation of screening results, whether those be imaging or some combination of imaging and biomarkers, breath-based, blood-based. There's so much going on that it is pretty exciting, but we're still going to have to overcome the stigma and lack of public support for lung cancer screening if we're going to move the needle. Dr. Cheryl Czerlanis: Yes, I think moving the needle is so important because we know lung cancer is still a very morbid disease, and our ability to cure patients is not where we would like it to be. But I do believe there's hope. There are a lot of motivated individuals and groups who are passionate about lung cancer screening, like myself and my co-authors, and we're just happy to be able to share some ways that we can overcome the challenges and really try and make an impact in the lives of our patients. Dr. Nate Pennell: Well, thank you, Dr. Czerlanis, for joining me on the By the Book Podcast today and for all of your work to advance care for patients with lung cancer. Dr. Cheryl Czerlanis: Thank you, Dr. Pennell. It's such a pleasure to be with you today. Thank you. Dr. Nate Pennell: And thank you to our listeners for joining us today. You'll find a link to Dr. Czerlanis' article in the transcript of this episode.  Please join us again next month for By the Book's next episode and more insightful views on topics you'll be hearing at the education sessions from ASCO meetings throughout the year, and our deep dives on approaches that are shaping modern oncology. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers:     Dr. Nathan Pennell    @n8pennell   @n8pennell.bsky.social Dr. Cheryl Czerlanis Follow ASCO on social media:     @ASCO on X (formerly Twitter)     ASCO on Bluesky    ASCO on Facebook     ASCO on LinkedIn     Disclosures:    Dr. Nate Pennell:        Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron       Research Funding (Institution): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi    Dr. Cheryl Czerlanis: Research Funding (Institution): LungLife AI, AstraZeneca, Summit Therapeutics

Why do children need real heroes, clear villains, and fairy tales that tell the truth?Author Haley Stewart joins Into the Truth to explore how stories shape children's imagination, prepare them for the Gospel, and why today's Disney falls short. From Tolkien and Jane Austen to Harry Potter and the Brothers Grimm, this is a call to reclaim storytelling that forms virtue and reveals eternal truths.✏️ Haley's Substack: https://haleystewart.substack.com/

Heute DAX Rally Pause. Die Wall Street startet verhalten. Der Bitcoin setzt dagegen neue Rekorde, nächstes Ziel bei 112.000 US-Dollar. Sorgen um steigende US-Defizite nach Trumps "Big Beautiful Bill" belasten die Börsen: Der DAX fällt um 0,5 % auf 23.999 Punkte, EuroStoxx50 verliert 0,6 % auf 5422 Punkte. Rheinmetall kooperiert in Indien mit Reliance Defence für Munitionsproduktion. Evonik will bis 2027 operativen Gewinn um 1 Mrd. Euro steigern, u.a. durch Einsparungen. ProSiebenSat.1 rät von MFE-Übernahmeangebot (4,48 Euro) ab. Vonovia plant Wachstum über verstärkten Wohnungsbau. Easyjet steigert Halbjahresverlust auf 394 Mio. Pfund. CTS Eventim mit Gewinneinbruch um fast 1/3 auf 46 Mio. Euro. Freenet-Aktie bricht zeitweise über 16 % ein. Walmart spart Kosten mit der Entlassung von 1.500 Mitarbeitern. Nike erhöht Preise und startet erneut den Verkauf über Amazon. BYD überholt erstmals Tesla bei Verkäufen in Europa. Bosch sammelt erfolgreich 4 Mrd. Euro per Anleihe ein. "Nur wer ruhig und gelassen bleibt, kann klar denken und richtig handeln." - André Kostolany

Accettare di sprecare un 10% dell'energia prodotta da sole e vento, potrebbe essere il modo più semplice per aumentare il contributo delle rinnovabili alla produzione elettrica, evitando di incorrere in costi infrastrutturali eccessivi. L'idea di buttare via dell'energia può apparire malsana, e questo è sicuramente vero in un sistema energetico in cui per produrla bisogna bruciare combustibili pagati a caro prezzo come gas o petrolio. Ma in un sistema caratterizzato da costi marginali pari a zero (tipici di rinnovabili come fotovoltaico ed eolico) potrebbe essere molto più conveniente che non investire in sistemi di accumulo che evitino di sprecarne anche una sola goccia. Sovrapprodurre potrebbe quindi essere conveniente in un sistema fondato su fonti non programmabili. Ne parliamo con Maurizio Delfanti, professore di Sistemi Energetici del Politecnico di Milano, Coordinatore del CTS di Italia Solare.

In this episode of ASTCT Talks, Dr. Shernan Holtan welcomes Andrew Lin, Manager of Clinical Pharmacy Services of Adult BMT and CTS at Memorial Sloan Kettering Cancer Center, to discuss the evolving role of tacrolimus levels in GVHD prophylaxis within the post-transplant cyclophosphamide (PTCy) era. They explore findings from a recent retrospective study examining whether higher tacrolimus levels offer added protection against GVHD, what this means for toxicity and patient outcomes and how these insights are shaping dosing strategies. The conversation also looks ahead to future research areas, including MMF optimization and the potential for simplified, patient-centered prophylaxis regimens.

【本期简介】2025年Mountain Fuji100, Joaquin Lopez（华金·洛佩斯）,一位来自拉丁美洲，厄瓜多尔的顶尖越野跑运动员成为了今年的冠军:17:48:40。同时这一成绩创下了自2012年赛事创办以来的最快纪录，新的历史最佳。在这次来中国的分享中，中国越野跑朋友们给他起了一个很邻家的绰号：金哥。Joaquin Lopez出生于厄瓜多尔首都基多，自幼在高山环境中长大，对户外运动充满热情。他从13岁开始跑步，并逐渐成长为一名职业越野跑运动员。在20岁时参加了第一场50公里越野跑比赛，并取得了胜利。从那此后，他专注于越野跑，并在UTMB等国际大赛中取得了优异成绩。金哥还分享了他的训练方法和策略，强调了在高海拔地区的训练对其越野跑生涯的重要性。他表示，未来将继续挑战自我，争取在更多国际大赛中取得好成绩，并计划在厄瓜多尔以及其他拉丁美洲国家推广越野跑运动。【主播】楥子、深焦镜头【嘉宾】Joaquin Lopez（华金·洛佩斯）— 凯乐石FUGA 精英运动员【Timeline】01:55 Joaquin Lopez（华金·洛佩斯）自我介绍，讲述他的出生地、成长环境、对运动的热爱，和哥哥对他的影响。 （以下简称为金哥）05:55 金哥讲述了他从旅游行业转向职业越野跑运动员和教练的经历。 11:06 金哥与CTS团队的合作和他的训练方法。21:40 金哥为UTMB所做的准备：三场不同类型的比赛31:40 媛子和金哥讨论了金哥的团队和他们在比赛中的角色。 38:40 金哥的营养策略，他的营养训练和比赛中的经验。 46:10 对未来比赛的规划48:10 金哥对厄瓜多尔越野跑社区的影响和对拉丁美洲越野跑的看法54:00 金哥在日本、中国香港和厄瓜多尔比赛和越野跑社群观察的体验。 56:50 金哥与KAILAS 凯乐石的合作和他的未来职业规划。欢迎大家全网搜索并关注、收听及收看越Talk越野的 “越野Talk” BGM: Vuelvo a nacer en Ecuador - Javier Neira剪辑：越野Talk

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, primarily affecting the median nerve at the level of the wrist. The condition results from compression of the median nerve within the carpal tunnel, leading to sensory and motor impairments in the affected hand. There are a range of causes for the condition, and treatments range from simple conservative measures to surgery. In this episode, Dr Roger Henderson looks at how to recognise the condition, some of the clinical and diagnostic tests available, when to refer to secondary care and management options including both surgical and non-surgical measures.Access episode show notes containing key references and take-home points at:https://gpnotebook.com/en-GB/podcasts/musculoskeletal-medicine/ep-156-carpal-tunnel-syndrome.Did you know? With GPnotebook Pro, you can earn CPD credits by tracking the podcast episodes you listen to. Learn more.

OVERVIEWColin Izzard and Adam Pulford have more than 45 years of coaching experience between them. In this casual conversation between two old friends and colleagues, they pull back the curtain on how the coaching process works, how it differs from a training plan or AI-generated program, and how coaching has changed for the better with the introduction of new technologies - including artificial intelligence. ASK A QUESTION FOR A FUTURE PODCASTLINKS/RESOURCESLearn About Cycling Coaching with CTSSchedule a no-charge, no-commitment consultation with a CTS CoachGUESTColin Izzard graduated from Syracuse University in 1998 with a BS in Exercise Physiology and Biomechanics. He served as the Head Coach for USA Swimming Teams as well as working at UNC Chapel Hill as a swimming and strength coach. He joined CTS as a coach in the early 2000s, developed CTS's first regional center in Asheville/Brevard NC, and mentored, developed, and trained dozens of coaches. Other fun projects have included writing stage races for Zwift and working with Training Peaks to help develop WKO 4 software. He served as a bike fit/sports science advisor for the Hincapie Racing Team, Columbia Es Passion Professional Cycling Team, The Toronto Maple Leafs NHL Team, and Trek Regional Factory Programs. HOSTAdam Pulford has been a CTS Coach for nearly two decades and holds a B.S. in Exercise Physiology. He's participated in and coached hundreds of athletes for endurance events all around the world.Listen to the episode on Apple Podcasts, Spotify, Stitcher, Google Podcasts, or on your favorite podcast platformGET FREE TRAINING CONTENTJoin our weekly newsletterCONNECT WITH CTSWebsite: trainright.comInstagram: @cts_trainrightTwitter: @trainrightFacebook: @CTSAthlete

มาถึงตอนนี้โยบไม่เหลืออะไรแล้ว ไม่มีทรัพย์สินเงินทอง ลูกๆเสียไป เป็นโรคร้าย ถูกทิ้ง ความเชื่อเดิมที่เคยเชื่อก็พังเหมือนปราสาททราย และ เพื่อนๆที่เชื่อๆมาแบบเดียวกันก็ไม่อาจตอบคำถามของโยบได้    อะไรคือความหมายของการมีชีวิต ชีวิตเกิดมาก็เพื่อที่จะเป็นทุกข์อย่างนั้นหรือ?     เขายังคงเชื่อในพระเจ้า แต่ ทำไมเขาต้องเผชิญกับความทุกข์? เขายังคงเชื่อว่าพระเจ้าอยู่ทุกแห่ง แต่ตอนนี้หันไปทางไหนก็ไม่พบ?   โยบยังคงหาคำตอบ  เขาจะมีชีวิตอยู่อย่างไรในความย้อนแย้งของชีวิตตอนนี้   …………………………………………. โยบ 27 -28 -29  เปลี่ยนโทนจากบทสนทนา มาสู่ภาษิตของโยบ โดยเฉพาะในตอนนี้ ที่เราจะกลับมาพูดถึงบทที่ 28 อีกครั้ง    เมื่อโยบสูญเสียทุกอย่างจึงเริ่มตั้งคำถาม “ความหมายของชีวิต” และโยบบทที่ 28 นี้ เป็นอีกครั้งที่พาเรากลับมาพบกับคำว่า “ปัญญา”   มีสิ่งมากมายที่มนุษย์พบ แต่เราจะพบ “ปัญญา” ได้จากที่ไหน   …………………………………………. มาติดตามตอนสุดท้ายของ ซีซั่น โยบ นี้นะครับ กับ โยบ บทที่ 28 ......................................................................... #ชูใจprojectpodcast  #พระคัมภีร์ไม่ไหลย้อนกลับ พระคัมภีร์ไม่ไหลย้อนกลับ ติดตามได้ทุกวันพุธ  จัดทำร่วมกับ  อ.ธนิต โลเกศกระวี  ผู้อำนวยการพระคริสต์ธรรมเชียงใหม่ (CTS) ......................................................................... ชาวชูใจสามารถร่วมเป็นส่วนหนึ่งในการสนับสนุน การผลิตคอนเทนต์ของทีมชูใจ ทั้งบทความและ Podcast ได้โดย การอธิษฐานเผื่อการแชร์บทความ และ การด้วยการสนับสนุนค่าใช้จ่ายในการผลิต รายละเอียดเพิ่มเติมทางลิงค์นี้ www.choojaiproject.org/donate

6.2 Engine Failure details 2015 Nissan Sentra Failing Transmission 06 Escape Ac Failure 20 Jeep Wrangler LED DRL Failure 2011 CTS fixing lots of stuff. We interview CRC about some of their best products and why we use them. 

บทสนทนาระหว่างเพื่อนกับโยบจบลงไปแล้ว แม้แต่คำถามของซาตานก็ถูกปิดลง ไม่ได้พูดถึงอีก เพราะ โยบ ยึดมั่นในความสัตย์จริง แม้จะไม่เหลืออะไรเลย   ปราสาทของความเชื่อเดิมพังทลาย แต่ก็ยังไม่พบคำตอบใหม่ โยบติดอยู่ตรงกลางในโลกของความย้อนแย้ง   โยบทำดี แต่ทำไมเหมือนถูกลงโทษ ในขณะที่คนชั่วที่เห็นๆก็ไม่ถูกลงโทษแถมเจริญรุ่งเรือง   พระเจ้ายุติธรรมไหม?   แล้วถ้าพระเจ้าไม่ยุติธรรม แต่โยบก็ยังต้องการเรียกร้องความยุติธรรมจากพระเจ้า นี่ก็ย้อนแย้งด้วย   โยบไม่อาจเข้าใจพระเจ้าได้ แต่เขาก็ยังอยากเข้าใจเรื่องนี้ด้วยพระปัญญาของพระเจ้า   แล้วถ้าต้องมาเชื่อพระเจ้าก่อน พระเจ้าถึงจะอวยพร ไม่เชื่อก็ถูกลงโทษ อย่างนั้นความสัมพันธ์ระหว่างมนุษย์กับพระเจ้าก็เป็นเรื่องผลประโยชน์ไม่ใช่หรือ แล้วความหวังมันอยู่ตรงไหนถ้าพระเจ้าบีบบังคับกันแบบนี้   ความย้อนแย้งที่โผล่ล้อมโยบ พระเจ้ายุติธรรมไหม ในชีวิตที่ย้อนแย้งแบบนี้   เนื้อหาในตอนนี้อยู่ระหว่างบทที่ 27-28  โปรดอ่านก่อน แล้วมาติดตามหาคำตอบไปด้วยกัน กับตอนนี้ครับ :D       #ชูใจprojectpodcast  #พระคัมภีร์ไม่ไหลย้อนกลับ พระคัมภีร์ไม่ไหลย้อนกลับ ติดตามได้ทุกวันพุธ  จัดทำร่วมกับ  อ.ธนิต โลเกศกระวี  ผู้อำนวยการพระคริสต์ธรรมเชียงใหม่ (CTS) ......................................................................... ชาวชูใจสามารถร่วมเป็นส่วนหนึ่งในการสนับสนุน การผลิตคอนเทนต์ของทีมชูใจ ทั้งบทความและ Podcast ได้โดย การอธิษฐานเผื่อการแชร์บทความ และ การด้วยการสนับสนุนค่าใช้จ่ายในการผลิต รายละเอียดเพิ่มเติมทางลิงค์นี้ www.choojaiproject.org/donate

Episode 404 is called “Wolfman Extravaganza” and the name says it all. Your hosts get together and talk about all three of the movies bearing the name “Wolf Man” or “Wolfman”. As an added bonus, they also discuss the 2024 “Werewolves”. So- break out your moonscreen and suspend your disbelief, because it's going to be a hell of a ride! Find us on Instagram where we are @chewingthescenery or easily find us on Facebook. CTS can be found on Soundcloud, Apple Music and anywhere fine podcasts can be found. Please rate, review, subscribe- it really does help new listeners find us! #horror #horrormovies #horrornerd #horroraddict #horrorjunkie #monsterkid #bmovie #scary movies #monstermovie #podcast #chewingthescenery #zombies #zombie #VHS #wolfman #werewolves #universalmonsters

เมื่อบทสนทนาเดินมาถึงรอบที่ 3 (ถ้ามันเหมือนกันมันก็คงไม่ถึงสามรอบ)   บทสรุปของเพื่อนที่ปลายทาง   เอลีฟัส สรุปให้โยบว่า ยอมรับผิดไปเถอะ ก็แค่รับผิด แล้วพระเจ้าก็จะกลับมาอวยพร ดีไม่ดีมากกว่าเดิมอีก   บิลดัด บอกกับโยบว่าพระเจ้านั้นยิ่งใหญ่ เราไม่อาจเข้าใจ เพราะมนุษย์นั้นต่ำต้อยเกินกว่าที่จะเข้าใจพระเจ้า   โศฟาร์ ….. เงียบ     บทสนทนาเดินมาถึง 26 บท และรอบนี้จะเป็นรอบสุดท้ายที่เป็นตอนจบ แต่กลับพบว่ามันเป็นทางตัน ซ้ำร้ายที่ทางปลายทางตัน รูเล็กๆที่เป็นรอยรั่วทำให้เราเห็นว่ามันกำลังจะพังทลาย    โยบไม่รู้ว่ามันจะเป็นอย่างไร เมื่อมันพัง แต่เขายังคงยึดมั่นในความสัตย์จริง และ เชื่อว่าเขาจะพบคำตอบจากพระเจ้า    ความย้อนแย้ง ที่ยังไม่ได้รับคำตอบ พระเจ้าจะลงโทษความอยุติธรรม และ ประกาศว่าโยบไม่ผิดจริงๆ    จะมีไหมคนกลางที่จะมาว่าความตามที่เขาคาดหวัง คนที่ต้องอยู่ต่อหน้าพระเจ้าได้(เป็นพระเจ้า) และ คนคนนั้นจะต้องเป็นมนุษย์เพราะจะได้เข้าใจความเป็นมนุษย์   …………………   ความเชื่อของคริสเตียนก็เช่นกัน หากไม่ได้ตรวจสอบว่ามันเป็นสิ่งที่เป็นตามสิ่งที่พระเจ้าประสงค์ เมื่อเจอลมพายุและความทุกข์ยาก มันอาจพังลงเป็นปราสาททรายเช่นกัน   …………………   พบกับตอนสุดท้ายของบทสนทนาระหว่างโยบและเพื่อนๆในตอนนี้ ตอนจบที่ไม่มีคำตอบ    แต่มี บทสรุป...   ............... #ชูใจprojectpodcast  #พระคัมภีร์ไม่ไหลย้อนกลับ พระคัมภีร์ไม่ไหลย้อนกลับ ติดตามได้ทุกวันพุธ  จัดทำร่วมกับ  อ.ธนิต โลเกศกระวี  ผู้อำนวยการพระคริสต์ธรรมเชียงใหม่ (CTS) ......................................................................... ชาวชูใจสามารถร่วมเป็นส่วนหนึ่งในการสนับสนุน การผลิตคอนเทนต์ของทีมชูใจ ทั้งบทความและ Podcast ได้โดย การอธิษฐานเผื่อการแชร์บทความ และ การด้วยการสนับสนุนค่าใช้จ่ายในการผลิต รายละเอียดเพิ่มเติมทางลิงค์นี้ www.choojaiproject.org/donate

Join us for the newest episode of How to Speak Maintenance!

  โยบไม่เข้าใจเรื่องปัญญา เพราะโยบไม่ได้เกิดมาแบบนั้น ขาดประสบการณ์ ขาดชุมชนที่ส่งต่อความรู้กันมา เอลีฟัสบอกกับโยบ   มันเป็นผลของคนทำกรรมชั่ว เหมือนต้นไม้ถูกถอน เหมือนสัตว์ติดกับ เหมือนอาชญากรที่ถูกตามมล่า คนชั่วต้องถูกถอนรากถอนโคนแบบโยบนั่นแหละ บิลดัดบอก   ส่วนโศฟาร์ก็มาลงท้าย โยบไม่รู้จักพอ คนชั่วต้องรับผลแบบนี้ ผมรู้เพราะผมรู้ว่าพระเจ้าจะทำยังไง   เพื่อนที่มาคุยด้วยไม่ได้ให้คำตอบ  ภรรยาไม่ได้ให้คำตอบ คนที่เคยรู้จักก็ไม่ให้คำตอบ และเมื่อโยบมองไปที่พระเจ้าก็ไม่แน่ใจ  เพราะตอนนี้ดูเหมือนพระองค์จะเป็นศัตรู ยังไม่มีคำตอบ   เมื่อคำถามตันใจ แต่ไร้ทางออก แล้วความหวังของโยบ จะไปอยู่ที่ไหน?  โยบจะพบคำตอบในเรื่องที่เขากังวลหรือไม่ ตอนนี้สิ่งที่ไม่เข้าใจมันหนักกว่าสิ่งที่เจอข้างนอกเสียอีก ความเชื่อที่เขามี ชอบธรรม ยำเกรง หันเสียจากความชั่ว เป็นเหมือนปราสาทที่เข้มแข็ง แต่ตอนนี้เขาเริ่มเห็น ว่ามันเป็นปราสาททรายและหากมันพังทลาย "ความหวัง" ของเขาอยู่ที่ไหน ............... #ชูใจprojectpodcast  #พระคัมภีร์ไม่ไหลย้อนกลับ พระคัมภีร์ไม่ไหลย้อนกลับ ติดตามได้ทุกวันพุธ  จัดทำร่วมกับ  อ.ธนิต โลเกศกระวี  ผู้อำนวยการพระคริสต์ธรรมเชียงใหม่ (CTS) ......................................................................... ชาวชูใจสามารถร่วมเป็นส่วนหนึ่งในการสนับสนุน การผลิตคอนเทนต์ของทีมชูใจ ทั้งบทความและ Podcast ได้โดย การอธิษฐานเผื่อการแชร์บทความ และ การด้วยการสนับสนุนค่าใช้จ่ายในการผลิต รายละเอียดเพิ่มเติมทางลิงค์นี้ www.choojaiproject.org/donate

พระเจ้าดี เราทำดี พระเจ้าก็จะปกป้องและอวยพร พระเจ้าดี มีคนทำไม่ดี พระเจ้ายุติธรรมก็จะลงโทษทันที   แต่สมการที่โยบและเพื่อนเคยยึดถือนี้ ดูเหมือนจะไม่ใช่   โยบรู้ตัวว่าไม่ไม่ได้ทำผิด - พระเจ้าลงโทษคนไม่ดี แต่ตอนนี้โยบกำลังเผชิญกับความทุกข์ราวกับโดนลงโทษ สมการที่เคยยึดถือ จึงค่อยๆล่มสลาย เพราะมันไม่ถูกต้องในตอนนี้   ส่วนเพื่อนๆ ที่มีก็มาย้ำเตือน ว่าสมการชีวิตที่มีนั้นถูกต้องแล้ว  แต่โยบต่างหากที่ต้องทำอะไรผิดสักอย่างแล้วไม่ยอมสารภาพ จึงมาช่วยเค้นกันดู ให้โยบรู้ตัวจะได้กลับใจ   ………………………………..   ส่วนสำคัญในเรื่องโยบคือบทสนทนานี่แหละ ที่พอฟังเพื่อนๆโยบพูดถึงพระเจ้าก็เหมือนจะถูก  และ โยบที่เหมือนจะผิด  หรือจริงๆแล้ว เป็นพระลักษณะของพระเจ้านั่นแหละที่เราไม่เข้าใจ ไม่ควรสงสัย ไม่ควรถาม? แต่ตอนจบพระเจ้ากลับบอกว่าเพื่อนโยบพูดไม่ถูกต้อง   เดี๋ยวก่อน!! อย่าพึ่งรีบไปตอนจบ  เพราะบทสนทนานี้แหละ บทสนทนาที่กำลังสะท้อนเสียงความคิดของโยบ เพื่อนๆ รวมถึงพวกเราด้วย กำลังค่อยๆเปิดโปงความเข้าใจของเรากับพระเจ้าออกมา   เป็นเรื่องง่ายที่จะกระโดดไปยังบทสรุปแล้วชี้นิ้วบอกว่าเพื่อนๆของโยบผิด แต่เป็นเรื่องท้าทายกว่า ที่จะเข้าไปยังบทสนทนา แล้วค่อยๆริดเอาความคิดที่ไม่ถูกต้องเกี่ยวกับพระเจ้าแบบเพื่อนของโยบออกไปจากความคิดของเรา   ………………………………..   พระลักษณะของพระเจ้าในเรื่องนี้คืออะไร และอะไรคือสิ่งที่พระองค์บอกกับโยบว่า เพื่อนๆโยบพูดถึงเรา   “ไม่ถูกต้อง”   มาค่อยๆติดตามบทสนทนานี้ไปด้วยกันในตอนนี้ครับ   ……………………………….. #ชูใจprojectpodcast  #พระคัมภีร์ไม่ไหลย้อนกลับ พระคัมภีร์ไม่ไหลย้อนกลับ ติดตามได้ทุกวันพุธ    จัดทำร่วมกับ  อ.ธนิต โลเกศกระวี  ผู้อำนวยการพระคริสต์ธรรมเชียงใหม่ (CTS) ......................................................................... ชาวชูใจสามารถร่วมเป็นส่วนหนึ่งในการสนับสนุน การผลิตคอนเทนต์ของทีมชูใจ ทั้งบทความและ Podcast ได้โดย การอธิษฐานเผื่อการแชร์บทความ และ การด้วยการสนับสนุนค่าใช้จ่ายในการผลิต รายละเอียดเพิ่มเติมทางลิงค์นี้ค่ะ  www.choojaiproject.org/donate

The watercooler TV show is back, thanks to the runaway success of The Pitt. We're joined by friend-of-the-pod and fellow Pitt-head, Miguel Nacianceno, for a SPOILERFUL deep dive into the countless intubations, crikes, and chaotic CTs of its fantastic first season.PLUS: a content catch-up with Sinners, Drop, and a quick look back at The White Lotus Season 3.Follow us on Twitter ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@endslatepod⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠, or join our Facebook group ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/groups/endslate⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for a safe space discussion on pop culture.For inquiries and feedback, email us at endslatepod@gmail.com

Demand for AV integration services is becoming more complex and widespread, making it increasingly difficult for integrators to scale operations without sacrificing profitability. According to AVIXA's 2024 Industry Outlook and Trends Analysis, the Pro AV market is projected to reach $422 billion by 2029, intensifying the need for flexible, scalable support. Amid these pressures, service innovations like LinkLab are helping AV integrators stay competitive while navigating labor shortages, regional growth, and evolving client expectations.So, how can integrators, especially small to mid-sized ones, expand regionally, improve operational efficiency, and take on new work without overextending their internal teams?In this episode of Pro AV Today, host Ben Thomas, sits down with Cory Allen, VP of Services at Exertis Almo, to explore how the launch of LinkLab is reshaping the way integrators approach service delivery, project scaling, and workforce development across the AV industry.Key Points from the Conversation:Strategic Rebrand with Purpose: LinkLab isn't just a new name for Exertis Almo's professional services; it reflects a clearer mission to support AV integrators with targeted, scalable solutions.Regional and National Reach: The service enables integrators to pursue business in new markets even nationwide, without the need to hire local staff or turn away opportunities due to resource constraints.Empowering New Talent: LinkLab supports industry growth by offering CTS-certified AutoCAD training, helping to upskill both newcomers and experienced technicians within the AV community.Cory Allen is a seasoned AV industry leader with over 15 years of experience in sales, services, and operations, currently serving as Vice President of Services at Exertis Almo. He has advanced through roles ranging from Territory Manager to Director and now VP, consistently driving strategic growth, operational excellence, and team development across the Pro AV sector. Allen was recognized as a Commercial Integrator 40 Under 40 honoree in 2022, underscoring his impact and leadership in the industry.

Jeff Pierce is a former professional cyclist and the current CEO of Carmichael Training Systems (CTS). In Jeff's distinguished cycling career, he rode for team 7-11, the first American to ride the Tour De France and in 1987, Jeff became just the third American to win a stage of the Tour De France on the final stage on the Champs-Elysees.   In his current role as CEO of CTS, Jeff is responsible for the overall operations and direction of CTS. In this episode, host Rick Prince chats with Jeff about the coaching landscape and how it has evolved over the years – as well as where it is heading. Questions covered in this episode include:1.       Please tell our listeners about your sport background as well as your career post being a pro cyclist2.       What was the coaching landscape like while you were racing professionally?3.       How has training technology changed the coaching profession over the years?4.       What are some of the main reasons that athletes hire coaches at CTS?5.       What do you think the increase in demand of qualified coaches is due to?6.       Are there any significant trends that you see in the coaching landscape at CTS?7.       To be a successful coach, what are some of key qualities that athletes are looking for, as well as you as the head of CTS?8.       What are some current challenges that the coaching profession faces?9.       Where to you see the coaching profession in 5-10 years with respect to its evolution?Lastly, as CTS is largely one of the first to legitimize the profession of endurance sports coaching, what do you attribute its longevity to? 

Episode 403 is like a folk tale from a different time and place. Wait, this film is literally those things exactly! “Savage Hunt of King Stahk” (1980) is a Soviet Union drama-horror set in the remote Belarusian woodlands in the late 19th century. Find us on Instagram where we are @chewingthescenery or easily find us on Facebook. CTS can be found on Soundcloud, Apple Music and anywhere fine podcasts can be found. Please rate, review, subscribe- it really does help new listeners find us! #horror #horrormovies #horrornerd #horroraddict #horrorjunkie #monsterkid #bmovie #scary movies #monstermovie #podcast #chewingthescenery #zombies #zombie #VHS #savagehuntofkingstahk #sovietmovies #valerirubinchik #borisplotnikov #elenadimitrova

OVERVIEWSo many athletes are focused on training in Zone 2, but they don't realize "Zone 2" means different things depending on which training system you use. There is a 3-Zone system, a 5-Zone system, a 7-Zone system, and even more! Two of the most popular are 3-Zones, championed by researcher Dr. Stephen Seiler, and a 7-Zone system used by CTS and many other coaching groups. In Episode 241 of "The Time-Crunched Cyclist Podcast", Coach Adam Pulford answers a listener question about how an athlete can compare or use more than one training zone methodology, and what "Zone 2" means in a 3-Zone system compared to a 7-Zone system.TOPICS COVEREDWhy training zones were created7-Zone system compared to a 3-Zone systemUsing aerobic decoupling to evaluate aerobic conditioningPractical advice for athletes trying to use training zonesASK A QUESTION FOR A FUTURE PODCASTLINKS/RESOURCESComplete Guide to Polarized Training with Dr. Stephen SeilerZones Calculator Overview – TrainingPeaks Help CenterCalculator Compare: https://docs.google.com/spreadsheets/d/1aptCiqhjm6Fn7vG6P50AX54pW1P7XdVWx-lCARzNA5U/edit?gid=965771708#gid=965771708Episode #170 “Leveraging Lab and Field Testing to Create a Bigger Aerobic Engine” https://podcasts.apple.com/us/podcast/trainright-podcast/id1494799053?i=1000634902218Aerobic Decoupling: https://help.trainingpeaks.com/hc/en-us/articles/204071724-Aerobic-Decoupling-Pw-Hr-and-Pa-HR-and-Efficiency-Factor-EFAre You Fit? All About Aerobic Endurance and DecouplingEpisode #169 Metabolic Testing:https://podcasts.apple.com/us/podcast/trainright-podcast/id1494799053?i=1000634127336Tim Cusick:https://podcasts.apple.com/us/podcast/trainright-podcast/id1494799053?i=1000468063825HOSTAdam Pulford has been a CTS Coach for nearly two decades and holds a B.S. in Exercise Physiology. He's participated in and coached hundreds of athletes for endurance events all around the world.Listen to the episode on Apple Podcasts, Spotify, Stitcher, Google Podcasts, or on your favorite podcast platformGET FREE TRAINING CONTENTJoin our weekly newsletterCONNECT WITH CTSWebsite: trainright.comInstagram: @cts_trainrightTwitter:

Episode 402 is about a prequel to a horror classic. “Apartment 7A” (2024) tells you all about a character you never really got to meet at the beginning of “Rosemary's Baby” (1968). Is this a story that really needed to be told? Would we all have been left to wonder otherwise? Listen and find out! Find us on Instagram where we are @chewingthescenery or easily find us on Facebook. CTS can be found on Soundcloud, Apple Music and anywhere fine podcasts can be found. Please rate, review, subscribe- it really does help new listeners find us! #horror #horrormovies #horrornerd #horroraddict #horrorjunkie #monsterkid #bmovie #scary movies #monstermovie #podcast #chewingthescenery #zombies #zombie #VHS #apartment7a #rosemarysbaby #juliagarner #diannewiest #prequel

OverviewWe love checking out what the pros are riding, but "normal" riders aiming to finish the Leadville 100 MTB in under 9 hours or under 12 hours have different needs on race day. Ten-time LT100 finisher, coach, and author Jim Rutberg talks with 3-time finisher Adam Pulford about the best bikes, equipment choices for the 2000+ riders behind the race leaders. And, since they're both coaches, they throw in a bunch of training, nutrition, and race strategy tips as well.Key topics in this episode:Challenges of Leadville 100 courseIs Leadville a drop-bar bike course?Best Bike Setup for Leadville 100How much suspension do you need?Bottles or hydration pack?What about a hardtail MTB?Wheels and Tires for Leadville 100Crank length for mountain bikingMTB, Gravel, or Road shoes and pedals?Training and Nutrition tips for Leadville 100LINKS5 Race Bikes from the 2022 Leadville 100 - PinkbikeTech Week – Bike & Tire Guide for the Stages Cycling Leadville Trail 100 MTBRoundup: The mountain bikes of Leadville - VeloXC vs Trail Bike Geo: Trail vs cross-country mountain bikes: Which is right for you? | BikeRadarASK A QUESTION FOR A FUTURE PODCASTGuestJim Rutberg has been an athlete, coach, and content creator in the outdoor sports, endurance coaching, and event industries for more than 20 years. He is the Media Director and a coach for CTS and co-author of several training and sports nutrition books, including Training Essentials for Ultrarunning with Jason Koop, Ride Inside with Joe Friel, and The Time-Crunched Cyclist with Chris Carmichael. A graduate of Wake Forest University with a Bachelor of Science degree in Exercise Physiology, Jim resides in Colorado Springs, Colorado, with his two sons, Oliver and Elliot. He can be reached at jrutberg@trainright.com or @rutty_rides on Instagram.HostAdam Pulford has been a CTS Coach for nearly 20 years and holds a B.S. in Exercise Physiology. He's participated in and coached hundreds of athletes for endurance events all around the world.Listen to the episode on Apple Podcasts, Spotify, Stitcher, Google Podcasts, or on your favorite podcast platformGET FREE TRAINING CONTENTJoin our weekly newsletterCONNECT WITH CTSWebsite: trainright.comInstagram: @cts_trainrightTwitter: @trainrightFacebook: @CTSAthlete

It's been some years since we last had these fellas on the pod, and a whole lot has happened in both of their shops since our last hang. So it's time to catch up with Rodney from DLH, and Miles from Miles T-shirts. Topics of discussion include: 4 day work weeks, how fast shops evolve, hair plugs, upgrading equipment, disc golf, towel prints, updating your financials, moving your shop, third party HR, diving into outbound sales, CTS, Miles' shirt reviews, garment printability, and Merch Madness.

Carpal tunnel syndrome is one of the most common nerve compression issues—but how can massage and manual therapy help? In this in-depth episode, Whitney Lowe and Til Luchau break down the anatomy, risk factors, and assessment strategies for carpal tunnel syndrome, exploring its causes, differential diagnosis, and effective hands-on approaches. They discuss the importance of nerve mobility, client education, and activity modifications to relieve symptoms and improve function. Whether you're a hands-on therapist looking to refine your treatment strategies, or someone experiencing wrist and hand discomfort, this episode offers valuable insights into understanding and managing carpal tunnel syndrome.

Episode 401 finds your hosts welcoming you back with a recent favorite, “The Substance”. Considering that horror cinema has become an embarrassment of riches, why not talk about one of the best? Join your kind hosts in a lively discussion, won't you? Find us on Instagram where we are @chewingthescenery or easily find us on Facebook. CTS can be found on Soundcloud, Apple Music and anywhere fine podcasts can be found. Please rate, review, subscribe- it really does help new listeners find us! #horror #horrormovies #horrornerd #horroraddict #horrorjunkie #monsterkid #bmovie #scary movies #monstermovie #podcast #chewingthescenery #zombies #zombie #VHS #demimoore #thesubstance #margaretqualley #coraliefargeat

This week's EYE ON NPI is neither-here-nor-there - it's STMicroelectronics' ST25R200 NFC/HF RFID Reader IC (https://www.digikey.com/en/product-highlight/s/stmicroelectronics/st25r200-nfc-hf-rfid-reader-ic) a simple but powerful NFC/RFID reader and writer chip that will let you add a contactless interface to your next design. Thanks to the high power RF stage and dual antenna support, you can avoid the frustration of "where do I tap??" by giving you plenty of surface area for successful transactions. We're big fans of intuitive RFID/NFC interfaces using tags, they come in all sorts of sizes and shapes (https://www.adafruit.com/product/365) from standard business cards to microtags that can fit in a manicure (https://www.adafruit.com/product/2800). They don't require a battery, and can store up to a few KB of data, including encrypted/secured data sections so as to make the tag 'trustworthy'. They're often used for small-money transactions like copy shops, laundromats and public transport, where speed is important and we can store value on the card. Or for identification like access cards. With proper design, they'll work up to 4 inches away from a reader, don't suffer from corrosion or contact wear or affected by water/humidity. Reading and writing RFID/NFC tags, which use 13.56MHz as a carrier frequency, requires a proper chip that can handle the requirements of blasting enough RF signal to 'power' the tag, then transmit a command and receive the response before the quiescent power runs out. If you have a big antenna, this isn't too hard - but the real challenge is to manage it with a small antenna. That's the nice thing about the ST25R200 (https://www.digikey.com/short/5ttf9ptj) - it has powerful output drivers so even mini wearable-sized antennas work well. You can configure the outputs to be one differential or two single-ended antenna coils. If you want to design your PCB antenna, we recommend ST's website for NFC inductance calculations (https://eds.st.com/antenna/#/) it will let you determine the inductance based on width, height, copper thickness and trace width so you get maximum power transfer. The ST25R200's connection to the controller is over standard 4-pin SPI, so you can use any microcontroller or microcomputer with 4 pins available. An IRQ line is also handy to 'wake on card detect'. Other than that, the interface is fairly low level: registers are used to configure the RF section and encoding but otherwise, data is transmitted or received via two FIFO buffers. This makes the chip easy to adapt to the various sub-protocols and standards (https://nfc-forum.org/build/specifications) designed by competing RFID companies: ISFO14443A/NFC-A, ISO14443B/NFC-B, ISO15693/NFC-V, NFC Forum T1T, T2T, T4T, and T5T tag types, and proprietary protocols, such as Kovio, CTS, and B'. In order to make your life easier when it comes to implementation, ST has released RFAL an RF/NFC abstraction layer (https://www.st.com/en/embedded-software/stsw-st25rfal004.html) that is written in pure C so that it can be ported to any platform or compiler. To get started quickly we recommend the STEVAL-25R200SA evaluation board (https://www.digikey.com/en/products/detail/stmicroelectronics/STEVAL-25R200SA/25701817) which comes with a USB debug STLink interface, SMTable module, 4 pluggable antenna options including one flex PCB printed antenna, and two micro-tags for testing. If you want to integrate RFID/NFC 'touchless' support to your next design, the ST ST25R200 NFC/HF RFID Reader IC (https://www.digikey.com/short/5ttf9ptj) is small, inexpensive, and fast to get started with minimal external components, and ready-to-go drivers. And best of all the chips are in stock right now at DigiKey for immediate shipment. Order the ST25R200 (https://www.digikey.com/short/5ttf9ptj) and an eval board today and you can tap your way to contactless communication by tomorrow afternoon!

In this episode I lay out a basic framework of high intensity training for Ultrarunners that we use here at CTS. To watch the YouTube version, please visit https://youtu.be/X49k_rfNQgQ

Episode 400 is, well, our 400th episode! Join your dear hosts in a lively discussion about what movies, actors and directors that make us the fans we are. Listen to our lists about all the good and bad horror movies we've covered. It's like book club without all the pesky reading! Find us on Instagram where we are @chewingthescenery or easily find us on Facebook. CTS can be found on Soundcloud, Apple Music and anywhere fine podcasts can be found. Please rate, review, subscribe- it really does help new listeners find us! #horror #horrormovies #horrornerd #horroraddict #horrorjunkie #monsterkid #bmovie #scary movies #monstermovie #podcast #chewingthescenery #zombies #zombie #VHS #400thepisode #episode400 #the400club

Episode 399 takes you back to a simpler time- 1971. This is when the psychotic behavior of other drivers couldn't be explained as easily and wasn't such a frequent occurrence. A budding young director knew just how to turn road rage and menacing behavior into true terror on the small screen for an ABC Movie of the Week. Steven Spielberg's “Duel” finds traveling salesman David Mann (Dennis Weaver) chased by a mysterious trucker with a tanker full of something flammable and the desire to terrorize. Find us on Instagram where we are @chewingthescenery or easily find us on Facebook. CTS can be found on Soundcloud, Apple Music and anywhere fine podcasts can be found. Please rate, review, subscribe- it really does help new listeners find us! #horror #horrormovies #horrornerd #horroraddict #horrorjunkie #monsterkid #bmovie #scary movies #monstermovie #podcast #chewingthescenery #zombies #zombie #VHS #spielberg #duel #itcamefromthe70s #dennisweaver #roadrage

Episode 398 is a Thanksgiving treat…Eli Roth's 2023 slasher, “Thanksgiving”. Your hosts talk turkey and have a little holiday fun! Find us on Instagram where we are @chewingthescenery or easily find us on Facebook. CTS can be found on Soundcloud, Apple Music and anywhere fine podcasts can be found. Please rate, review, subscribe- it really does help new listeners find us! #horror #horrormovies #horrornerd #horroraddict #horrorjunkie #monsterkid #bmovie #scary movies #monstermovie #podcast #chewingthescenery #zombies #zombie #VHS #niccage #thanksgiving #eliroth #jeffrendell#slasher #patrickdempsey

25% off www.acinfinity.com - use code GROWCAST15 - BEST time of year to stock up on a new setup! FAT PACKS at www.growcastpodcast.com/growcast-seed-co Peach Smash is coming with fat packs, and the freebies are mostly CTS fems... Members get additional $20 off per pack. 42% off www.rootedleaf.com - use code GROWCAST - stock up on the carbon based, no PH nutrients! MARK YOUR CALENDARS - Grand Pheno Hunt Round Two coming on 2/15/25. Make sure you're in Membership.

Hoy en #LaEncerrona: 👮‍♂️🔫 La seguridad peor que nunca: Falsos operativos y armas incautadas por la policía volvieron a los criminales en las calles. 🚉CONFIRMADO: Se concretó el negocio de los trenes. MTC extenderá la concesión al "hermanito" de Rafael López Aliaga. ADEMÁS: Nuevo fake news sobre la detención de Marco Sifuentes. 💸 ¿Eres trabajador dependiente y aún no sabes cuánto te toca de CTS? Hoy te explicamos todo lo que necesitas saber. **** ¿Te gustó este episodio? ¿Buscas las fuentes de los datos mencionados hoy? SUSCRÍBETE en http://patreon.com/ocram para acceder a nuestros GRUPOS EXCLUSIVOS de Telegram y WhatsApp. También puedes hacerte MIEMBRO de nuestro canal de YouTube aquí https://www.youtube.com/channel/UCP0AJJeNkFBYzegTTVbKhPg/join **** Únete a nuestro CANAL de WhatsApp aquí https://whatsapp.com/channel/0029VaAgBeN6RGJLubpqyw29 **** También estamos en TokyVideo https://www.tokyvideo.com/user/marcosifuentes/videos **** Para más información legal: http://laencerrona.pe

Shauna the Tax Goddess, CPA, MTax, CTC, CTS, is a two-time published author who founded Tax Goddess Business Services in 2004, a 100% digital firm with an expert team of more than 65 people around the globe that has saved their clients over $1 Billion in taxes! Shauna is a sought-after speaker who advises business owners, investors, and entrepreneurs to create plans of action to increase their bottom line, reduce costs, significantly reduce taxes, increase cash flow, and perform what-if scenario options so that owners know what decisions to make and which paths are best suited to their particular situation.    Before starting her own company, Shauna had garnered experience and sharpened her skills working with leading corporations such as KPMG and American Express. She is a Certified Public Accountant (AZ) with a master's degree in Taxation and is ranked in the top 1% of Tax Strategists in the entire country (per AICTC).  Her resourcefulness and mastery in her field have led her to be featured by numerous top broadcast media platforms such as Forbes, CNN Money, Daily Herald, Big News Network, Entrepreneur, CBS, FOX, ABC, Sonoran Living, The List, The Connect Show, The Arizona Republic and many more!   In this episode, we talked to Shauna about finding the right tax professional for your situation, tax preparer versus a tax strategist, available options to save on taxes, her book “The 6% Life”, how CPAs and tax strategists collaborate, tax strategies for real estate investors, and much more.   Announcement: Learn about our Apartment Investing Mastermind here.   Tax Strategies;   02:18 Shauna's background; 05:44 Seeking the right tax professional; 11:57 Tax preparer vs. tax strategist; 14:24 Options to save on taxes; 18:35 About her book, "The 6% Life"; 22:59 How tax strategists and CPAs collaborate; 27:05 Tax strategies for real estate investors; 32:03 Round of Insights   Announcement: Download our Sample Deal package here.   Round of Insights   Apparent Failure: Running out of money frequently earlier. Digital Resource: Cash Goblin. Most Recommended Book: The 4-Hour Workweek. Daily Habit: Getting up early and spending time with her pets. #1 Insight for saving on your taxes: If you have kids, it's all about them.   Contact Shauna: Website   Thank you for joining us for another great episode! If you're enjoying the show, please LEAVE A RATING OR REVIEW,  and be sure to hit that subscribe button so you do not miss an episode.

Episode 379 is about the brand new Oz Perkins movie, “Longlegs”(2024), starring Nic Cage and Maika Monroe. You can definitely see that Perkins is refining his voice as a writer and director. Find us on Instagram where we are @chewingthescenery or easily find us on Facebook. CTS can be found on Soundcloud, Apple Music and anywhere fine podcasts can be found. Please rate, review, subscribe- it really does help new listeners find us! #horror #horrormovies #horrornerd #horroraddict #horrorjunkie #monsterkid #bmovie #scary movies #monstermovie #podcast #chewingthescenery #zombies #zombie #VHS #niccage #maikamonroe #longlegs #ozperkins

Annabelle Bitterman was our 2024 Central Texas Showdown (472 miles) 1st place female, which was also good enough to secure 3rd overall. This was her third time participating in a Texas Showdown Series event. Her first bikepacking race was the 2023 Central Texas Slowdown (297 miles) and was our 1st place female finisher. Next she signed up for the 2024 East Texas Slowdown (280 miles) where she was our 3rd place female finisher. She only started riding bikes seriously a few years ago and was quickly bit by the cycling bug and was further hooked by the cycling community. Hailing out of Austin, TX she's found a robust community of other rad cyclists that continue to ignite her passion for throwing a leg over the top tube and go for long rides. Those long rides led her to find ways to continually challenge herself which is when she discovered the Texas Showdown Series. Since then, she's become a staple at the events and a staple on our podiums. On today's episode we take a deep dive into CTS, ETS, and Annabelle's experience as a relatively new cyclist who's looking to challenge herself on her bike.  EPISODE SPONSORS Follow My Challenge USA ~ The preferred gps tracking service for the Texas Showdown Series New Patrons  Pierre Delecto Ryan Staffen Join them won't you? Now is a great time to sign up at Patreon.com/bikesordeath!

Episode 396 finds your hosts back in the studio to discuss the newly released Irish horror film, “Oddity” (2024). This one has lots of spooky atmosphere and one of the best jump scares ever! Find us on Instagram where we are @chewingthescenery or easily find us on Facebook. CTS can be found on Soundcloud, Apple Music and anywhere fine podcasts can be found. Please rate, review, subscribe- it really does help new listeners find us! #horror #horrormovies #horrornerd #horroraddict #horrorjunkie #monsterkid #bmovie #scary movies #monstermovie #podcast #chewingthescenery #zombies #zombie #VHS #oddity #damianmccarthy #gwilymlee #carolynbracken #tadghmurphy #irishhorror

Episode 395 is a treat just in time for Halloween. Richard sits down for an interview with John Dugan, also known as Texas Chainsaw Massacre's Grandpa Sawyer. This one is full of behind-the-scenes stories you won't hear anywhere else! Find us on Instagram where we are @chewingthescenery or easily find us on Facebook. CTS can be found on Soundcloud, Apple Music and anywhere fine podcasts can be found. Please rate, review, subscribe- it really does help new listeners find us! #horror #horrormovies #horrornerd #horroraddict #horrorjunkie #monsterkid #bmovie #scary movies #monstermovie #podcast #chewingthescenery #zombies #zombie #VHS #texaschainsawmassacre #TCM #tobehooper #johndugan

Standing desks, CTS, and more.

In this episode of CTS, we explore three powerful themes: unexpected life shifts, the accountability of men in today's society, and how achievement in sports does not give anyone a free pass from morality. Kip kicks things off by reflecting on a tweet about the Dallas Cowboys that sparked a deep dive into how we measure character in athletes and why achievement shouldn't excuse immoral behavior. We then turn to the work of Michael Flood and Lula Dembele, who challenge the idea that men are inherently violent and unemotional, supporting Kip's belief that harmful behaviors are learned and can be unlearned through better social conditioning. Finally, Kip introduces the term "lifequake," a major upheaval that forces personal growth and transformation. Drawing from his own experiences with family and career challenges, Kip reflects on how these moments of crisis shaped the person he is today. Tune in to hear about the lessons these lifequakes have taught, the importance of holding men accountable, and how transformation often begins with discomfort.

Shauna A. Wekherlien, CPA, MTax, CTC, CTS is a two-time published author and the Founder of Tax Goddess Business Services. Tax Goddess is a fully digital firm with a skilled team of over 65 people worldwide that have saved their clients over $1 billion in taxes. Shauna advises business owners, investors, and entrepreneurs to actively create custom strategies to maximize deductions and reduce their tax burdens to the legal minimum. She is ranked in the top 1% of Tax Strategists in the USA and has been featured on many platforms, including Forbes, CNN Money, Entrepreneur, CBS, FOX, ABC, and others. What You Will Learn: Who is Shauna A. Wekherlien? How she transitioned from studying astrophysics to tax consulting. Shauna explains how she fell in love with the intricacies of tax law and strategy, comparing it to a chess game. The importance of tailoring tax strategies to individual circumstances, such as marital status and family situation. Shauna explains that the tax code allows smaller businesses and individuals to access the same deductions as larger corporations. How different personal and business goals influence tax planning, such as wealth transfer and real estate investments. How to assess whether a CPA is effectively using tax strategies in a client's best interest, including the importance of specialization. How to identify critical strategies for real estate investors, such as cost segregation and aggregation elections? What is the Profit First method? Shauna shares insights from her experience scaling her accounting firm and managing a fully remote team. How tax planning can be used strategically for business growth, not just compliance. The importance of balancing offensive (growth-oriented) and defensive (compliance-oriented) strategies in business. What is the importance of having the correct business entity (LLC, S Corp, etc.) for tax benefits and legal protection? What are the benefits of the Cash Goblin app in automating savings and managing finances? How financial success relates to personal freedom and the overall quality of life. Shauna shares how everyone can contact her. Additional Resources from Shauna A. Wekherlien: Website: https://podcasts.apple.com/us/podcast/top-1-of-tax-strategists-in-the-usa-specializing/id1396344349?i=1000591099545, https://podcasts.apple.com/us/podcast/secret-tax-strategies-of-wealthy-investors/id916463101?i=1000642185245, https://podcasts.apple.com/us/podcast/tax-planning-on-steroids-with-the-tax-goddess/id960041122?i=1000605726652, https://podcasts.apple.com/us/podcast/how-to-work-with-a-tax-strategist/id1432566703?i=1000622032896 Email: shauna@taxgoddess.com Phone: +1 (602) 362-7939 LinkedIn: https://www.linkedin.com/in/taxgoddess Twitter: https://x.com/TaxGoddess Facebook: https://www.facebook.com/shaunataxgoddess?mibextidZbWKwL Attention Investors and Agents Are you looking to grow your business? Need to connect with aggressive like-minded people like yourself? We have all the right tools, knowledge, and coaching to positively effect your bottom line. Visit:http://globalinvestoragent.com/join-gia-team to see what we can offer and to schedule your FREE consultation! Our NEW book is out...order yours NOW!   Global Investor Agent: How Do You Thrive Not Just Survive in a Market Shift? Get your copy here: https://amzn.to/3SV0khX HEY! You should be in class this coming Monday (MNL). It's Free and packed with actions you should take now! Here's the link to register: https://us02web.zoom.us/webinar/register/WN_sNMjT-5DTIakCFO2ronDCg

Dr. Lindsey Hughey // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Extremity Division leader Lindsey Hughey dives into the topic of carpal tunnel syndrome (CTS). Lindsey explains what CTS is, including its symptoms and the populations it affects. The episode primarily focuses on the various treatment options available for CTS, discussing their efficacy as supported by current literature. Lindsey discusses the heterogeneity of treatment outcomes and presents a "PT first" approach to treatment. Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our Extremity Management course or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.

Sabina is one of our VBAC-certified doulas from Canada and is sharing her peaceful FBA2C today. While free birth comes with its own risks and benefits, we know that many women feel drawn to this option when they have no support or do not feel safe birthing any other way as Sabina did. We want to share all types of births after Cesarean and honor all stories! The way Sabina trusted in her body and in the physiological birth process after a traumatic experience with HELLP syndrome is truly inspiring. Among the many important messages from this episode, Meagan says: “If you are a provider listening and you perform C-sections, please, please hear what we are saying today. What you say to us while we are on the table in the most vulnerable position… impacts us. Every word that comes out of your mouth, please think about it. Please think about it because it impacts us…I'm getting emotional because I remember my provider talking crap like that and saying things like that. It impacts us longer than you will ever, ever know and it will impact us for every future birth. Please, providers. Please, please, please from the bottom of my heart, I beg of you. Watch what you say to people.” The VBAC Link Blog: VBAC with PreeclampsiaNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, hello Women of Strength. It is Meagan and I'm so excited to be recording wtih you today. You've probably been listening all summer but I've actually not been in the recording studio all summer. I record up until May until my kids get out of school then I take June and July off so I can be with my kids and save you guys from the screaming and the dog barking and all of that in the background. It's August and we are back in the studio and we have our friend, Sabina. Hello. Sabina: Hello. Meagan: I'm so excited to have her on today. You guys, she is one of our VBAC-certified doulas which is so exciting. She is also a mama of three. She is a FBA2C. Okay, you guys. F is a new one. We haven't been sharing a lot of F. We've had H and V and breech B so what does F stand for?Sabina: F stands for free birth which means I did not have any kind of provider with me during my pregnancy or during my birth. I just did it all by myself. Meagan: Yep, you did. Sometimes I feel like it's a mother-led pregnancy. Sabina: Yes. Yes. Meagan: This is something. We've talked about this a little bit before we got recording. The world, when we look at free birth, frowns deeply upon it. It's not for everyone. Sabina: No. Meagan: That's why a good majority doesn't. However, I think it's important to share these free birth stories. They are still beautiful stories and it doesn't mean because you didn't have a provider that your story doesn't deserve to be heard, right?Sabina: Right. Meagan: I think that it's also important to talk a little bit about the fact that so many people are not getting the support. You're going to tell us a little bit more about why you chose free birth, but the world as we know it is not VBAC-supportive in many ways, in most ways. Sabina: Still. Meagan: Yeah, as we know. You are in Canada, right?Sabina: Yep. Meagan: We know that there are some hurdles there too. Even here in Utah, over the last 10 years of me being a doula and having babies of my own, I've watched the VBAC support wane and actually wane in the less-ideal way which is really unfortunate. We have a lot of people who try. They try and find the support. They try and get what they deserve. You deserve support. Women of Strength, no matter who you are or where you are, you deserve support. Most people who choose to free birth ran out of those options and decide that they are still going to do what's best for them. That is what Sabina did and I'm excited for her to share her stories. In addition to free birth, we have some other little things in there. HELLP syndrome, if you've ever heard of HELLP syndrome you guys, or if you haven't ever heard of HELLP syndrome, we're going to talk more about that and what that looks like, the symptoms and things like that, and what it could mean. Then larger babies and then yeah, I want to talk a little bit more about VBAC doulas too because we love our VBAC doulas. I don't know. Are you serving right now? Sabina: I am, yeah. Meagan: You have a new babe, but you are. Okay, if you are in Canada– and where are you again?Sabina: I'm in Ottawa. Meagan: Ottawa. Okay, you guys, give her a call. You can find her on our website at thevbaclink.com/findadoula. Sabina: I don't have a website but my Instagram is @letsdoulathisvbac. Meagan: Let's doula this. We will make sure to tag her so just go to today's Instagram or Facebook and find her. We do have a Review of the Week so we will jump into that and then get into your beautiful stories. This review is by mitaya. I don't know. I think it's probably an abbreviation. I don't know. Maybe it's a name but it says, “I vote this place on over the speaker in every OB/GYN office.” I love that. It says, “I cannot even begin to describe what an encouragement these podcasts have been for me. I have completely binged on these in the past few weeks and they have grown my confidence for my up and coming baby. I cannot stop sharing everything I am learning and even helping to encourage first-time moms on how to educate themselves to avoid a Cesarean in the first place.” Ding, ding, ding. We're actually going to have an episode about that, y'all. So if you're ready to share an episode with a first-time mom, it's coming up. “Thank you so much for this no-B.S., truth-declaring, and empowering platform that I know has encouraged so many more than just myself. Keep being amazing. I can't wait to share our story in just a few short months. All of my love.”Thank you so much for your review and I hope that you had your VBAC and had a beautiful birth. If you are still listening with us, let us know. Give us a shoutout on my email or on Facebook or Instagram. Meagan: Okay, Ms. Sabina. Are you ready to dive in to these beautiful stories? Sabina: I am. Meagan: Let's do it. Sabina: This is surreal because I've been picturing this whole pregnancy how I would talk about things if I was on the podcast. Every time I had a symptom, I thought about how I would say it on a podcast so it's very cool to actually get to do it. Meagan: Tell us all of the things. Here you are. Sabina: Okay. I'll start with my first birth. I was pregnant in 2019 and I had one appointment with an OB then realized it wasn't for me. I switched to midwives and had a perfectly uncomplicated pregnancy. I'm very athletic so I was in shape working out the whole time. No symptoms of anything other than heartburn and some rib pain. We had midwives who were great and then around 41 weeks, actually on 41 weeks to the day, we had our ultrasound just to make sure everything was going well. When we got there, I started getting a lot of pain in my right side. Again, I had rib pain so I just brushed it off. It's nothing. I had seen my midwives the day before and everything looked good. Blood pressure was fine. We were sitting in the waiting room and it just kept getting more and more uncomfortable. I started sweating and I asked my husband if we could just step outside for a bit then I remembered one of my friends saying that when she was in labor, she would put her arms around her husband and just dangle to open everything. I tried that hoping it would relieve some pressure and I just started panicking. My husband who was very naive at the time was like, “Oh, this is it. You're in labor.” I was like, “No. This is not right. It's not going away.” Meagan: Something's off. Sabina: Something's off. We went back in and I asked the receptionist if I could just go lie down. They brought me into a room and at this point, I couldn't sit still. We called my midwife and she asked if I was prone to panic attacks and I said, “No, I've never had one.” They checked the baby and he was totally fine. But my midwife was like, “Okay, I'll meet you at the hospital.” We called the ambulance and this is where it starts to get fuzzy. I was in shock. I couldn't remember everything but we took an ambulance and the only reason we took an ambulance was because I thought they would help but they didn't do anything. They just waited and took me to the hospital. I spent the ride on my hands and knees and when we got to the hospital, my blood pressure was 275/174. Again, we had just checked it the day before and it was totally normal, 121/80. My midwife was there and they asked if they could check my cervix just to see if it was a bizarre labor and I was barely a centimeter. I was still very posterior so nothing was really happening. I do remember my mom quickly poking her head in. My husband must have called her but then they were like, “Okay, let's do a C-section.” I don't remember a lot. I remember as soon as they gave me the epidural, I could relax. Everything just went away. I briefly remember seeing my husband and being like, “Oh my god. We're going to have a baby.”I remember hearing him cry. They showed him to me the first time. I also had a cyst on one of my ovaries so they showed me that. It was kind of cool. Then in the recovery room, I very briefly remember trying to feed my son and then I told them that my vision was jumping around and I couldn't focus so they handed him over to my husband and then I don't remember anything else. Basically, they never treated my blood pressure. They just–Meagan: Wait, they didn't do anything? They were just like, “We've got to get the baby out” type thing then they ignored the astronomically high blood pressure?Sabina: Yes. Meagan: Okay. Sabina: Even though the baby was fine because we had just had the ultrasound and checked everything, they completely neglected the blood pressure. Obviously, it dropped when I got the epidural because it gets rid of the pain so it goes down a bit. Later, I found out that they had the medication ready, they just never gave it to me. So as soon as the epidural wore off, my blood pressure shot right back up and I ended up having a seizure. My husband, I mean I don't remember any of it, but my husband was kicked out into the hall shirtless holding our newborn not knowing what was going on. My parents were down the hall and heard the code blue and just knew it was for me. Then I was just talking to my mom about it yesterday. She said that they were at the nurse's station demanding to know what was going on. They were telling her to calm down and they just sent them to see my husband. He was in a dark room by himself with a newborn who was crying because he probably wanted to eat or whatever. He just looked like he was a ghost. He didn't know what was going on. It was horrible. Even to this day, it hurts knowing that that was his entrance into parenthood. Meagan: And both of your experiences too. His entrance and both of your experiences. It didn't start off very positively. Sabina: No. Definitely not. I remember seeing my dad briefly and then I don't remember anything until the next day. I woke up and my dad was there and I just said, “What happened?” He told me I had a seizure and then the first couple days, I don't remember much. My son was in the NICU just because I couldn't take care of him and they would bring him to me once in a while so I could feed him. My mom said she noticed that every time he was with me, my blood pressure would drop obviously. It makes sense. She advocated for him to get to stay with me. I started breastfeeding even though I was honestly half-dead. They told my family the day it happened that the next 24 hours would determine which direction I went so it was pretty scary. Meagan: Oh my gosh. Sabina: Yeah. Pretty scary. We ended up getting a private room in the ICU and my son was allowed to stay with me as long as somebody else was there. My mom and husband just kept switching off. The nurses were phenomenal. Every nurse we had was great. They brought us a full cart of baby supplies because we had nothing. We didn't even have a hospital bag but I saw every other person in the hospital. It was incredibly frustrating. We saw residents. We saw random specialists who had nothing to do with me. We saw interns. I never saw the same doctor twice and I was there for a week.Meagan: Whoa. Sabina: Yeah. We kept being told by one doctor that, “Okay, if your blood pressure stays below this level for the next 24 hours, you get to go home.” Then the next day, a doctor would come on and I'd say, “Okay, it stayed below. Can we go home?” They were like, “Oh no, no, no. You're probably here for the next several days.” It was back and forth like that and it was incredibly frustrating. Eventually, I left against medical advice because I knew I couldn't heal in the hospital. I knew I needed to go home. We went home with two blood pressure medications and by day two, I had to stop taking them because my blood pressure was so low. Meagan: Whoa. Sabina: Obviously, I made the right choice. It got to the point where I could hardly get out of bed and I was so lethargic because of the blood pressure being so low. Meagan: Your body truly was responding. It was in that flight/fight mode where you're probably so tense the whole time you were there. Your body was not able to even try to recover. Sabina: Yeah. I mean, that was our first week as parents. It was in the hospital. Eventually, we got moved to the labor and delivery ward but still, we were not home. We weren't comfortable. We were bored because we were just there and then we're seeing everybody and their uncle at the hospital coming in because I was a unique case. It was super frustrating. I do want to mention with the HELLP syndrome that my kidneys were failing. I had swelling in my brain. I had to get one MRI or two CTs or the other way around. I only remember one of them. Meagan: Your liver obviously. Sabina: Yes, yeah. My liver was definitely not ideal. Meagan: That was the start of the pain. Sabina: Yeah, again, I thought that was the rib pain. Meagan: Kind of up there. Sabina: I was perfectly healthy. Yeah. I was perfectly healthy. I had worked out that morning. Meagan: Wow. Sabina: I felt totally fine. It was very sudden. Meagan: Did you have any other symptoms like headache, blurred vision, swelling, nausea? Sabina: Not until after that pain. After the C-section, my vision was jumping. Meagan: Yeah, you said. Sabina: Yeah. I couldn't focus and then the next two days, right here on my head on the right side had severe pain. Nothing would help. They were giving me pain meds and stuff and nothing was helping so eventually, I just stopped taking them. But beforehand, there was absolutely nothing. They didn't test my blood or urine because it wasn't routine to check it at that time and they had no reason to check it but it was very, very sudden and very severe. Because they didn't deal with the blood pressure, I still wonder to this day if they had dealt with it or tried. Meagan: Given you magnesium or something. Sabina: If it wouldn't have been as severe of a reaction or a problem. Meagan: Yeah. Sabina: It's very frustrating to look back. Of course, after that I had PTSD but I didn't know that I had PTSD and the support wasn't really there. My midwife was like, “Well, of course, you're going to have some hard times,” but that was kind of it. That was the only support I got. My sister actually was pregnant at the same time and was due a month later. She got induced because she just went past her due date and I was so upset when she was in labor because I was so jealous. It's a horrible feeling because you're happy for them but I was just so jealous. My midwife came over that day. Again, there wasn't really much support surrounding that. It was just like, “Yeah, that's normal. Move on.” My sister ended up getting a C-section just because she got the cascade of interventions. It was a typical story. For the next year, it was extremely difficult mentally. Any time I tried to talk to somebody about it, it was always like, “Well, you have a healthy baby,” so trying to justify that everything was worth it because the baby is healthy. Again, I didn't tell my family how much I was struggling but anytime like for example, I would talk to my mom about it and be like, “I missed all of those moments with him like the first night. I wasn't with him at all.” She would always say something like, “Well, he was taken care of,” because she was there. I'm super grateful that they were there, but it would crush me inside because–Meagan: But not by me. Sabina: It should have been me. All of those moments should have been me. Then toward my son's first birthday, we were talking about his birthday party and again, my sister did not mean anything by this because she just didn't know what I was going through but she was like, “Well, you didn't really give birth so we'll call it his removal day.” I just played it off like it was fine, but my insides just crumbled. Meagan: That would impact me. That just made me have a little bit of an ick. I'm sure she didn't mean any harm by that, right? But that just gave me the ick. Sabina: Yeah, she didn't mean harm at all. So I just would play these things off and smile and nod sort of thing, but inside it just crushed me. Meagan: I'm sorry. Sabina: I never thought that I would have a C-section. You just don't think that's going to happen to you. His first birthday was really hard and then after that, I just started looking forward to the next one which was good but also not good because I didn't really do any healing or recovering. I just was like, “Okay, it's done. Let's move on.” So my second birth was in 2021 and it was more of a classic unsupportive provider scenario. I went with the same midwife because she was amazing during our first birth and I had a lot of trust with her. She was amazing but she told me I needed to see high-risk as well. I went to see the high-risk doctor and he did not want to see me. He just was l​​ike, “You are a pretty low high-risk because it happened so late in your pregnancy. Take baby aspirin. Get some extra ultrasounds. We don't need to see you.” I said, “Great. That's perfect. I don't care.” But my midwife was like, “Nope. You need to see him every month if you want to continue with us.” Meagan: Was that the protocol of their staff or was that just her opinion giving her comfort of you seeing an OB?Sabina: Yep. I think it was her comfort because she said that then if something did happen, we had him on hand sort of thing. Meagan: Okay. Sabina: I still wanted a home birth. I wanted a home birth with my first. Obviously, it didn't happen so I still was totally comfortable. I knew it wasn't going to happen again. We were going to take every precaution but my midwife was like, “Nope. It's too risky because you are a VBAC and you've had that happen, we can't support you in a home birth.” Again, I didn't know all of the red flags at this time and I just trusted her too much to think otherwise. I pretty much left every midwife appointment crying because any time I had tried to be positive and be like, “Okay, well if I can't deliver at home, I'll deliver at the hospital,” they'd be like, “No. You can't deliver at this hospital. You have to go to a higher-level hospital.” Those were the ones where I stayed in the ICU for a week so I didn't want to go there. Meagan: Triggering. Sabina: Yeah, and that's where I had to go for the high-risk too. I was going there once a month and then 2-3 times a month toward the end of this hospital where we had been through all of this trauma. Eventually, I asked if I could do the appointments over the phone because you'd get the ultrasound then you'd have to wait 2-3 hours to see the doctor because they were always so behind. I checked my blood pressure. I was just like, “Can you just call me?” That was fine so it made it that much easier. Yeah. Eventually, my midwife said that if everything was fine by a certain point, she would talk to the OB at the hospital that I wanted to deliver at and see what they thought. Ultimately, they said I had to transfer to OB care if I wanted to deliver there. It was stupid. Again, another red flag. I had to be induced and yada, yada, yada. There were all of these stipulations and everything needed to be what they needed. We saw the OB once and I did not– we were in and out in 5 minutes. I did not like it. She could not have cared less about me. It was very obvious. My midwife said that starting at 38 weeks, we should try and do stretch and sweeps every few days to get things going before my due date. Meagan: She really wanted you to have a baby before that 41-week mark. Sabina: Yes, exactly. She was more scared than we were. Even my husband wasn't as scared and he is a very anxious person. Yeah. We started doing the stretch and sweeps and again, I should have refused but you don't know what you don't know at that point. I found The VBAC Link when I was 37 weeks so I wish I had found it earlier so that I could have done the course and saw all of these red flags and had taken things into my own hands. Eventually, we kept going in to get induced but we got sent home because there were no beds. Again, I was like, “Why are we doing this then? I'm obviously not high on their priority list.” Eventually, we went in. They broke my water. We waited to see if anything would happen and nothing did. They started Pitocin. For the first 6 hours on Pitocin, I was able to handle it but my husband and I were so uncomfortable in the hospital room mentally, physically, and emotionally. We didn't want to be there. We were never in the room alone so we couldn't be ourselves because there were strangers there. I eventually asked for the epidural. I told my midwife that if I asked for the epidural, try everything else first, then do the epidural. As soon as I asked for the epidural, she was just like, “Okay, let's do it.” No pushback, so that was super frustrating as well. We got the epidural then 2 hours later, a different OB came in, checked me, and was like, “No. You are not dilating. It's not working. You need a C-section.” Again, I didn't know this at the time, but she said there was no progress but I had dilated a centimeter. I had fully effaced and– yes, fully. Not just a little bit. Fully effaced. Meagan: If everybody could see my face right now, I'm like, what? That's not change or progress?Sabina: Then my cervix had come forward too. Meagan: Big changes all around. Sabina: Big changes. Big changes, just not fast enough for this doctor. I knew it wasn't necessary. I waited for my midwife to come in and fight for me and she just went along with it. I was like, “What? No.” I didn't know I had the right to just say, “No, I'm not doing that.” Neither did my husband. Meagan: Even though you had the right, it's still very hard. Sabina: It's very hard. Meagan: It's a very difficult thing to be like, “Actually, no. I've got two medical professionals here telling me what I should do but I think no and how do I say that?” Sabina: Yeah, and you're already in such a vulnerable state then there is all that negative energy too which really affects me. I'm a highly sensitive person so energies really affect me. Meagan: You were proof in your first birth too. As soon as that doctor walked in, I could feel that negative energy. I knew she didn't care about me. She wasn't in this job for the right reasons. I bawled and my husband tried to comfort me. He was like, “It's going to be different. We're going to remember everything. We know what's happening this time.” I just kept saying, “Yeah, but we don't need it. The baby is fine. I'm fine. It's just not necessary.”Anyway, eventually, we had the C-section and I just laid there on the table sobbing. I did obviously remember everything but I was just miserable. I was pumped full of every drug so I was exhausted. I think it really affected the bonding experience between me and my baby. That first night with my son, I wanted him constantly. I wanted him on me. I didn't want anyone to take him with her. I wanted her to sleep separately so I could sleep which is very unlike me. I really think all of the Pitocin and everything blocked my natural hormone releases. While I was lying on the table, my husband and the baby got taken away to the recovery room and I was just trying to rest. The OB was like, “So do you want more kids?” I was like, “Yeah.” She was like, “Well, they'll all have to be C-sections,” while I was laying on the table after sobbing that whole time. It was just horrible. Meagan: I don't want to interrupt you but I do because I want to point out to everyone that especially if you are a provider listening and you perform C-sections, please, please hear what we are saying today. What you say to us while we are on the table in the most vulnerable position– some of us are strapped down to a table– what you say to us impacts us. Every word that comes out of your mouth, please think about it. Please think about it because it impacts us and it impacts us longer– I'm getting emotional because I remember my provider talking crap like that and saying things like that. It impacts us longer than you will ever, ever know and it will impact us for every future birth. Please, providers. Please, please, please from the bottom of my heart, I beg of you. Watch what you say to people. Okay, sorry. Keep going. Sabina: That's okay. I totally agree with you. The lack of bedside manner, especially for VBACs because when you've gone through a C-section, even if it was planned or whatever, it still can be traumatic and they just don't get it. She even told me, “I had 3 C-sections. Once your baby is out, you won't care how it happened.” It's like, good for you but not everybody is the same as you. Maybe you don't care about birth experiences but lots of women do. It was super frustrating. We stayed one night in the hospital and then left. Of course, the PTSD came back. The midwives all tried to tell me that the C-section was necessary because her hands were up over her face so she wouldn't have come out anyway but their stories weren't the same so I realized that they were lying and were just trying to justify that it was necessary. Meagan: Yeah. That's unfortunate.Sabina: Yeah. The PTSD came back and I it got to a point– I can't remember how many months my daughter was but I was visiting with a neighbor and I was talking about my experiences and I was like, “Next time, I'm going to have a VBAC. I'm going to do whatever it takes to have a VBAC.” She was like, “Why would you even try that?” I was like, “What do you mean?” She was like, “Well, there's the risk of rupture so why would you even do that when you could just have a C-section?” It broke me. I came home. I bawled to my husband and a few days later, I was still really upset about it. He didn't know how to help which is fair and he was just like, “Maybe you need to see a therapist.” I'm sure there are some out there, but I couldn't find any that fit here and therapy is not something that I thought would help me. I know it helps lots of people so I started looking up my symptoms and things. I found out that it was PTSD. It got to a point where I was like, okay. I need to fix this for myself. I took The VBAC Link Course which already was super helpful just because I felt empowered going forward. I knew that my potentially both C-sections weren't necessary but definitely the second one. I knew the risks and benefits of having a vaginal birth after two C-sections. I had all of the proof in front of me. Then it also pushed me to become a doula. I've always wanted to be in the birth world. I became a nurse to work in obstetrics but then left nursing after 4 years because it just wasn't for me. I was like, “This is what I'm meant to do.”I wish I had known about doulas for my other two births. I took a doula course and then I took The VBAC Link Doula Course and within a month of starting my doula page, I already had a VBAC client who reached out which was super exciting. She got in with the midwives that I had, with the particular midwife that I had. I was like, “Okay. Maybe this is a good thing. Maybe I can teach her about VBACs.” The first appointment, she was great apparently then after that, it was constantly, “Well, you have this so maybe we should do a hospital birth or you have this.” Every time she saw them, they were trying to push her to a hospital birth. She ended up having a free birth with me which was really cool. Meagan: She did? Really? Sabina: I told her from the get-go, “If that's something you want, I'm here for you. I'm totally comfortable with that.” Her original plan was just to maybe not call the midwives unless she felt something was wrong but then after some of those appointments, she was like, “No. They're not coming. We're not calling them. If we need help, we'll just go to the hospital.” Yeah. She had a free birth and it was awesome. It was great to be there. I was 14 weeks pregnant at the time so it was great for me. I actually met my doula a year before we even tried to conceive because I wanted to be prepared. She wasn't a VBAC doula, but she was newer and very open to the idea of having a home birth after C-sections. We became friends to the point where I actually attended her birth 3 months before she attended mine. Meagan: Oh my gosh, so cool. Sabina: Yeah, when I got pregnant with this one, I pretty much knew right away that I wasn't going to have a provider. It wasn't for me. I did apply to the midwife groups but every one of them either refused or said I was on the waitlist but I wasn't. As soon as they saw I wanted a home birth after two C-sections, that was thrown out. I mentioned it to my husband once and then the second time I mentioned it, he was fully on board which was mentioned. Meagan: Really? Because you said he was anxious about things yeah. Sabina: Anxious, yeah. But I had been educating him along the way too with everything that I learned. Any time I told him stories of other women who had difficult births or my client who was having these horrible appointments, he would get angry too so yeah. He really had become pretty educated on the topic which was amazing. He was very comfortable with our doula as well. He was like, “She's really knowledgeable.” We had a plan in place for if there was an actual emergency and if I wanted to transfer for whatever other reason. We had it set up and most other things I felt like I could handle myself unless it was one of the few very serious emergencies. My mindset going into this birth was amazing. I read daily affirmations to myself before bed and then I would listen to her heartbeat. I could hear it with a stethoscope around 15 weeks so every night I would listen to her heartbeat and I just felt so connected and so in tune with my body and my intuition which was something that kept getting shut down with my other births I found. It was the most stress-free pregnancy. We didn't do any tests. We got a couple of ultrasounds just because I like seeing the baby and I'm a very visual person but that was it. Both me and my husband were like, “This is amazing. We're just living our lives normally and not these stipulations and all of these worries being pushed on us.” I was checking my blood pressure but I just eventually was like, I don't really feel like I need to do this. It was very low. It was 90/50 for most of the pregnancy so I was like, I'm fine. I was still taking the aspirin just as a precaution but that was it. I wasn't in a rush. I wasn't like, baby has to be out at a certain time. I was just like, let's let things happen because we didn't get that opportunity with the last two. I had my mucus plug start to come out around 39 weeks and 4 or 5 days which was very exciting but I told my husband that it doesn't really mean much. Things are happening as they should. A couple of days later, the bloody show came out as well. Again, I was like, “We are fine. This could be going on for weeks. Whatever.”Then that night, so it was actually the morning of my due date, I had prodromal labor. I started feeling contractions and of course, I got excited but it started I think at 4:00 in the morning. I just sat there and breathed through them. They weren't intense. They were very easy to get through then me and my husband got everything ready when he got up then it stopped. I was like, “Okay, whatever. My body is just practicing.” For the next week or so, the mucus plug kept coming out throughout the week just in little bits. I didn't have any other contractions until– I have it written down here– the night of July 3rd into the morning of July 4th so probably 10 hours. I had prodromal labor overnight then it stopped as soon as I got up in the morning. I tried doing the Miles Circuit and both times it stopped the contractions so I was like, okay. Whatever. At least I know how to stop them. Meagan: Sometimes Miles Circuit does stop them because a lot of the times prodromal is a positional thing. Baby is trying to figure it out so the Miles Circuit helps with position and if it moves baby, it can stop them. Sabina: Yep. I was a little bit frustrated that day because I was like, I'm losing sleep now. I don't know if I should rest during the day because I still could be weeks away from giving birth. I was like, “We need to stay busy. We need to have plans for every day just so I don't feel like I'm rushing.”Meagan: Take your mind off of it. Sabina: Yeah. We kept busy that day then we were sitting after dinner. Around 8:00 PM I started feeling them again and I was like, “Great. Another night of no sleep. Okay, whatever.” The second night I had them, they were stronger than that first time but I could still breathe through them and stay lying down. That night they were even stronger which is odd because usually prodromal labor is the same. Meagan: It's monotone, yeah. Sabina: But these ones, I couldn't lay down which was really frustrating because I was so tired. I had to keep getting up. I tried doing the Miles Circuit and it didn't help so I was like, “Okay, I guess I'm going to stay awake all night.” In the morning, I got up and I was waiting for them to stop. I tried to have a hot shower and they were still going. It was 10:00 in the morning at this point and the other ones had always stopped at 8:00. I was like, “Okay. Maybe this is something.” My husband was like, “Get Jess here.” I was like, “Well, I'm fine though. I don't need the help.” But I texted her to let her know what was going on and then for my husband's sake, told her to come because I knew he needed that comfort. We called her and we called our friend who was going to come watch the kids. For the whole day, I was contracting and dealing with it beautifully. I was breathing through it no problem. I was excited every time I got a contraction. I wasn't timing them because I felt like that was stressing me out. I felt like they needed to be a certain length and a certain time apart. I stopped timing them and it was just really nice. Our friend was taking the kids swimming. Me and my doula were mulling around the house and she would play with the kids too. It was like we were all just hanging out. It was so peaceful. Then around 4:00, she does reflexology, my doula, so she got me to lay down and did some acupressure stuff on my feet. While she was doing that, I had a really big contraction and after that they pretty much stayed. I think that was the shift into active labor. My husband made everybody dinner which was nice and I was just in the kitchen picking up the food while going through contractions. Eventually, the kids went to bed and our friend left. At this point, it was 8:00 at night. I had the TENS machine on. I had been going back and forth from the toilet because the toilet is the dilaton station. Any time I had to go to the bathroom, I would stay there for 4-5 contractions. Again, I was still fully in control and mentally fully aware. I was happy in between contractions so around 9:30, I decided to get in the tub because they were still increasing. My husband and doula were both there. My husband and I really got to connect during this labor and he was so present. I had asked him after my previous births if he was proud of me. He was like, “I don't know if I would say proud.” He didn't mean it negatively, but it just hurt that he wasn't. So throughout this labor, anytime I looked at him, he'd tell me how proud he was of what I was doing or he would tell me how amazing I was and it was just so nice. He could hold me and we could just be ourselves without feeling the pressure of people watching. So then around 10:30, transition hit. I struggled. I was so mentally tired because I hadn't slept in three nights of no sleep and my mental strength had been what was keeping me going the rest of the time. I was struggling. It lasted 3.5 hours so it was a long transition. Of course, I had the moments of “I can't do this. I'm not strong enough” or whatever and my doula just went, “Okay, if that's how you feel then we need to talk about the alternative.” I was like, “No.” I shut it down. I can do this. We're not going anywhere so that was great. All she needed to say was that one thing. I felt my water break at 12:30 which was amazing because I'd never felt that before and it gave me that push then a couple of contractions later, my body started pushing on its own which again, was amazing. It was very intense and I just couldn't stop it. Every time I got a contraction, I couldn't stop myself from pushing so I just went with it. I could feel her. I reached up inside me and I could feel her head around 1:40ish which was so incredible. How cool is that? So a couple of contractions later, I could feel her crowning, and my husband– I sat up and my husband was like, “Oh my god. I can see the hair.” He was so excited. It was adorable. It took me another 20 minutes to get her head out. I had a lot of pressure in my back and on my right side so I was like, “Maybe she's posterior,” but I didn't know. Once her head came out, she wasn't posterior. Meagan: Was she looking sideways a little?Sabina: I think she was asynclitic because all the pain was on the right and I ended up tearing only on the right side so I'm pretty sure she was crooked. Her head wasn't really coned either so that's what I'm assuming. That's my guess anyway. Meagan: Yep. Coming down a little wonky. Sabina: Her head was out. I got to feel her. We didn't know the gender of this one either which was very exciting. We were 99% sure it was a boy so I kept referring to her as “it”. “Oh, I can feel its ear. It's turning.” I felt her turn too which was cool. My doula took videos. In the video, right before she came out, I said, “She's all gooey,” which is crazy to me because I thought it was a boy but in the moment I said “she”. It was very cool. I'm pretty sure that was all intuition. Meagan: That is crazy. Sabina: I had a 3.5-minute break between when her head came out and the next contraction then on the next contraction, I pushed 3 or 4 times. I felt her come out. I sat back and got to pull her up to my chest. I just looked at my husband and I was like, “We did it. We did it. She's here.” His reaction was everything. I don't think he realized she was out because I had been moving around so when I sat back I think he thought I was just readjusting then all of a sudden, I pull her out. He had a huge smile on his face. He put his hands on his face because he couldn't believe it. He started bawling and it was just, oh my god, incredible. She cried. The second I took her out of the water, she squawked and was moving around and everything. It was the best moment of my life. It was everything and even though it felt like a dream because I was so tired and of course, you're in shock that this actually happened, but it was incredible. She was totally healthy. I got to feel her cord pulsing. I didn't even get to see the placentas with the other two even though I wanted to so then we just stayed in the tub for a bit. I was extremely sore. Once that initial high wore off, I was like, “Holy crap. My crotch.” Meagan: I just had a baby. Sabina: I was like, “My crotch hurts.” My husband ran the other tub for us and we got to see the gender too which was super fun and a big shock to both of us. I got up to switch over to our shower tub and I was like, “Oh, there's a little bit of pressure.” I grunted and the placenta came out which was very cool because I didn't get to experience that the other two times. We went to the other tub and I got to do the placenta tour by myself. I got to let her latch by herself. I love those videos of babies finding the nipple themselves so I let her do that. She was coated thickly in vernix. For a 41-week baby, it was super thick. I think it was intentional for me because I always wanted that gooey baby and she was extremely gooey. I have photos of it all over my face, all over my nose. It was just everywhere. Yeah. Then we transferred to the bed. We got to cut the cord. I made a little cord tie because I hate those plastic chip clip things. I made her a cord tie and I got to put that on. When the kids woke up in the morning, they just got to come in the bedroom and she was there so it was the best. My doula was great. She did counterpressure and she helped my husband any time he was having moments of panic. At one point, I said, “What's taking so long? Is she stuck?” That's his trigger. For some reason, he's terrified of the babies getting stuck. You can see in the video that he looks over to my doula all panicked. I didn't know because she just calmed him down without me knowing which was great. Sabina: I did tear. When I was in the tub, I looked down and I saw something floating. I was like, oh is it gunk? But it was a piece of my inner labia that had ripped off. Meagan: So what did you do about that? Did you let it heal naturally? Did you do the super glue thing?Sabina: I've never heard of the super glue thing but I wouldn't have tried that. Meagan: Yes, super glue. There are some midwives here in Utah, birth center and home birth midwives who when there's a little bit more tear that would maybe make them say, “We need to do some stitches but not too bad,” they would superglue it. It's pretty minor, but they would superglue it. They just say that it causes more trauma to put a needle in, a needle in, a needle in, yeah. Sabina: I originally told myself that if I tore, I would just let it heal, but I couldn't actually figure out where it attached to. We even got a mirror and we were trying to figure out where it had actually ripped off of so I was like, “You know what? We're going to have to go in.” There's a really small hospital about 20 minutes from us. We went to the emergency room and told them, “I just gave birth. I don't have midwives. I need to be stitched up.” They sent us to the OB unit. The doctor really took his time and he stitched up every little tear that he saw which I didn't really want but I didn't know any different. At one point, I asked, “How many stitches are you putting in?” He was like, “You've kind of got a zig-zag tear up.” That was part of it and then beside my urethra. “I'm trying to fix it but I'm also trying to make it look aesthetically pleasing.” I was like, “Okay, I appreciate that. I want it to look decent afterward.” We did have some issues with her. They wouldn't leave her alone even though we didn't want her looked at. There was one doctor in particular who just really caused a lot of problems and threatened to call child services and stupid stuff like that. In hindsight, I would have just let them call child services because she was perfectly healthy and they would have come here. They did end up coming here even after we did what they wanted and she was like, “Why am I here? This is so unnecessary and such a waste of my time.” In hindsight, that's what we would have done. Anyway, the stitching was fine then we came home. I healed. The stitches were the most uncomfortable and sore part. With everything else, I healed relatively quickly. I was back to working out just after two weeks which I know is very quick. Meagan: Whoa, that's really quick. Sabina: That's just me. I did that with my C-sections too. Meagan: You felt really good. Sabina: After the C-sections too, I was back after two weeks with light stuff. I worked my way up. I didn't just go back to the intense stuff. My husband even said that it was the best experience of his life and he would gladly do that again over what we had been through. It was amazing. It was amazing. Meagan: I'm so happy for you. I can see the joy. I can see this cute little one right here. Oh my goodness. I am so happy for you. Sabina: Thank you. Meagan: I'm happy you had that support. You had that team. You even had support for your kids. You had everything planned out and I'm so, so, so happy for you. Sabina: Thank you. I should point out too that she was our biggest baby. Meagan: Was she?Sabina: Our other two were 6 pounds, 14 ounces and she was 8 pounds, 5 ounces. Of course. Meagan: Okay, that's definitely a lot bigger of a baby. I wanted to talk about that too. It's actually going to be in another episode where we are talking about big babies. Did people ever comment on your pregnancy like, “Oh,” and did that ever impact you like, “Oh my gosh, maybe I'd have too big of a baby?” Sabina: I honestly instinctively knew it was going to be our biggest baby because I knew that I was going to deliver vaginally. With the other two, their heads were in the 5th percentile and they would have slipped out. I knew it was going to be challenging and I knew that I was meant to have the biggest challenge that I could basically. She was very fluid-filled so she lost over a pound after birth. She dropped down to the low 7s so I don't know if the vernix had anything to do with that, but I looked the exact same as the other two pregnancies, maybe even smaller. It just looked like I had a soccer ball stuffed up my shirt. I was not big at all. Meagan: Okay, okay. That's good. Sabina: Yeah, we never really got comments about a big baby or anything. 8,5 is big but not crazy big. Meagan: It's not but it's bigger than 6 pounds. So many people are being told, “Oh my gosh. You're so big.” All of these things. Don't let people get to you, Women of Strength. Believe and understand that your body is going to make the right-sized baby.Sabina: Yep, exactly. Just because you're big doesn't mean your baby is big. You could have lots of fluid. It could be how you're carrying. It's all so silly. The ultrasounds are silly. Meagan: Torsos. Sabina: Yeah, exactly. If you have a shorter torso, you're going to stick out further which makes sense. I weighed myself before and after birth just out of curiosity. I had gained 18 pounds during pregnancy and I lost 16 of it with her coming out. So 16 pounds of baby, fluid, and placenta is a lot. Meagan: That is a lot and that's amazing. People have a hard time bouncing back like that. You just bounced back right after the baby was born. I also wanted to talk about HELLP syndrome a little bit because there are people who worry about it happening with future pregnancies. You had mentioned that your provider was like, “Well, you are a low risk because it happened so late in pregnancy.” According to the Preeclampsia Foundation, HELLP syndrome, there are two L's in this and is it hemolysis?Sabina: Hemolysis? Meagan: I'm like, I never know how to say that. Elevated liver enzyme levels so that pain that she was describing in the beginning was her liver. It was her liver. Anyway, we've got symptoms of blurry vision, pain or sharpness in that upper-right middle part of the belly, headache– and she mentioned it was on her right side but these are things that are common with preeclampsia. A headache, blurry vision, overall not feeling well, fatigue, sweats– I only had one client who had HELLP but she had night sweats. She would wake up and was just Iike, “I just was so wet then I would feel yucky.” Sabina: I had a lot of that in the recovery of HELLP syndrome. I was very sweaty at night. Meagan: Very, very sweaty at night, yeah. Super nauseated that continues to get worse. Nose bleeds are kind of a weird thing but that can be a symptom and they can have a hard time stopping. You keep getting nosebleeds. And seizures. They are the last and most serious and weight gain and swelling. Sabina: Yeah, the major one. Meagan: But according to the Preeclampsia Foundation, women who have had HELLP syndrome in previous pregnancies have a 2-19% chance of getting it again. 2-19% is pretty low.Sabina: That's the range. Meagan: Women who experience HELLP before 29 weeks of gestation in their first pregnancy may have an even higher risk though. So where your provider was like, “It was 41 weeks,” you had a lot of a lower risk. Just know if you have had HELLP syndrome, could you get it again? Yes. Will you get it again? Maybe, but your chances are lower than if you got it earlier on. Sabina: Yeah, and there are a lot of precautionary things you can do to prevent it. Meagan: That's what I was just going to say so we can talk about that. If you've had HELLP syndrome, and even just preeclampsia, what are some things? You mentioned aspirin. What are some other things you did to try and avoid it in future pregnancies?Sabina: As I mentioned, I'm a very active person so obviously a healthy lifestyle in general is going to help but then we did a lot of extra urinary tests and blood work. Even if you have no symptoms, it can still show up in those tests so maybe if we had done blood work for me or a urine sample, we would have known ahead of time. Those are really the only ones I did to help prevent it. Then I checked my blood pressure twice a day at home which was excessive but with all of the pressure from my providers, I just felt like I should. Meagan: I think it's warranted for sure. Sabina: Yeah. It was a good way to monitor. Sometimes it would go up slightly so you'd be cautious and then if it went back down, you're like, okay it's fine. It was just a one-off thing. Like I said, with this pregnancy too, I did all of those things other than the tests. I took the aspirin. I stayed healthy. I made sure I was well-hydrated the whole pregnancy. Meagan: Yes. I was going to say hydration. Sabina: Yes, that's a hard one. It's something I struggle with on a daily basis. Meagan: I know. I struggle and I'm not even pregnant. That's why I love our Needed hydration packets from our Needed partner and it helps me because hydration is so hard. Sabina: It is. Meagan: Hydrate. Make sure you are watching out for those symptoms. If you've had it, don't hesitate to call your provider or take charge of your care. Thank you so much again for sharing your beautiful stories. I really appreciate you so much. I'm trying to think if we've had a free birth, an intentional free birth. Sabina: You've had one and I've listened to it. Meagan: Have we had one?Sabina: You've had one and it was Ashley Winning. Meagan: Oh, duh. Of course. Yes. Sabina: She was the first one who I had ever had of a free birth then I found Free Birth Society after that so she started me down this path. Meagan: Yes. Oh, she's so great and she's in Australia. Definitely someone to listen to for sure. Okay. Well thank you so much and congrats and we'll talk to you later. Sabina: Thank you. Thank you so much for having me. This was a dream come true in so many ways. Meagan: Oh, it makes me so happy that you're here. And remember if you're looking for a doula, go find her. Her link will be on today's episode. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Ever wondered how elite trail and ultra runners manage to stay competitive throughout a jam-packed racing calendar? Join us as CTS coaches Neal Pallas and Adam Ferdinandson unlock the secrets to mastering the race recovery cycle. From developing tailored recovery plans to navigating the intricacies of transitioning between different race categories, this episode is loaded with actionable strategies to keep you performing at your peak while steering clear of injury and burnout.What happens when you need to balance high-intensity training with essential recovery? Addison lays out a comprehensive framework for categorizing race sequences, helping athletes pinpoint the critical phases of their training regimen. Whether transitioning from B races to A races or tackling back-to-back A races like Western States and UTMB, you'll gain clarity on how to optimize your training peaks and recovery intervals. And let's not forget the psychological aspects—physical healing isn't complete without addressing your mental well-being. Discover how maintaining supportive relationships and engaging in enjoyable activities can help you stay mentally sharp and avoid burnout.Finally, we dive into the practicalities of tapering and reintroducing intense workouts post-recovery. Neil and Adam share their expertise on individualized tapering strategies, emphasizing the importance of choosing races that align with your personal interests and values. Plus, get insider tips on monitoring your progress and knowing when to push the intensity. From determining appropriate recovery times to the benefits of community engagement at races, this episode offers a holistic approach to sustaining peak performance throughout the racing season. Don't miss our invitation to join us at the Javelina 100 and explore how being part of the CTS family can elevate your running game.Additional resources:SUBSCRIBE to Research Essentials for UltrarunningBuy Training Essentials for Ultrarunning on Amazon or Audible.Information on coaching-www.trainright.comKoop's Social MediaTwitter/Instagram- @jasonkoop