Podcasts about decreased

Hackamania debrief WATP Sept 12 at the Magic Bag in Detroit, MI Brawny Edema Virus on the Pen15? Decreased sensation? WTF? Neurosyphilis vs Lyme Disease Refractory Tinea Pedis ("athlete's foot") GET YOUR COPY OF "WET BRAIN: THE GAME OF LOSERS AND TROLLS" HERE! It's a fun party game for 4-8 players featuring all your favorite internet idiots. Please visit: ⁠⁠⁠simplyherbals.net/cbd-sinus-rinse⁠⁠⁠ (the best he's ever made. Seriously.) ⁠⁠⁠instagram.com/weirdmedicine⁠⁠⁠ ⁠⁠⁠x.com/weirdmedicine⁠⁠⁠ ⁠⁠⁠stuff.doctorsteve.com⁠⁠⁠ (it's back!) ⁠⁠⁠youtube.com/@weirdmedicine ⁠⁠⁠(click JOIN and ACCEPT GIFTED MEMBERSHIPS. Join the "Fluid Family" for live recordings!) ⁠⁠⁠youtube.com/@normalworld ⁠⁠⁠(Check out Dave and crew, and occasionally see your old pal!) CHECK OUT THE ROADIE COACH stringed instrument trainer! ⁠⁠⁠roadie.doctorsteve.com⁠⁠⁠ (the greatest gift for a guitarist or bassist! The robotic tuner!) see it here: ⁠⁠⁠stuff.doctorsteve.com/#roadie⁠⁠⁠ Also don't forget: ⁠⁠⁠Cameo.com/weirdmedicine⁠⁠⁠ (Book your old pal right now because he's cheap! "FLUID!") Most importantly! ⁠⁠⁠CHECK US OUT ON PATREON! ⁠⁠⁠ ALL NEW CONTENT! Robert Kelly, Mark Normand, Jim Norton, Gregg Hughes, Anthony Cumia, Joe DeRosa, Pete Davidson, Geno Bisconte, Cassie Black ("Safe Slut"). Stuff you will never hear on the main show ;-) Learn more about your ad choices. Visit podcastchoices.com/adchoices

Buyers could hold all the cards, based on a plunge in Auckland Council home valuations. Numbers have been released today for 630,000 properties across the region, and will affect how the spread of rates from next month. On average, residential homes dropped nine percent from 2021 CVs. Real estate agent, Rawdon Christie, says buyers could use it to help beat down prices. He explained they're making it clear they think they're making a good offer - given values have dropped. LISTEN ABOVESee omnystudio.com/listener for privacy information.

Almond forecast, extremely small cherry crop, USDA plans to helps small-scaled farmers, food safety reminders for those summer cookouts.

"The less you care, the harder you come."Your therapist won't tell you this, but caring too much is the ultimate cockblock to pleasure. And you, my sweet, overly invested friend, are drowning in a sea of giving-a-fuck when you could be floating in an ocean of delicious indifference.Welcome to this week's episode, where we're going to strip you of your precious concerns like a dominatrix peeling off your armor of good intentions.You think you need more love? More connection? More meaning?Wrong.What you need is the courage to stop giving a damn, and I'm here to hurt you in all the ways that'll set you free.Get ready for:- A master class in the art of strategic apathy- The dirty truth about why your caring addiction is cock-blocking your evolution- How psychedelics might divorce you from your neediness (and why that's hot)- The sexiest thing about power (hint: it doesn't care what you think about it)Listen as we explore why drama is the foreplay of existence, and how your resistance to pleasure is just fear wearing a consent-culture costume.This isn't self-help. This is self-harm in reverse – destroying the parts of you that keep sabotaging your liberation.If you're clutching your pearls of wisdom too tight to let new pleasure in, this episode will teach you the art of letting go like a zen master having a tantric breakthrough.WARNING: Side effects may include:- Spontaneous outbreaks of not giving a fuck- Increased pleasure tolerance- Decreased tolerance for your own bullshit- Sudden urges to prioritize your pleasure over others' comfort- The ability to say "no" without writing a thesis to justify itAvailable now wherever you get your permission to stop caring so damn much.The stakes are high, but your anxiety about them doesn't have to be.Come play in the space between caring too much and not caring at all. That's where the real pleasure lives.And remember: If you're worried about whether you should listen to this episode, that's exactly why you need to.Your enlightenment is optional. Your pleasure is mandatory.Got something to say to me? Slide into the DMs.Support the showIt's OUT! Sophistication Nation: Brief Interviews with Women I Pretend to Understand: https://emersondameron.hearnow.com/sophistication-nation

Police Chief Paul Neudigate said beach crowds have changed from college students to daytrippers, making it difficult to predict large influxes of people. Staffing shortages also add to the challenge of the Oceanfront's safety.

The number of Indian students studying abroad decreased with a significant drop in Canada. Guest: Arshdeep Kaur, Journalist Host: Rishi Nagar, RED FM Calgary

In this episode, I sit down with Dr. Stuart Slavin—pediatrician, medical educator, and a true superhero in the world of educational reform. Stuart's groundbreaking work has shown that yes, we can dramatically improve student mental health without compromising academic performance—and he has the results to prove it.We get into why today's high schoolers are more stressed than med students, how maladaptive perfectionism is quietly damaging our youth, and what it really means to build resilience that lasts. Whether you're a parent, educator, or just someone who cares deeply about kids and learning, you don't want to miss this conversation. Stuart's work is inspiring, actionable, and—best of all—hopeful. Episode Highlights:[0:00] - Introducing our new workbook, "The 7 Principles for Raising a Self-Driven Child".[1:08] - Dr. Stuart Slavin on the surprising pressures teens face—more intense than med school.[3:22] - Stuart's origin story and how a curriculum role led to mental health reform.[5:32] - How adolescent anxiety and perfectionism carry into adulthood.[7:42] - The dangerous cost of maladaptive perfectionism and chronic stress.[8:36] - What Stuart's research revealed about depression, suicide risk, and medical students.[11:41] - The 3-part intervention that changed everything at Saint Louis University.[14:10] - Can cutting 10% of class time improve both health and test scores? (Spoiler: Yes.).[17:54] - How a 90-minute resilience curriculum taught students to challenge toxic thoughts.[22:01] - Why we must teach kids to recognize and reframe distorted thinking early.[24:20] - Replacing perfectionism with a healthy pursuit of excellence.[26:53] - Ned shares his own experience with depression and the power of having tools.[28:26] - From frustrated parent to systemic change: Stuart's fight for student well-being.[30:21] - Final thoughts: to help kids thrive, we have to start upstream. Links & Resources:Learn more about Dr. Stuart Slavin's work at ACGME: https://www.acgme.org/ Episode 49 of The Self-Driven Child: How To Redesign Schools to Unleash Extraordinary Learning For AllResearch cited in the episode: Medical student mental health 3.0: improving student wellness through curricular changesFinding the Why, Changing the How: Improving the Mental Health of Medical Students, Residents, and PhysiciansReflections on a Decade Leading a Medical Student Well-Being InitiativeIf this episode has helped you, remember to rate, follow, and share the Self-Driven Child Podcast. Your support helps us reach more people and create more content that makes a difference.If you have a high school aged student and would like to talk about putting a tutoring or college plan together, reach out to Ned's company, PrepMatters at www.prepmatters.com

Discover all of the podcasts in our network, search for specific episodes, get the Optimal Living Daily workbook, and learn more at: OLDPodcast.com. Episode 2996: With hormonal shifts impacting metabolism, bone density, and heart health, preparing for menopause through nutrition is vital. Dr. Neal Malik outlines how women can optimize macronutrient intake, especially protein, throughout the day, while also incorporating key micronutrients and lifestyle habits like strength training and soy consumption to reduce symptoms and support long-term wellness. Quotes to ponder: "Decreased estrogen levels lead to an increased risk of bone loss, which in turn, can progress to osteoporosis." "Now, if we're increasing our protein intake to prevent muscle loss, we should also make sure we're performing some strength training along with it." "The soy isoflavones, the specific antioxidants found in soy products, can help relieve the symptoms associated with hot flashes, can prevent bone loss, and protect the heart all at the same time." Episode references: Vitamin D and Bone Health - NIH Fact Sheet: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ Magnesium Fact Sheet - NIH: https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/ Dietary Guidelines for Americans: https://www.dietaryguidelines.gov Learn more about your ad choices. Visit megaphone.fm/adchoices

Discover all of the podcasts in our network, search for specific episodes, get the Optimal Living Daily workbook, and learn more at: OLDPodcast.com. Episode 2996: With hormonal shifts impacting metabolism, bone density, and heart health, preparing for menopause through nutrition is vital. Dr. Neal Malik outlines how women can optimize macronutrient intake, especially protein, throughout the day, while also incorporating key micronutrients and lifestyle habits like strength training and soy consumption to reduce symptoms and support long-term wellness. Quotes to ponder: "Decreased estrogen levels lead to an increased risk of bone loss, which in turn, can progress to osteoporosis." "Now, if we're increasing our protein intake to prevent muscle loss, we should also make sure we're performing some strength training along with it." "The soy isoflavones, the specific antioxidants found in soy products, can help relieve the symptoms associated with hot flashes, can prevent bone loss, and protect the heart all at the same time." Episode references: Vitamin D and Bone Health - NIH Fact Sheet: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ Magnesium Fact Sheet - NIH: https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/ Dietary Guidelines for Americans: https://www.dietaryguidelines.gov Learn more about your ad choices. Visit megaphone.fm/adchoices

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Sutherland Institute's "Defending Ideas": The two sides of tariff policy -- Utah businesses worried about decreased tourism from Canada

Today, we're going to talk about the benefits of stretching every day. A simple stretching workout can provide the following benefits:•Improved sleep •Decreased inflammation•Decreased pain•Counters past injuries•Calms the nervous systemMany people think their muscles are tight when it's really the fascia! Your fascia is like a wetsuit that surrounds the entire body. Helene Langevin of the National Institutes of Health discovered through acupuncture that when a needle is inserted into the skin, collagen fibers of the fascia begin winding around the needle! When you injure your fascia, you develop scar tissue, which can interfere with movement. Healthy fascia should be dynamic, movable, flexible, and even has electrical properties! Unhealthy or injured fascia develops a disorganized pattern of connective tissue. Stretching at home daily keeps your fascia healthy.Tight muscles and tissues that cause bad posture are one of the biggest problems you can have with your fascia. The more you can elongate your connective tissue, the better it will be for your fascia. A good daily stretching routine is one of the best ways to prevent stiffness associated with aging.Follow along and try this easy stretching routine for healthy fascia, flexibility, and improved posture!Dr. Eric Berg DC Bio:Dr. Berg, age 60, is a chiropractor who specializes in Healthy Ketosis & Intermittent Fasting. He is the author of the best-selling book The Healthy Keto Plan, and is the Director of Dr. Berg Nutritionals. He no longer practices, but focuses on health education through social media.

Werner syndrome is a rare condition marked by accelerated aging. A recent study, featured as the cover paper in Aging (Aging-US), Volume 17, Issue 4, led by researchers at the University of Oslo and international collaborators, suggests that nicotinamide adenine dinucleotide (NAD+), a vital molecule involved in cellular energy production, may be key to understanding this disease and developing future strategies to manage it. Understanding Werner Syndrome Werner syndrome (WS) is a rare genetic condition that causes people to age more quickly than normal. By their 20s or 30s, individuals with WS often show signs typically associated with older age, such as cataracts, hair loss, thinning skin, and heart disease. This premature aging is caused by mutations in the WRN gene, which normally helps repair DNA and protect cells from damage. While the WRN gene's role in maintaining genetic stability is well understood, the reasons behind the rapid decline of cells in WS patients are still not fully clear. The Study: Investigating NAD+ in Werner Syndrome Nicotinamide adenine dinucleotide levels naturally decline with age. In the study titled “Decreased mitochondrial NAD+ in WRN deficient cells links to dysfunctional proliferation,” researchers investigated whether this decline is more severe in people with WS and whether restoring NAD+ levels could help slow the aging process in these patients. Full blog - https://aging-us.org/2025/05/fighting-premature-aging-how-nad-could-help-treat-werner-syndrome/ Paper DOI - https://doi.org/10.18632/aging.206236 Corresponding author - Evandro F. Fang - e.f.fang@medisin.uio.no Video short - https://www.youtube.com/watch?v=WpRpi8TYPfU Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.206236 Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Keywords - aging, Werner syndrome, premature aging, NAD+, mitochondria, proliferation To learn more about the journal, please visit our website at https://www.Aging-US.com​​ and connect with us: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Bluesky - https://bsky.app/profile/aging-us.bsky.social Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

Sandymount beach in Dublin and Lady's Bay in Donegal are the beaches with the worst water quality in Ireland. That's according to a new report from the Environmental Protection Agency, which found the number of beaches with poor bathing water quality has decreased from five to two. Shane discusses the report findings with Eimear Cotter, Director of the EPA's Office of Evidence and Assessment.

Sandymount beach in Dublin and Lady's Bay in Donegal are the beaches with the worst water quality in Ireland. That's according to a new report from the Environmental Protection Agency, which found the number of beaches with poor bathing water quality has decreased from five to two. Shane discusses the report findings with Eimear Cotter, Director of the EPA's Office of Evidence and Assessment.

Program notes:0:47 Gun injuries and deer hunting season1:47 Other associated injuries2:47 Coincidence of hunting?3:48 Restrict hunting guns to that use4:10 Can we avoid surgery in some with cancer?5:10 Dostarlimab treatment6:10 Can help avoid surgery in few who have this mutation7:10 Look at specific pathways7:30 Lung cancer treatment8:32 71% responded9:12 Impact of Pepfar funding freeze10:12 Looked at waiver scenarios11:12 Decreased deaths and infection12:13 Takes time to resume13:06 End

BUFFALO, NY — May 1, 2025 — A new #research paper was #published in Aging (Aging-US) on April 2, 2025, as the #cover of Volume 17, Issue 4, titled “Decreased mitochondrial NAD+ in WRN deficient cells links to dysfunctional proliferation.” In this study, the team led by first author Sofie Lautrup and corresponding author Evandro F. Fang, from the University of Oslo and Akershus University Hospital in Norway, discovered that cells from people with Werner syndrome (WS)—a rare genetic disorder that causes premature aging—have low levels of a molecule called NAD+ in their mitochondria. This molecule is essential for energy production, cellular metabolism, and maintaining cell health. The researchers also found a potential way to improve cell function in WS patients, pointing to new directions for treating age-related decline and other premature aging disorders. Werner syndrome leads to signs of aging much earlier than normal, including problems such as cataracts, hair loss, and atherosclerosis by age 20 to 30. The team found that when the WRN gene is missing or damaged, cells cannot maintain healthy NAD+ levels in their mitochondria. As a result, the cells age more quickly and stop growing properly. When the researchers boosted NAD+ levels using nicotinamide riboside (a vitamin B3 compound) the affected stem cells and skin cells from patients showed less aging and improved mitochondrial activity. “Interestingly, only 24 h treatment with 1 mM nicotinamide riboside (NR), an NAD+ precursor, rescued multiple pathways in the WRN−/− cells, including increased expression of genes driving mitochondrial and metabolism-related pathways, as well as proliferation-related pathways.” The study also found that the WRN gene helps regulate other important genes that control how NAD+ is made in the body. Without WRN, this system becomes unbalanced, which affects how cells function, grow, and respond to stress. Although adding more NAD+ helped some cells look healthier, it could not completely fix the growth problems in other types of lab-grown cells. This suggests that while NAD+ supplementation is beneficial, it cannot fully replace the essential functions of the WRN gene. These findings offer new insights into the biological mechanisms of aging and reinforce the therapeutic potential of targeting NAD+ metabolism in age-related and genetic diseases. Future studies will aim to better understand how subcellular NAD+ regulation interacts with mutations like those seen in WS. Finally, this research supports ongoing efforts to develop NAD+-based treatments that could slow cellular aging and improve quality of life for patients with premature aging conditions. DOI - https://doi.org/10.18632/aging.206236 Corresponding author - Evandro F. Fang - e.f.fang@medisin.uio.no Video short - https://www.youtube.com/watch?v=WpRpi8TYPfU Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.206236 Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Keywords - aging, Werner syndrome, premature aging, NAD+, mitochondria, proliferation To learn more about the journal, please visit our website at https://www.Aging-US.com​​ and connect with us: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Bluesky - https://bsky.app/profile/aging-us.bsky.social Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

Dr. Mitch Shulman can be heard every weekday morning at 7:50 on The Andrew Carter Morning Show.

In Ep. 59, Senior Attorney Match's Jeremy E. Poock, Esq. explains why most key employee lawyers do not want to purchase their boss' law firm. As Poock points out, key employee lawyers typically do not want to purchase their boss' law firm because, at some point, they will perform a Risks vs. Rewards analysis.   Even though the rewards, at the outset, appear appealing, the risks often outweigh those rewards.   The rewards include: (i) Increased compensation and access to profits; (ii) Management authority to make changes; and (iii) The option and ability to grow the practice.   As good lawyers, key employee lawyers then start spotting issues, i.e., risks, which include the following: (i) The possibility of not originating enough new clients to maintain the firm's cash flow needs; (ii) The challenge of replacing a Senior Attorney founder from the standpoints of skills, billings, and rainmaking capabilities; (iii) The potential for making less money rather than more; (iv) Personal debt exposure (egs. personal guaranty to a lease or line credit); (v) Decrease in work-life balance; (vi) Unforeseen changes (ex. loss of 1 or more key employees).   “So, when key employee lawyers . . . perform this Risks vs. Rewards analysis, the risks just all too often outweigh the rewards,” Poock states.   Poock also points out that most key employee lawyers do not want to purchase their boss' law firm and cannot afford to either.   Instead, most key employee lawyers seek the following:   A reliable, safe, and predictable job.   When Senior Attorney law firm owners falsely expect their key employee lawyers to purchase their law firms, unfortunately, such false expectations can result in a Random Tuesday Event, where a key employee lawyer gives his or her boss only 2 or 4 weeks notice in advance of joining another firm.    In addition to the short-term loss in revenues that such a Random Tuesday Event can cause, Poock explains that the unexpected departure of a key employee presents the following longer-term negative impacts, as well: (i) The inability to retain as many new clients if the firm no longer has the capacity to represent as many clients; and (ii) A loss in firm value due to a combination of (a) A potential loss of clients who join a former key employee at a new law firm; and (b) Decreased appeal to a Growing Law Firm purchaser who wants and needs a selling law firm's key employee lawyer to continue representing the firm's clients, as well as clients of a purchaser's firm.   By contrast, when Senior Attorney law firm owners recognize (realize) that their key employee lawyers do not want to purchase their law firm and can't afford to either, they can then realize the following:   Key employee lawyers present 1 of the following 3 key resources that Growing Law Firm purchases seek when purchasing a law firm:   The Selling law firm's Book of Business   Key employee lawyers and para-staff, whom Growing Law Firms want and need for the purposes of continuing to represent a Seller's clients, plus clients of a Growing Law Firm.   The combined subject matter knowledge of Senior Attorneys and their key employee lawyers, which today's Growing Law Firms need to convert to digital content for the purposes of attracting the attention of today's and tomorrow's clients who search online for lawyers and law firms to retain.   And, when Senior Attorneys sell their law firms to Growing Law Firms, Poock explains the following 4 Winners that result:   Senior Attorneys: Senior Attorneys win by monetizing their law firms; spending more time with their families; no longer needing to manage “the office;” and having the option to continue practicing in an Of Counsel type capacity for months, or even years to come.   Key Employee Lawyers & Para-Staff: Key employee lawyers and para-staff win by maintaining a reliable, predictable and safe job, as well as the benefits and joy of maintaining their team at a new employer.   Clients: Clients of a Senior Attorney-led firm win by benefiting from continuing, competent legal representation.   Growing Law Firms: A Growing Law Firm purchaser wins by acquiring the following 3 resources needed to boost growth (i) Clients; (ii) Experienced lawyer and non-lawyer staff; and (iii) Subject Matter Knowledge offered by Senior Attorneys and key employee lawyers to convert into digital content to boost their multi-channel digital marketing efforts to generate new clients who search online today for lawyers and law firms to retain.

MLB.com Blue Jays Reporter Keegan Matheson joined OverDrive to discuss the headlines around the Blue Jays, the lack of hitting and power on the team, the stars struggles with the bat, the rotation's positive factors, Vladimir Guerrero Jr. and Bo Bichette's statistics under the microscope and more.

Send us a textIn this conversation, Ashley and Danielle discuss the importance of medication in managing Inflammatory Bowel Disease (IBD) and how it can significantly improve quality of life. We share personal experiences and insights on the emotional aspects of medication, the role of nutrition, and the impact of hormonal changes on symptoms. We hope to normalize medication use and convey the importance of not letting fear dictate treatment choices.Takeaways-- Medication can improve quality of life for IBD patients.- It's important to normalize medication as a life-saving treatment.- Decreased inflammation doesn't always mean decreased symptoms.- Nutrition strategies can help improve quality of life.- Personal experiences with medication can be complex and emotional.- Hormonal changes can impact IBD symptoms - Fear of medication is common but should not dictate choices.- You haven't failed nutrition if you need medication.- There is hope for a better quality of life with IBD.00:00- The Role of Medication in IBD Management03:02- Navigating Personal Experiences with Medication06:00- Understanding Nutrition's Role in Quality of Life08:59- Overcoming Fear and Embracing HopeLooking for further support? Check out our website for resources or to book a call with Ashley! https://crohnsandcolitisdietitians.com/Follow us on instagram @crohns_and_colitis_dietitiansFollow us on youtube @thecrohnscolitisdietitiansWe love helping provide quality content on IBD nutrition and making it more accessible to all through our podcast, instagram and youtube channel. Creating the resources we provide comes at a significant cost to us. We dream of a day where we can provide even more free education, guidance and support to those with IBD like us. We need your support to do this. You can help us by liking episodes, sharing them on your social media, subscribing to you tube and telling others about us (your doctors, friends, family, forums/reddit etc). Can you do this for us? In return, I promise to continually level up what we do here.

In Ep. 58 of the State of the Market for Law Firm Sales in 11 Minutes, Senior Attorney Match's Jeremy E. Poock, Esq. addresses the following 2 Random Tuesday Events: A Key Employee Random Tuesday Event; and   A Pre-Mature Death or Incapacity Random Tuesday Event   A Key Employee Random Tuesday Event occurs when a key employee lawyer(s), typically the lawyer(s) whom a Senior Attorney views as the firm's internal successor, provides only 2 or 4 weeks about accepting a new job at another law firm.   This type of Random Tuesday event causes the following short-term and long-term negative results for a Senior Attorney-led law firm.   Short-Term Impact: In the short term, the sudden loss of a key employee attorney impacts law firm revenues because key employee attorneys typically generate considerable billings, either in the form of hourly billings or revenues derived from flat fee or contingency type matters.   Immediate losses also stem from the potential loss of clients and referral sources who may choose to continue working with a key employee lawyer at the law firm that a key employee lawyer joins.   Long-Term Impact: A Key Employee Random Tuesday Event negatively impacts the following 2 key components of a Senior Attorney-led firm's long-term value:   The value of a Senior Attorney-led firm's Book of Business due to (i) The loss of clients and referral sources who follow a key employee lawyer to a new law firm; and (ii) The potential for not accepting as many new clients if the firm can no longer service the work before replacing a key employee lawyer; and   Decreased appeal to a Growing Law Firm purchaser due to Growing Law Firms seeking the following when considering growth by acquisition: (i) A Book of Business; and (2) Experienced, key employee lawyers to continue providing sophisticated legal services to a seller's clients post-sale.   Once Senior Attorneys realize that their key employee attorneys prefer a reliable, predictable, and safe job, Senior Attorneys can then pursue a sale with a Growing Law Firm that seeks the following 3 resources to boost growth (1) Clients; (2) An experienced workforce, including key employee attorneys; and (3) Digital content derived from the subject matter knowledge of Senior Attorneys and key employee attorneys alike.   A Pre-Mature Death or Incapacity Random Tuesday Event occurs when a Senior Attorney law firm owner prematurely dies or becomes incapacitated prior to selling their law firm or establishing an internal succession plan.   Here, we focus on small business law firms, lead by 1 or more Senior Attorney founders and for whom their key employee lawyers do not want to purchase their boss' law firm and cannot afford to either.   In those instances, the primary sale option involves selling or merging with a Growing Law Firm per a Law Firm Sales 1.0 type structure that consists of fee sharing upon a percentage of collections derived from a defined Book of Business during a negotiated period of time.   In the event of a Pre-Mature Death or Incapacity Random Tuesday Event, the value of the Senior Attorney-led law firm plummets because of the unavailability of Trust Transfer by the Senior Attorney who maintains the relationships with the firm's clients.   Instead, a Pre-Mature Death or Incapacity Random Tuesday Event typically results in the firm's clients retaining successor counsel, or receiving referrals to successor counsel at 1 or more law firms without any fee sharing terms.   Even if a personal representative or power of attorney can sell a law firm following a Pre-Mature Death or Incapacity Random Tuesday Event, the consideration typically involves minimal realization of the firm's true value due to the inability for its Senior Attorney owner to transfer the trust of clients to lawyers at a purchasing law firm.

Navigating the complexities of relationships can be challenging, and sometimes, despite our best efforts, a connection reaches its natural end. In this insightful podcast episode, we delve deep into the crucial question: How do you know when a relationship has run its course? *Decreased communication and emotional intimacy: Feeling distant, having less to talk about, and a lack of vulnerability.  Frequent arguments and unresolved conflict: * Constant bickering, feeling unheard, and an inability to find common ground.  Loss of shared goals and values: Growing apart in your aspirations and what you deem important in life. Feeling more like roommates than partners:  We fall in love with hope of what these relationships can be which creates a toxic connection, but it doesn't always have to be toxic to know the season of that relationships is over. Whether you're currently questioning your relationship or want to be better equipped for the future, this episode offers valuable insights and actionable steps. Listen now to gain clarity and guidance on navigating the difficult but sometimes necessary process of ending a relationship and share with anyone who may need it today. Become A Patreon: www.patreon.com/thepositivityxperience Get the FREE Letting Go Workbook: www.thepositivityxperience.com

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Are you menopausal and have any of the following symptoms? Hot Flashes Night Sweats Dry Vagina Painful intercourse Dry skin Lack of sex drive Lack of motivation Fatigue Depression and or anxiety Change in body composition, with fat collection in the abdomen Loss of Muscle Mass and strength Irritability Inability to remember names and places Decreased ability to problem solve Insomnia Arthritis Body pain These are all symptoms we currently are aware of associated with menopause and low testosterone.  These symptoms can be treated and reversed with bioidentical estradiol and testosterone pellets. Menopause should be treated like an illness that is universal but more severe in some women compared with others.  If your symptoms affect your lifestyle, relationships and work then you should see a doctor who treats hormone deficiency and accept treatment! However, if you allow yourself to be manipulated by a male-dominated medical system that teaches all doctors to believe that menopause is normal as women age and don't seek out hormone replacement, then you just may be setting yourself up for years of symptoms that are treated with handfuls of medications, but never get you back to normal. Just think about this for a minute: Men develop erectile dysfunction and experience muscle loss as they age, but medicine doesn't consider ED or Sarcopenia a natural aging process for men, they advocate and endorse treatment with testosterone, ED medications, injections for ED and therapy for ED, and in most cases pay for it!  If the male mentality would include women we would all be treated with estrogen and testosterone when we got to age 50 (or menopause). It is not just about the symptoms that E-T replacement can cure, but the diseases that you can avoid by taking estrogen and testosterone after menopause.  These avoidable diseases of aging include: Osteoporosis leading to broken bones and spinal stenosis. Heart disease and stroke Diabetes Alzheimer's Dx and dementia Obesity Low muscle mass and inability to walk or move independently. Autoimmune diseases Loss of blood flow to Lower extremity, resulting in amputations and inhibiting walking and running Severe arthritis Gout Worsening depression and anxiety Frailty which is what causes most older people to be placed in a nursing home. Just think it is not fate that gives you these conditions.  It is genetics plus lifestyle plus whether you replace your sex hormones or not! This decision is in your control.  If you really want a life free of debilitating disease and symptoms that are require constant medical care, then you must buck the system (that was designed to keep us from maintaining our mind and body) and look for a doctor to replace your testosterone and estradiol in a non-oral delivery system and maintain it for life. By stopping ERT or Testosterone like the ACOG doctors tell you to, you will start the symptoms all over again.  My job is to offer you the right type of help to reverse the effects of menopause…both symptoms and diseases. Your job is to decide whether you want to get help and become healthy by taking non-oral estrogen and testosterone for the rest of your life. Think of menopause as a disease and you will be more prepared to fight for your right to be treated by the medical system.

Today, we're going to discuss some of the causes of low testosterone and the most common low testosterone symptoms. Check out these 6 common low testosterone signs:1. Breast tissue “Man boobs” can be caused by an increase in estrogen and a decrease in testosterone.2. Shrinking testiclesThis is also known as hypogonadism. Testosterone is involved with muscle formation, so if your testosterone is low, you may also notice your muscles shrinking.3. Reduced semen production 4. Decreased body hair This may be most evident in the beard, chest, legs, and the top of the head. 5. AndropauseThis can cause hot flashes and night sweats in men. 6. Excess belly fat This is often caused by insulin resistance. The most common causes of low testosterone include:•High-carb diets•Endocrine disruptors•Microplastics and forever chemicals•Poor sleep •Chronic stress•Wifi•EMFs •Phytoestrogens (soy products)•Low zinc •Statins•Iron overloadYou can help increase testosterone naturally with the following:1. Zinc 2. Magnesium3. Vitamin D 4. Exercise5. Water filters 6. L. reuteri Dr. Eric Berg DC Bio:Dr. Berg, age 59, is a chiropractor who specializes in Healthy Ketosis & Intermittent Fasting. He is the author of the best-selling book The Healthy Keto Plan, and is the Director of Dr. Berg Nutritionals. He no longer practices, but focuses on health education through social media.

Lynne Farrow delves into the critical importance of iodine for your health. Discover how iodine deficiency can impact your well-being and learn how to ensure you're getting enough of this essential nutrient. #IodineHealth #NutrientDeficiency #Wellness

What happened to MOST churches during the 2020 worldwide covid-19 pandemic? Decreased attendance, worsening attitudes, and reduced income, but not for THIS church who staked their building for the first time ever! (Staking is placing stakes with Bible verses–Scriptures on them in the ground around the borders of the church property and praying for that church.) Download 4 The One Studio app to view Taking Groundhttps://active-faith.org/active-faith-online-studies SteveHemphill1@me.com https://active-faith.org/donate/

Send us a textCould changing your diet in your 70s actually improve your health, or is it too late? According to nutrition expert Amy Covington, the power to transform health through diet remains strong throughout our entire lives.Amy shares the remarkable story of a senior who initially refused to change his eating habits but experienced dramatic improvements in his diabetes management and mobility after just six months of nutritional changes. This transformation challenges the widespread belief that older adults can't reverse chronic conditions or improve their metabolic health.Drawing from her experience overseeing Utah's nutrition programs and researching senior malnutrition, Amy distinguishes between simply "plant-based" eating and truly nutritious whole foods. She offers practical approaches for seniors hesitant to completely eliminate animal products, suggesting an 80-20 rule that allows flexibility while maximizing health benefits.Perhaps most valuable are her strategies for addressing decreased appetite, a critical issue for many seniors. From making mealtimes social events to enhancing food's visual appeal and stimulating appetite through light activity, these techniques help break the cycle of poor nutrition that often accelerates health decline. Amy also recommends specific screening tools caregivers can use to identify nutrition risks before they become serious medical concerns.Whether you're caring for an aging parent, working professionally with seniors, or planning for your own healthy aging journey, these evidence-based nutrition strategies offer a path to enhanced quality of life. Discover how simple changes like incorporating more colorful vegetables, switching to whole grains, and being mindful about protein sources can significantly impact wellness in our later years.• Nutrition changes can significantly improve health at any age – even in your 70s or 80s• Plant-based nutrition offers specific benefits for chronic conditions common in seniors• Small changes like following the 80/20 rule can make meaningful health improvements• Decreased appetite is a major concern for seniors, often creating a cycle of poor nutrition• Eating with seniors, making meals visually appealing, and encouraging light exercise can improve appetite• Eating less red meat (ideally twice monthly) and focusing on whole grains offers significant health benefits• Medicare and Medicaid increasingly recognize nutrition services for chronic conditions• Simple screening tools like the Malnutrition Screening Tool can help identify nutrition risks• Frozen fruits and vegetables are cost-effective alternatives that maintain nutritional value• Changing the plate composition to include more colorful vegetables and fruits is an easy first stepContact your local Area Agency on Aging through das.utah.gov/locations to learn about meal programs and nutrition services available in your county.Support the show

In this episode of the Pediatric and Developmental Pathology, our hosts Drs. Mike Arnold (@MArnold_PedPath) and Dr. Jason Wang speak with Drs. Andrew Franklin, Alexa Freedman and Linda Ernst of NorthShore University HealthSystem about their article in Pediatric and Developmental Pathology: Decreased Alpha Klotho Expression in Placentas Exposed to Severe Maternal Vascular Malperfusion Hear how the peer-review process improved their article, and their advice for developing and publishing projects. Find out how aging and alpha klotho relate to placental development.    Featured public domain music: Summer Pride by Loyalty Freak

Even the healthiest diet may no longer provide all the nutrients your body truly needs...     The truth is, our food isn't what it used to be.     Over the past 50–70 years, due to changes in soil quality and agricultural practices, there has been a significant decline in the vitamin and mineral content of our foods.     So join me on today's Cabral Concept 3323 as we uncover what this decline in nutrition means for your health and what you can do to support your body. Enjoy the show, and let me know what you think!   - - - For Everything Mentioned In Today's Show: StephenCabral.com/3323 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

Illinois saw a drop in drug overdose deaths in 2023, according to newly released data from the Illinois Department of Public Health. And in Cook County, that trend seems to have held in 2024 as well, according to preliminary data from the county coroner's office. Reset talks with Fanya Burford-Berry, a community worker at West Side Heroin Opioid Task Force, where they provide outreach to hear what's led to this decrease and what's needed to bring the numbers down even further and WBEZ reporter and anchor Araceli Gomez-Aldana. For a full archive of Reset interviews, head over to wbez.org/reset.

USDA Secretary Brooke Rollins takes on bird flu.  Researchers look to deter mountain lions from attacking livestock. Decreased consumption hurts California winegrape growersUSDA stops taxpayer money for food assistance to illegal aliens.Mexico opens its market for more U.S. corn.A bill to provide overtime tax credits to farm employers to get more money to their employees.

 Are you experiencing unexplained fatigue, decreased libido, or mood changes? These symptoms might be related to testosterone levels – yes, even in women. In this enlightening episode of AGE BETTER, NYU Langone Health's Dr. Margaret Nachtigall breaks down everything you need to know about testosterone's role in women's health.   About Our Guest  Dr. Margaret Nachtigall is a renowned Reproductive Endocrinologist at NYU Langone Health, specializing in women's hormonal health. With extensive experience in treating hormone-related conditions, Dr. Nachtigall brings clarity to this often misunderstood aspect of women's health.  Why This Episode Matters to You  If you're a woman experiencing:  - Unexplained fatigue or low energy  - Decreased sex drive  - Mood changes  - Difficulty maintaining muscle mass  - Brain fog or reduced mental clarity  This episode provides crucial information about how testosterone might be affecting these symptoms.  What You'll Learn  - The surprising truth about testosterone's role in women's bodies  - How and where testosterone is produced in women  - Why testosterone levels change with age and menopause  - The connection between testosterone and common symptoms  - Current treatment options and their availability  - What to consider before pursuing testosterone therapy  - How to discuss this topic with your healthcare provider  Connect and Share  Have questions about testosterone or other women's health topics you'd like us to cover? We want to hear from you! Reach out to agebetterpodcast@gmail.com and join the conversation about women's health and healthy aging.   About AGE BETTER  AGE BETTER is dedicated to providing you with expert insights and practical information to help you make informed decisions about your health. Join us each week as we explore crucial topics in women's health with leading medical experts.  Learn more about your ad choices. Visit megaphone.fm/adchoices

According to the Atlantic's Yoni Applebaum, America is STUCK - literally and otherwise. In his new book Stuck: How the Privileged and the Propertied Broke the Engine of American Opportunity. Appelbaum argues that America faces not just a housing crisis but a mobility crisis, with prohibitively expensive housing in prosperous areas preventing people from moving toward opportunity. Applebaum traces how zoning laws, initially driven by racism and classism, have created a system where Americans move less than ever before, despite more wanting to relocate. This decreased mobility has wide-ranging consequences for civic engagement, social cohesion, and economic dynamism. His solution: simplify building regulations, reform housing policy to facilitate mobility, and dramatically increase housing supply.Here are the 5 KEEN ON take-aways from our conversation with Appelbaum:* America faces a mobility crisis, not just a housing crisis: People can't afford to move to areas with economic opportunity, which has dramatically reduced the rate of Americans relocating (from 1 in 3 annually in the 19th century to 1 in 13 today).* Restrictive zoning laws have racist and classist origins: America's first zoning laws were designed to segregate Chinese residents in Modesto, and Berkeley's first single-family zoning aimed to keep out working-class people.* Decreased mobility has widespread negative effects: Beyond economics, reduced mobility damages civic engagement, social cohesion, and even contributes to political polarization and populism.* Tenements served a positive historical purpose: Despite reformers' criticism, tenements were vehicles for economic mobility that allowed cities to absorb immigrant waves - a capacity many cities have lost.* Applebaum offers three solutions: Simplify building regulations, redesign housing policy to facilitate movement rather than keeping people in place, and dramatically increase housing supply ("build baby build").Yoni Appelbaum is a deputy executive editor at The Atlantic and the author of Stuck: How the Privileged and the Propertied Broke the Engine of American Opportunity. Appelbaum is a social and cultural historian of the United States. Before joining The Atlantic, he was a lecturer on history and literature at Harvard University. He previously taught at Babson College and at Brandeis University, where he received his Ph.D. in American history. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit keenon.substack.com/subscribe

Teniah was admitted to the acute care hospital with community-acquired pneumonia. She reports shortness of breath and fatigue. Auscultation reveals decreased breath sounds in the right lower lobe, and SpO₂ drops from 95% to 88% with exertion. Resting vital signs: HR 92 bpm, BP 142/86 mmHg, RR 22 breaths per minute. Which finding requires the MOST immediate communication with the medical team?A) Decreased breath sounds in the right lower lobeB) Blood pressure of 142/86 mmHgC) Resting respiratory rate of 22 breaths per minuteD) Oxygen desaturation to 88% with exertionJoin the FREE Facebook Group: www.nptegroup.com

Common Symptoms of Low TestosteroneLow testosterone, also known as hypogonadism, can manifest in a variety of ways. Here are some of the most common symptoms:Decreased libido (sex drive)Erectile dysfunction (ED)FatigueReduced muscle mass and strengthIncreased body fatDecreased bone densityMood changes, such as depression or irritability  Cognitive difficulties, such as trouble concentrating or remembering thingsHair lossDecreased testicular sizeIt's important to note that these symptoms can also be caused by other medical conditions, so it's essential to consult with your doctor for a proper diagnosis.Total Testosterone vs. Free TestosteroneTotal testosterone measures the total amount of testosterone in your blood, both bound to proteins and unbound.Free testosterone measures the amount of testosterone that is not bound to proteins and is biologically active.While both measurements are important, free testosterone is often considered a more accurate indicator of testosterone deficiency because it reflects the amount of testosterone that is available to your body's tissues.Normal Testosterone RangesNormal testosterone levels can vary slightly depending on the laboratory and the specific assay used. However, in general:Total testosterone: 300-1,100 ng/dL (nanograms per deciliter)Free testosterone: 50-210 pg/mL (picograms per milliliter)It's important to note that these are just general guidelines, and your doctor may consider other factors, such as your age and overall health, when interpreting your testosterone levels.Risks and Benefits of Testosterone Replacement Therapy (TRT)TRT can be an effective treatment for low testosterone, but it's essential to weigh the risks and benefits before starting therapy.Risks:Prostate enlargementIncreased risk of blood clotsSleep apneaAcneBreast enlargementTesticular shrinkageIncreased risk of heart problemsBenefits:Improved libido and sexual functionIncreased muscle mass and strengthDecreased body fatImproved bone densityImproved mood and cognitive functionIncreased energy levels  Here are some proven natural ways to potentially increase testosterone levels without replacement therapy:1. Exercise and Lift WeightsExercise is a powerful way to boost testosterone levels.  Resistance training, like weightlifting, is particularly effective.  High-intensity interval training (HIIT) can also be beneficial.  2. Eat a Balanced Diet3. Manage StressLong-term stress can elevate cortisol levels, which can negatively impact testosterone.  4. Get Enough SleepAim for 7-9 hours of sleep per night.5. Get Some Sun or Take Vitamin D SupplementsVitamin D is linked to testosterone production.  6. Maintain a Healthy Weight7. Limit Alcohol Consumption8. Consider Certain Supplements -  Do your homeworkhttps://rocksolidfamilies.orgSupport the show#Rocksolidfamilies,#familytherapy,#marriagecounseling,#parenting,#faithbasedcounseling,#counseling,#Strongdads,#coaching,#lifecoach,#lifecoaching,#marriagecoaching,#marriageandfamily,#control,#security,#respect,#affection,#love,#purpose,#faith,#mastersofdisaster,#storms,#disasterrelief,#tornados,#hurricanes,#floods

Send Eve a text, question, or suggestion! Welcome back to Please Me, the podcast bringing you bold conversations and Big Clit Energy! I'm Eve, your host on a journey from trauma to sexual liberation. In today's Friday Bonus Episode, we're diving into an issue that affects so many women—decreased vaginal sensitivity and dryness.What You'll Learn in This Episode: The hormonal changes that cause vaginal dryness and loss of sensitivity Why blood flow is critical for female pleasure and how to improve it The connection between nutrition and sexual health The groundbreaking treatment of Acoustic Wave Therapy and how it works Practical steps to reclaim pleasure and improve intimacySupport the ShowJoin Patreon : For Early Release Ad Free Episodes, Eve's Monthly Webinars, Bonus Episodes and Eve's weekly live Q&A sessions and more!Website: Please Me Online - Reach Eve and stay connected.Juice Plus+: Enjoy plant-based nutrition with the nutrition of 30 fruits and veggies daily....Get your Bonnie's Herbals Today!Support the showSupport the Show: $3, $5, $8, $10 and get a shoutout for being a Super Fan! Explore these affiliates and support Please Me Podcast: Website: Please Me Online - Reach Eve and stay connected. OWWLL App: Call Eve on OWWLL app using code EH576472 for a $10 free trial. Download OWWLL SDC.com: Join the premiere "modern lifestyle" ENM website with a free trial membership using code 37340. Sign up on SDC.com Streamyard: Get $10 towards your streaming products and stream live with Eve! Visit Streamyard Organic Loven: Treat yourself to new bedroom toys at this incredible website. Explore Organic Loven Parlor Games: Hormone replacement for women, eliminating issues like incontinence. Shop at Parlor Games Buzzsprout: Save $20 on the best podcast hosting site. Get Buzzsprout LifeWave: Experience stem cell technology that enhances libido and changes lives. Visit LifeWave Juice Plus+: Enjoy plant-based n...

In this episode of the RCP Medicine Podcast, Dr. Rohan Mehra, an Infectious Diseases/Microbiology SPR, discusses the critical role of behavioural science in addressing health inequalities. Decreased vaccine uptake and lack of engagement with healthcare services are pressing issues, particularly among those affected by health disparities. To shed light on these challenges, Rohan  is joined by Professor Susan Michie, a leading expert in health psychology and behaviour change from University College London. With her extensive research and practical expertise, Professor Michie explores how we can apply behavioural science to improve healthcare engagement and design effective interventions. Tune in to discover how understanding human behaviour can drive meaningful change in health outcomes.References:A synthesis of evidence for policy from behavioural science during COVID-19, Ruggeri et al.https://www.nature.com/articles/s41586-023-06840-9The human behaviour change project www.humanbehaviourchange.orgComplex Systems for Sustainability and Health https://www.ucl.ac.uk/complex-urban-systems/cussh.Behaviour Change Wheel: A Guide to Designing Interventions www.behaviourchangewheel.comWHO behavioural science grouphttps://www.who.int/initiatives/behavioural-sciences 

Period poverty and the stigma surrounding getting products, learning how to use them, and having them on you is an uphill battle. People miss school, sports events, and other important life activities all because they might not be able to afford period products or are too ashamed to ask for free ones.  Key Takeaways:   [2:07] The pop culture movies that shaped how many women feel about periods  [9:54] Social stigma around not knowing how to use products or having a period  [14:43] The marathon runner that bled while winning  [16:23] Not having access to quality products, missing school, and the reality of prisons  [22:23] India and Kenya's unique culture problems surrounding periods and solutions  [31:13] Decreased sports participation and taking pain seriously [35:03] Experience teaching health, having boys take ownership, and my past athletes  [42:55] Women with the worst outcomes medically and a transmans experience  [47:59] Free period products in schools and how women are seen as gross  [53:20] People shouldn't be embarrassed to talk about their periods  Resources:    A Bloody Mess About Bloody Time Below the Belt  Period. End of Sentence.  Pandora's Box  Pad Man Connect with Barb:   Website   Facebook    Instagram   Be a guest on the podcast    YouTube   The Molly B Foundation 

David Murphy, Economics and Public Affairs Correspondent, reports that a total of 30,330 homes were built in 2024, a decrease of 6.7% on 2023, according to figures from the Central Statistics Office.

Show Notes for Episode 41 of “The 2 View” – reversible cerebral vasoconstriction syndrome, cerebral venous thrombosis, cardiopulmonary resuscitation and emergency cardiovascular care science, prehospital tourniquets, blood pressure, and more. Segment 1 – Reversible cerebral vasoconstriction syndrome and cerebral venous thrombosis Ropper AH, Klein JP. Cerebral Venous Thrombosis. N Engl J Med. Published June 30, 2021. https://www.nejm.org/doi/full/10.1056/NEJMra2106545 Spadaro A, Scott KR, Koyfman A, Long B. Reversible cerebral vasoconstriction syndrome: A narrative review for emergency clinicians. Am J Emerg Med. ScienceDirect. Published December 2021. https://www.sciencedirect.com/science/article/abs/pii/S0735675721008093 Segment 2 – Cardiopulmonary resuscitation and emergency cardiovascular care science, Prehospital tourniquets, and more Greif R, Bray JE, Djärv T, et al. 2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations: Summary from the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; And First Aid Task Forces. Circulation. AHA | ASA Journals. Published November 14, 2024. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001288?utmcampaign=sciencenews24-25&utmsource=science-news&utmmedium=phd-link&utmcontent=phd-11-14-24 Roberts M, Sharma M. The Center for Medical Education. 36 - Marijuana, Sunburns, Pulse Oximetry, Lower UTI's. 2 View: Emergency Medicine PAs & NPs. Published May 31, 2024. https://2view.fireside.fm/36 Roberts M, Sharma M. The Center for Medical Education. The 2 View: Episode 2. 2 View: Emergency Medicine PAs & NPs. Published February 3, 2021. https://2view.fireside.fm/2 Smith AA, Ochoa JE, Wong S, et al. Prehospital tourniquet use in penetrating extremity trauma: Decreased blood transfusions and limb complications. J Trauma Acute Care Surg. NIH: National Library of Medicine: National Center for Biotechnology Information. PubMed. Published January 2019. https://pubmed.ncbi.nlm.nih.gov/30358768/ STB home page. Stop the Bleed. American College of Surgeons. https://www.stopthebleed.org/ Teixeira PGR, Brown CVR, Emigh B, et al. Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury. J Am Coll Surg. NIH: National Library of Medicine: National Center for Biotechnology Information. PubMed. Published May 2018. https://pubmed.ncbi.nlm.nih.gov/29605726/ Segment 3 – Blood Pressure Bress AP, Anderson TS, Flack JM, et al. The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association. Hypertension. NIH: National Library of Medicine: National Center for Biotechnology Information. PubMed. Published August 2024. https://pubmed.ncbi.nlm.nih.gov/38804130/ Liu H, Zhao D, Sabit A. Arm Position and Blood Pressure Readings: The ARMS Crossover Randomized Clinical Trial. Jamanetwork.com. JAMA Network. JAMA Internal Medicine. Published October 7, 2024. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2824754 Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Send us a textSummaryKeith Hanks introduces a groundbreaking perspective on customer profiling by distinguishing between the Ideal Customer Profile (ICP) and what he terms the Actual Customer Profile (ACP). Drawing from his extensive experience in client success and program management, Hanks emphasizes the critical shift that occurs post-contract signing, highlighting how organizations must adapt their approach to serve and understand their existing customer base effectively.Detailed AnalysisThe Evolution of Customer ProfilesThe discussion reveals a fundamental transformation in how businesses should approach customer relationships in the modern era. Hanks introduces the concept of "love your customers, tolerate your prospects," emphasizing the distinct difference between pre-sale targeting and post-sale reality. This perspective challenges traditional customer profiling methods by acknowledging the gap between theoretical ideal customers and actual client relationships.Impact of Modern Work DynamicsA crucial insight emerges regarding the changing nature of customer relationships in the post-COVID landscape:Decreased tenure of client contacts due to remote work flexibilityReduced impact of non-compete clausesAccelerated need for re-onboarding and re-engagement strategiesGrowing importance of adaptable customer success strategiesCross-Functional ImplicationsThe analysis highlights the necessity for enhanced cross-functional collaboration:Integration between sales, marketing, and product teamsNeed for ongoing comparison between target profiles and actual customer behaviorImportance of adaptive learning and engagement strategiesFocus on developing next-generation power usersStrategic RecommendationsRegular assessment of actual customer profiles against ideal customer profilesDevelopment of micro-learning opportunities for evolving customer needsImplementation of power user identification and development programsCreation of adaptive engagement strategies for varying customer tenuresIntegration of AI tools for streamlined customer understandingBusiness Impact ConsiderationsShorter CRO tenures (averaging 17 months) affecting strategic continuityNeed for robust customer success metrics aligned with actual usage patternsImportance of identifying and nurturing power usersFocus on sustainable customer relationships over initial targetingNow you can interact with us directly by leaving a voice message at https://www.speakpipe.com/CustomerSuccessPlaybookPlease Like, Comment, Share and Subscribe. You can also find the CS Playbook Podcast:YouTube - @CustomerSuccessPlaybookPodcastTwitter - @CS_PlaybookYou can find Kevin at:Metzgerbusiness.com - Kevin's person web siteKevin Metzger on Linked In.You can find Roman at:Roman Trebon on Linked In.

Is your faith dead? What would you call a dead church?  What is a church?  What does God say about a dead church.    Revelation 3:1. And unto the angel of the church in Sardis write; These things saith he that hath the seven Spirits of God, and the seven stars; I know thy works, that thou hast a name that thou livest, and art dead. A church building might be considered dead if it is abandoned or unused. Signs of a dead church* Decreased attendance: The number of people attending services consistently decreases  Decreased tithes: The amount of money given in tithes decreases  Lack of baptisms: There are no baptisms taking place  Lack of disciple making: There is no effort to make new disciples  Unhealthy prayer culture: The church's prayer culture is unhealthy  Lack of service to others: The church doesn't serve the community  Refusal to change: The church doesn't listen to calls to repent or renew their zeal  What does the Bible say about a dead church?  In Revelation 3:19-20, Jesus calls on believers to repent and renew their zeal. A dead church doesn't listen to these calls and refuses to change. Please continue to look inward.  You are only responsible for yourself in relation to God.     Make sure you are right with Him.  Check your pulse.

Joe Biden gives his final foreign policy speech, where he touts his "achievements" and calls climate change the single greatest threat to humanity. Plus, Biden also claims the number of illegal border crossings went down when he came into office. Visit the Howie Carr Radio Network website to access columns, podcasts, and other exclusive content.

 Do you ever wonder if your forgetfulness is normal or an early sign of dementia? Could losing your keys be something more sinister? While memory lapses are just part of getting older, knowing the difference between normal aging and early dementia could change everything. Today, we'll uncover the subtle warning signs that should not be ignored  I'm Dr.Vickie Petz Kasper. I practiced obstetrics and gynecology for 20 years until I landed on the other side of the sheets   as a very sick patient. When my own body betrayed me, I took a handful of pills to manage my disease and another handful to counteract the side effects. My health was out of control. Through surgery, medications, and lots of prayers, I  regained my strength only to face another  diagnosis.  My doctor challenged me to make radical changes through lifestyle medicine. Now I feel great and I want to help you make changes that make a difference. Healthy Looks Great On You podcast takes you to many medical schools so you can learn the power of lifestyle medicine. If you're ready to take control of your health, you're in the right  place. Whether you're focused on prevention or you're trying to manage a condition. I'll give you practical steps to start your own journey toward better health because healthy looks great on you.    This is episode 154, Is it Normal Aging or Early Signs of Dementia?   Today we resume our month long series on dementia. If you've ever worried about your own cognitive function, or that of a friend or a family member You're going to learn what's normal and what's an indication of something more ominous. And we're going to start by taking a look into the complexities and wonders inside our skulls. The brain. It's the most complex organ in the body. When I was a medical student, over the course of gross anatomy, we dissected a cadaver. All the organs. It was a long and tedious process, separating tendons and blood vessels in the hand, examining the stomach, pancreas and liver as we removed layer after layer from the abdominal cavity. We inspected the lungs inside and out.  But you want to know what we did not do in gross anatomy? brain.  Now, before you think we skipped something, just the opposite is true. At the end of the semester, we had to remove the brain because there was an entire course that followed on neuroanatomy.  But don't worry, I don't call this mini medical school for nothing, so I'll be quick, but we are going to do a very surface overview of the anatomy of the brain. Your brain weighs about three pounds and it contains lots of nerve cells. and an intricate network of communication.  This may surprise you, but about 40 percent of it is water, protein, carbohydrates, and salts. And guess what comprises the other 60%?  If you said fat, you get to graduate early, but I'm guessing that you didn't. There are three main parts of the brain and two main layers. Now, of course, this is a huge oversimplification, and there's so much more, but we're going to stick to the very basics. The biggest part of the brain is the cerebrum, and it takes up about 80 percent of the brain. This is your thinking, feeling, reasoning, learning, problem solving memory part of the brain. It's the part that makes you uniquely you. It allows you to speak, and exercise judgment, and feel, and see, and hear, and touch. It also helps regulate temperature and controls the movement of your body. But it's the cerebellum in the back part of the head that keeps your body balanced and coordinated. And it's about the size of your fist. It may also play a role in thought, emotions, and social behavior, even addiction.  The third part is at the bottom of the other two parts. It's called the brainstem, and it connects the brain to the spinal cord, and it controls basic functions, like your heart rate and breathing.  The outer layer of the brain is called gray matter because it's literally a darker shade. The interior of the brain is made up of white matter.  And speaking of matter, why does any of this matter? Well, you see, different parts of the brain control different functions. And wherever there is pathology, There is loss of function and like real estate, location, location, location is everything.  The surface of the brain is convoluted with these deep folds and this creates more surface area for more connections between neurons or nerve cells.  But as we age, the brain starts to shrink and it actually starts in your 30s and 40s. Then, like crow's feet and gray hairs, it starts to ramp up at age 60 along with saggy skin. and accelerates even more after age 70. Hmm, aging is not for the faint at heart, but a lot of people are doing it. In fact, one in six American adults is over the age of 65. According to U. S. Census data, this age group grew nearly five times faster in the total population over the last 100 years to reach nearly 17 percent of the entire population in this country. to To the tune of 55 million gray headed, pickleball playing, Medicare receiving, joint creaking, golden agers. And yeah, we're concerned about living independently, driving, retaining our mental acuity, and remaining productive members of society.  Full disclosure, I'm not quite there, but I'm also not far away.  The brain's characteristics can actually be seen on imaging. MRI is the most sensitive, and with aging, the radiologist can see that the surface of the brain is less wrinkled and occupies less space inside the cranium or skull.  I mean, when your belt's a little loose, that's not a bad thing, but who wants a smaller brain? And unfortunately, this is not like Honey, I Shrunk the Kids, where you can just aim a contraption and zap it back to normal.  It's more like the sweater you accidentally put in the dryer. It's not going to be the same.  And although it's normal for the brain to lose volume as we age, it's When it exceeds what's expected for age, that's not normal. When the brain no longer fits snugly inside the skull, we call that atrophy. And there are varying degrees from mild to severe, and symptoms typically match depending on which areas of the brain are affected.   In this episode, we're going to focus on 10 signs that you should not ignore. And you can find this information on the AA website. Oh, not that AA, but if you need it, I'll put a link to that in the show notes too. I'm talking about the Alzheimer's Association website. We're going to discuss each one as well as when to worry and when not to, but here's the list from their website.  Memory loss, challenges in planning or problem solving.  Difficulty completing familiar tasks. Confusion with time or place. Trouble understanding visual, imaging, and spatial relationships. New problems with words and speaking and writing. Misplacing things and losing the ability to retrace steps. Decreased or poor judgment. Withdrawal from work or social activities. And finally, changes in mood or personality. Now let's dive into each one. When you think of Alzheimer's or dementia, what do you think of?  I'm not sure I heard you, but I think you said trouble remembering things. And you know, we all have trouble remembering things, especially if we're distracted with a million thoughts running through our mind. And it's perfectly normal to have trouble remembering things like someone's name.  Not someone close, like your kid, but maybe someone you just met. And you know most people say, I'm just not good with names. Well here's a little tip. Most people aren't good with names because they don't listen in the first place. When you're at an event and you're meeting lots of people and you're going to be introduced to people, you're thinking about what you're going to say, not what they're saying to you. So here's a little hint. The best way to get good with names when you're meeting new people is repeat their name back to them. That's It forces you to listen and it helps you remember.  It's also normal to miss an appointment occasionally or forget a call you were supposed to make. Or forget to pick something up that you were supposed to do. But what's not normal is forgetting information.  Also forgetting birthdays and anniversaries of people close to you, that's not normal.  People with early signs of dementia may start to rely more on putting everything on their calendar or taking notes or setting an alarm on their phone to remember things. Now, some of these are just organizational skills, like set a reminder on your phone to take medication. But when people start forgetting routine things, That's way more concerning.  I'm not sure telling the same stories over and over is necessarily a bad thing. It's kind of part of our social fabric. But, certainly asking the same questions over and over is a red flag. Like, when is my hair appointment? Then five minutes later, when is my hair appointment? Over and over.   Next on the list is difficulty with what we call executive function. And this is the part of the brain that helps us follow a plan or solve a problem. It's necessary when dealing with numbers. And this can manifest itself as the inability to do something like follow a recipe. That's a warning sign. But also more subtle things like just difficulty concentrating. Mentally tasking exercises just take a lot longer in people with early dementia. Now, it's normal to slip up occasionally and forget to pay a bill, or leave out the baking soda in a recipe.  But with early dementia, things that should come easy, get more and more difficult.  Playing games becomes more of a challenge, or navigating directions. And getting lost is a big concern for people with dementia, both driving, as well as something we call wandering.  But, it's perfectly normal to have to ask your grandkids how to program your favorite shows on your streaming platform.  But, it's perfectly normal to have to ask your grandkids how to program your favorite show on Netflix. You've probably even seen those commercials where the grandparents are just waiting on their grandkids to come and help them with their phones.  But, if someone loses the ability to do something simple like return a text message or read an email, That's more serious. And back when everything was on paper, it seems like we often wrote the date. Now, sometimes I have to think about what day it is. You too? Well, that's normal, as long as you can remember quickly. Dementia, on the other hand, causes people to not know what day, month, year, or even season it is. And what about trouble seeing?  As we get older, our eyesight tends to go kaput due to normal aging as well as things like cataracts. Recently, uncorrected vision loss has been linked to dementia just like untreated hearing loss. Good grief, I have to get up and put in my hearing aids and put on my glasses in order to function.   While declining visual acuity is normal, difficulty interpreting what you see is not. And people with dementia start losing the ability to read and comprehend. They also have difficulty with color contrast, and this can be very dangerous because they may fall because they don't realize there's a step or there's a rug and that can trip them up.  Have you ever lost your train of thought in the middle of a conversation?  I remember a particularly stressful season of my life about 10 years ago, and I felt like I couldn't complete a thought or a conversation, but it's because my mind was a million miles away.  Turns out it's normal to occasionally have trouble finding the right word you're looking for. But in people with dementia, this is more pronounced. They may start stories in the middle instead of a logical beginning, and they often repeat things in a loop.  But they come to a word and they can't recall it, so they kind of make a weird substitution like calling a watch a hand clock. What about losing things? Well, it's okay if you have to ping your cell phone on your hand clock or search for your keys.  I'm kidding, I hope you know that. But when my kids would lose things, I always told them to look with their brain, not their eyes. And think back to when you last saw it, and then retrace your steps. It usually works, but people with dementia can't do that. They also may put things in weird places, like put a can of vegetables in the refrigerator.  And when they can't find their car in the parking lot, They may jump to the conclusion that someone has stolen it.  Since the decision making part of the brain is affected by dementia, people make poor decisions. And of course, we all have bad judgment occasionally, but in dementia, this can be a serious problem, and it can be really dangerous. Because they're more susceptible to scams, and that can have devastating financial consequences. But it's also physically dangerous, because they may forget to turn off the stove or the faucet, and as the disease progresses, their hygiene is affected, as well as their ability to dress appropriately.  Now, after the holidays, you may just be ready for some peace, quiet, and solitude. Sometimes we all just want to stay home and veg out, but people with dementia struggle to participate in conversations, so they may withdraw from things that they used to enjoy. Especially if it requires more complex mental activity.  And lastly, there can be mood swings and personality changes. In fact, and hear me on this one, Dementia can present as depression, anger, extreme irritability, and anxiousness.  Because here's the deal, when all of this is slipping, they know, and it's scary.  And even though it's frightening, I don't want you to ignore warning signs in yourself or in someone you love.  Because if something's wrong, there is hope. Stay tuned for more about prevention, treatment, and even some evidence about reversal. And of course, it's all about a healthy lifestyle. And if you're ready in this new year to make healthy lifestyle habit changes, I have a great resource for you. You can go to my website, www. healthylooksgreatonyou.  com and find kickstart to healthy habits in just seven days. Of course, I'll also put a link in the show notes, and there are lots of podcast episodes that will help. And when you're on my email list, I send out lots of goodies. Recipes, sources of fiber, foods that affect your mood. So this is not something you want to miss.  Because your physical health affects your brain health, and healthy looks great on you.      The information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or health care provider and take medication as prescribed. Though the information in this podcast is evidence based, new research may develop and recommendations may change. RESOURCES Kickstart to Healthy Habits in 7 Days Alcoholics Anonymous Alzheimer's Association Healthy Looks Great on You Podcast episodes by email

Does your gut microbiome ever recover from antibiotics? If you understood what antibiotics really do to gut health, you might think twice about taking them. Find out about the biggest myth about your microbiome and the importance of human microbes. How to Fix Your Gut: ▶️ • Fix Your Gut with ONE Microbe L. Reuteri strain: https://www.amazon.com/BioGaia-Osfort... Super Gut Book Link: https://amzn.to/4dIxTy2 Recipes for L. Reuteri Yogurt: https://www.culturedfoodlife.com/reci... https://drdavisinfinitehealth.com/201... https://www.culturedfoodlife.com/l-re... **I am finding that using only ONE TBS of fiber in the recipe makes a better-quality product. Microbiome Master Class Link: https://innercircle.drdavisinfinitehe... Yogurt Maker—https://lvnta.com/lv_lrJY1A8ZLtxmwUpYdX Yogurt Jars—https://lvnta.com/lv_qB2B90JNh0hQjaMoXk Yogurt Containers—https://lvnta.com/lv_SFt3wnanoNkBHrf0Rs Antibiotics, corticosteroids, junk food, and glyphosate can all wreak havoc on gut health. Antibiotics wipe out certain strains of good microbes from your gut microbiome, and they do not come back! Some of the microbes that are wiped out are called keystone microbes. If they're eliminated, it affects the entire gut microbiome ecosystem, putting you at risk for inflammatory conditions, autoimmune diseases, allergies, and more. A healthy microbiome means good immunity, low risk of disease, and sufficient neurotransmitters. An alteration of your microbiome can cause a cascade of health problems, including leaky gut, increased susceptibility to autoimmune disease, and SIBO. Polyphenols and fermented foods can help create a healthy gut microbiome. Lactobacillus reuteri is missing in around 96% of the population. It makes seven natural antibiotics and increases the population of other good microbes. It may also help prevent SIBO and increase oxytocin. Dr. William Davis created a yogurt-like product with L. reuteri using a long fermentation process. After consuming L. reuteri yogurt, many people notice the following benefits: •Restoration of youthful musculature •Increase in strength •Increase in testosterone in men over 50 •Increased libido •Increased immune response •Accelerated wound healing •Increased dermal thickness •Decreased waist circumference Without L. reuteri and other important microbes, fecal microbes could end up in the small intestine. This can lead to endotoxemia, which contributes to a range of health conditions. Ingredients for L. reuteri yogurt: 1 L. reuteri probiotic capsule 1 tbsp inulin 1 quart half & half To make L. reuteri yogurt, break open one probiotic capsule into a bowl and combine it with one tablespoon of inulin and two tablespoons (from 1 quart) of half-and-half to form a paste. Mix in the remaining quart of half-and-half and add the mixture to a yogurt maker for 36 hours at 99 degrees. Consume ½ cup of L. reuteri yogurt every day!

Aubrey shares her three birth stories that tell of resilience, healing, trust, and miracles. She has had a vaginal birth, a crash Cesarean, and a VBAC– all of which presented cholestasis. Aubrey's first birth was a long but routine induction. Her second birth was a traumatic whirlwind including a complete placental abruption, general anesthesia, and her baby miraculously surviving 15 minutes without oxygen. Though her third pregnancy had many complications, the open and honest relationship Aubrey had with her provider is what ultimately led to her TOLAC and successful VBAC at 37 weeks and 6 days after another medically necessary induction. Aubrey is proof that no two births are the same, and miracles happen even when circumstances threaten to say otherwise. **Aubrey also wanted to mention that after her VBAC, she was readmitted to the hospital for postpartum preeclampsia. She had a headache every day, decided to eventually buy a blood pressure machine, and it was through the roof. She took herself to L&D, and they put her on magnesium. Aubrey had no idea it was even possible to get it postpartum and wanted to share!Managing Cholestasis SymptomsHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, everybody. It is almost Christmas, and I am so excited to bring another story your way. This is a VBAC story from a mama who is from Louisiana. She had quite a few roadblocks within her pregnancies that could have easily stopped her from having a VBAC, but she really established a good relationship with her provider even though her provider wasn't actually as gung-ho or excited about the VBAC specifically because she was nervous, together they communicated their feelings and understood where each other were, and came up with a plan to ultimately have a VBAC.I just respect that so much. It's important to know. We talk about providers all of the time. Providers are so important, and they make such a big impact on our outcome, but this provider, even though she wasn't really comfortable with VBAC, she truly believed in our guest, Aubrey, today. You'll have to hear it from her own words. It's awesome to hear how everything unfolded. We also have a topic today that maybe isn't shared a ton. It's called ICP or cholestasis that we are talking about. It is a liver condition that can occur during pregnancy and cause a range of symptoms. A lot of the times, it is baby being born that is the thing to end cholestasis. We are going to talk a little bit more about that, but I wanted to go over some of the symptoms. We've got dark urine, pale or light gray stools, and she'll talk about this. That is definitely something that is not normal in pregnancy, so if you are seeing that, that is a reason to contact your provider. Nausea, she described some other symptoms there. Decreased appetite, pain in the abdomen, or jaundice. These are some things to look out for. Now, there is a website called icpcare.org. We're going to make sure to attach that in the show notes, so if you have had cholestasis before or you want to learn more about cholestasis and how to manage the symptoms, and what types of things like healthy diet, they have so many amazing resources on their website. They even have recipes and different types of healthy fats and grains and legumes and things that we can focus on. We know that all of the time in pregnancy, really what we are putting into our body is so important. Definitely check out icpcare.org if you want to learn more about ICP and managing symptoms and resources and community support and all of the above. We do have a Review of the Week, so I want to get into that, and then turn the time over to Aubrey. This reviewer is reneekc89. The review title is, “A Turning Point”. It says, “When I was pregnant with my first, I was one of those ‘whatever happens is fine' moms about birth. Then I had an unplanned Cesarean after a stalled induction. It wasn't until I saw family members and friends so easily have vaginal births that I knew I had to try something different the second time around. I found this podcast through a local mom's group and immediately binged every episode. I continue to listen every week even after my successful VBAC in October 2020.”It says, “Listening to what seemed like every possible outcome helped me release my fear that I might have had. I felt emotionally prepared for anything that might have come my way. I switched hospitals and advocated through my entire 25-hour labor in the hospital, and felt like every decision was a conversation between two adults rather than demands.” Oh, what a powerful thing right there, you guys. She says, “I advocated throughout my entire 25-hour labor in the hospital and felt like every decision was a conversation between two adults rather than demands.” That is how it should be. It says, “I have to thank this podcast for helping me gain that kind of confidence. Thank you also to the Facebook Community for always answering my questions.” Oh my gosh. Thank you, reneekc89, for that review. Just a reminder, you guys, if you have not found us on Facebook yet, check us out. You can find us at The VBAC Link Community. You have to answer a few questions to get in, and then you'll get into this amazing community. We have the community on Instagram, and Facebook, and in this Facebook group. I believe so much that this Facebook community will empower you along the way. Like she said, you can ask questions, share pictures, and share concerns, and share triumphs and feel that love and support along the journey. I also wanted to throw out that we have a CBAC group, so if you are going for a TOLAC and it does end in a Cesarean, or you choose a Cesarean birth after a Cesarean, this group is here for you as well. You can find that at The CBAC Link Community on Facebook. Meagan: All right, Ms. Aubrey. Welcome to the show. Thank you so much for being here. I know you've probably been waiting. I feel like there are so many times when people are really excited to record their story, then I'm like, “Hey, you're going to be aired this much further out.” You have two months to wait. You're recording now, and then in two months, you'll be airing on, but I'm so glad you are here to share your three stories. You had a C-section, then two VBACs, right? Aubrey: I had a vaginal birth, then a C-section, and then a vaginal birth. Meagan: That's why I'm thinking two vaginal births. So vaginal birth, then Cesarean, then vaginal birth. You've got all sorts of different things added to your story. Aubrey: So many. Meagan: Cholestasis is one of them, right?Aubrey: Yes. Meagan: Okay. I'm excited to talk about that, because I think a lot of people think with cholestasis, there's only one answer. We're going to be talking about that, but I'm going to turn the time over to you.Aubrey: Okay. I guess we'll start with my first birth. Heads up if I cry at all during it because I just do that sometimes. Meagan: That is okay. That is okay. Aubrey: My first pregnancy was totally normal. I had no complications. I was big and miserable, but that was about it. I did have SPD, so my pelvis hurt really bad. I didn't know enough about it to go to a chiropractor to fix it. That was really my only thing until right at 38 weeks, it was that night at about 11:00 at night. I started itching on my feet. I couldn't scratch the itch. I got my husband's socks, and I put gel ice packs inside of them and wore them. That helped, then the itching started in my hands. This had been going on for about 2 hours, so I got in a really cold bathtub. The itching had started to spread more. It wasn't just my hands and my feet. It wasn't a normal itch. It was coming from underneath my skin. It was like my blood was itching. Meagan: People have described it to me as an unreachable itch.Aubrey: It is. It's the most miserable. Meagan: You touch the spot, but you can't get to it.Aubrey: Yeah. It's like when the inside of your ear itches. You're like, ugh. It's like that but all over. Nothing helps. I called the after-hours line at probably 4:00 in the morning. The doctor on call was like, “Pregnancy can be itchy. Take some Benadryl.” I was like, “I've already taken Benadryl. It's not helping.” She was telling me to take some creams, and I knew something else was wrong. I spent the rest of the morning researching. I came to the conclusion that I was 99% sure that I had something called cholestasis, and that I was going to have to be induced.One thing that solidified that was that there were other symptoms that I didn't know about. My stool was white. It was really weird. It just was white-colored. I had this really violent episode of vomiting beyond anything I had ever experienced in my life. That's one of the things. It's this uncontrollable exorcist-style vomiting. Meagan: I actually did not know that. Aubrey: Yeah. It was unnatural. I remember thinking, “That was so weird,” but it was a couple of days before that, and then the next day or so was when I had the weird white-colored stool, but again, I had never been pregnant, so I was like, “I guess this is just pregnancy,” then the itching. That's when I put it all together, and I was like, “Well, I've got cholestasis.” My husband was working that weekend, so I got my best friend to bring me to the hospital. When we got there, I was scratching all over. I was saying, “I'm pretty sure I've got cholestasis.” They clearly didn't believe me. They weren't being ugly. They were like, “All right. Let's see what's really going on here.” They put me in triage, and the on-call doctor came in. She is a lovely person. I don't mean anything bad, but she walked in. She said, “Okay, here's why you don't have cholestasis.” She starts listing off all of these reasons. One of them was that I wasn't jaundiced. Later on, in my research, there's only 30% of women who have elevated bilirubin levels when you have cholestasis. I wouldn't have been jaundiced because my bilirubin wasn't elevated. I said, “Okay. I understand all of that, but can you please just run the labs?” She was like, “Okay, if you want me to run them.” She brought the lady in there. They did the labs, and about 30 minutes later, she came back in, and she was like, “Okay. You were right, and I was wrong. You have cholestasis, and we are going to induce you right now.” I was like, “Okay.”Meagan: Oh my gosh.Aubrey: I called my husband and told him he needed to leave work. At about 5:00, I think– I guess it was about 5:00. They put misoprostol. Meagan: Mhmm, misoprostol, yeah. Cytotec. Aubrey: Yeah, they inserted that. After the first dose, they determined that my cervix was not tolerating it well. They decided to not continue it. They went straight to Pitocin. I didn't know then that what they were doing was really, really fast, but they were upping it every 15 minutes 2 milliunits. Meagan: 15? Wow. That is really fast. Aubrey: It is. Now that I know. At the time, I was like, “Okay.” During my birth, I prepped. I read books, and I went to classes, and I did the Bradley method, and all of the things, but I didn't prepare for induction because I had no idea that I would ever need that, so I knew a lot about birth, but I did not know anything about induction. I was like, “Okay, if you say we're going to do that, we'll do it.” I think I felt my first contraction. It wasn't that long after the Pitocin, but it wasn't that strong. I had contractions off and on for several hours, and the nurses would come in and say, “Oh, are you okay? That was a really strong one.” They didn't feel that bad to me, so I was like, “Oh, I can do this.” That went on for a while, and I guess once I got going more, It just felt like I was always contracting. I didn't know any different, again. I didn't know any different. I just thought this was what it was. Sometimes, it would be more intense, but there was always a contraction. Even on the monitor, you could see that it never dipped down. She asked if she could break my water at 7:00 that morning. It was my doctor. I don't know if she came to check on me or if she happened to be on rounds. She asked to break my waters. I told her I didn't want her to right now. She came back later, and I was okay with her breaking it, so the floodgates opened. I had so much fluid. We did not realize how much fluid I had. That was that morning or maybe the mid-morning. That evening, I hadn't slept in two days at that point because of the itching the night before, and then the contractions. I asked the nurse, “If I get an epidural, will I sleep?” She was like, “Probably so,” then I was like, “Then give it to me. I am so tired.” I did. I slept like a baby. The nurse, I wish I knew her name, but she was so sweet. She came in the night. She put a peanut ball in between my legs. I was only 4-5 centimeters at that point. She put a peanut ball in, and she would come in every 30 minutes. She would flip me from one side to another while I was sleeping. I woke up the next morning at 6:00 in the morning. I had been in labor at that point for 39 hours. I got the epidural at 30 hours. Meagan: Wow. Aubrey: Yeah. She came in the next morning, and the doctor was like, “Okay. You're ready to push.” I was like, “I am?” The epidural was so strong. I couldn't wiggle my toes. I had no idea. She came in, and set everything up. I pushed her out in 15 minutes. Meagan: Whoa. That's awesome. Aubrey: 14 minutes actually. My doctor was like, “That's the best I've ever seen a new mom push.” I was like, “Wow, yeah. Okay.” Meagan: Go me!Aubrey: Yeah. I didn't have any reference. For me, I was like, “This is taking so long, but apparently it was very quick.” Now I know it was pretty quick. Afterwards, my uterus would not contract back. My placenta wouldn't come off. Now I know it's because afterwards, she told me that my contractions never stopped. There was never a break between contractions, so my uterus was just completely exhausted. Meagan: Uterine atrophy, yeah. Aubrey: Yeah, so she had to manually go in there inside of me and start my uterus to contract again which was not pleasant, but she just basically had to shock it. Meagan: Stimulate it, yeah.Aubrey: Yeah. Eventually, it did, and my placenta just fell out. That was that. When they broke my water, I forgot to say, they did find meconium which is common in cholestasis. It was very light, and she wasn't worried about it. It wasn't an automatic C-section because of the meconium. It was really light. She did have to be suctioned, but other than that, she was perfectly fine. We didn't know any of the genders for any of my babies, so it was fun to find out that she was a girl. That was birth number one, and that was in 2018.A year and a half or whatever it was, I got pregnant right before COVID became a big thing. I was pregnant all through the COVID scare. I was due in September, at the end of September. Again, it was non-complicated. I forgot about this. I had a subchorionic hemorrhage around 16 weeks which I didn't know about. I didn't have any bleeding or anything. They just found it on the ultrasound, and then by the next time I went, it was resolved. I was considered high-risk though the whole time because of the cholestasis, so I had frequent scans all the time. That was really the only thing that was weird. We had tested for cholestasis. There were a couple times because anyone who has had cholestasis knows that anytime you itch, you're like, “It's back.” There were several times I had her test me, and there were no elevated levels. Right before 39 weeks, I told her about some intense itching on my foot. I told her that this time was it. It was the itch. She was like, “Okay, well because of COVID, and we're not sure what the hospital bed situation is going to be like, we're going to go ahead and test your blood and find out if it's present, but in the meantime, let's go ahead and schedule your induction to make sure you have a place if we do have to induce, then you're already there.” She wanted me to induce that day. I couldn't because my husband was gone for the Army. I said, “I just need a few days for him to get back in town.” That was on a Thursday or Friday, and I was induced either Monday or Tuesday. It was on September 1, 2020. I went in for my induction. This time, I had not prepared at all. I was like, “Oh, it's like riding a bike. I've done it once. I can do it again.” I want to say upfront that anything they did during the induction, I was totally a party to it. I agreed. I never said no. I never asked questions. I was uninformed or unprepared or whatever, but I never spoke up, so I don't blame them for anything that happened because I could have spoken up, but I didn't. They always asked me. They never told me, “This is what we're doing.” They asked me my permission for everything. We got there. They did not do Cytotec because it hadn't worked before. They went straight to Pitocin. Again, the same 2 milliunits every 15 minutes. Meagan: Is this just their way?Aubrey: I think it was. I don't think it is anymore, because it was different when I went for my VBAC, but yeah. Meagan: Well, I wonder if that's because you were a VBAC though. Aubrey: No, because one of the conversations I had with one of the nurses, I asked her if we could start slow. She was like, “Well, our policy is to go 2 milliunits every 30 minutes.” I was like, “I'd like to go slower than that.” I think they must have changed their policy. I don't know. That's what my hospital records say is that they were doing 2 milliunits every 15 minutes. I got those thanks to y'all. I was like, “Let me go see what that says.” Meagan: It's nice to see what it says, yeah. Aubrey: Yeah, it is because in my situation especially with what happened to my son, it was so amazing to read what really happened and to know my son is where he is. I'll get to that. Anyway, so she came in around 7:00 in the morning. My doctor was on shift. She asked if she could break my waters. I was like, “Sure, go ahead.” She broke my water. So far, it had been a pretty uneventful induction, nothing to write home about. I didn't have an epidural. I didn't feel like I needed one. I was going to try to do it without one if I could, but that might have been at 8:00 or 9:00 in the morning. I don't know. It was in the morning. Around lunchtime, they started saying that the baby was wiggly and that they couldn't really get a reading of his heart. He had been wiggly before, and so they were like, “Is it okay if we insert an IUPC?” I had that with my daughter. It doesn't harm the baby. It didn't hurt me. I didn't mind them putting it in, which is for those of y'all who don't know, it is a–Meagan: Intrauterine pressure catheter. You've got it. Aubrey: It measures the contractions from the inside so you can see how effective they are and all that. I was like, “Fine, yeah.” My nurse, whose name is Becca, she's lovely, inserted the catheter into my uterus, and the tube that comes out is clear, and it filled with dark red blood. I knew something was wrong. I said, “That shouldn't be red like that.” She said, “It's okay. Sometimes we have a little bleeding.” I said, “Not like that. That's red.” She was trying to calm me down. Meagan: Yeah, and sometimes they can knick the cervix and it can cause bleeding, but you were like, “No. Something's not right.” Aubrey: Yeah. I just knew something was wrong, but before that, I had no symptoms. I had no clue that anything was wrong. I didn't feel bad. I didn't feel any pain. Nothing. I was like, “You need to take it out. Please take it out. Please take it out.” She called my doctor who was in her clinic down the hospital, and she said, “It's okay to take it out if she's not comfortable with it.” When she took it out, blood just came shooting out of me. It was gushing. Meagan: Really?Aubrey: I know it was blood mixed with fluid, so that's why it was so much, but it looked like it was pure blood. It was so dark. I mean, I was like, “Okay, I need the doctor.” Becca was so sweet. She said, “Okay, just give me one minute. I'm going to go outside and get the doctor.” She was so calm. I was freaking out. She went out there. My doctor was in my hospital room within a couple of minutes. I think she was across the hospital in her office. She was there within a couple of minutes. She had an ultrasound machine. There wasn't a lot of time for talking about what was going on. She just got the ultrasound machine, looked for a second, pushed it up against the wall, and my doctor has the most wonderful bedside manner with the way she talks even when she is stressed out. She said, “Okay, Aubrey, we're going to have to go back to surgery now. Brandon, I need you to tell your wife goodbye.” As she's telling him that, they're pulling my jewelry off. The other nurse handed me a consent form for a C-section. They were prepping me as we were talking. Then they ran me down the hall. It felt like Grey's Anatomy. They pushed this poor woman up against the wall. I remember her head hitting the wall. It was that fast. We were running down the hall. We got into the OR, and I just remember them prepping my body and prepping the room. They were getting the instruments lined up. There was no time for anything. I didn't have an epidural, so they didn't have time to call an anesthesiologist to my knowledge. They started putting the lidocaine where my incision was or was going to be. I started hyperventilating. The nurses threw a bedsheet over my head. They popped up under there with me. They were like, “I'm so sorry, but this is the best we can do. We don't have time to put a sheet up. We're going to have to stay under here. We'll stay here with you.”Meagan: Oh my lanta. Aubrey: Yeah, it was really scary. I remember right before they threw the sheet, I could still see the door swinging. That's how fast everything happened. They eventually, she was like, “You have to calm your breaths down because the baby needs the oxygen.” Little did I know that it really didn't matter how much breath I took. He wasn't getting anything. Eventually, they put me out with gas. Meagan: Did they put you under general?Aubrey: I had to be gassed out. I was hyperventilating. They were like, “We need you to be still.” At the time, they were literally about to cut me before they threw the sheet over. I remember the very last thing that my doctor said to her nurse was, “There's no fetal heartbeat. There are no fetal tones.” I knew at that point that he was dead. Meagan: That's the last thing you heard. Aubrey: Yeah. I woke up. I don't know how much longer it was. It was pretty quickly after surgery because I don't think they anticipated me waking up so early. I was in a hallway. I wasn't in a recovery room. Because I wasn't out all the way, I don't know, but I woke up, and two of the nurses, because there were like 18 people in the room with me when everything happened. The nurses' backs were to me. I said, “Is my baby alive?” One of them said, “Oh, she's awake.” They turned around. One of them said, “They're doing everything they can.” I passed back out. Then I woke back up in the recovery room. My doctor was waiting for me. It was COVID, so my husband wasn't anywhere near any of this. Meagan: Yeah, I was wondering. You said his name was Brandon, right? They were like, “Bye, Brandon. We have to take her.”Aubrey: Then he was just left alone in the labor and delivery room freaking out. Meagan: No one talked to him?Aubrey: He told me later that my doctor had come in after the surgery to tell him everything that happened. Immediately afterward, she came in there to tell him. She is the best doctor in the whole world. Meagan: But he had to wait. Aubrey: Yeah, he had to wait. There wasn't any time for anybody to tell him anything. Meagan: How scary for him. Aubrey: Because come to find out, my placenta had spontaneously 100% completely detached from my body in a matter of a couple of hours. If anybody has ever had a placental abruption, it starts slow. It comes off a little bit at a time. Mine came off in a couple of hours. It was completely detached. We didn't know why at the time. It was very unexpected. She was there. I woke up, and I said, “Is my baby alive?” She said, “Do you want to know what you had?” I said, “Is the baby alive?” She said, “He's alive, and he's a boy.” Then she told me what happened. He was dead when he was born. He was dead for 15 minutes. Meagan: Wow. Aubrey: Yeah, 15 minutes. He had no blood flow or oxygen flow to his brain. A lot of his blood had been drained out of him because my placenta had pulled it out of him because it was detached so quickly I guess. He was not completely exsanguinated, but he lost a lot of blood and he had no heartbeat. According to my hospital records, they tried compressions. They tried the electrode things. They tried an epinephrine shot, and they tried an epinephrine drip, and nothing started his heart, and then after 15 minutes, his heart just spontaneously started by itself. Meagan: Wow. Aubrey: Yeah. That's why it was so cool reading back my hospital records to see. My doctor and everyone involved was like, “We can't believe this. I cannot believe he is alive. I cannot believe you are alive,” but reading it and seeing how amazing it really was was really cool. She told me that the surgery had happened in just a few minutes, and that because of how quickly she had to perform that surgery, that my recovery was going to be really intense, and that most people who have a C-section would not be in as much pain as I'm going to be in because they literally had to rip my body open to get him out, but she said, “Your incision is fine.” Luckily, she's a really skilled surgeon. She did all of that perfectly. She said, “I don't expect any trouble with you healing or anything with your scar.” He was put on a cooling blanket and intubated and given maybe six blood transfusions. If anybody from the hospital is listening, I'm sorry if I get the numbers wrong. But it was a lot. There were six little stickers missing from his transfusion bracelet. He couldn't eat. We couldn't pick him up. We couldn't touch him. I couldn't see him for the first 24 hours because I couldn't move, so the nurses had taken pictures of him and brought them to me so I could see what he looked like. They didn't show me the really scary ones until later because there were some at the very beginning that were very scary-looking. My doctor came in the next day to check on me. It was her day off. She just came in to check in on me to tell me how grateful she was that I was there. I know it traumatized her too because she said she had never opened up someone and seen their placenta floating inside of their body. My nurse, Becca, came to see me. She was also pretty traumatized. But anyway, it was a lot. Once he was in the hospital, they put him on the cooling blanket and all that. He had to be on the cooling blanket for 72 hours, and then they were going to be able to test him to see how significant the brain damage was because we knew that he would have some. I mean, after 5 minutes, you start to have brain damage, and then we knew having been out for 15 minutes that we were looking at something pretty significant based on science. That was the thing that I think was different about me then than now. My background was in physiological psychology. That's what I studied in grad school. My immediate thought was, “I know what science says. I know the probability is of my baby,” and that's what I was looking at. What do we need to do to take care of this baby with significant brain damage?We waited, and on the second day, the day before I was released from the hospital, I had a really cool encounter that was just the way that God changed everything for me which came into my VBAC later because of the faith that it gave me, but I had dragged myself to the shower that morning. It was so painful. My husband was still asleep on the couch. I got in the shower, and the water was cold. That made it even worse pain because it was cold. I was in the shower, but I couldn't get up because I was frozen in pain. I was like, “Why is this water in the hospital cold? It shouldn't be cold.” I sat in there for about 15 minutes. The water stayed cold, and it never warmed up. Finally, I said, “God? If you can't save my baby, can I at least have some hot water?” The water turned hot. I just started laughing and crying at the same time. I just knew that my baby was okay. I don't know how I knew. I just knew that even if he wasn't going to be perfect, whatever was wrong with him was okay. It helped me to get through the next few days because it was hard to see him just laying there. Finally, when they were able to do his tests after 72 hours, we had to go to a different hospital. He had to go in a little ambulance and go over there. We had one of the best pediatric neurologists in the area, Dr. Holman. She's not known for her bedside manner, but she's an incredible, incredible doctor. I say that in a way that she's very to the point. She doesn't sugarcoat anything. My sister, who is a nurse, warned me, “I'm just telling you that she's the best of the best, but she's not–” Meagan: She's blunt. Aubrey: She'll give it to you straight. That's what we were expecting. They did his little scans, and when she came back she said, “I don't have a medical explanation, but your baby is perfect. There's not a single spot on his brain. The cooling blanket does incredible things, but I should see something, and I don't see anything.” Meagan: Wow. Aubrey: She said, “Your baby's going to be perfectly fine.” She told us that he's probably going to have some issues from being in the NICU and being still. He would have to have physical therapy to help his muscles and all of that, but as far as his functioning as a human being, he was perfectly fine, and nothing was wrong with him. Meagan: Yay. What a miracle. Aubrey: Yeah. That's what she said. She said, “Your baby is a miracle, and I don't get to say that with what I do very much.” Meagan: That's awesome. Aubrey: Yeah. So that was his birth, and after that, that day, my husband left and went back to the Army. I recovered from that. I recovered from that pretty much alone which was almost as traumatic as what happened in the hospital because I was in so much pain, and I had a 1.5-year-old and a new baby who screamed all the time which was one of the things they warned me about after the NICU. They said, “He's going to cry a lot. We don't know why, but coolant babies just scream a lot.” He did. For hours and hours and hours, he would scream. It felt like torture in a way because it was like I couldn't do anything. He would scream and scream and scream. My friend, Ashley, and my sister were the only way I made it through that. I would call my sister, Kelly, and be like, “I need to come over,” at 3:00 in the morning. She was like, “Come on.” She would hold him while he screamed so I could go in the back and sleep because I was so sleep-deprived and in so much pain. Then my friend, Ashley, would come over and help me clean. She helped me with my daughter. They helped me through that part. My husband was gone for the first 6 months of Amos' life. About 2 years later, I got pregnant again. I was really scared of having to have another C-section. I was on a pregnancy app, and I asked, “Has anyone ever had a vaginal birth after they've had a Cesarean?” Somebody on there was like, “Oh, you should try this thing called a VBAC. There is a place called The VBAC Link.” I was like, “Okay.” I had no idea. I had never heard of The VBAC Link or the term “VBAC”. I found The VBAC Link, and like everybody else, I became obsessed. I listened to every episode, read every article, and every post. By the time it came time for my first appointment with my doctor, I knew that I was going to at least give it my best try. When I told my husband that I wanted to have a VBAC, he was not okay with that. He was really freaked out because, I mean, everybody involved was traumatized. He was. The nurses, the doctors, everybody. He was just like, “Are you sure that's safe?” I was like, “Yes, actually. I am sure that's what is safest.” I got on The VBAC Link, and I was like, “How do I make my husband understand?” They were like, “Enroll in the course and show him the course.” Meagan: Yes. Take the course with him. Aubrey: We did. By the end of it, he was like, “Okay. If that's what you want to do, we will do it.” That's what we planned for. I was really hoping that I didn't get cholestasis for the third time. There's not really anything you can do to prevent it, but I was just really hoping that somehow it wouldn't show up. About, I guess, 20 weeks, I was told that I had complete placenta previa, so that was super fun. My maternal-fetal medicine doctor explained it, and this is for everybody who gets diagnosed with that. It made my brain so much more calm. He told me that your uterus is a muscle. It's juicy, and it has all of these blood vessels. Your cervix is a connective tissue. It doesn't have all of that. Naturally, your placenta is going to gravitate toward where it can get the most nutrients. It almost always resolves itself because it's not going to get what it needs off of your connective tissue. I just banked on what he said, and by 28 weeks, it had gone so far up that it wasn't a concern at all. Around 24 weeks, I started seeing a chiropractor for severe SPD. My pelvis was on fire. It was grinding, and all of the things. It was worse than with my daughter. I didn't have it at all with my first son, but man, it was back with a vengeance with my third pregnancy. The chiropractic care helped so much. If anybody is in the Natchez, Mississippi area, my chiropractor moved to Natchez, Mississippi after she helped me. But anyway, that's where she is if you're near there and you need a good Webster-certified chiropractor, she's amazing. Her name is Dr. Ashley Edwards. She helped me. Then she helped me with positioning and stuff. She's really good. That was 24 weeks. I started that. Early on in pregnancy, I had been coming from one doctor to the other in the same building, and I was really huffing it. My blood pressure was high. They let me sit for a minute and retest it, and it was fine. I didn't think anything of it until later on in pregnancy when that happened again. My maternal-fetal medicine doctor freaked out. He was like, “You've had two high blood pressure readings. We need to test you for preeclampsia.” That was in my third trimester at some point. I'm probably skipping around. He kept pinching me to see, and asking me if the swelling was normal. I kept telling him, “That's just my ankles. I just have big calves and ankles.” Every time, he would be like, “Is this swelling always like this?” I'm like, “That's not swelling. It's just what my ankles look like, but thank you.”Meagan: Oh my goodness. Aubrey: That was fun. I had to carry around my urine for 24 hours to the urine test. He said that I did have protein in my urine, but it didn't meet the threshold of preeclampsia, so I was not preeclamptic, but they were going to watch me for it. Toward the end, I did get, “Your baby's really big,” not from my OB, but from my maternal-fetal medicine. My OB– I guess I should rewind. I didn't even talk about how we had that conversation. My OB from the very start was so amazing. When I first came in, she was like, “I'm so excited for you.” She was like, “Is it okay if I tell Becca (my nurse from before)?” I said, “Yeah, you can tell her.” She texted Becca and told her. Becca and I stayed in touch through everything. She texted me, and she was excited for me. But I told my doctor that I wanted to try for a VBAC, and she said, “I'm perfectly fine with that. I don't see an issue.” She was like, “The only thing that could possibly present an issue is if your cholestasis comes back, and it's early on. But for now, let's plan for a vaginal birth, and that's the goal. If something changes, then we'll talk about it when it changes.”She's a very great doctor because you can talk to her, and you can be open with her and be honest and never feel like she's judging you for telling her how you feel. I can't tell you how many times I cried just with her telling me all kinds of different things. She just listens and never judges. We went through most of the pregnancy with that as the goal until at the end, around 32 weeks, my itching came back. They tested me, and I had elevated bile acids, so I was considered to have cholestasis. They put me on ursodiol. I only itched for a few hours, but I knew what the itching was. It's so different. I knew what it was. I never itched again the whole pregnancy. Even before I got on the medicine, before I had even picked up the prescription, the itching had stopped. I still took it. At that point, they were like, “Okay. We can't let you go into labor naturally. We're going to have to induce,” because that is an automatic induction. Then the whole thing with the preeclampsia came around a little bit after that, so my maternal-fetal medicine doctor was talking about, “We might need to do this at 35 or 36 weeks.” I was like, “I don't think I'm comfortable with that.” My doctor was like, “We'll see, but if you have preeclampsia, that changes everything.” My doctor, my OB doctor– I was talking to her about everything, and she was like, “The reality is that what you have could potentially be dangerous for baby. So every week from about 35 weeks on, we're just going to have to determine if baby is safer in or if baby is safer out, then at that point, we can determine how we are going to deliver the baby because we don't know what your body is going to be doing. We just have to see.” She said, “I'm not telling you that you can't have a VBAC. I'm just telling you that we need to be open to the possibility that it could turn into a C-section if this doesn't go the way we want.” She said, “I feel like as your doctor, I wouldn't be doing you any service if I didn't at least have this conversation with you because if it came to the point that we had to have a C-section, and we had never talked about it, then you would be like, where did this come from? I don't want you to feel blindsighted.” I appreciated it. I did leave really discouraged from that conversation. I cried because I thought that secretly she was trying to bait and switch me. But I should know that my doctor really is great. Anyway, so we went through the next couple of weeks where she would tell me, “Baby is safer in, so baby gets to stay in.” I had scheduled a lunch with Becca. I had asked her if she would be at my new baby's birth. She said she would be my labor and delivery nurse. We'd get to try it again. She was like, “I'm going to help you have a VBAC. You can totally do this.” We had lunch. I told her about the conversation that I had with my doctor. I said, “I just want the opportunity to try. If I get to try and something happens and it doesn't work out, then I'll be okay with that. I just want to try because I know my body can birth a baby.” I said, “I don't have to have the epidural, but if that's what makes her comfortable, I'm okay with that because I've had the epidural before. It's not like I'm anti-epidural. I'll have it if that makes her more comfortable.” I've realized that she is a person with trauma, and I knew that what I was asking her to do was scary for her because of what happened and because probably most people don't know, but cholestasis comes with the risk of placental abruption. It does something to the vascular structure, so it's not that it causes it, but it makes you more susceptible to placental abruption. I knew that she was worried about that. I knew that everything else that had popped up and popped up and popped up, she probably was like, “I don't think I want to do this anymore.” I told Becca all that, and she said, “Have you ever told your doctor that?” I said, “No,” because she knows her. She works with her. She said, “I think if you have that conversation with her, and you tell her just like you told me that she would feel a lot differently about it.” The next appointment was the appointment where we were going to do my first cervical check. We needed to know what my body was doing, so if I had to induce, they knew. Meagan: Where you were at. Aubrey: Yeah. It was one that I wanted and that I needed, I think, in that situation. Before she checked me, I knew that this time if she checked me and it wasn't doing anything that she was probably going to be leaning more toward C-section because I was going to have to be delivering within that week or a few days after based on everything that was going on. When I got in there, I said, “Before you check me, I want to tell you something.” I said, “I just want to tell you this so you don't think that my response to whatever happens in the check is me begging or anything like that. I just want you to know that this is how I feel.” I told her everything I told Becca. I told her that I wanted to meet her halfway and do whatever made her comfortable as long as I got to try. She said, “Okay. Let's just check you and see what's going on.” She checked me, and she said, “You're soft. You're 1 centimeter dilated, and we can have a VBAC.” She said– hold on. Let me get myself together. She said, “I'm uncomfortable with this, but the reason that I'm okay with this is because I trust you. I trust you enough to know that when you tell me your body can do this, I believe you. I know that you trust me enough to know that if I tell you it's time to call it, then you'll believe me and we'll call it.” She said, “The reason that we're doing this is because we have a mutual trust and understanding. We can be honest with each other.”I just sobbed and sobbed and sobbed. I mean, I was just so excited. On the way home, I got into a wreck. I totaled my car. Meagan: Oh my gosh!Aubrey: Yeah. It wasn't as bad because it was totaled because my airbag came out, but it was in very slow bumper-to-bumper traffic. I had to go back to the hospital. She was on-call, and she was like, “Why are you here?” I had to be monitored for that, but everything was okay. Saturday at midnight was my induction. I came in, and they started my IV. It took them a while because I have really weird veins and they are hard to stick. Eventually, they called in an anesthesiologist to use his machine to find my veins. If anybody has hard-to-stick veins, you can use an anesthesiologist, and it works like a charm. He got my vein, and we started fluids. About 30 minutes later, it was probably at 2:30 or so whenever the Pitocin was in. I had my first baby contraction. Rebecca– a different Rebecca, but her name was Rebecca– said, “Okay, here's the schedule we're going to go on.” I forgot to mention this too, but right before my induction, my husband surprised me with his VBAC certification doula course. He had gone through the doula course. Meagan: Oh my gosh!Aubrey: He went through The VBAC Link doula course. He was like, “Surprise! I can be your doula.” Meagan: That is amazing. Aubrey: It was cute. My husband, when she starts telling me the schedule of how we were going to do everything, was like, “Excuse me, I think we need to not be going every 30 minutes. We need to be going every 45 to an hour.” He was so well-educated about the whole thing. She did. She did it slow at first, then we did that through the night. I don't remember if I slept or not, but Becca came on her shift at 7:00. She was like, “Okay. You're doing good, but here's the reasons why I think that we need to increase the interval. We were having contractions, but we need to get a pattern going.” She told me why. I agreed with her that I was okay with it as long as it didn't go faster than 30 minutes. We did that, and that started to actually get a pattern which was really nice. She is a brilliant nurse, and she knows what she's doing. She was like, “We're going to get you moving. Come on. Get up. We're getting out of bed.” She had me walking down the hall, and with the peanut ball, and sitting on the ball. My doctor came in around 9:00. She told me that she thought we needed to break my water. I was really nervous about that because in my research of what happened to my placenta, I had found that it was likely that I had a placental abruption due to the rapid decompression of my uterus. My doctor agreed that that's probably what happened, but when they broke my water, because my vessels were already weak, the pressure suctioned it off. I was really worried about breaking my water. She was like– I've never seen her be so stern with me before because she's always so calm and nice. She said, “Aubrey, I'm very uncomfortable right now. I do not want to see you have a rupture. I do not want to see your placenta detach. We need to be real about this.” She said, “You have a lot of fluid. If we do not let some of that fluid out, your baby is not going to drop. You have a lot of fluid.” I did. I guess I forgot to mention that. I wasn't quite poly, but I was pretty close to having poly.Meagan: Borderline. Aubrey: Yeah. I told her that I was scared. She said, “You cannot make decisions based off of fear. You have to make decisions based off of what is happening and what is fact. The facts are that your baby is high. Your body is contracting. You have a pattern, but your baby is not dropping. There is a reason, and it's likely because of the fluid level.” So, she said, “I can break your water in a way that is not aggressive. I will just cut a tiny little slit and let it come out on its own, then it will come out.” I agreed. I mean, when I step back and look at it, I was like, “She's right. Scientifically, the baby is buoyant and is just floating there.” Come to find out, I definitely had poly. I had so much fluid. When it finally came out, Becca was like, “I don't think I've ever seen that much fluid come out of somebody.” It was the exact thing that the baby needed. He came down, and immediately, I went from 4 centimeters to 6 in an hour. I could feel my body doing very differently. It was changing differently than it had before. I started to get nauseous and shaky. I knew that I was probably getting closer to go-time. I told Becca, “You might want to get the guy to come give the epidural now. I promised her I would get the epidural, and if we're going to get it, we're probably going to need to get it now.” She was like, “Yep. Let's go ahead and get it put in.” She had him put it in really light though so I could still move my legs and wiggle my toes. I could even put pressure on my legs which was nice. That was maybe at 2:00 in the afternoon or 3:00. Oh no. I got the epidural at almost 5:00. I was way off on the time. It was almost at 5:00 that I got my epidural. I had been between a 6 and a 7 and about 70% effaced. After the epidural, they had to go to an emergency, her and my doctor. They came back afterward, and me and my husband were playing Scrabble. I started throwing up. I had the bag, and I was like, “I need to throw up.” Becca came in and she was like, “You're throwing up? This is the best!” She was like, “It's time. It's time.” I was like, “How do you know?” She was like, “I'm telling you. I'm telling you.” She checked me, and then Dr. Barrios came in, and she was like, “Okay, Aubrey. We're going to have this baby.” My husband caught the moment. He has a picture of me the second that she told me I was going to have my VBAC. It was just the least flattering picture I could possibly have, but it's so cool because it's a live picture, and I could see the wave of emotion washing over me. I could feel pretty much everything. I mean, I'm sure if I had no epidural whatsoever, and I think Becca said she turned it down, but I'm sure it was way more intense if I was doing it without completely. I could feel everything. I could feel the ring of fire. I could feel opening up. To me, it didn't feel like I had to poop. It felt like I had a bowling ball just sitting there. They were still setting up while I was trying to push. They were like, “Wait. Let somebody get there, so we can catch it.” Right as they were finished setting up and getting dressed and everything, I was like, “Okay, we're pushing now.” I pushed. I don't remember how many times I pushed, but I felt the head come out. I said, “Is that what the head feels like?” She was like, “Yep. That was the head. We just need one more push and we can get the body.” I pushed. He was out in 4 minutes. Meagan: Wow. Aubrey: Yep. It was crazy. I had to go back and make sure I was not crazy. I looked at the timestamps of the pictures because I was like, “There was no way that it was that fast. It felt like an eternity.” It was 4 minutes. Everybody cried. My husband got a picture of the first time they put him on my chest. As soon as I pushed him out, it was like all of the trauma and everything from before just washed off of me. It was so amazing. Meagan: I bet it was so healing for you to see that you could have a different experience. Aubrey: It was. Meagan: Even though you had a different experience with your first, after having that experience the second time, I'm sure that weighed over you for sure.Aubrey: Yeah. I love the fact that both my doctor and my nurse from the time before were there and we all got to do it again. Meagan: Yeah. Yeah. I was going to say that. I bet this was really healing for your provider and your nurse, and not even just healing for your provider, but something that stepped up her experience to see that birth could go a different way after a very traumatic experience. Aubrey: Yeah. Yeah. I think so. I hope that. I would say she's not, “Woo, I love VBACs.” She was not anti-VBAC at all, but I would like to think that it helped her see VBACs in a more positive and more probable light. Meagan: Mhmm, exactly. I think you probably did a lot for her that she may not have even known that you did. Aubrey: She did a lot for me. She's the best. The sad thing is that I have different insurance now so if I got pregnant again, I can't have her. But she's incredible. She really is. My baby– we didn't have a name picked out. One of the other nurses, Jordan, who helped me deliver my baby was like, “I know you don't have a name picked out. You don't have to use this if you don't want to, but I was just thinking that y'all wanted a cute, short name that started with A, and Becca's last name is Anders, and it would just be really cute.” So we named our son Anders.Meagan: Cute. Oh my gosh. That's adorable. I bet Becca is so happy. Aubrey: Yeah. When she left the hospital that night, because she charted forever and she left at 11:00 that night, we still hadn't picked out a name. Jordan came in after she had left. She suggested it, and we were like, “That's it. That's his name.” I sent her a picture of the announcement with his name on it. She said, “I had to pull my car over on the road. Don't do that to me while I'm driving.” Meagan: Oh my gosh. That is so cool and so special.Aubrey: Yeah. There were so many times on The VBAC Link where I see people who are like, “I don't know if I should do it. I'm scared.” Just do it. Just try. If you succeed, it changes you. It's so, so powerful. Meagan: It really is. It's hard to explain. It's so hard to explain that feeling that you get after having a VBAC. It's unreal. It really is unreal. We just had a client the other day who had to be induced due to some pretty severe preeclampsia, and she was a VBAC. The second she found out that she had preeclampsia and needed to be induced, I think a lot of her faith slipped and her belief that it was going to happen slipped. We too have a very raw, beautiful, live photo of the second she saw her baby and her hands reaching down to grab the baby. It tells the whole story within that and that one image tells her whole story. It's incredible. It's incredible. Aubrey: The picture that I submitted to y'all is a picture of right when they put him on my chest, and I mean, it was so surreal. Another thing that I think I didn't really mention is that there was a point when– because I had so much going on. I had all of these different complications and week to week. We don't know if you're going to have a baby this week. It was so stressful. Eventually, I just had to say, “Okay, God. You healed my baby. You started his heart. You healed his brain. You can make my body do what it's supposed to do. I can only do so much. I can eat the dates. I can drink the tea, but after a certain point, there's nothing else I can do other than just walk it out and just trust that God's going to walk me through that.” I had to keep reminding myself of that with every single step because it got really hard. There's a community called “Labor Nurse Mama”, and I was a member of that community too. There's a doula on there. Her name is Lamay Graham. I think she's in Milwaukee. I'm going to tell you where she is, but she's a doula, and she's incredible. We would have these live chats and Zoom calls. They would talk to you.She would help remind me, “You can only do so much, Aubrey. You're doing everything that you can. Stop putting it on you because your body is going to do what it's going to do, and you're not going to change that the more you stress yourself out. You have to just trust God.” She is one of the reasons I kept being able to come back to reality. It was because she would remind me, “You have to just remember. Stop trying to do it all yourself.” Meagan: Yeah. We have to trust, have faith, and do everything we can within our own power, but then understand that there are going to be other things, and you have to have faith in those things. The more educated we are and prepared we are, we can navigate through those things. Well, I am just so stinking happy for you. I can see the emotion. I can hear the emotion. I saw the pictures. If you guys are listening right now, go over to our Instagram or Facebook page, and check out this beautiful image of her just holding your baby. You've got Jordan in the background, your nurse Jordan. I mean, really, it's so beautiful and I'm so happy for you. Congrats. Aubrey: Thanks. I'm sorry I was kind of all over the place. Meagan: No. Listen, that's okay. That is totally okay. I'm just so happy you are here to share your stories. Aubrey: Thanks. I appreciate you. 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

Dimitri Filipovic is joined by Sean Shapiro to look at the early season trend of shot totals being down across the board in the NHL and the reasons why, the impact time of during the Four Nations is going to have on the top players not participating, older players that are defying Father Time this year, and why talented guys like Daniel Sprong have trouble sticking with one team. If you'd like to participate in the conversation and join the community we're building over on Discord, you can do so by signing up for the Hockey PDOcast's server here: https://discord.gg/a2QGRpJc84 The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the position of Rogers Media Inc. or any affiliate.