Podcasts about dilaudid

On today's episode, I'm joined by Dr. Peter Martone @drsleepright, an educator, injury prevention specialist, and chiropractic expert who has spent the last 25 years transforming health by helping people sleep better through spinal alignment. After a personal injury led him to uncover a surprising link between poor sleep posture and chronic health issues, Dr. Martone developed what he calls the “Corrective Sleeping Position” a method that supports spinal health, optimises vagal tone, and enhances parasympathetic nervous system function. We dive into how nervous system imbalances impact fertility, why improving sleep is about who you become, and how simple shifts in your sleep setup can profoundly change your energy, hormone regulation, and overall wellbeing. Dr. Martone also introduces his animal sleep avatar test and shares practical advice on how to align your body and mind for optimal healing, starting in bed!   Key Takeaways:  The autonomic nervous system plays a central role in fertility, especially the parasympathetic (rest and digest) system. Correct spinal alignment during sleep can reduce nerve interference and improve organ function, including reproductive health. Many fertility challenges can stem from imbalances in vagal tone and nervous system inhibition. Dr. Martone's “Corrective Sleeping Position” helps improve heart rate variability and promotes deeper healing at night. Sleep isn't just about rest—it's about becoming a better, more aligned version of yourself. Guest Bio: Dr. Peter Martone @drsleepright, is an educator, injury prevention specialist, and patient care health practitioner with over 25 years of experience in improving biomechanics and overall wellbeing. As a chiropractor and exercise physiologist, he has long held the belief that spinal structure directly impacts the function of the central nervous system, and that interference in this system is often at the root of chronic health issues. Today, Dr. Martone uses this foundational principle to help people achieve W.A.Y. Better Sleep, a transformative approach that supports healing through sleep posture and nervous system alignment. His groundbreaking techniques have been featured on CBS, NBC, Fox News, and more than 50 international podcasts. Dr. Martone now travels the country teaching individuals how to reclaim their health, starting in bed. Websites/Social Media Links: Dr. Peter's WebsiteFollow Dr. Peter on Instagram Check out Neck Nest here —------------- For more information about Michelle, visit www.michelleoravitz.com To learn more about ancient wisdom and fertility, you can get Michelle's book at: https://www.michelleoravitz.com/thewayoffertility The Wholesome Fertility facebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/ Instagram: @thewholesomelotusfertility Facebook: https://www.facebook.com/thewholesomelotus/ Transcript: [00:00:00] Episode number 334 of the Wholesome Fertility Podcast. My guest today is Dr. Peter Martone. Dr. Martone is an educator injury prevention specialist and patient care health practitioner who has been focused on improving patients biomechanics for over 25 years. During his private practice as a chiropractor and exercise physiologist, Dr. Martone always believed that the structure of your spine affects the function of the central nervous system, and this interference is at the root cause of most of the chronic problems people face. Dr. Martone now uses this principle as the cornerstone to help people get WAY better sleep. His techniques have been featured on C-B-S-N-B-C, Fox News and over 50 international podcasts. He currently travels the country teaching people how to regain their health in the bed by getting [00:01:00] way better sleep.  Michelle Oravitz: Welcome to the podcast, Dr. Marone.  Dr. Peter Martone: Thank you so much for having me. I can't wait to dive in. Michelle Oravitz: Me too. So I'm really intrigued. We have not had a chiropractor yet on the show. However I love chiropractic work and I also believe. That it can help a lot with the nervous system. And I often talk about the nervous system and how that impacts fertility. So I'm really excited to have this conversation. And before we get started, I would love for you to give us a bit about your background and how you got into the work that you do, and especially when it comes to [00:02:00] sleep.  Dr. Peter Martone: Yeah. Wow. That's like a, it's a big zigzag. A lot  Michelle Oravitz: It always is.  Dr. Peter Martone: we  Michelle Oravitz: It always  Dr. Peter Martone: wait. I never thought up. I never like, woke up one day and said, oh, you know what? I'm gonna be in the most exciting field of my life. I'm gonna be in the sleep industry. Like, it's so, it was like so boring. But you know, it, so what I was, I'm a chiropractor, I'm an exercise physiologist, a nutritionist. I've always loved the to help people. Improve their function and quality of life by changing their lifestyle. So I was, I was, I was big on helping people, what's called balance, the autonomic nerve nervous system. So there's, in our, in our system, we have organs and our organs are typically not controlled by like the conscious nerves that controlled by like autopilot stuff, which is the sympathetics and the parasympathetics. So what I found a long time ago is that most people when they have chronic illness or dysfunction. They have an imbalance within that autonomic nervous system. So I [00:03:00] spent a good part of my first 15 years in practice helping people balance their autonomic nervous system until finally, and I always had bad back, which isn't really what brought me to chiropractic. What brought me to chiropractic is I got adjusted once and my stomach problem went away, and, and I'm like. I'm a chiropractor, I have a bad spine, and I was in a little bit of an injury mountain biking, and I finally herniated my disc. So I was in the emergency room. I'm sitting there saying, how can I come to this? I've been helping people with back pain and wellness, and I'm now hooked up on Dilaudid because I'm in the emergency room because I'm, I was just, my back finally failed. And in your own brain? at a subconscious level, I felt like I was a failure because I'm like, how can. I not help myself, so not a really good place to be. And then, so out of big lows, a lot of times you can learn from those. And, and I have a very [00:04:00] competitive mind, so I'm like, I gotta figure this out. I have to figure out why I had disc issues and, back problems. So I started reviewing x-rays. I reviewed 3000 x-rays and I found a pattern. And that pattern was I had loss of cervical curve in my neck. And, and due to an adaptation, which I found is that it, it adapts with a, what's called a SOAs, major muscle spasm in your lower back, and the SOAs attaches directly to a disc. So I'm like, holy Mac, maybe I had a neck issue, no pain in my neck. Maybe I had neck issue all this time, and it was messing with my lower back. So I'm like, well, how do I fix that? I've been getting adjusted. I'm like, the only time I can do it is a one third of my life. I ba basically do nothing and that's sleeping. So I started to cha, I was always a side sleeper. I curled up in a ball and my back was always twisted. I had shoulder issues and I'm like, you know what? I bet you it's alignment when I'm sleeping. So I started [00:05:00] to put pillows under my neck and I started to force myself to sleep in a specific position, which we now call the corrective sleeping position. Then once I started to. Have my patients sleep in those positions. Now, their chronic issues I've been dealing with, they're needing me so much less because their body's healing really at night while they sleep, which now, hence now another 10 years later. I am in the sleep industry after 25 years of zigzag, right? Michelle Oravitz: That's so interesting. And so how have you noticed that impact? Well, actually let's take it back to like why chiropractic works, not just for the spine. I think people think, just like you said, you went for for back pain or for the stomach pain, or you ended up getting your stomach issues resolved. People don't, may not realize that chiropractic work. Can impact [00:06:00] internal organs, systems and other things other than just your back.  Dr. Peter Martone: Yeah. So let's look at, so this is gonna be a really different way for people to think, okay, but I'm going to make it and break it down into a very simple analogy. If you go to into a room and there are lights in the room, and then you take the dimmer switch and you dim the switch down to 50%. Somebody walks into this room, they're like, wow, it's really, it's not light in this room. Now what you would do is you go to the Dimmi switch and you turn it up. Well, now in our current paradigm, people don't even look at the dimmi switch as the problem. They look at the light bulb, which is the organ. Nobody looking at the nervous system going to that organ. They all look at the organ. So they'll put new bulbs in there. They'll put a transformer in there that puts more energy at the bulb when. The pressure, the, the, the li the, the dim switch being down is an issue. [00:07:00] So the spine is basically your fuse panel to the body and, and it's set up where these nerves come out of these holes in the spine. And if the spine's out of alignment or your hips out of alignment or your neck's out of alignment and you have these curves, you're putting pressure on a nerve. There's research that's been done. Pressure equal to the weight of a quarter on a nerve will cause a nerve to malfunction by 60%, leaving it only with 40% function. So think about that. If the nerve is only functioning at 40%, how can the organ be healthy? And nobody on the planet looks at that as cause of disease, except chiropractic. Everybody looks at it like, oh, you just get your spine adjusted 'cause you're in pain. I was never in the industry for pain. And I tell my patients, listen, I'm a little different. I said, look, I wanna help you with the pain, but if you are walking with one shoe on and one shoe off, you're gonna have back pain. If I just focus on [00:08:00] your back and I don't create it, don't fix the imbalance, then you're just gonna be dependent on what I do. And that's the same thing. Now, when we help our clients with chronic illness and fertility and breathing issues and digestion issues, the first thing we do is align the spine, turn up the dimmer switch. Then we see what happens. Internal organs. Michelle Oravitz: Interesting. And so what I know that obviously. Because I know in Chinese medicine there's so many different reasons that cause one thing, so we look at the root cause for fertility conditions. What have you seen so far? I.  Dr. Peter Martone: That is so great. So that's a great question. Now when within our sleep system we the, the, I guess you can say the crust. That, that connects all the, all the other, like everybody give anything that most of the experts tell you, you can Google, right? Oh yeah. Room temperature and beds and all this stuff. It's all [00:09:00] Googleable. But the crust that holds all of the, be the missing pieces, the crust, and that's, we live our life through our nervous system and everything we say, do function, feel, happens through that system. So when you look at fertility, don't look at it as the infertility, as the issue. That's the outcome. Look at it as. What controls fertility? People would say hormones, right? What controls hormones? Nervous system. Okay. What specific nervous system? That nervous system is called the parasympathetic nervous system. The parasympathetic nervous system is your thrive nervous system verse, your survive nervous system, which is your sympathetics. So you can either run from a tiger and you're in survive 'cause your body needs to get away from it. You can sleep and thrive. So our bodies thrive at night and survive during the day. So it needs to be a balance. The three systems that are controlled by your Thrive system. And when you have infertility, you have [00:10:00] an issue with all three of these systems. It's immune system, it's digestive system. It's reproductive system, so anybody that has an issue with one or of them has an issue with all three of them because you have an issue with parasympathetic inhibition. So, so it's not that you're just all sympathetic dominant because you're, you know, you're, you're super excited, you're inhibited because you're dimmer switch is down 50% and nobody's addressing it. So most of the time what we see with our, our patients that have infertility, they have issues at the atlas, which is right at the brainstem, and it's due to loss of function there, or it's down in the Coio plexus, which is in the, which is in the, in the, in the coic, which is in the pelvis. So a lot of times it's pain associated, but there's also digestion issues. There's eczema, there's skin issues, there's all of these other issues. But all, all that's telling us is the nervous system imbalance. Michelle Oravitz: That's interesting. It's interesting that you pointed [00:11:00] behind the ears because that's where you can stimulate the vagus nerve.  Dr. Peter Martone: Correct. That's, that is the reason why, 'cause it's true to the carotid sheath. There's three nerves that go through there. It's the vagus, the glossopharyngeal, and the spinal accessories. So, lot, lot of times if, if a, a woman has infertility, she has definitely a loss of cervical curve, but. Her hands might fall asleep or she has a thyroid issue also because of that forward posture, or she gets reflux because of the upper portion of the stomach is also addressed by the carina, which is, you know, the cough reflux Michelle Oravitz: Interesting. And do you see this for men? Men as well?  Dr. Peter Martone: I do, but a different manifestation of symptomatology. A lot of times that's gonna be a low testosterone. That's gonna be like especially with men with the prostate is a, is a big issue at that area, but men, women, some, a lot of times will have it. We're, we're seeing it now more than ever in women. I have my own theories on it, actually. I believe it's covid [00:12:00] vaccine, but they we're seeing a lot of heart palpitations, so we're seeing a lot of imbalance within the arrhythmia of the heart. That's why I am I have these rings on. I always measure my heart rate variability and that's what  Michelle Oravitz: Oh yeah. I love that. The HeartMath.  Dr. Peter Martone: clients. Yeah, absolutely. Michelle Oravitz: Yeah, so, so talk about that. I talk about it a lot too, but I always like to get different perspectives. 'cause I feel like even if it's the same topic, if somebody else talks about it, you might get something different. So,  Dr. Peter Martone: This is so great. So the, so just to understand what heart rate variability is, is your heart needs to beat. And when you're running from a tiger, your body wants a very rhythmic beat so that the muscle in the brain can really consistently know the amount of sugar that the organs are getting, right? So the, so when you're sympathetic dominant, which means you're in survival, you have a very rhythmic heart rate, which means if you, let's say, have a a heartbeat of 60 beats per minute, every second you have a beat. And that's what [00:13:00] people think is good. That is really bad to have that chronically because you put the same stress on the heart and the heart will fail. So when you're, when you're in thrive or you're parasympathetically dominant, your body's ready for anything. So the heart rate is very in irregular interval. So instead of every second, maybe it's 0.75 seconds. Then the next one is 1.1 second. Then the next one's 0.5 seconds. Then the next one's 0.8 seconds. So it's done. So you're, you're spreading the stress around the heart, which is a very healthy thing to do for the heart. But what that's telling us is when you are, when your heart rate variability is high, your parasympathetic dominant. When your heart rate variability is low, you're sympathetic dominant. So most people that have dysfunction, especially in the, in the autonomic nervous system or in the parasympathetic nervous system like fertility, they're going to have low HRV readings because they're going to be [00:14:00] sympathetic dominant. Whether it's due to parasympathetic inhibition because you're, you're turning, you're putting pressure at the brainstem on the vagus nerve, or it's due to you just so stressed that you never turn this on into weak muscle, whether it is, you can analyze that through these trackers and then, and then we can then, let's say meditate and then connect the subconscious brain to a scent every time you meditate and then take a heart rate variability reading. Then know what improves your high rate variability during the day, then connect you to a scent any other time. That's a scent. So when you smell the scent, your HRV comes down and then you can start to retrain the  Michelle Oravitz: It's an association.  Dr. Peter Martone: Yes. Michelle Oravitz: That's interesting 'cause I've said that before. You know, that's what in India they used to put the incense on during meditation. So immediately when you smell it, it puts you in that state so that it's quicker to get into a deeper state of meditation. And it's kind of [00:15:00] interesting how really the heart becomes so adaptive when we're in this rest and digest mode. The parasympathetic. And it's also more creative in a sense because it's not, it doesn't act predictably. It's creative based on the needs, And that's  Dr. Peter Martone: becomes creative when  Michelle Oravitz: and your body becomes creative,  Dr. Peter Martone: then yeah, the mind becomes creative because you're taking the blood from the, what I call the immature, ignorant child brain, right? Or the Yeah, the, the, the, the  Michelle Oravitz: reptilian  Dr. Peter Martone: Yeah. Reptilian brain. And it starts to transfer it to where really, where you can get true inspiration and innovation in, in, in, in that, in the back portion of the brain. So you can, you can start to think better and consequently. You, we, my, my daughter's now working on one of my companies and she's like, dad, I don't care what's mindset mastery? Because we have five core elements of sleep. I'm like, honey, mind [00:16:00] mindset mastery is like everything, right? If you, if you can master your thoughts, remember thoughts, create an adaptation within the nervous system. So if you want to. Be sympathetic, dominant, fair anxiety, financial stress, relationship, stress, hate, envy. Those are sympathetic emotions. If you want parasympathetic emotions, focus on gratitude, love, caring, prayer. Those are parasympathetic emotions. So if you can master the mind and focus the thought, which you can. Then you can focus the neurology, which is the real step in bringing back control in chronic illness. Michelle Oravitz: So fascinating. I love this topic and I love how you could look at it in so many different ways, but there's so many different schools of thought and they all kind of point to the same thing, even like ancient. Teachings and then now some of the current [00:17:00] research that's coming out. And it's fascinating because it really is something that can be measured, like you said, with the heart rate variability and also the heart brain coherence, and that they do actually communicate, you know, there's a communication between the two and the fact that people do have a choice in this, I think that that is often missed. I think that people don't realize that they actually have a choice.  Dr. Peter Martone: Yeah, and I think that that's, you know, that is a great. Way to say it, right? You do have a choice. And, and like I told my daughter, I'm like, you have a choice on what to think, right? And, and, and, and what we focus on is what we become.  Michelle Oravitz: Mm-hmm.  Dr. Peter Martone: When you are looking like, think about this. So I'm not, we haven't even talked about sleep. I've only talked about my intention. My intention is balance, the autonomic nervous system and health. Sleep is, you can't just put your head on a pillow. Buy. Buy a new what? Buy a new pillow. Buy a new [00:18:00] bed, buy a new sleep supplement and get better sleep. So what we talk about is who do you have to become to do what you need to do during the day? And then sleep is a byproduct of living a healthy life in our intention is everything. Our intention is balance in the nervous system. Yes, I wanna help you sleep, but I didn't enter the sleep industry to make you a better sleeper. I'm there now. I entered the sleep industry to allow you to become a healthier individual. So who are you when you're waking up? I want that to be a better version of you, A more energetic version of you. So we have this animal sleep avatar test that we have people take. It's a free test. And what animal do you sleep like? And then based on what animal you sleep, like I can give you. The tips specific to how you sleep and tell you how you need to fall asleep because each animal needs to fall asleep differently. Michelle Oravitz: That's fascinating. That's so, so I'd love to hear how you approach sleep altogether, like how [00:19:00] your method works to doing that. You'd mentioned obviously figuring out really how you sleep, what type of animal but how do you really help people? What are the different steps you take them through?  Dr. Peter Martone: So the, the, so think about, think about the, let, let's look at sleep as an analogy. This is a analogy that we're actually putting into our way Better Sleep program now is think about it as a, a battery charger. Okay? First thing you do with the battery charger or a charger is you have set up. So first have to set it all up, plug it in. You have to, you know, do a whole bunch of stuff to set up. Set up is how you fall asleep. Okay? I have three steps. It's called the triune of sleep, so we put people to sleep. Then we have the five core elements of sleep, which is when you're sleeping, are you waking up refreshed? How much. Is your energy being recharged? Are you only recharge it from, you know, zero to 25%, [00:20:00] 25 to 50%, 50 to 75? Or are you waking up like me? You are freaking ready for the day because your battery is so full. So most of the time where, where it, it's too complicated to dive into the five core elements 'cause there's just so much. That you have to do. It's, it's, it's, it's be, do, have, it's changing your life, eating right, being fit, and thinking well. So, so we, we have different roadmaps on every month. We change a different lifestyle habit to be, make somebody become healthier and then a better sleeper. But I think really where, where the most applicable advice I can give you right now is the setup in talking about what we call the triune of sleep. This is what 99% of the people on the planet get wrong. And this is why really my first step was figuring out the triune. And then the other step, you know, is different. So the triune of sleep is [00:21:00] this. You have three things at play when you need, when you're falling asleep, you have the body, the need, the needs of these three things, the needs of the body. The needs of the subconscious brain and then the needs of the conscious brain. Okay? The body wants alignment. It just doesn't want to be in pain. It just, it needs to be in a pain-free situation. The average person tosses and turns 20 to 40 times a night because the body's in pain. That's it. That's why we toss and turn, so. The next thing is the subconscious brain. The subconscious control sleep. The body pain will interfere with sleep or the subconscious control, sleep, the subconscious need. Safety. The sub body just wants to feel safe and protected. I grew up in Malden, Massachusetts and it was on a busy street, and every once in a [00:22:00] while the kids would bang on my window to play a prank. I was on the front, front porch, so I thought when I went to sleep I was going to get abducted every single night. So the only reason I could, I would be able to fall asleep is I'd have to put all my stuffed animals around me. I'd curl up in a ball to feel safe, then I would be able to fall asleep. So think about that. When you put your kids to sleep, there's subconscious need for sleep, and the reason why they wanna sleep with you is safety. And now the. The conscious brain, it's where everything screws up. It's like, oh my God, I wanna feel comfortable. You're not comfortable 'cause the body isn't comfortable. What you mistake for comfort is safety for the con subconscious brain. So the conscious brain screws everything up. So we have a whole host of things that we do to get people mindset mastery, to get them out of their consciousness, and we can go over some of those. So to set the try put, most people put themselves to sleep with their conscious brain thinking they're comfortable. We want to [00:23:00] reverse the triune, put the body in an aligned position. I, I'll show you that in a second. It's called the corrective sleeping position. This position inherently is unsafe for the subconscious brain. That is where people take an animal sleep avatar test to develop to, to identify the amount of safety that needs to be created by each avatar. So you have a gorilla and armadillo and an ostrich. Ostrich, it wants to stick its head under the ground. Right. It is so timid. You know, that's where abuse relationships, those are timid, timid people that need so much safety created. You know, when you sleep, it's gonna be very difficult to get them to sleep in a line position. Then you have the armadillos, which are like 60% of the population. They curl, they, they, they need safety, but they curl up in balls. They, they like to have their, you know, on their side with that pressure on their  Michelle Oravitz: That's me.  Dr. Peter Martone: And then I can tell 'cause your head's tilted [00:24:00] and then, and then  Michelle Oravitz: Oh, is it  Dr. Peter Martone: it is, and then when, and then the gorillas, they can, you know, they can fall asleep anywhere. So, so depending on what avatar you are, then we give you advice and tips based on your avatar to  Michelle Oravitz: husband's a gorilla  Dr. Peter Martone: yeah. Right.  Michelle Oravitz: anywhere  Dr. Peter Martone: Yeah.  Michelle Oravitz: with his mouth open.  Dr. Peter Martone: And then and then, and, and then, and then from there, then we teach you to, to shut down the conscious brain. Michelle Oravitz: Got it. That's interesting. So what's the proper position?  Dr. Peter Martone: All right. Is this, is this on video?  Michelle Oravitz: Well, it is for some people  Dr. Peter Martone: Okay. So then what you'll do is  Michelle Oravitz: you guys could check, check it out on YouTube if you wanna check this out.  Dr. Peter Martone: and then you explain what I'm doing. Okay.  Michelle Oravitz: Mm-hmm.  Dr. Peter Martone: Alright, so the position is typically, hold on, I gotta, I don't, I've shorted an out outline. Alright, I'll  Michelle Oravitz: Okay. He's moving away from his mic, so I'll have [00:25:00] to explain. I.  Dr. Peter Martone: Okay. All what I have right now is I have a a neck nest. That's the pillow we created, but you can do this with a soft down pillow or, and, or, you know, any type of  Michelle Oravitz: so he's got basically a pillow. that looks like it's gonna support his neck, Right?  Dr. Peter Martone: Yep. So the one thing with sleep is, or, or anytime you support something in the body, you weaken it. I, that's why, you know, sneakers or art supports, it weakens the foot. Back support weakens the back chair. Support weakens the back. A pillow defined as a support for your head. Anytime you support your head, you weaken the cervical curve. So what you wanna do is you wanna support the neck, but let let the head hang off the back of the pillow so it's not supported  Michelle Oravitz: So basically just have a pillow for your neck.  Dr. Peter Martone: And then you don't want the head supported because the weight of [00:26:00] your head will cause a, a sense of distraction. And that distraction will reinforce the curve in the neck, aligning it, improving vagal tone, improving the function of the vagus nerve. So just by sleeping in this position, you're gonna improve higher rate variability by 10 to 30%. Michelle Oravitz: Interesting. Okay, so he's basically laying on his back and he is got something that looks like a bolster, but it's soft and it surrounds his neck. He put, he has it supporting his neck and it surrounds on the side, and then his head is not supported behind it. It's just laying back.  Dr. Peter Martone: Yes. And that's, that's the design that we created with the Neck Nest. So I'll, this is, so I'll show you now how to do it with like a sound. It would be. It has to be a soft, soft pillow. This is what I used before we created the ness. So I, I would put pillows on their edges [00:27:00] and see a pillow is support for your head. You do not wanna support your head when you're sleeping on your back. You want to support your neck and allow the head to hang off the back. Michelle Oravitz: Okay, so now he's using it with a pillow, but having the pillow on its side, so it's basically not laying flat and it's a very soft pillow, so he's able to adjust it.  Dr. Peter Martone: of your head is unsupported. That is really, really, really important. Michelle Oravitz: That's interesting. I'm gonna try that.  Dr. Peter Martone: It's,  Michelle Oravitz: I'm gonna try that.  Dr. Peter Martone: That's awesome.  Michelle Oravitz: So you gotta train yourself to be a back sleeper.  Dr. Peter Martone: Yes. Well, you have to train yourself to fall asleep in that position. Remember, when you are trying to start to get to that type of mindset where you gotta be a back sleeper, you're not in control. All you have to train yourself to do is fall asleep in that [00:28:00] position and go take your animal avatar test, and then it'll tell you how to, how you need to create safety to start in that position because you won't be able to shut off the brain. Actually, you know what? Let me give you another tip. Because this is important. If you're gonna start to fall asleep in this position, a lot of times people will feel like they're falling backwards or they, they, they'll, they'll, they'll lose their breath because their body does not like that extension, because of the vestibular. You feel like you're, you know, you, you're, you're, you're,  Michelle Oravitz: you're not supported.  Dr. Peter Martone: Yeah. Yeah. Your, well, your body your body's brain or valid system doesn't like it. So you can use either a bed wedge or something and sleep slightly sitting up.  Michelle Oravitz: Mm-hmm.  Dr. Peter Martone: another way that I do this  Michelle Oravitz: So he's saying to put a bed wedge if that's the case. If it makes you feel uncomfortable Or not safe and supported, you can use a bed wedge. [00:29:00] And then on top of that, use that neck support that he was mentioning before.  Dr. Peter Martone: if you don't have a bed wedge, which a lot of people don't, you can put two pillows. See how I have two pillows down there Michelle Oravitz: Yeah. So instead of a bed wedge, you could put two pillows to support your back.  Dr. Peter Martone: and then  Michelle Oravitz: So that it elevates you  Dr. Peter Martone: And then you're sleeping elevated. Michelle Oravitz: got it. Yeah. So you could elevate yourself to make That, an easier way to fall asleep. Interesting. Dr. Peter Martone: Yeah. that  Michelle Oravitz: you got me curious. And that helps your vagus nerve and it helps get you in parasympathetic mode, which helps your hormones. Gets you in creative mode, which of course the physical creativity is your fertility. Dr. Peter Martone: And that you can't Google,  Michelle Oravitz: No, that's really fascinating. So how can people find this or really find out how [00:30:00] to like learn all of these amazing techniques?  Dr. Peter Martone: they can take they can go to Dr. S-L-E-E-P-R-I-G-H-T, that's dr. Sleep right.com. They can take a free animal sleep avatar test and then, then you're in our world, you'll get some you'll get anytime we do like sleep things, you can do that. And then there you can find out about our programs. And then if you wanna dive deeper and, and look into Neck Nest, there's you can get a link for to Neck Nest from there. Michelle Oravitz: That's so interesting. Dr. Peter Marone. This is really, really fascinating. I've never had anybody come on here and talk about it with also, I mean, first of all, talk about this subject, but also with such a unique approach to sleeping.  Dr. Peter Martone: Yeah, thank you. It's we put a lot of, a lot of sleepless nights into it and you know, now it's, it's act two, it's, my mission is to change the way the world sleeps. Helping them get way better sleep. And the way [00:31:00] is awakening the full potential of a well-rested, aligned you and the you's important. It's who do you need to become to have the be be the best version of you? And, and it's, it's not, I wanna have it right. I want to have better sleep. Then you're just gonna go from what to what? To what, to what to what. And it's like, who do you need to become to change your mind to be able to get there? Michelle Oravitz: Yeah. And so really the idea is getting into that state and the new habits will help you stay asleep.  Dr. Peter Martone: It's, it's, it's amazing how it, once you start to work on the drills of the 10 minute sleep ritual, which is putting yourself to sleep for the setup. Then the five core elements of what you do during the day is fun because now you're just becoming healthier and  Michelle Oravitz: Right. Feel more arrested,  Dr. Peter Martone: gonna make you a better sleeper. As long as you get the, if you don't plug the, the charger in you,  Michelle Oravitz: then you're grumpy. you don't wanna learn anything.  Dr. Peter Martone: exactly.[00:32:00]  Michelle Oravitz: We don't wanna be grumpy,  Dr. Peter Martone: No  Michelle Oravitz: we wanna feel good. Awesome. Well, thank you so much for coming on the podcast and sharing this amazing information. And so, so you gave them the email. Is there, I mean the website, is there any other place that people can find you or learn  Dr. Peter Martone: We're, we're on Instagram at Dr. Sleep Wright. We're on TikTok now. We just had one thing go over a million views.  Michelle Oravitz: Oh, cool.  Dr. Peter Martone: It's. Sleep. Right. So, Dr. Sleep Wright is the is the brand that you'd be able to find me on. Michelle Oravitz: Fantastic. Well, thank you so much Dr. Martone for coming on. today. This is a great conversation.  Dr. Peter Martone: Thank you for having me. Michelle Oravitz: Awesome. [00:33:00]   

This Week on Dopey! Old School Dopey Abounds! Jason Cabello brings the fucking serious Dopey - too much to describe - but lets just say that his favorite mixture - his signature blend - if you will - was: The Jason Special

Evan Morgan, a dedicated fire captain from Central California, provides a raw and deeply personal account of his struggle with addiction, illustrating the harsh realities faced by healthcare professionals battling the stigma that comes with it. Once an ambitious student experimenting with drugs, Evan's journey spiraled into dependency on prescription painkillers after a workplace injury. His candid narrative reveals the devastating effects of addiction on his professional life and personal relationships, offering listeners a rare glimpse into the internal conflicts of a first responder caught between duty and dependency.Listeners will discover how Evan's life took a pivotal turn when an encounter with law enforcement acted as a much-needed wake-up call. The story unfolds to reveal the weight of maintaining a paramedic career while wrestling with a Dilaudid addiction and the unexpected relief that came with being honest about his struggles. With backing from his supportive fire department chiefs, Evan embarked on a rehabilitation journey at the International Association of Firefighters in Maryland, which ultimately led him to sobriety. Through his inspirational account, we explore the power of transparency and the surprising support system that can emerge when someone is brave enough to ask for help.Our episode underscores the critical need to shift perceptions around addiction in professional settings, with a focus on reducing stigma through empathy and understanding. Evan's experience exemplifies how sharing personal stories can foster compassion and break down prejudices in healthcare environments. By shedding light on the prevalent issues of substance abuse and PTSD among first responders, we aim to promote a culture of support and awareness, encouraging others to view addiction through a more compassionate lens. Join us as we commit to creating resources and raising awareness for addiction treatment, inspired by the bravery and resilience of those like Evan.

We have 100k overdose deaths each year in the US. The media breathlessly declares them to be a result of fentanyl, which "is deadly." Nothing could be farther from the truth. Those deaths are unnecessary, but fully predictable, economic effects of drug prohibition.

Welcome back to The Pulling Curls Podcast! In today's episode, Hilary Erickson shares her personal experience with appendicitis. From the initial symptoms to her time in the hospital and the recovery process, Hilary provides a detailed and eye-opening account of what it's like to deal with a ruptured appendix. Tune in for valuable insights, emotional moments, and practical tips on navigating an unexpected medical crisis while balancing motherhood and daily life. Big thanks to our sponsor Family Routines -- they can really save you when the stuff hits the fan. If routines have only one fan it's me -- especially after this. Links for you: My Semaglutide episode. Timestamps: 00:00 Mom's thoughts overwhelm before surgery; responsibilities linger. 05:07 High cost delayed treatment despite severe pain. 07:35 Delayed surgery led to complications, still satisfied. 11:03 Mom's hospital worries: life insurance and minutiae. 15:18 Gnawing stomach pain caused anxiety and fear. 16:09 Grateful for doctor; small change improved everything. 19:36 Upcoming episodes: pregnancy exercise, health insurance. Keypoints: Hilary Erickson shares her recent experience with appendicitis, highlighting the details of her symptoms and diagnosis. She describes the importance of routines, which helped her family manage during her absence. Despite the signs, she initially attributed her stomach pain to other causes, including semaglutide and muscle pain. Hilary discusses the tests for appendicitis, explaining the concept of rebound tenderness and how her symptoms differed. She eventually went to the ER, detailing the financial concerns and pain that prompted her to seek medical help. Her appendix had burst, leading to septic shock and a more complicated recovery process. She emphasizes the challenges of hospital life, including the struggle to get rest and the limited food options. Hilary voices the emotional weight of being a mom facing surgery, worrying about household tasks and family needs. Post-surgery, she talks about her recovery process, the trauma of the event, and the importance of communicating with healthcare providers. Upcoming episodes will cover topics like pregnancy exercise with Kaylee Cohen and her unconventional approach to health insurance. Producer: Drew Erickson Keywords: Hilary Erickson, Pulling Curls podcast, appendicitis, episode 247, nurse, pregnancy nurse, family routines, semaglutide, abdominal pain, lower right quadrant, DigestZen, doTERRA, rebound tenderness, ER visit, septic shock, CT scan, morphine, Fentanyl, Dilaudid, IV antibiotics, laparoscopic surgery, general anesthesia, post-operative recovery, hospital stay, clear liquids diet, hospital at home, protonics, infection control, surgeon, home healthcare, patient experience.

August 30, 2024 Mark, Scott, and Ray talk about questions that came into the PRS Communities.Hi, I have a coding question pls. Thanks so much.Our urologist performed HIFU a month ago. Pt. had come back for Dysuria postop complication, has been having dysuria for 2 weeks. Our urologist decided to perform Cystoscopy for this.Cystoscopy performed, but we did Not bring Pt. back to OR. So, it should Not be a billable serviceBut then, Per NCCI, Diagnostic test and procedures may be paid as a separate service during global.Should we bill CPT 52000? and If so, will modifier be -58, since it did not occur in OR so -78 would not be an appropriate modifier? Please suggest, thank you!Modifier 73 Question: Can this modifier be used when the patient is in the pre op area and he/she was given Dilaudid and another mediation and then prepped for surgery but then the patient decided they did not want to proceed because the pain medication made them feel better(Patient had a Kidney Stone). It seems resources were used and a block of time was scheduled for the facility. Wording can be a little different from our MAC, CPT, etc when some state the patient has to be taken to the operating room. Thanks for your time. Hi, We are getting some pushback and would like to know when/if ureteral stents are billable intraoperatively. Our providers are placing a stent, performing pyeloplasty in the same ureter, and the stent is routinely removed one week later.Is this stent placement an inherent part of performing the primary procedure, or is this a billable service? Thank you!PRS Billing and Other Services - Book a Call with Mark Painter or Marianne DescioseClick Here to Get More Information and Request a QuoteUrology Advanced Coding and Reimbursement Seminars - In-Person SeminarsRegister Now for the Urology Advanced Coding and Reimbursement SeminarClick Here for Information and RegistrationEvent DetailsLocation:Las Vegas: December 6-7, 2024, at HorseshoeNew Orleans: January 31-February 1, 2025, at Harrah'sTime: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pmIncludes: Breakfast and Lunch on both days, plus 14 AAPC CEUs   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/    Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Here to Start Your Free Trial of AUACodingToday.com

In this episode of Hart2Heart, Dr. Mike Hart sits down with addiction specialist from London, Ontario, Dr. Sharon Koivu. Dr. Koivu offers a unique perspective on the origins and consequences of ‘Safe Supply' initiatives, which were initially introduced to combat the opioid crisis. They discuss the complexities of addiction medicine, the unintended consequences of ‘Safe Supply' programs, and the urgent need to regain focus on the four pillars to approach addiction: harm reduction, treatment, prevention, and enforcement.  Guest Bio and Links: Dr. Sharon Koivu is an Addiction Medicine Consultant for both London Health Sciences Centre and St. Thomas Elgin General Hospital. She has practiced addiction medicine and palliative care in a number of settings over the past 20 years. Dr. Koivu enjoys teaching, has been involved in research projects on infectious complications of injection drug use, and is committed to harm reduction and advocacy for meaningful change. Resources/ Glossary of Terms: Safe Supply Program: A harm reduction approach where regulated opioids are prescribed to individuals with substance use disorders to prevent the harms associated with unregulated street drugs. Hydromorph Contin: A long-acting opioid, previously used as a substitute for OxyContin, known to cause significant complications when injected. Dilaudid: A brand name for hydromorphone, an opioid used for pain management, now commonly prescribed in Safe Supply programs. Dr. Sharon Koivu: 'Safe supply' has only worsened the addiction crisis in London, Ont. Show Notes: (0:00) Welcome back to the Hart2Heart Podcast with Dr. Mike Hart    (0:15) Dr. Hart introduces guest, Dr. Sharon Koivu to the listeners  (1:30) Dr. Koivu gives a brief introduction of herself  (4:00) Intro and intention behind the Safe Supply program (8:45) Dr. Koivu explains the unexpected rise in severe infections due to Safe Supply (12:30) The link between opioid diversion from Safe Supply and organized crime (15:00) The data speaks - increasing opioid use (21:00) Police data of how many dilaudid have been seized off the streets  (27:30) Safe Supply's impact on the youth and the rise of fentanyl use (31:00) Psychological and social effects of opioid addiction on youth (35:30) The challenges faced by healthcare providers in managing patients on Safe Supply (41:00) “So, essentially, dilaudid or D8s, they are more or less like a gateway drug to fentanyl.” (43:00) Opioid use and effects on the developing brain  (48:00) Four Pillars to help with addiction (51:00) CPSO does not monitor Safe Supply prescribers  (56:30) Supervised injection sites and consumption sites   (1:03:00) 2023 Paper of The SOS Program (1:11:00) The need for comprehensive addiction treatment (1:15:30) Closing thoughts --- Dr. Mike Hart is a Cannabis Physician and Lifestyle Strategist. In April 2014, Dr. Hart became the first physician in London, Ontario to open a cannabis clinic. While Dr. Hart continues to treat patients at his clinic, his primary focus has shifted to correcting the medical cannabis educational gap that exists in the medical community.  Connect on social with Dr. Mike Hart: Social Links: Instagram: @drmikehart Twitter: @drmikehart Facebook: @drmikehart  

Cette semaine, le journaliste José Soucy nous informe que selon ses sources, le Parti Québécois serait en train de créer des "focus groups" afin de mieux écouter les arguements la droite de Québec sur la souveraineté du Québec. Le Dr Karim Elayoubi nous parle d'une nouvelle forme de Dilaudid, un opioïde qui a fait son entrée dans les rues de Montréal. On vous présente aussi un extrait d'un bulletin de nouvelles humoristique réservé aux abonnés Patreon de Ian & Frank. Finalement, Jacinthe-Eve Arel nous commente la menace de François Legault de déclencher un référendum sur l'immigration si le fédéral ne lui apporte pas de solution concrète pour régler la crise de l'immigration massive. TIMESTAMPS 0:00 Intro 0:31 Le PQ à l'écoute de la droite ? 7:33 Une nouvelle drogue dans les rues de MTL 13:52 Extrait Bulletin de nouvelles Patreon 19:24 Un référendum sur l'immigration ? 24:17 Conclusion #friday #gauche #droite #scandal #actualité #ianetfrank #canada #quebec #bulletindenouvelles #patreon #bestof #santé #consultation #rightwing #independance #pq #nationaliste #dilaudid #opioids #drugs #referendum #immigration N'OUBLIEZ PAS VOTRE 10% de RABAIS POUR ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠RANCHBRAND.CA⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ AVEC LE CODE «IAN10» Le livre de FRANK ici : ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amazon.ca/-/fr/Frank-Fournier/dp/B0BW2H65G5/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1677072629&sr=8-1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ La Boutique du Podcast : ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://ian senechal.myspreadshop.ca/all?lang=fr⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Ian & Frank : ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://open.spotify.com/show/6FX9rKclX7qdlegxVFhO3B?si=afe46619f7034884 ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Le Trio Économique : ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://open.spotify.com/show/0NsJzBXa8bNv73swrIAKby?si=85446e698c744124⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Le Dédômiseur : ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://open.spotify.com/show/0fWNcURLK6TkBuYUXJC63T?si=6578eeedb24545c2 ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ PATREON ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Patreon.com/isenechal⁠⁠⁠ --- Send in a voice message: https://podcasters.spotify.com/pod/show/ian-snchal/message

Finding Hope and HealingLong before the pandemic, in the mid to late 2010s, there was a significant issue with the overprescription of painkillers by medical professionals. Nationwide, doctors were criminally charged for prescribing dangerous amounts of opioids like OxyContin, Vicodin, Percocet, and Dilaudid. The actions of a few doctors had significant implications, contributing to the opioid crisis and impacting many lives in Tucson, Arizona, and beyond. And, for Kelsey, it destroyed her life. Kelsey is a Tucson native whose life took a dramatic turn due to her opioid addiction. Kelsey openly shares her struggles, from the traumatic experiences with her abusive father to her battle with drug dependency that started with prescribed painkillers. Her journey into addiction led her away from her family and into a life of isolation and legal troubles.But her story doesn't end there. In this Christmas episode, Kelsey talks about the peace and joy she found in her newfound faith in Christ and how Gospel Rescue Mission's approach to recovery helped her overcome her addictions.Support the show If you would like to support our ministry or you know someone who needs help in the Tucson area, please visit us online at GRMTucson.com

Ask Dr. Drew LIVE! Callers from Spaces ask Dr. Drew anything about ANYTHING! Topics include: treatment for Long Covid (Covid Long Haulers), safety of fentanyl epidurals in childbirth, experiences with dilaudid (Hydromorphone) IV in a hospital, and more from callers. Plus a special appearance from Jimmy Failla! WHY 3 CALLER SHOWS? Producer Kaleb Nation and his wife just had a baby! To prepare for sleepless nights with a newborn, we are not scheduling guests for a week… and instead, Dr. Drew is taking YOUR calls in 3 special episodes! 「 SPONSORED BY 」 Find out more about the companies that make this show possible and get special discounts on amazing products at https://drdrew.com/sponsors • GENUCEL - Using a proprietary base formulated by a pharmacist, Genucel has created skincare that can dramatically improve the appearance of facial redness and under-eye puffiness. Genucel uses clinical levels of botanical extracts in their cruelty-free, natural, made-in-the-USA line of products. Get an extra discount with promo code DREW at https://genucel.com/drew • PRIMAL LIFE - Dr. Drew recommends Primal Life's 100% natural dental products to improve your mouth. Get a sparkling smile by using natural teeth whitener without harsh chemicals. For a limited time, get 60% off at https://drdrew.com/primal • THE WELLNESS COMPANY - Counteract harmful spike proteins with TWC's Signature Series Spike Support Formula containing nattokinase and selenium. Learn more about TWC's supplements at https://twc.health/drew • PALEOVALLEY - "Paleovalley has a wide variety of extraordinary products that are both healthful and delicious,” says Dr. Drew. "I am a huge fan of this brand and know you'll love it too!” Get a discount on your first order at https://drdrew.com/paleovalley 「 MEDICAL NOTE 」 The CDC states that COVID-19 vaccines are safe, effective, and reduce your risk of severe illness. You should always consult your personal physician before making any decisions about your health.  「 ABOUT THE SHOW 」 Ask Dr. Drew is produced by Kaleb Nation (https://kalebnation.com) and Susan Pinsky (https://twitter.com/firstladyoflove). This show is for entertainment and/or informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment. 「 ABOUT DR. DREW 」 Dr. Drew is a board-certified physician with over 35 years of national radio, NYT bestselling books, and countless TV shows bearing his name. He's known for Celebrity Rehab (VH1), Teen Mom OG (MTV), Dr. Drew After Dark (YMH), The Masked Singer (FOX), multiple hit podcasts, and the iconic Loveline radio show. Dr. Drew Pinsky received his undergraduate degree from Amherst College and his M.D. from the University of Southern California, School of Medicine. Read more at https://drdrew.com/about Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of HoodTech Presents Da HoodCast, Da Crew explores a series of surprising news stories. They discuss the ongoing search for a nurse accused of stealing 600 vials of Dilaudid, as well as a tragic incident involving a woman found in the jaws of an alligator. They also delve into different ways to cook alligator and share breaking news about gold bars found in a senator's house. In a lighter segment, they recount Congresswoman Lauren Boebert being kicked out of a musical for vaping. Lastly, Jenn E shares a comical personal story. The episode ends with a tribute to the late Rev. Steward. Join Da Crew for unexpected headlines, laughter, and heartfelt remembrance on HoodTech Presents Da HoodCast. If you want to get your music played on our podcast please send your ORIGINAL mp3s to daHoodCast@gmail.com...... #NurseHeist#AlligatorHorror#GoldBarsUnveiled#VapingDrama#ComicalMistakes#ReverendLegacy#UnexpectedHeadlines#CulinaryAdventures#PoliticalScandals#WildRidePodcast

There was time during the early 70's when the field of oncology began to take hold where the singular focus was to extend the patient's life. In this ASCO Education podcast, our guest was one of the first to challenge that notion and rethink methods that focused the patient's QUALITY of life. Dr. Patricia Ganz joins us to describe her transition from cardiology to oncology (6:00), the moment she went beyond treating the disease and began thinking about treating the WHOLE patient (10:06) and the joy of the increasing numbers of patients who survive cancer (21:47).  Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Patricia Ganz: Leadership - Intrinsic LifeSciences  Stock and Other Ownership Interests - xenon pharma,  Intrinsic LifeSciences, Silarus Therapeutics, Disc Medicine, Teva,  Novartis, Merck. Johnson & Johnson, Pfizer, GlaxoSmithKline, Abbott Laboratories Consulting or Advisory Role - Global Blood Therapeutics, GSK, Ionis, akebia, Rockwell Medical Technologies, Disc Medicine, InformedDNA, Blue Note Therapeutics, Grail Patents, Royalties, Other Intellectual Property - related to iron metabolism and the anemia of chronic disease, Up-to-Date royalties for section editor on survivorship Resources If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT  Disclosures for this podcast are listed on the podcast page.   Pat Loehrer: Welcome to Oncology, Etc., an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University.  Dave Johnson: And I'm Dave Johnson, a Medical Oncologist at the University of Texas Southwestern in Dallas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of the podcast is to introduce listeners to interesting and inspirational people and topics in and outside the world of oncology. Pat Loehrer: The field of oncology is relatively new. The first person treated with chemotherapy was in the 1940s. Medical oncology was just recognized as a specialty during the 1970s. And while cancer was considered by most people to be a death sentence, a steady growth of researchers sought to find cures. And they did for many cancers. But sometimes these treatments came at a cost. Our next guest challenged the notion that the singular focus of oncology is to extend the patient's duration of life. She asked whether an oncologist should also focus on addressing the patient's quality of life.  Dave Johnson: The doctor asking that question went to UCLA Medical School, initially planning to study cardiology. However, a chance encounter with a young, dynamic oncologist who had started a clinical cancer ward sparked her interest in the nascent field of oncology. She witnessed advances in cancer treatment that seemingly took it from that inevitable death sentence to a potentially curable disease. She also recognized early on that when it came to cancer, a doctor must take care of the whole patient and not just the disease.  From that point forward, our guest has had a storied career and an incredible impact on the world of cancer care. When initially offered a position at the West LA VA Medical Center, she saw it as an opportunity to advance the field of palliative care for patients with cancer. This proved to be one of her first opportunities to develop a program that incorporated a focus on quality of life into the management of cancer. Her work also focused on mental, dietary, physical, and emotional services to the long-term survivors of cancer.  That career path has led to many accomplishments and numerous accolades for our guest. She is a founding member of the National Coalition for Cancer Survivorship, served as the 2004 Co-chair of ASCO's Survivorship Task Force, and currently directs UCLA's Cancer Survivorship Center of Excellence, funded in part from a grant from Livestrong. Our guest is Dr. Patricia Ganz. Dr. Patricia Ganz: It's great to be with both of you today. Dave Johnson: We always like to ask our guests a little about their background, where they grew up, a little about their family. Dr. Patricia Ganz: Yes. I grew up in the city of Beverly Hills where my parents moved when I was about five years old because of the educational system. Unlike parts of the East Coast, we didn't have very many private schools in Los Angeles, and so public education was very good in California at that time. So I had a good launch and had a wonderful opportunity that many people didn't have at that time to grow up in a comfortable setting. Dave Johnson: Tell us about your mom. I understand she was a businesswoman, correct? Dr. Patricia Ganz: Yes, actually, my parents got married when my mom was 19 and my dad was 21. He was in medical school at the University of Michigan. His father and mother weren't too happy with him getting married before he could support a wife. But she worked in a family business in the wholesale produce business in Detroit. One of six children, she was very involved with her family in the business. And they were married, and then World War II started, my father was a physician in the military, so she worked in the family business during the war. After finally having children and growing up and being in Beverly Hills, she sat back and was a homemaker, but she was always a bit restless and was always looking for something to do. So wound up several years later, when I was in my early teens, starting a business with one of my uncles, an automobile parts business. They ultimately sold it out to a big company that bought it out.  Pat Loehrer: Where did your father serve in World War II? Dr. Patricia Ganz: He was actually D-Day Plus 21. He was in Wales during the war. They had to be stationed and moved down into the south before he was deployed. I have my parents' correspondence and letters from the war. He liberated some of the camps. Actually, as I have learned about the trauma of cancer and post-traumatic stress that happens in so many people, our military veterans, most recently, I think he had post-traumatic stress. He didn't talk very much about it, but I think liberating the camps, being overseas during that time, as it was for that silent generation, was very profound in terms of their activities.   He wound up practicing medicine, and Los Angeles had a practice in industrial medicine, and it was a comfortable life. He would work early in the morning till maybe three or four in the afternoon and then go to the gym, there were moonlighting physicians who worked in the practice. But I kind of saw an easy kind of medicine, and he was always very encouraging and wanted me to go into medicine -- that I could be an ophthalmologist or a radiologist, good job for a woman. But I didn't really see the tough life of some of the internists and other people who were really working more 24/7, taking care of patients in the way medicine used to be practiced. Dave Johnson: Yeah. So you were interested in, early in your career, in cardiology. Could you tell us about that, and then a little bit more about the transition to oncology?  Dr. Patricia Ganz: I went away to college, I went to Harvard Radcliffe and I came home during the summers. And was interested in doing something during the summer so I actually in a pediatric cardiology research laboratory as a volunteer at UCLA for a couple of summers between my freshman and sophomore year then my sophomore and junior year. And then I actually got a California Heart Association Fellowship between my junior and senior year in college.  And this pediatric cardiology lab was very interesting. They were starting to give ketamine, it had an identification number, it wasn't called ketamine. But they were giving it to children in the cardiac cath lab and then were very worried about whether it would interfere with measuring the pressures in the heart. So we had intact dogs that had catheters implanted in the heart, and the drug would be given to the animals and we would then measure their pressures in the heart.  That cardiology experience in 1970, the summer between my first and second year of medical school, the Swan-Ganz catheter was being tested. I worked at Cedars that summer and was watching them do the various studies to show the value of the catheter. And so by the time I was kind of finishing up medical school, I'd already invested all this time as an undergraduate. And then a little bit when I was in medical school and I kind of understood the physiology of the heart, very exciting. So that's kind of where I was headed until we started my internship. And I don't know if any of you remembered Marty Cline, but he was the oncologist who moved from UCSF to Los Angeles to start our hem-onc division. And very exciting, a wonderful bedside teacher.   And so all of a sudden, I've never been exposed to oncology and this was very interesting. But at the same time, I was rotating through the CCU, and in came two full-arrest patients, one of whom was a campus cop who was very obese, had arrested at his desk in the police station. And we didn't have emergency vehicles to help people get on campus at that time. This was 1973 or 1974, something like that. And he came in full arrest, vegetable. And then another man had been going out of his apartment to walk his dog and go downstairs, and then all of a sudden his wife saw him out on the street being resuscitated by people. And he came in also in full arrest.   So those two experiences, having to deal with those patients, not being able to kind of comfort the families, to do anything about it. As well as taking care of patients in my old clinic who had very bad vascular disease. One man, extremely depressed with claudication and angina, all of a sudden made me feel, “Well, you know what? I'm not sure I really want to be a cardiologist. I'm not sure I like the acute arrest that I had to deal with and the families. And also, the fact that people were depressed and you couldn't really talk to them about how serious their disease was.” Whereas I had patients with advanced cancer who came in, who had equally difficult prognoses, but because of the way people understood cancer, you could really talk about the problems that they would be facing and the end-of-life concerns that they would have.  So it was all of those things together that made me say, “Hmm.” And then also, Pat, you'll appreciate this, being from Indiana, we were giving phase II platinum to advanced testicular cancer patients, and it was miraculous. And so I thought, “Oh my gosh, in my lifetime, maybe cancer is going to be cured! Heart disease, well, that's not going to happen.” So that was really the turning point.   Pat Loehrer: When many of us started, we were just hoping that we could get patients to live a little bit longer and improve the response rate. But you took a different tack. You really looked at treating the whole patient, not just the disease. That was really a novel approach at the time. What influenced you to take that step forward? Dr. Patricia Ganz: Well, it was actually my starting– it was thought to be in a hospice ward. It would turn out it was a Sepulveda VA, not the West LA VA, but in any case, we have two VAs that are affiliated with UCLA. And it was an intermediate care ward, and there was an idea that we would in fact put our cancer patients there who had to have inpatient chemotherapy so they wouldn't be in the acute setting as well as patients who needed to travel for radiation. Actually, the West LA VA had a hospice demonstration project. This is 1978. It's really the beginning of the hospice movement in England, then in Canada, Balfour Mount at Montreal and McGill was doing this. And so I was very much influenced by, number one, most of our patients didn't live very long. And if you were at a VA Hospital, as I was at that time, you were treating patients with advanced lung cancer, advanced colon cancer, advanced prostate cancer, other GI malignancies, and lung cancer, of course. So it was really the rare patient who you would treat for curative intent.  In fact, small cell lung cancer was so exciting to be treating in a particularly limited small cell. Again, I had a lot of people who survived. We gave them chemo, radiation, whole brain radiation, etc. So that was exciting. This was before cisplatin and others were used in the treatment of lung cancer. But really, as I began to develop this ward, which I kind of thought, “Well, why should we wait just to give all the goodies to somebody in the last few weeks of life here? I'm treating some patients for cure, they're getting radiation. Some of them are getting radiation and chemo for palliation.” But it was a mixed cancer ward. And it was wonderful because I had a team that would make rounds with me every week: a pharmacist, a physiatrist, a psychologist, a social worker, a dietitian. This was in 1978 or ‘79, and the nurses were wonderful. They were really available to the patients. It wasn't a busy acute ward. If they were in pain, they would get their medication as soon as possible. I gave methadone. It was before the days of some of the newer medications, but it was long-acting. I learned how to give that. We gave Dilaudid in between if necessary. And then we had Brompton solution, that was before there was really oral morphine.  And so the idea was all of these kinds of services should really be available to patients from the time of diagnosis until death. We never knew who was going to be leaving us the next few days or who was going to be living longer and receiving curative intent. We had support groups for the patients and their families. It was a wonderful infrastructure, something that I didn't actually have at UCLA, so it was a real luxury. And if you know the VA system, the rehabilitation services are wonderful. They had dental services for patients. We had mostly World War II veterans, some Korean, and for many of these individuals, they had worked and lived a good life, and then they were going to retire and then they got cancer. So this was kind of the sadness. And it was a suburban VA, so we had a lot of patients who were in the San Fernando Valley, had a lot of family support, and it was a wonderful opportunity for me to learn how to do good quality care for patients along the continuum.  Dave Johnson: How did you assemble this team? Or was it in place in part when you arrived, or what? Nobody was thinking about this multidisciplinary approach?  Dr. Patricia Ganz: I just designed it because these were kind of the elements that were in a hospice kind of program. And I actually worked with the visiting nurses and I was part of their boards and so forth. And UCLA didn't have any kind of hospice or palliative care program at that time. But because the VA infrastructure had these staff already, I didn't have to hire them, you didn't have to bill for anything. They just became part of the team. Plus there was a psychiatrist who I ultimately began doing research with. He hired a psychologist for the research project. And so there was kind of this infrastructure of interest in providing good supportive care to cancer patients. A wonderful social worker, a wonderful psychologist, and they all saw this patient population as very needy, deserving, and they were glad to be part of a team.  We didn't call it a hospice, we called it a palliative care unit. These were just regular staff members who, as part of their job, their mission was to serve that patient population and be available. I had never been exposed to a physiatrist before. I trained at UCLA, trained and did my residency and fellowship. We didn't have physiatry. For whatever reason, our former deans never thought it was an important physical medicine, it wasn't, and still isn't, part of our system. Pat Loehrer: Many decisions we make in terms of our careers are based on singular people. Your dad, maybe, suggesting going into medicine, but was there a patient that clicked with you that said, "Listen, I want to take this different direction?" Or was it just a collection of patients that you were seeing at the VA? Is there one that you can reflect back on? Dr. Patricia Ganz: I don't know if you all remember, but there was something called Consultation Liaison Psychiatry where, in that time, the psychiatrist really felt that they had to see medical patients because there were psychological and sometimes psychiatric problems that occurred on the medical ward, such as delirium. That was very common with patients who were very sick and very toxic, which was again due to the medical condition affecting the brain. And so I was exposed to these psychiatrists who were very behaviorally oriented when I was a resident and a fellow, and they often attended our team meetings in oncology on our service, they were on the transplant service, all those kinds of things. So they were kind of like right by our side.  And when I went to the VA, the psychiatry service there also had a couple of really excellent psychiatrists who, again, were more behaviorally focused. Again, you have to really remember, bless her heart, Jimmie Holland was wonderful as a psychiatrist. She and Barrie Cassileth were the kind of early people we would see at our meetings who were kind of on the leading edge of psychosocial oncology, but particularly, Jimmie was more in a psychiatric mode, and there was a lot of focus on coping. But the people that I began to work with were more behaviorally focused, and they were kind of interested in the impact of the disease and the treatment on the patient's life and, backwards, how could managing those kinds of problems affect the well-being of the patient. And this one psychiatrist, Richard Heinrich, had gotten money from the VA, had written a grant to do an intervention study with the oncology patients who I was serving to do a group intervention for the patients and their families. But, in order to even get this grant going, he hired a project manager who was a psychologist, a fresh graduate whose name was Anne Coscarelli, and her name was Cindie Schag at that time. But she said, "I don't know much about cancer. I've got to interview patients. I've got to understand what's going on." And they really, really showed me that, by talking to the patient, by understanding what they were experiencing, they could get a better handle on what they were dealing with and then, potentially, do interventions. So we have a wonderful paper if you want to look it up. It's called the “Karnofsky Performance Status Revisited.” It's in the second issue of JCO, which we published; I think it was 1984.  Dave Johnson: In the early 90s, you relocated back to UCLA. Why would you leave what sounds like the perfect situation to go back to a site that didn't have it? Dr. Patricia Ganz: Okay, over that 13 years that I was at the VA, I became Chief of the Division of Hem-Onc. We were actually combined with a county hospital. It was a wonderful training program, it was a wonderful patient population at both places. And we think that there are troubles in financing health care now, well, there were lots of problems then. Medicaid came and went. We had Reagan as our governor, then he became president, and there were a lot of problems with people being cared for. So it was great to be at the VA in the county, and I always felt privileged. I always had a practice at UCLA, which was a half-day practice, so I continued there, and I just felt great that I could practice the same wherever I was, whether it was in a public system, veteran system, or in the private system.   But what happened was, I took a sabbatical in Switzerland, '88 to '89. I worked with the Swiss International Breast Cancer Consortium group there, but it was really a time for me to take off and really learn about quality of life assessment, measurement, and so forth. When I came back, I basically said, "I want to make a difference. I want to do something at a bigger arena." If I just continue working where I am, it's kind of a midlife crisis. I was in my early 40s, and my office was in the San Fernando Valley at the VA, but my home was in West Los Angeles. One day I was in UCLA, one day I was at the VA, one day I was at the county, it was like, "Can I practice like this the next 20 years? I don't know that I can do this. And I really want to have some bigger impact.” So I went to Ellen Gritz who was my predecessor in my current position, and I was doing my NCI-funded research at UCLA still, and I said, “Ellen, I really would like to be able to do research full time. I really want to make a difference. Is there anything available? Do you know of anything?" And she said, "Well, you know, we're actually recruiting for a position that's joint between the School of Public Health and the Cancer Center. And oh my goodness, maybe I can compete for that, so that's what I did. And it was in what was then the department called Health Services, it's now called Health Policy and Management. I applied, I was competing against another person who I won't name, but I got the position and made that move.  But again, it was quite a transition because I had never done anything in public health, even though UCLA had a school of public health that was right adjacent to the medical school. I had had interactions with the former dean, Lester Breslow, who I actually took an elective with when I was a first-year medical student on Community Medicine. So it kind of had some inklings that, of what I was interested in. I had actually attendings in my medical clinic, Bob Brook, a very famous health policy researcher, Sheldon Greenfield. So I'd been exposed to a lot of these people and I kind of had the instinctive fundamentals, if you will, of that kind of research, but hadn't really been trained in it. And so it was a great opportunity for me to take that job and really learn a lot and teach with that.  And then took, part of my time was in the cancer center with funding from the core grant. And then, within a year of my taking this position, Ellen left and went to MD Anderson, so all of a sudden I became director of that whole population science research group. And it was in the early ‘90s, had to scramble to get funding, extramural funding. Everybody said to me, "How could you leave a nearly full-time position at the VA for a soft money position?" But, nevertheless, it worked out. And it was an exciting time to be able to go into a new career and really do things that were not only going to be in front and center beneficial to patients, but to a much larger group of patients and people around the world.  Pat Loehrer: Of all the work that you have done, what one or two things are you most proud of in terms of this field? Dr. Patricia Ganz: Recognizing the large number of people who are surviving cancer. And I think today we even have a more exciting part of that. I mean, clearly, many people are living long-term disease-free with and without sequelae of the disease. But we also have this new group of survivors who are living on chronic therapy. And I think the CML patients are kind of the poster children for this, being on imatinib or other newer, targeted agents over time, living with cancer under control, but not necessarily completely gone. And then melanoma with the immunotherapy, lung cancer, all of these diseases now being converted to ones that were really fatal, that are now enjoying long-term treatment.   But along with that, we all know, is the financial toxicity, the burdens, and even the ongoing symptoms that patients have. So the fact that we all call people survivors and think about people from the time of diagnosis as potentially being survivors, I think was very important. And I would say that, from the clinical side, that's been very important to me. But all of the work that I was able to do with the Institute of Medicine, now the National Academy of Medicine, the 2013 report that we wrote on was a revisit of Joe Simone's quality of care report, and to me was actually a very pivotal report. Because in 2013, it looked like our health care system was in crisis and the delivery of care. We're now actually doing a National Cancer Policy Forum ten-year follow-up of that report, and many of the things that we recommended, surprisingly, have been implemented and are working on. But the healthcare context now is so much more complicated.  Again, with the many diseases now becoming rare diseases, the cost of drugs, the huge disparities, even though we have access through the Affordable Care Act and so forth, there's still huge disparities in who gets care and treatment. And so we have so many challenges. So for me, being able to engage in the policy arena and have some impact, I think has been also very important to me. Dave Johnson: 20 years ago, the topic of survivorship was not that common within ASCO, and you led a 2004 task force to really strengthen that involvement by that organization, and you also were a founding member of the National Coalition for Cancer Survivorship. I wonder if you might reflect on those two activities for us for a moment. Dr. Patricia Ganz: In 1986, Fitzhugh Mullen, who in 1985 had written a really interesting special article for the New England Journal called "Seasons of Survivorship" - he was a young physician when he was found to have a mediastinal germ cell tumor and got very intensive chemotherapy and radiation therapy and survived that, but realized that there was no place in the healthcare system where he could turn to to get his questions answered, nor get the kind of medical care that was needed, and really wrote this very important article. He then, being somebody who was also kind of policy-oriented and wanting to change the world, and I would say this was a group of us who, I think went to college during the Vietnam era - so did Fitz - and we were all kind of restless, trying to see how we could make a difference in the world and where it was going.   And so he had this vision that he was going to almost develop an army of survivors around the country who were going to stand up and have their voices heard about what was going on. Of course, most people didn't even know they were a survivor. They had cancer treatment, but they didn't think about themselves as a survivor. And so he decided to get some people together in Albuquerque, New Mexico, through a support group that he had worked with when he was in the Indian Health Service in New Mexico. And there were various people from the American Cancer Society, from other support organizations, social workers, and a couple of us who are physicians who came to this meeting, some Hodgkin survivors who had been treated at Stanford and were now, including a lawyer, who were starting to do long term late effects work. And we gathered together, and it was a day and a half, really, just kind of trying to figure out how could a movement or anything get oriented to try and help patients move forward.  So that's how this was founded. And they passed the hat. I put in a check for $100, and that was probably a lot of money at that time, but I thought, well, this is a good investment. I'll help this organization get started. And that was the start. And they kind of ran it out of Living Beyond Cancer in Albuquerque for a few years. But then Fitz, who was in the Washington, DC. area decided they weren't going to be able to get organizations all over the country organized to do this, and they were going to have to do some lobbying. So Ellen Stovall, who was a Hodgkins survivor living in the Washington area, beginning to do policy work in this area, then became the executive director and took the organization forward for many years and championed this, got the Office of Cancer Survivors established at the NCI in the 1990s, and really did a lot of other wonderful work, including a lot of the work at the Institute of Medicine. She was very involved with the first Quality of Care report and then ultimately the survivorship report, the Lost and Transition report in 2005, 2006, I was on that committee. So that was really how things were evolving.  And by that time, I was also on the ASCO board, 2003 to 2006. And so all of these things were kind of coming together. We had 10 million survivors. That was kind of an important note and a lot of diseases now - lymphoma, breast cancer, multi-agent therapy had certain benefits, but obviously toxicities. We lived through the horrible time of high-dose chemotherapy and transplant for breast cancer in the ‘90s, which was a problem, but we saw a lot of toxicities after that. And so there were people living after cancer who now had sequelae, and the children obviously had been leading the way in terms of the large number of childhood cancer survivors. So this was this idea that the children were kind of the canary in the coal mine. We saw them living 20, 30 years later after their cancer diagnosis, and we were now beginning to see adults living 10, 15, 20 years later, and we needed to think about these long-term and late effects for them as well. Dave Johnson: I'm glad you mentioned Fitz's article in the New England Journal that still resonates today, and if listeners have not read it, "Seasons of Survivorship" is a worthwhile five-minute read.  What do you think the most pressing issues and challenges in cancer survivorship care today?  Dr. Patricia Ganz: Many people are cured with very little impact. You can think of somebody with T1 breast cancer maybe needing endocrine therapy for five years, and lumpectomy radiation. That person's probably not going to have a lot that they're going to be worried about. But if they're a young breast cancer patient, say they're 35 or 40, you're going to get five years of ovarian suppression therapy. You're going to be put into acute menopause. You're going to lose bone density. You're going to have cardiac risk acceleration. You may have cognitive changes. You may have also problems with cognitive decline later. I mean, all of these things, the more intense treatments are associated, what we're really thinking about is accelerated aging. And so a lot of what I've been studying the last 20-25 years in terms of fatigue and cognitive difficulties are related to neuroinflammation and what happens when somebody has intensive systemic therapy and that accelerated process that's, again, not everyone, but small numbers of patients, could be 10-15-20%. So I worry a lot about the young patients. So I've been very focused on the young adult population who are treated intensively for lymphoma, leukemia, and breast. And that's, I think, something that we need to be looking out for.  The other thing is with the newer therapies, whether it's immunotherapy or some of the targeted therapies, we just don't know what the late effects are going to be. Where we're very schooled now in what the late effects of radiation, chemo, and surgery could be for patients, we just don't know. And another wonderful part of my career has been to be able to do quality-of-life studies within the Clinical Trials Network. I've been affiliated with NSABP, I was SWOG previously, but NSABP is now NRG Oncology doing patient-reported outcomes and looking at long-term outcomes in clinical trials. And I think we're going to need this for all of these new agents because we have no idea what the long-term toxicities are going to be. And even though it's amazing to have people surviving where they wouldn't have been, we don't know what the off-target long-term effects might be. So that's a real challenge right now for survivorship.  And the primary care doctors who we would want to really be there to orchestrate the coordinated care for patients to specialists, they are a vanishing breed. You could read the New England Journal that I just read about the challenges of the primary care physician right now and the overfilled inbox and low level of esteem that they're given in health systems. Where are we going to take care of people who really shouldn't be still seeing the oncologist? The oncologist is going to be overburdened with new patients because of the aging of the population and the many new diagnoses. So this is our new crisis, and that's why I'm very interested in what we're going to be looking at in terms of a ten-year follow-up report to the 2013 IOM report. Dave Johnson: The industry-based trials now are actually looking at longer-term treatment. And the trials in which interest is cancer, we cut it down from two years of therapy down to nine weeks of therapy, looking at minimizing therapy. Those are difficult trials to do in this climate today, whereas the industry would just as soon have patients on for three to five years worth of therapy as opposed to three to five months. Talk a little about those pressures and what we should be doing as a society to investigate those kinds of therapies and minimizing treatments. Dr. Patricia Ganz: Minimizing treatments, this is the place where the government has to be, because we will not be able to do these de-escalation studies. Otherwise, there will be countries like the UK, they will be able to do these studies, or other countries that have national health systems where they have a dual purpose, if you will, in terms of both financing health care and also doing good science. But I think, as I've seen it, we have a couple of de-escalation trials for breast cancer now in NRG Oncology, which is, again, I think, the role that the NCTN needs to be playing. But it's difficult for patients. We all know that patients come in several breeds, ones who want everything, even if there's a 1% difference in benefit, and others who, “Gee, only 1 out of 100 are going to benefit? I don't want that.” I think that's also the challenge. And people don't want to be denied things, but it's terrible to watch people go through very prolonged treatments when we don't know that they really need it for so long.  Dave Johnson: Pat and I both like to read. I'm wondering if there's something you've read recently that you could recommend to us. Dr. Patricia Ganz: It's called A Gentleman in Moscow by Amor Towles. I do like to read historical fiction. This one is about a count at the time of the Bolshevik Revolution who then gets imprisoned in a hotel in Moscow and how constrained his life becomes, but how enriched it is and follows him over really a 50-year period of time and what was happening in the Soviet Union during that time. And of course, with the war in Ukraine going on, very interesting. Of course, I knew the history, but when you see it through the drama of a personal story, which is fictional, obviously it was so interesting.   My husband escaped from Czechoslovakia. He left in '66, so I had exposure to his family and what it was like for them living under communism. So a lot of that was interesting to me as well.  Dave Johnson: Thank you for joining us. It's been a wonderful interview and you're to be congratulated on your accomplishments and the influence you've had on the oncology world.  We also want to thank our listeners of Oncology, Etc., and ASCO Educational Podcast where we will talk about oncology, medicine and beyond. So if you have an idea for a topic or a guest you'd like us to interview, by all means, email us at education@asco.org. To stay up to date with the latest episodes and explore other ASCO educational content, please visit education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name hydromorphone Trade Name Dilaudid Indication moderate to severe pain Action alters the perception and reaction to pain by binding to opiate receptors in the CNS, also suppresses the cough reflex Therapeutic Class Opioid Analgesic, allergy, cold and cough remedies, antitussive Pharmacologic Class opioid agonist Nursing Considerations • Assess BP, respirations, and pulse before and during administration – medication causes general CNS depression • Narcan (nalaxone) is the antidote for overdose • use caution with concurrent use of MAOI – avoid use within 14 days of each other • may be used as an antitussive • advised to dilute with NS prior to administration and to administer slowly to decrease CNS depression

Giving up was not an option for Brittany, even though she was only one wrong decision away from a life full of despair and possibly death. She joined Ty in the Big Z Media studio and shared how she flew under the radar with her drug and alcohol use, shocking her parents at the kitchen table while pleading for help from the grip heroin had on her everyday life. Brittany recounts frequently moving to different cities (and states) due to her father's work and having the gnawing feeling she doesn't truly fit in anywhere. She found ways to relate to kids in high school, as many adolescents do, by dating, drinking, and sometimes drugging. Alcohol introduced her to cocaine and Benzos, which inevitably led to intravenously using Dilaudid for the first time. She turned to stripping to support the newly found heroin addiction that took her down Salisbury St., Kingshighway Blvd., and Hall St. while evading the Jump Out Boys to stay out of jail. After four stints in residential treatment, Brittany knew she had to make a drastic change and plunged into a 12-step community where she has been ever since with almost 12 continuous years of recovery. She now works as a social worker, giving her heart and soul to help parents escape their own Hell and unify with their children.  www.myrecoverypodcast.comwww.facebook.com/recoveryuncensoredwww.twitter.com/recoveryuncens1

Continuing the drug box discussion, the crew discussed the clinical math, preparation, and dosages of various drugs including Zofran, Epi, and Dilaudid. This is a great episode to watch on our YouTube channel. Med UPDATES: The new ADULT dosing is to mix 2 grams (2000 mg) in 100 ml of D5 and administer that dose over 10 minutes and Push Dose Epi can be given up to 50 mcg per dose prn.

Oregonian Taylor Spike added his name to the very short list of ultra-endurance athletes to complete a sub-60 hour, 200 mile ultramarathon. For Taylor, running is about life — and life is about submitting to the friction necessary to get uncomfortable. Comfort is hiding after a lousy day at work to bust into a case of beer. Comfortable is overweight. Comfortable is Dilaudid, a buzz and a couch. There was a time in Taylor's life when he went through the motions of addiction to cope. "I didn't have a pill problem, I had a pain problem". Back surgeries and a gut left him uninspired and lethargic.  In the suffering of the long run, he finds his family and his truth. “I was quick to look for the easy out,” according to Taylor, who at the time was trapped in the spiral of routine, but which ultimately spun into a self-destructive path chasing numbness and a false high. When a second surgery was required for his back, he was already walking down that road. Alone. When the second round of therapy and pain management was heaped on his plate, Taylor expected help and accountability. He hoped again to skate through riding the easy out. Life was not gritty, raw, or real. What he found instead was a heavy dose of self-accountability and a hard look in the mirror. No one offered to do the heavy lifting for him, and he realized that no one could alter the map of his life besides himself. There are prisons we lock ourselves in that we hold the only key to. “We all go through life avoiding confrontation,” he says. Even conflict within ourselves. Listen to this podcast with Coach Blu and Taylor. See if you can relate to anything said here, and make sure to share the word with others! We can all recover. "I am a CHAMPION!" Follow Taylor Spike Twitter @Taylorspike  Instagram:  tspike2

Oregonian Taylor Spike added his name to the very short list of ultra-endurance athletes to complete a sub-60 hour, 200 mile ultramarathon. For Taylor, running is about life — and life is about submitting to the friction necessary to get uncomfortable. Comfort is hiding after a lousy day at work to bust into a case of beer. Comfortable is overweight. Comfortable is Dilaudid, a buzz and a couch. There was a time in Taylor's life when he went through the motions of addiction to cope. "I didn't have a pill problem, I had a pain problem". Back surgeries and a gut left him uninspired and lethargic.  In the suffering of the long run, he finds his family and his truth. “I was quick to look for the easy out,” according to Taylor, who at the time was trapped in the spiral of routine, but which ultimately spun into a self-destructive path chasing numbness and a false high. When a second surgery was required for his back, he was already walking down that road. Alone. When the second round of therapy and pain management was heaped on his plate, Taylor expected help and accountability. He hoped again to skate through riding the easy out. Life was not gritty, raw, or real. What he found instead was a heavy dose of self-accountability and a hard look in the mirror. No one offered to do the heavy lifting for him, and he realized that no one could alter the map of his life besides himself. There are prisons we lock ourselves in that we hold the only key to. “We all go through life avoiding confrontation,” he says. Even conflict within ourselves. Listen to this podcast with Coach Blu and Taylor. See if you can relate to anything said here, and make sure to share the word with others! We can all recover. "I am a CHAMPION!" Follow Taylor Spike Twitter @Taylorspike  Instagram:  tspike2

MySafe Society is one of several safer supply pilot projects in British Columbia. It provides around 130 people in the province with a prescription supply of Dilaudid – hydromorphone tablets that are taken orally. Dilaudid is an opioid that is sometimes used to treat pain. The prescriptions are intended to allow people who had been […]

In this episode we welcome critical care nurse practitioner, Kali Dayton, DNP, AGACNP. Kali is a member of the Society of Critical Care Medicine and host of the ‘Walking Home From The ICU' podcast. Kali works closely with international ICU teams to help transform patient outcomes. They focus on early mobility and management of delirium in the ICU. She joins us to chat about her early days and experience in the ICU, sedation in patients and the effects of mobility of patients in the ICU, medications, how she helps with patient healing and more. Kali tells us about what inspired her to start her podcast and shares a story about her experience with an ICU survivor.SPONSORBETTERHELPBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to a licensed therapist. BetterHelp makes professional counseling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use discount code “solvinghealthcare"TRANSCRIPTKK: We are on the brink of a mental health crisis. This is why I am so appreciative of the folks over at BetterHelp everybody the largest online counseling platform worldwide to change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to licensed therapists. BetterHelp makes professional counseling available anytime, anywhere through a computer, tablet, or smartphone. Sign up today go to better health.com And use a promo code solving healthcare and get 10% off signup fees.SP: COVID has affected us all and with all the negativity surrounding it, it's often hard to find the positive. One of the blessings that has given us is the opportunity to build an avenue for creating change. Starting right here in our community discussing topics that affect us most such as racism and health care, maintaining a positive mindset, creating change the importance of advocacy, and the many lessons we have all learned from COVID. If you or your organization are interested in speaking engagements, send a message to kwadcast99@gmail.com or reach out on Facebook @kwadcast or online at drkwadwo.caKK: Welcome to ‘Solving Healthcare', I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physician here in Ottawa and the founder of resource optimization that one, we are on a mission to transform healthcare in Canada. We're going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better health care system that's more cost effective, dignified, and just for everyone involved. KK: Kwadcast nation super exciting episode I got flowing with you. We got Kali Dayton. She is a nurse practitioner that has taken ICU delirium, ICU mobility so seriously, she's got her own consulting firm. She also has her own podcast ‘Walking from the ICU'. Such a great phenomenon. So, we got her you'll hear this episode. It's a live cast that we did a couple of weeks ago. I'm just proud of her. Someone that's taken getting people healthier and out of the ICU and functional seriously, and we need more of that going on right now. We're only gonna see higher demands. So, without further ado, I'm gonna bring Kali on but first, check out our latest newsletter, kwadcast.substack.com It has everything Kwadcast, our episodes, or newsletter, guest blog appearances, guest vlog appearances, you're gonna love it. Kwadcast.substack.com Check it out. Without further ado, I want to introduce you to Kali Dayton. Welcome to the podcast.KD: Thank you so much for having me on. I've been following your podcast; I appreciate your mission. I see a lot of our objectives are in line.KK: Oh 100% 100%. So, Kali, can you walk us through your story? You're a nurse practitioner. That is, like I said, changing the outlook for critically ill patients. How did you get here?KD: Absolutely. I'm sure a lot of my listeners know my story very well. I started out as a brand-new nurse, many years ago, over a decade ago, in awake and walking ICU. That's just what I call it now. That's the term that I've coined to describe what they do there. In the interview in my naivete, I was just excited to be there. I had no idea what they were talking about when they asked, ‘Would you be willing to walk patients that are on ventilators?' and I was willing to do anything, right. I was just brand new graduate. I said yeah, of course absolutely teach me everything. I didn't understand the magnitude of that question until probably three to eight years later. Because when I started working there, no one made a big deal out of it, for decades and that ICU it's a medical surgical ICU, its high acuity, they've had a COVID ICU throughout the pandemic. They've maintained it this practice of allowing almost every patient to wake up, usually right after intubation, unless there's an actual indication for sedation. What's been intubated on mechanical ventilation is not an indication for sedation. So, unless they have an inability oxygen with movement, seizures and cranial hypertension, something like that, otherwise they are awake. They're reoriented and they're allowed to communicate, tell us what they need. We manage their pain according to what they tell us. They're usually mobilizing shortly after within hours after intubation, and throughout the day, and throughout their time on the ventilator. So that was completely normal. No one told me ‘Hey, Kali, this is the gold standard of care. This is the model for all early mobility protocols in the world' Everyone knows about this ICU. No one told me that. So, I spent a few years there thinking that that was normal critical care, medicine, knowing none the wiser. Then I became a travel nurse, and I went to other ICUs in the in the United States. My very first contract when I walked into the ICU, it just felt different. But I knew I expected things to feel different, right? It's a new environment. But everyone was in bed. Everyone looked like they were asleep. There were very few signs of life, and I got my patient assignment, and the patient was sedated and on the ventilator. I didn't know why they were sedated. I wanted to continue my routine, do a neuro exam, hopefully get the patient in the chair ready for physical therapy, because that was my routine, in the wake & walk ICU. A lot of times physical therapy comes out of that patient is in the chair waiting for the physical therapist, take them on a walk even on the ventilator. So, I asked my orientee nurse, ‘Hey, can I get this patient up and take him for a walk?' and she looked at me in horror and said, ‘No, they're on the ventilator. They're intubated' What didn't make sense to me, because I've cared for at least hundreds, maybe even 1000s of patients that were on the ventilator and were awake and walking. I had no idea what she was talking about. I said, ‘I know that they're intubated. But why are they sedated?' ‘Because they're intubated?' and I say, ‘Okay, but why are they sedated?' and we went in circles. That was the first time it ever crossed my mind that a patient would be automatically sedated, just because they were intubated. I quickly realized that that was the common perspective throughout the ICU, that I was the odd man out there. Here's the thing. Despite my years of experience, treating patients like that, I knew how to do it. I didn't know why we did it. No one had taught me what sedation actually does. No one taught me what it's actually like for patients, and how much it changes outcomes. So, in that environment, I didn't have the tools to support my approach and my practices and to advocate for my patients. I was still kind of a new nurse, and I was, you know, you just had to fit in in the ICU. There's so much peer pressure, there's the culture is such a huge part of it. I ended up just taking the ‘When in Rome' approach and I just went with what I was surrounded with, and I ended up following along sedating my patients. I didn't really obviously know the difference. I mean, I saw a difference in outcomes. I saw patients stay on the ventilator for far longer. I missed the human connection, I noticed that there were a lot of tracheostomies and nursing home and LTech discharges that I did not see the way can walk in ICU 93% of survivors from that high acuity medical surgical ICU that I came from, went straight home after the after the ICU.KK: That is nuts. That is nuts.KD: That's what I thought was normal. So, I was noticing things, but I couldn't really put my finger on it. I couldn't advocate and I just went with it. Right. I even laughed at some of the nursing jokes about yeah, I hope my patient sedated, and totally snowed today. Thinking that that was funny, and it wasn't till years later that I was in grad school. Of course, even in my acute care doctorate program, nothing was mentioned about sedation or mobility practices. It was just assumed even in our case studies, it was assumed that if a patient came in with pneumonia, they were going to be sedated if they were on a ventilator. I was on a plane ride, and I sat next to a survivor. When he heard that I was a nurse and ICU nurse, the color dropped from his face. He started telling me about his experience over four years before that moment when he was a patient. He told me what it was like to be on a ventilator. He just barely mentioned the ventilator. All he could fixate on was what it was like to be in the middle of a forest with his limbs nailed to the ground and trees were falling down on him and he couldn't run away. Demons were coming to the sky and lots of things that he still couldn't talk about, because he was so deeply traumatized. I was stranger on this plane and he's sobbing to me, telling me about what he experienced. Of course, I wanted to diagnose him and I said ‘it sounds like you had ICU delirium' but that meant nothing to him. I came to realize as I listened with real empathetic ears, that that wasn't just a nightmare. Those weren't hallucinations. Those were vivid and real. He was psychologically scarred as if he physically lived through those scenarios. I was really shaken. I really hoped that he was one in a million, because he was telling me that for year after discharge, it was really difficult to relearn how to sit, stand, walk, swallow, that was really hard. The hardest part was that for year after discharge, every time he closed his eyes, he would be lost back in that forest back in that scenario, and he could not sleep. So, the depression, anxiety, physical disability, I didn't ask about the cognitive function because I didn't enough know enough to know that he wouldn't be at high risk of having post ICU dementia. He said that he still had not returned to his career. His life was over. He said ‘I know I feel bad even telling you this, I should be grateful to the ICU to him for saving my life, but my life is over. The life I knew before the ICU is gone. I lost my life in the ICU. If I were ever to become sick, I would never cross a toe back into the ICU. He was a DNR/DNI in his 40s, with no other real comorbidities because he never wanted to live through that again. I think what he meant by that was ICU delirium. I had worked in the ICU about six years. We have never I never heard anyone talk about anything like that. So, I thought this must be a fluke, he must be one in a million. So, I went survivor groups. I thought I would have to post and ask survivors questions. No, the second I got into survivor group, I just scroll through and almost all their posts were about the trauma suffered under sedation and these medically induced comas, what it was like to not be able to balance their check book, read a book, read a clock, like they were barely able to text. These are people thinking ‘How long is this going to last? my brain is not the same'. So that is what got me into looking into the research. I was shocked to find decades of research, exposing the harm of our normal practices. Yet we continue to do those things and I was back in that awake and walk ICU. Seeing a completely different way and I've seen this contrast from what I experienced for years as a travel nurse. Then where I was currently at as a doctorate student, nurse, and then I started working as a nurse practitioner, in that same ICU. That's when I started this podcast ‘Walking home from the ICU' to show what they were doing in the ICU and now it's turned into ‘how do we revolutionize our normal practices in the ICU?'KK: I got so much here, first. I never even would have comprehended or would have thought that your initial experience, I didn't realize that your initial experience was people were able to ambulate and get out of bed and reduce the amount of sedation. KD: People are gonna say ‘Oh, well, that must have been, you know, long term mentors or not that high acuity' They were the first ICU to publish the study back in 2007, showing that it was safe and feasible to walk patients on ventilators and in that study, they had PF ratios less than 100.KK: What that means in nonmedical folk is that your lungs were extremely damaged and require a lot of supplemental oxygen to make sure your saturations are high enough that your oxygen levels are high enough. So, this is the sickest of the sick. From a breathing perspective, getting up and hustling and movement answered. So that is amazing. From a personal side, it must have been an absolute mind F that you couldn't, that you went from one extreme to the other. I'm doing tell you from my I've worked in several ICUs in my country, and the latter is the norm, people aren't getting up on a ventilator, you know, they're not getting, they're barely getting up into a chair on a ventilator. KD: They aren't even getting sedation vacations, they're snowed. KK: One of my main jobs in the ICU when I walk in is minimize the sedation and even often I've seen in practice, they're getting Dilaudid or opioid infusions for no real reason to be honest with you. They're not post op. They have no pain syndrome and we're given pain medication in infusion, which accumulates and what you're describing to amongst patients, my other job is in palliative care when they get toxic or delirium. Delirium from medication. Yeah, that can be traumatic, these memories, these images. That must have been an absolute frustrating experience to go from one version to the other.KD: I was just really confused. I mean, I was still I feel like I'm still new in my career and impressionable. No one taught me the why that's the unfortunate thing about a lot of our medical education is we're taught how we're taught task lists, but we're not taught the why that allow us to critically think and see a bigger picture. I feel like looking back I was really victim to that. I but I would still ask every ICU ‘So, shouldn't this patient get up? Can I get them up?' because it I knew that was beneficial. I wanted that and a lot of it for me was, I wanted to see my patients get better. When you're walking a patient moments later, you know that they're progressing, you get to connect with them, you get to know who your patients are, I had no idea who my patients were, they were just bodies in the bed. That's not why I got into medicine. So even just selfishly, I wanted them to be off sedation, had I known that by taking off sedation, we could decrease their seven-day mortality by 68%. Oh, I would have been all over that, but I didn't know. I did work in one ICU, where they had some level of ABCDEF bundle, which is a protocol to help guide teams to minimize sedation and get patients up. There's such a spectrum of compliance and different approaches to it. So, I was taught to do an awakening trial, which means you turned on sedation. The purpose really should be to get them off sedation, it should be sedation cessation, but I was taught. So, you know, at five o'clock in the morning, we must turn down sedation, it's super annoying, I know but just turn it down. Wait to see them thrash - that's how you know, when you see all their limbs move that they haven't had a stroke. When you can tell they can't tolerate the ventilator, then you turn the sedation back on and call it a failed trial, just chart it. I was confused. I didn't know what the objective was, I didn't know what we were doing. I didn't know why they were agitated. For her to say it's because I can't tolerate the ventilator. That was confusing to me because I'd seen so many patients tolerate the ventilator. I didn't understand delirium, and I hated awake new trials. They were laborious, they were stressful, they felt unsafe. It's hard to see patients between delirium, it's hard to see them be so uncomfortable, and you can see the terror in their eyes. But again, when in Rome, I just did what I was told, unfortunately. So, this is my journey now is almost my penance for the harm that I caused my patients during those years. KK: Well, Let's be honest, Kali, you can't be looking at it that way, man. We all remember sedation is the norm. What we're doing now is trying to advocate for change. I can't emphasize enough the change can be dramatic for people like it really comes down to function. If you in the ICU and you're paralyzed into intubated on sedation and analgesia, you're not moving, like you're not using your muscle. Then when you're trying to go back to what you want it to where you want it to be. I think a lot about our COVID patients. They were in the 40s/50s/60s, that are trying to get back to working, trying to get back to doing the activities that they love to do. When you think about this not only are you impacting their ability, like they're not getting to their functional level, but what's it doing for their family. Now you got a loved one that's got to take care of them, that might have to take off time off work too. It just is an absolute amplifier when people can't be functional.KD: For those that maybe don't work in the medical field, or even especially those that do, here's what we're not talking about the bedside, here's what we're not telling patients and families. When we go into surgery, they give us informed consent, they tell us here are the remote risk that things that could happen, right. What we don't do before intubation for patients and our families is tell them the actual risks of sedation. We don't understand ourselves that sedation is not sleep, it disrupts the brain activity so severely that they don't get real REM cycle. So, my perspective is that it's a form of torture, really, I mean, that's what we do, and war in the military, we deprive people of sleep, and that's what we're doing to our patients when we give medications that make it so they cannot get restorative sleep. Many of our study, sedatives are myotoxic, meaning that they're toxic to the muscles, so it causes more muscle breakdown. Then on top of that, if there's absolute disuse when you're stopped sleeping deeply sedated, you're not even contracting a muscle usually. So that disuse makes it so that our muscles break down more. That disruption of sleep often caught is one of the mechanisms that causes delirium, which is acute brain failure. It's an organ dysfunction. That can turn into long term post ICU, dementia, cognitive impairments. So, they cannot return to their normal lives can't take care of their families can't go back to their jobs because they can't. Cognitively their brains can't function the same way anymore. They have this post ICU PTSD because of those vivid scenarios that they live. I'm not going to call them hallucinations, because that's, that's not accurate. Those were real to them. We just don't see that big picture of sedation, and we just don't even question and I do that a lot in my life too. They're things that I'm just taught that I don't question, but we don't question whether or not sedation is necessary. Sometimes it is. When we understand how risky it is, then we can do a true risk versus benefit analysis for each patient to say, ‘they're intubated for this reason, does that necessitate sedation?' If not, let's get it off and see what they need. Let them communicate. Let's prevent delirium. Your platform is all about preventative medicine. In the ICU you come in with one acute critical illness and we sign them up for chronic conditions?KK: Absolutely, as you said, like it really is about what can we do to prevent this from becoming a chronic condition. Honestly, it's a culture change, from what I could see. What's sad about medicine, is that we have data to support how bad things are or how good things are. The amount of time we invest in create that change is limited. If you look at the data for sedation vacation, so that same principle of, turn off someone's sedation, periodically, that we know that has positive outcomes, like we know that, but you could go through an ICU, throughout any country in North America and the odds are that they're not getting it routinely. Why doesn't that happen? That's why I'm proud of Kali. Number one, being a champion of this, ICU care sucks, but a lot of us that will end up in there. So, we want to be able to optimize care, but also like just doing some about it. It's one thing to want to bring attention to it but also, being an activist. I think it helps. So, you've got the podcast, Kali, you've done some other work, how else have you been able to increase awareness? You could even get into like, what the podcast also has done for you or in the people around you?KD: So with a podcast, I started that right before COVID hit. I don't know if your god person but I, God told me to start a podcast in December 2019. I barely even listened to podcast didn't know how to start one, but I couldn't. I couldn't rest. I knew exactly that I had to start, I had to put out 32 somewhat episodes by the beginning of March of 2020. I didn't know why it had to be so fast and so furious, and survivors came out of nowhere. I interviewed my colleagues, researchers, it was just this miraculous setup that just came together, put out all these episodes, and then COVID hit. I thought ‘well now it's all gonna be all about COVID, and no one's gonna care about this'. God back handed me and said, ‘This is for COVID They're gonna be millions of people on ventilators, how is this not relevant to COVID'. So, I continue to throw out COVID Even though I recognize that the ICU community was not really in a place to revolutionize. The hard thing is that this could have been so beneficial to COVID we created more work for ourselves with the sedation practices, you talked about awakening and breathing trials. Once I just looked at only wake & breathing trial started sedation, turn it off once a day and then turn it back on. Decrease ventilator days, by 2.4 days, days in the ICU decreased by three days in that hospital decreased by 6.3 days, when we're in a staffing crisis, we need to have a process of care that's efficient actually gets patients out of the ICU. Instead, we created this bottleneck where patients are now stuck on the ventilator because they're too weak to breathe on their own. Even if their lungs are better. Now they need tracheostomies. They're stuck in a ventilator. We can't at least in the States, we couldn't get them to LTACH because LTACH's were too full of all the other COVID long term patients. So, then the ICU wasn't rehabilitating these patients, and so then they develop more hospital complications, and then they ended up needing more care. It's just we created so much more work for ourselves. It just was a hard time to really take on a new endeavor and totally change your practices. But during COVID, everyone ran back to the 90s. Not everyone but a lot of people ran back to the 90s. As far as using benzodiazepines, higher doses of sedation, deeper sedation longer times, there was so much fear. We did a lot of fear-based medicine. So, I just kept chugging along with my podcast, knowing that the community was going to need healing after all of this. We were going to need a lot of rehabilitation within our own clinicians, but also within our practices. So now, teams are coming to me saying what we're doing now. We're still doing COVID care even these are not COVID patients, we're still we're back to deeply sedated patients. Where are we lost so many seasoned clinicians, new clinicians came in during COVID. They've been trained to deep deep, deeply sedate, they don't know how to move patients they're scared to. But one team said I look on my ICU It's not an ICU, these aren't ICU patients. These are LTACH patients. These are rehab patients that we're not rehabilitating. We're bottlenecked. We can't get these patient outpatients out, we can't get new patients, we're stuck. We're creating that kind of scenario. So now, I work as a consultant and I do training with the teams, I teach them the why the reality of delirium, giving them a picture of an awake & walking ICU using real case studies, pictures, videos, so that we have a vision of what could be I feel like the ABCDEF bundle when it was rolled out in the mid 2000's good change happened, a lot of things moved forward. I do feel like we didn't explain fully the why behind it. Until every ICU clinician hears the voice of survivors, they won't be afraid of sedation, they'll still be inclined. We started, we continued this start sedation automatically, then at some subjective point down the road, start to take it off, when they come out, agitated, turn it back on, we just didn't, we didn't give them this perspective of ‘Hey, most patients should be awakened walking. Here's how to treat delirium and here's how the team works together' we put a lot of it on nurses, which is not fair, feasible or sustainable. So, as I work with teams, I tried to really give them a foundation of why, and then how, how to treat patients without automatically sedating them. When the sedation necessary. How do we navigate appropriate and safe sedation practices? When do we use it? How do we mobilize patients, I go on site with teams and I do simulation training, we do real case studies and practice and the whole team practices together. Because it's a skill set, we think about pronation, when we started printing patients, everyone was terrified. And it took so many people and it took so long, you know watching every little line and now teams flip them like pancakes, right? It becomes a skill set. So, I tried to get them opportunity to practice that on a pretend patient. So, they can think through critically think through the scenario, think through delirium, thanks for ICU acquired weakness, then practice mobilizing patients with different levels of mobility.KK: My brain is going like, the whole time, it's like you need to come see our group.KD: Let's do it. I'll hope on a plane tomorrow – I can't actually. I'm going to Kentucky tomorrow, but let me know I'll be there!KK: We would absolutely love to have you. Just knowing where a lot of clinicians lack is hearing the voice of the people that have gone through it. Clearly, that's been a motivator for you in terms of why we need to pivot and provide less sedation to our patients and mobilize our patients and avoid them from having all these secondary complications as a result of being immobile. The means are there. KD: The data is strong; the data is really powerful. I mean, decreased mortality by 68%. Who doesn't want to do that, right? So, but almost even more powerful are the voices survivors, when you hear their voices in your head when you're sitting in a patient. It's haunting COVID, there were times when patients could not oxygenate the movement. I had to sedate them. I hated it. I just felt sick because I, I just didn't know what they were experiencing. I didn't know if they were in pain. I didn't know what was going on underneath that they were going to live with us the rest of our lives, it's because of the survivors that have interviewed on my podcast, they are the educators.KK: Yeah, I have so many ideas going through my head. I would love after when we jump off, links to the some of the episodes from the survivors that we can pass along to our group, to our show in general, but our group to give a sense of what it really is like to go through this. Yeah, our patients don't come I mean, every once in a while we get a patient come back and say how they're doing but they don't give us the they don't give us the negative side, they really focus on showing some gratitude. KD: Which is good, but if they came back, it's probably because they weren't too traumatized to come back. The ones that don't come back. I mean, why would you go back to the place that you are sexually assaulted?KK: Yeah, no, yeahKD: It's like to trigger and some people can't even go the same street as that hospital. On my website under the resources tab, the clinician podcast, at the bottom, the page is organized by topics. One of those topics is survivors of sedation and mobility, as well as survivors of an awake & walk ICU. So, you can hear their different perspectives and testimonies, it's organized by different topics. KK: You're an organized cat, I'm looking at it right now. I can tell you, you're very structured and organized just by the way your website is set up. It's on point.KD: It's curriculum. This is education, this is not just a hobby. I mean, this is we've got to make sure we get the right information to the right people.KK: You're so boss. You're gonna be running an organization one day, and ICU, I don't know. I see big things for you.KD: We'll see. I mean, I have a lot of optimism for the future of critical care, going to conferences, meeting with people at the bedside podcast listeners reaching out. It's not just me that cares about this. That's why I continue is that there are so many people that I call revolutionists, sometimes as the lone voice in their ICUs. But they're bringing big changes, they're making waves there so my motivation with podcasts is to provide the ammo, the quiver the arrows in their quiver, so that they can share that with their colleagues get more buy in, so that they don't have to reinvent the wheel. It's a lot to change a perspective and change a culture. It's hard.KK: Yeah, and maybe just seeking some advice, we had Dr. Wes Ely on the show and how to create some culture change around this issue. I want to hear your perspective. Kali, how do you think you do create that culture change? Because you bring this up to many staff, and they'll be like, ‘Oh, they're gonna extubate themselves? Oh, we're short staffed. This is not gonna be able to work.' What are your thoughts?KD: Yeah, this has been a lot of my journey is figuring out what are the barriers? and how do we address them? I think we're over the checklists. I think it is important to systemize and protocolized our practices. When we implement these kinds of changes, we this can't just be “Hey, Nurse, take off the sedation' that is not going to work. They have some valid fears at all I had ever seen. With a patient coming off sedation. After days, two weeks of sedation, I would have a lot of inhibitions. When I'm busy. I don't have time to wrangle that patient. I don't have time to make sure they don't self extubate. I have a Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.whole episode on unplanned extubations, but delirium increases the chances of unplanned extubations by 11 times. So, it's just changing the perspective understanding what is delirium? why should we be panicked about it? What causes it? We are practices are some of the biggest risk factors and culprits of delirium in the ICU, and to learn doubles that are in hours required for care. So, when we're short staffed, why would we create a delirium factory? When it doubles our workload? It doesn't make sense, but when that's all we know, we don't understand that there's a better way to do it. So, my approach when I go to help a team have culture change is to, again explain the ‘why' give a perspective of what could be, here's what patients can be like, when we don't sedate them. If they when they wake up after intubation, it's like coming out of a colonoscopy. Endotracheal tubes not comfortable. Here are some tools to help make it more comfortable. Here's how we can talk to them. Give them a pen and paper, I would get agitated and panicked. I couldn't communicate. Here's how you involve the family, here's the toolbox to help you succeed and have that patient be calm & compliant. And they will protect their tubes. I've had patients write ‘please be careful my tube' That's what I need to experience. So, when you find a couple of case that isn't so easy hits, easy wins. Allow your team to see a patient awake, communicative, calm in even more while on the ventilator, the perspective starts to shift. Then they start to ask, okay, that was easy. That was fun. That changed outcomes. They walked up the ICU. Who else can we do this on and it starts to have a domino effect. So suddenly, we expect him to just shut up and do it. That's, that's not going to cut it. I don't think that I think that's partially why the ABCDEF bundle rollout, years ago was not has kind of gone away, because we didn't provide the why. We also, again, I think starting sedation, and then taking off later, is a lot of work. We should only do that if it's absolutely necessary. Otherwise, I mean, I have an episode with a hospital in Denmark, they do the same thing and that allow patients to wake up right after intubation. They are so much easier, more compliant, because they don't have delirium, we have to understand that that agitation is usually rooted in delirium, we have to come to really be terrified of delirium.KK: I'm really enjoying this, I'm really liking this because it's even at that added perspective of saying, ‘Hey, your workload is going to be worse if people are delirious, so let's avoid going delirious in the first place' Let's just get a grip on this bad boy, out of the gate.KD: You're all about preventative and it's like, Let's prevent one of the biggest culprits of mortality. Delirium doubles the risk of dying in the hospital. So, people say we don't have time to mess with all sedation practices, like let's just sedate them and like, save their lives and figure it out later. No. By doing that, by increasing the risk of delirium, we could double their chances of dying. So, if we care about mortality, then we will care about our sedation practices. We also know that ICU acquired weakness is really laborious. When people imagine mobilizing patients on ventilators. What they're imagining is taking off sedation days to weeks later when they're delirious. They can barely lift a finger and now we're trying to mobilize these, you know, 200 plus pound adults to the side of the bed. That's dangerous, laborious, it takes so many people. If a patient walks into the ICU or into the hospital, hypoxic hypotensive, whatever. We have moments later, we haven't stabilized. Why can't they walk? Did we cut their legs off? Right? So, once we have oxygenated, perfused, what's the harm in sitting outside of the bed and seeing how they do when they're not delirious, they can tell us how they're feeling. We can provide more support on the ventilator; they can probably walk better than they did come in and hypoxic. Once they're stabilized hours later, or even 24 hours later. So that is so much easier when they maintain their ability to walk. So, in the COVID ICU, many patients were standby assists to the chair with a nurse while they were on a ventilator, because they're alone in the room, right? Physical therapy could go in and work with a patient, just scoot the ventilator wall to wall as they're stuck in their rooms, help them stand or sit, step on steps, they were alone in that room with these patients, because they were strong enough to do it, because we didn't allow them to be under myotoxic sedation and I would say rot in the bed. So, all of that plays into an ease of workload. Then obviously the get off the ventilator sooner, get out of the ICU sooner. It makes the workload easier. So, it's a little bit of an exchange and efforts in some ways. Yes, you must talk to a patient. Yes, you must assess them a little bit more. But also, could during COVID, I was hearing about swapping out propofol bottles every hour, picking up to go in and out to titrate vasopressors that we were getting just because of the sedative and hypotensive effects. All of that is effort but wasn't necessary and wasn't beneficial.KK: I'm telling you, you are changing the boogie. Yeah, changing the conversation and perspective. This is something that can dramatically impact patient care. If we could get the buy in, in the culture. Wow.KD: You know, people will say ‘Well, we don't have we're trying to save $25 million this year. We can't afford to pay our payer clinician some extra time for education or whatnot' The ABCDEF bundle, even in their spectrum of compliance, decreased healthcare costs by 24 to 30%. KK: Oh, yeah. KD: ICU acquired weakness increases healthcare costs by I want to say 30-40%. Delirium increases healthcare costs by 40%. ICU acquired weakness increases healthcare costs by 30.5%. So, by having a process of care that prevent those complications with decreased healthcare costs. So why wouldn't we, right? KK: 100%. We even we had a paper out last year showing the financial impacts of ICU delirium. We always think to have the opportunity cost, that money could be diverted into more staffing, more resources for physio, optimizing nutrition, all these things can be enhanced. If we, if we make it a priority. KD: I think it's one of our one of our strongest cards to play for staff, safe staffing ratios. To say staff is better, we'll get better care in this using this protocol. We will save you so much money so it's investing thousands to save millions or billions.KK: I love it. You're speaking my language. We are definitely going to have you back in some capacity. I don't know that for some reason. It's not just gonna be the show. I really want to get you talking to our group. Maybe regional rounds, or something. I don't know what it's gonna be. It's something that we need to hear more of talked about the patient experience, your own experience and the drive like what's pushing this. Knowing my people a lot of intensivists and an ICU nurses and allied health professionals, we want to achieve this, get our patients to a point where they are better. Really better, not just alive, but thriving. This starts here. I really do believe it starts here. So I just want to give number one, Kali some mad love on what you're doing and continue to hustle, it's paying off. Second. How do people get to know you a little bit more? and about the show and the consulting and so forth?KD: So, have a website www.daytonicuconsulting.com. There's more information about consulting services available, the podcast is on there, the podcast has transcriptions and citations organized by topics. KK: So organized folks. KD: 116 episodes, and I really didn't even know how much of a what's called a rabbit hole that this would become. There's so much to learn about the science behind what we're doing as well as the patient and clinician perspective. So, check that out, find the topics. If nothing else start at the beginning. I think the beginning lays a foundation, I was very intentional about how I organized it at the beginning to lay a foundation of ‘why' and ‘how' comes later. I'm on Instagram @daytonicuconsulting, Twitter, Tik Tok. Go ahead and set up a consultation with me send me an email and we can chat about your team, your barriers, even your family members what's going on? I'm obviously obsessed. So, I'm here for you! let me know.KK: So good. So good. Thank you so much for joining us. Those on the chat group or that are watching live. You want a piece of this episode just tap NL into the chatbox will give you a copy the video and the end the podcast when it's released. Awesome work. Congratulations.KD: Thanks for caring about this.KK: 100% KK: Kwadcast nation that's exactly what I'm talking about changing the boogie right here in ICU care. Follow us on Instagram, YouTube Tiktok Facebook @Kwadcast Leave any comments at kwadcast99@gmail.com, subscribe to our newsletter. Essentially, it's like a membership you want to know more about Kwadcast nation. Go to Kwadcast.substack.com Check it out. Leave that five-star rating and continue to allow us to change boogie in unison. Take care, peace. We love you.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

 Risky behavior is inherent in teens and tweens. Risk taking is a necessary part of growing up and learning to be independent. But many of these risks could literally cost them their life.  Using drugs is one of those life endangering activities, especially with more and more illicit fentanyl being introduced into the drug supply by Mexican drug cartels. According to the DEA, these cartels illicitly manufacture the extremely potent, and potentially deadly synthetic opioid in clandestine “laboratories” and smuggle it into the US in the form of powder (for “cutting” into heroin and cocaine) and counterfeit pills. They do this because it's extremely cheap to make, and very potent so a little bit goes a long way to stretch the other drugs out – and it's extremely addictive and makes for repeat customers (if they don't die first).These counterfeit pills are made with a mixture of fentanyl and other chemicals and manufactured to look like the drugs teenagers gravitate towards (for parties, experimentation, and self-medicating). Fentanyl has been found in fake Adderall, Oxycontin, Percocet, Dilaudid, Xanax, MDMA (molly or ecstasy). And the amount that would fit on the tip of a pencil can be lethal…and has been for way too many. From 2019 to 2021, deaths from fentanyl overdoses tripled in teenagers. And teens don't have to look too hard for the deadly pills. Snapchat and other social media platforms are teaming with dealers who seek your kid out and market to them. Please take the time to learn about the danger fentanyl poses to your teen or tween and how to talk to them about it so they will actually hear you.  Speaking of Teens is sponsored by https://neurogility.com, where you can find lots of wonderful resources for parents of teens and tweens. I founded neurogility after our family went through a couple of difficult years. Our teenage son struggled with ADHD, learning issues, horrible anxiety, major depression and all the accompanying academic, social, self-medication, legal and behavior issues. After finally finding a positive path forward, I knew I wanted to dedicate myself to making sure you're better equipped that I'd been.  Please share this episode with other moms you think may find it helpful and follow the show right here where you're listening. New episodes are uploaded every Tuesday morning. For show notes and a full transcript, go to https://neurogility.com/21 I would love to get your feedback and ideas for the show. Reach out to me anytime at 864-313-7277 or acoleman@neurogility.com. This show is for you, and I want to make sure I'm bringing you the insight and information you need the most!Ann Coleman Privacy Policy 

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/HydromorphoneDilaudidNursingConsiderations    Generic Name hydromorphone Trade Name Dilaudid Indication moderate to severe pain Action alters the perception and reaction to pain by binding to opiate receptors in the CNS, also suppresses the cough reflex Therapeutic Class Opioid Analgesic, allergy, cold and cough remedies, antitussive Pharmacologic Class opioid agonist Nursing Considerations • Assess BP, respirations, and pulse before and during administration – medication causes general CNS depression • Narcan (nalaxone) is the antidote for overdose • use caution with concurrent use of MAOI – avoid use within 14 days of each other • may be used as an antitussive • advised to dilute with NS prior to administration and to administer slowly to decrease CNS depression

Life hasn't been the same for Troylana and her family since April 26th when they lost her son Aaron, who was only 26 years old. Aaron was pursuing his last year of college to receive his bachelor's degree in business when he unexpectedly died at their family home of a multi-drug overdose. The coroner reported Aaron died from a mixed drug toxicity of cocaine, hydromorphone (opioid; brand name Dilaudid), antihistamine, and prescribed anti-anxiety medication Escitalopram (SSRI; brand name Lexapro) and kratom (mitragynine speciosa) overdose. The coroner reported that the levels of mitragynine(MG) were “extreme and fatal.” Also the coroner reported the MG levels were so high that alone without the other substances would have caused an overdose, and the levels were those "associated with fatalities". I recently had the pleasure of sitting down to have a great conversation with Troylana. I believe this was a very difficult conversation for both of us to have, while at the same time such a pleasure and a relief. The more I spoke with Troylana, a mom on a mission, I got to experience her true nature and kind hearted soul. Troylana opened up so much only to be relieved that she and I were more similar and wanted many of the same things than I ever could have imagined. We covered a lot in our conversation from learning about Aaron, his pursuits and strengths, along with his struggles with addiction, recovery and anxiety. Her thoughts on harm reduction vs. abstinence. What they know happened along with speculations on that dreadful morning. We go in depth about the coroner's findings along with what modern science says about kratom toxicity and lethal overdoses. We also get into why even after what happened to Aaron Troylana does not want to see a ban on kratom, but rather regulations. As well as why she feels that harm reduction is such a viable way forward and how legalizing all drugs with a safe supply is so important and will ultimately save lives. We get into all of that and more! This episode is sponsored by: Organa Kratom Organic. Raw. Natural Discount! https://www.organakratom.com/?rfsn=5665756.aa868b2 $100 Giveaway: https://www.organakratom.com/thekratomguyshow Support our work on https://www.patreon.com/KratomGuyShow Youtube Channel! https://www.youtube.com/c/TheKratomGuyShow Music by: Lion Heights Track: “Dread Step” https://lionheights.com/ Sources: https://bit.ly/Troylana-FB https://linktr.ee/Troylana https://bit.ly/cbc-ca https://bit.ly/KamloopsThisWeek https://bit.ly/castanetkamloops https://bit.ly/infotel-ca https://tgam.ca/3I9Dk9R https://bit.ly/hydromorphone https://bit.ly/drugs-escitalopram https://bit.ly/NEJM-kratom --- Send in a voice message: https://anchor.fm/kratom-guy-show/message

The Dilaudid IV is typically injected once every 2 to 3 hours as needed.https://recoverypartnernetwork.com/drug/opioid/dilaudid-addiction

The half-life of Dilaudid (hydromorphone hydrochloride) after an intravenous dose is approximately 2.3 hours. For most healthy individuals, it will take 1 to 2 days for hydromorphone to fully clear the blood.https://recoverypartnernetwork.com/drug/opioid/dilaudid-addiction

The liquid version of Dilaudid is usually taken every 3 to 6 hours, and the tablets are usually administered every 4 to 6 hours. Extended-release tablets, on the other hand, are taken once a day with or without food.https://recoverypartnernetwork.com/drug/opioid/dilaudid-addiction

Dilaudid is not a sedative.https://recoverypartnernetwork.com/drug/opioid/dilaudid-addiction

The starting dose is 0.2 to 1 mg every 2 to 3 hours. The intravenous dose should be administered rather slowly over a period of at least 2 to 3 minutes, depending on the dose.https://recoverypartnernetwork.com/drug/opioid/dilaudid-addiction

My name is Carl V. I am a 52-year-old mother of four and grandmother to one with one on the way! Before discovering Kratom tea, my consisted of chronic pain, being a recluse,with no future. I was suffering depression, drugged and miserable having to endure the amount of pain I was in. Narcotic Pain medications made my existence lonely and dependant. It just didn't seem like life was worth living with so much pain until 4 years ago when a nurse practitioner friend of mine suggested I try Kratom . Since taking Kratom daily, I no longer need pain Percocet, Dilaudid, or anti-anxiety medications, and antidepression medications!  My life has turned completely around and I feel alive again. I now feel I have a future to look forward to and can be the wife, mother, and grandmother I've always wanted to be. High quality Kratom powder has taken away my pain, my anxiety and the depression resulting from so much pain. I have my health and life back! I'm motivated, clear headed, happy, and look forward to my future again! When I'm asked what will I do if the DEA succeeds in banning kratom? I can honestly say that I have only two choices to consider; continue taking Kratom illegally, or I go back on narcotics in full time pain management thereby ruining my life and the lives around me! I am Nate R., a responsible adult working as a General Manager at a 5 star restaurant, I have worked 70+ hours a week and at the same company for 7 years and have been a part of the top 10% of my fine dining establishment for 2 of those years. I am a responsible user of Kratom, I use it for an energy boost for my long work shifts, as well as depression issues, and back pain. My life would be detrimental without kratom leaves. I feel that if I am able to drink caffeine, alcohol, or smoke cigarettes, all of which are far more detrimental to my health and kill millions of people a year, I should be able to use this kratom tea in my daily life without question. I feel the federal government has overstepped their bounds, and we should have checks and balances in place for them. They shouldn't be able to make federal laws banning kratom without going through the public, or the other branches of government first. Not to mention this is a perfect way to start a black market for kratom product which would increase crime. Canada, Mexico, and the origin countries of this plant are all legal, which means easy entrance to the USA. I am not a criminal or an irresponsible drug addict, I am a hardworking kratom user who takes care of his family any way possible.

In this podcast I discuss the schedule of drugs and some other random drug facts! •Schedule of drugs https://www.dea.gov/drug-scheduling •Book I reference: https://www.amazon.com/Drugs-Society-Human-Behavior-Carl/dp/1259913864 Prevent access to drugs vs teaching someone the correct facts. •When schedule of drugs was created: -1970- War on Drugs began/ DEA (drug enforcement administration) was given more funding -1914- Harrison Act * 5 schedules were created - Schedule 1: Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are: - heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote •1937- Reefer Madness, Targeting Hispanics with laws on marijuana - Schedule 2: Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of Schedule II drugs are: - Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin Barbiturates- CNS depressants, to use to reduce anxiety: sedative (Xanax- which is schedule 4, Ativan), Xanax and alcohol mixed would cause death due to short respiratory rate - Schedule 3: Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples of Schedule III drugs are: Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone 18:14 - Schedule 4: Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence. Some examples of Schedule IV drugs are: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol 24:30 Schedule 5: Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Some examples of Schedule V drugs are: - cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin 28:42- Opioids were a major cause of addiction in 1910, 1914 Harrison Act- putting taxes on drugs, Rockefeller drug laws 33:31- Alcohol and example of how it leads to wanting more. 36:24- Ketamine - strong antidepressant, horse tranquilizer Thank you for listening to my podcast! Follow me on Instagram! Living.wild.with.em

Sign up today: http://betterhelp.com/solvinghealthcareand use Discount code “solvinghealthcare"Solving Healthcare Merchandise.https://solving-healthcare.myshopify.com/Proceeds will be going to Feeding Frontline Healthcare Providers:gf.me/u/xstpfkDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8wFeeding Frontline Staff COVID-19:https://www.gofundme.com/f/feeding-our-frontline-workersBridges Over Barriers:https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33

In this episode, Stephen and I discuss many topics, from safe consumption sites to medical heroin to Dilaudid dispensing machines on the streets. Yet, the underlying theme of this podcast episode is the value of having empathy and forming relationships with people who struggle with addiction. People who inject heroin are real people who deserve a chance to recover, no matter how long it takes for them to be ready finally. British Columbia, Canada, takes harm reduction to a new level with supervised consumption sites and many other programs to help people who use drugs on the streets to stay safe and help them along the path towards recovery. These programs serve as a positive example for what other countries, such as the United States, that do not allow these advanced forms of harm reduction, could do to save many more lives from the deadly effects of opioids and other street drugs.Stephen Finlay is the manager of addiction services in the Surrey region for Lookout Housing and Health Society. Lookout is a non-profit organization that provides homeless shelters, supportive housing, subsidized housing, outreach, harm reduction, and related services throughout southern British Columbia, including Vancouver. Surrey is one of the largest cities in the Greater Vancouver area and has experienced problems arising from homelessness and drug use for many decades. As an addiction services manager, Stephen oversees an Intensive Case Management team, a supervised drug smoking site, and SafePoint, which is the second federally sanctioned supervised injection site in Canada. SafePoint opened in June 2017. Since it opened, there have been over 190,000 visits to SafePoint. The staff has reversed almost 1,500 overdoses, with no fatalities. Before joining Lookout, Stephen served as executive director of ARA Mental Health Advocacy, a small non-profit that provided advocacy services to people living with mental illness and poverty. He also has 29 years of experience in marketing, product development, and regulatory affairs at TELUS, Canada's second-largest telecommunications carrier, and four years of experience in marketing research at Procter and Gamble. Stephen served as a civilian volunteer for Law Enforcement Against Prohibition from 2006 to 2015. In his spare time, he enjoys international folk dancing.Please visit my podcast website at https://therehab.com and my professional website at https://drleeds.com. Thank you!

In this episode of Psychotropic we hear from Elyse. She shares a story that makes us think about vulnerability, the origins of our choices and behaviors, and the importance of family. Drugs Mentioned: Alcohol, Marijuana, Spice, Bath Salts, LSD, Dilaudid, Adderall, Ketamine Music Featured: “My Unbelief” by Hill and “Retreat” by Chelsea McGough If you have a story you’d like to share, or if you’d just like to give some feedback, you can do so via psychotropicpodcast.com or directly at psychotropicpodcast@hotmail.com. Thanks for listening everybody.

Kate Sullivan Broke both her neck and back multiple times. She was on 13 prescriptions taking 550 Pills a month: fentanyl, Dilaudid, Zanaflex, Valium, Ambien CR, Ativan,  you name it, she was on it. Kate was bedridden, in a wheelchair, and gained so much weight she was unfunctional. When she found out about medical Marijuana she decided it couldn't be worse than the drugs she was on and she gave it a try. Kate made an incredible recovery. Here is her story. Read here story or watch the video here >>>

Author: Don Stader, MD Educational Pearls: Suboxone, methadone, and naltrexone are commonly used as treatments for opiate use disorder.  Naltrexone is a full mu-opiate receptor antagonist, making acute pain control difficult in patients taking it.  Options for pain control in patients on naltrexone include nerve blocks, NSAIDS, ketamine, and high doses of opiates.  Of the opiates, Dilaudid (hydromorphone) has the highest affinity for mu-opiate receptors, and will be the most effective. References Vickers AP, Jolly A. Naltrexone and problems in pain management. BMJ. 2006;332(7534):132–133. doi:10.1136/bmj.332.7534.132   Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

B-Mack(@MartezLVE) and B-Eazy (@preacher_the_accuser) are once again joined by Coach(@coach_e17) and they discuss Tyler Perry's big move, Wendy Williams, RIP Lennox, Byron Allen and much more.  Call us and leave a voicemail 404-436-2370 email the show djblazeshow@gmail.com

B-Mack(@MartezLVE) and B-Eazy (@preacher_the_accuser) are once again joined by Coach(@coach_e17) and they discuss Tyler Perry's big move, Wendy Williams, RIP Lennox, Byron Allen and much more.  Call us and leave a voicemail 404-436-2370 email the show djblazeshow@gmail.com

Bunny tells Lene the tragic tale of Sid Vicious and Nancy Spungen

This week on Dopey! As promised Ashley Hamilton returns to the show give us a little bit more of his Dopey truth. We hear about getting speedballs through an IV-Drip at the hospital on his rough road from recovery to relapse and back again. We also hear about what it is to live with trauma, and what Ashley is trying to do to get passed it. We also play games, hear voicemails and talk cake and ice cream on another especially special episode of Dopey. 

Today’s guest is Elizabeth Alvarez, also known as The Dancing Crohnie. Elizabeth was diagnosed with Crohn’s disease in 2011 at the age of 21. Since then, she’s described her journey as one wild ride trying to attain remission.  She’s been on numerous medications–including included Remicade, Entyvio, Humira, Stelara, Prednisone, Dilaudid, Valium and many others–and is now pairing conventional medicine with non-conventional treatments and organic lifestyle changes. Elizabeth shares her journey in pursuing a career in professional dancing, how she gave it all up when she experienced the worst flare of her life, and how she’s regaining her health and finding her way back to dancing. She relies on the expertise of her Gastroenterologist, her Naturopathic Physician, and a Dietitian to help guide her in her healing journey. In this episode, we talk about the importance of diet–including suggestions for cutting out known inflammatory foods like dairy, gluten and sugar–and her latest addition to her nutritional protocol: celery juice. (http://www.medicalmedium.com/blog/celery-juice) She urges every IBD patient to learn how nutrition can play a role in IBD management and encourages everyone to be an advocate for their own health. Follow Elizabeth online: BLOG: www.thedancingcrohnie.comCheck out her blog for articles, tips, and tricks for navigating everyday life with Crohn’s and Colitis. SOCIAL MEDIAInstagram @thedancingcrohnieFacebook: https://www.facebook.com/The-Dancing-Crohnie-517797962006260/

This week on Dopey we are joined by Hollywood royalty, the great Ashley Hamilton. We learn all about the dark side of Los Angeles, smoking crack with Scott Weiland, his first heroin, relapse, fatherhood, and his 33 stints in rehab. Plus emails, voicemails, the Dopey Nation and much, much more on a very very special episode of Dopey. 

Join Dr. Patrick for a “phast” pharmacology update on hydromorphone/dilaudid. We’ll discuss its uses, relative strength, side-effects and the future role of dialudid at MCHD.

September Quick Summary September Podcast Articles   Abscess I&D with POCUS, Dilaudid vs IV Tylenol for pain, Coronary CTA for Chest Pain, 2018 Surviving Sepsis Guidelines, Low Acuity Visits, AIRWAYS-2, Effect of Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults with OHCA, Infectious Endocarditis, ARRIVE trial, MRI for Appendicitis in kids/pregnant patients, UTI in Renal Colic, PE in AECOPD, Macrolide Resistance in CAP in the ED, Dripped lidocaine for Mucosal Lacerations, and ED Patients with Advanced Directives in the ICU

F&H’s PILOT Podcast reference link in order they came up in conversation:Foxes and Hedgehogs: “The fox knows many things, but the hedgehog knows one big thing.”-ArchilochusArchilochus (/ɑːrˈkɪləkəs/; Greek: Ἀρχίλοχος Arkhilokhos; c. 680 – c. 645 BC) was a Greek lyric poet from the island of Paros in the Archaic period.Thomas did a remote recording saxophone session for a Samantha Bee episode for Flavorlab: In search of "economic anxiety," Sam found a whole group of working class people who have been ignored by the media...and all of society. Produced by Halcyon Person with Adam Howard. Edited by Andrew Mendelson. Flavorlab:“Flavorlab is an award-winning audio production company that composes, records, mixes and masters music and sound for the biggest brands in the world.”Marc Maron:“For over twenty years, Marc Maron has been writing and performing raw, honest and thought-provoking comedy.”Yerkes–Dodson law: The Yerkes–Dodson law is an empirical relationship between arousal and performance.Rocky V Quote "Frankie Fear": “Rocky: No no no no no no, no, your best friend is a guy named Frankie Fear…” Tom Hanks paintings: Make Christopher Walken/James Spader image with Jon in the middle. Asian-American jazzis a musical movement in the United States begun in the 20th century mainly, though not exclusively, by Asian-American jazz musicians. Bob Lovitz/Wedding singer: Ladies nightJoe Piscopo: Joe Piscopo offers advice to President Trump on how to watch "SNL."The Orchard:The Orchard is an American music and entertainment company founded in 1997 by Richard Gottehrer.TH Creative NYC (Rebrandedto “Artists Without Labels”):Remote saxophone or other recording sessions, mixing, music production & distribution available through Thomas Hutchings “unlabel” Artists Without Labels”.Perforated colon: It is widely recognized that perforation of the sigmoid colon leading to abscess formation or spreading peritonitis is a common complication of sigmoid diverticulitis.Dilaudid: “Hydromorphone, also known as dihydromorphinone, and sold under the brand name Dilaudid, among others, is a centrally acting pain medication of the opioid class.”Star Wars: The Force Awakens (also known as Star Wars: Episode VII – The Force Awakens) is a 2015 American epic space opera film produced, co-written and directed by J. J. Abrams.Star Wars: The Force Awakens: Star Wars: The Force Awakens (also known as Star Wars: Episode VII – The Force Awakens) is a 2015 American epic space opera film produced, co-written and directed by J. J. Abrams.Near Death Experience: A near-death experience (NDE) is a personal experience associated with death or impending death. Such experiences may encompass a variety of sensations including detachment from the body, feelings of levitation, total serenity, security, warmth, the experience of absolute dissolution, and the presence of a light.Pick Up The Pieces: Pick Up the Pieces" is a 1974 song by the Average White Band from their second album, AWB.The Subtle Art of Not Giving a F*ck: A Counterintuitive Approach to Living a Good Life: In this generation-defining self-help guide, a superstar blogger cuts through the crap to show us how to stop trying to be "positive" all the time so that we can truly become better, happier people.Dalai Lama Book-Destructive Emotions: Imagine sitting with the Dalai Lama in his private meeting room with a small group of world-class scientists and philosophers...Bird & Diz/Kansas City:Emerging from the Jay McShann Orchestra from Kansas City and relentlessly curious about how to play the new music he heard in his head, Charlie Parker found sympathetic players in New York, especially Dizzy Gillespie.Good to Great-Jim Collins: In what Collins terms a prequel to the bestseller Built to Last he wrote with Jerry Porras, this worthwhile effort explores the way good organizations can be turned into ones that produce great, sustained results.Simply the Best-Tina Turner"The Best" is a song written by Mike Chapman and Holly Knight, originally recorded by Bonnie Tyler on her 1988 release Hide Your Heart (in the US the album was titled Notes from America). The song was later covered by Tina Turner, and released as a highly successful single in 1989. It was included on her hit album Foreign Affair. The saxophone solo on Turner's version is played by Edgar Winter.Earbuds Podcast Documentary:Years in the making.  Sort of. There has been a lot of chatter bandied around about the revolution of podcasting, how it's changing things, how it works and there should be a documentary about it.Support Foxes and Hedgehogs by donating to their Tip Jar: https://tips.pinecast.com/jar/foxes-and-hedgehogsThis podcast is powered by Pinecast.

Author: Jared Scott, M.D. Educational Pearls:   Recent study compared Compazine with Benadryl vs. Dilaudid for acute migraine management in the ED. Compazine + Benadryl demonstrated migraine relief in 60% of patients compared to the 31% of patients who were relieved with Dilaudid. Compazine + Benadryl is a superior migraine treatment than Dilaudid.   References: Friedman BW, et. al. (2017). Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine. Neurology. 89(20):2075-2082

Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I’m looking forward to sharing with you some of our community’s questions that have come in over the past few weeks…  Let’s get started! Cristi: Dear Dr. Cabral, I am a fairly new listener to your program, and I have been slowly catching up on all of your past episodes as they are both fascinating and helpful. I am in my early 40s, live a healthy, busy (two kids, full time job) active lifestyle with daily exercise (yoga, weight training, interval training, stretching, foam rolling) and an anti inflammatory diet similar to what you recommend. My BMI is optimal. Recently I have been able to feel a tendon or something (maybe my IT band) snap over a bone in my hip. At first, I thought it was happening only as I walked up hill and up stairs, but now it is there as I walk as well. From what I researched, this seems to be "snapping hip syndrome." It doesn't hurt, but I do not want it to progress to a point where it does. I do not know what caused it--maybe jumping on a cheap rebounder or doing full range of motion squats with weight (though it wasn't much more than 60 pounds, and I know I used correct form). I went to a chiropractor a couple of times, and that may have started to help, but I had previously used up my other visits in the allotted 12 my insurance allows per year, so I could not continue. I tried to go to a PT, but they wanted a written "diagnosis" from a medical doctor before they would see me. It seems to make sense to avoid motions during which this occurs, but it occurs even walking! I do not want to cut down on my activity level, but I don't want this to progress. Do you have any suggestions? Thank you!  Amber: I’m on several different medications. I’ve had three failed back surgeries. I have fusion in my lower back. I’m in pain everyday even with the medications I’m taking, also severe anxiety/panic attacks, and nerve pain down my left leg. I had a csf leak after second surgery which caused me to have a PICC Line in for three months. I had to hav Vancomyocin and Cephapine IV in high doses twice a day. That stuff was brutal. The medications I’m on is Dilaudid (2mg 3x day), Gabapentin (900mg 3x day), Klonopin (1mg 3x day), Zoloft (200mg 1x day), and Birth Control (1x day), plus they are currently adding Propanolol (10mg 3x day prn). I feel so sick and toxic inside every day. I’ve been in bed for three years straight except to get up to eat, shower, go to my appointments. I’m 28 now and hate feeling so sick and in terrible back pain. I was wondering how I could cut down on medications and what natural medications I can use. If I had the money to come see you, I would. I think one of my neighbors with chronic pain is going to fly from Tampa, FL to come see you. I’m on workers comp and living with my parents. I don’t have any money coming in and can’t work or even sit because of severe tailbone pain(which could be related to the metal rods and screws in my lower back). I would like to get that taken out, it’s been a little over two years since fusion surgery. Anything you can suggest, even a back surgeon I can see for a second opinion would be great. I really appreciate the your time in reading this. I hope you can help. Btw- I do take your cbd oil. It helps me to sleep, and sometimes helps my anxiety. My pain management doctor wants me to start medical marijuana vapor as soon as he gets his license to prescribe it. Plus, after my emg, I’m going to try acupuncture (workers comp is starting to do more natural things. I’ve been through a lot. Over 250 nights in hospitals since January 2015. I could keep going and tell you more, but the most important aspects are written to you here. Again, thank you so much!!! Amber Anonymous: Hi Dr. Cabral, I am a 34yo female who is 5’4.5” weighing 120lbs. I have been lifting heavy weights about 4x per week where I alternate days of upper and lower body weight training. I also take a gentle yoga class on Wednesdays. My cardio has been inconsistent 30 minutes here and there of the stair master or an occasional hour long step class once a week. I have also been on a completely vegan diet for over a year with very limited amounts of soy and gluten. Although I am small in stature (size 0), I feel like I am too soft for the amount of heavy lifting I am doing. I really want to see more definition in my arms, legs and abs and change my shape. Do you have any recommendations on how I should change my weight/cardio routine and what foods I should eat to ensure I get enough protein for my goals? Is it possible to get the right kind of body building protein on lentils/beans and vegetables? Should I consider soy? I used to eat tons of chicken breasts, egg whites and Greek yogurt and I do notice that I don’t have as much muscle definition but I wasn’t healthy either and had major digestive issues. I am trying to find a balance and at a loss on what is the best diet for my health as well as physique. I appreciate what you do each and every day. My husband ordered me your candida cleanse and 21 day detox and I cannot wait to begin.  Teresa: Hello, I would like to know if you have ever treated a child diagnosed with pandas or tics. We have seen tics go away with clostridia treatment but it rises again. Thanks. Judy: Hi Dr. Cabral, I have just received your 21day detox and your candida cleanse protocol. Which do you recommend I complete first? I noticed that I can have berries in the shake on the candida protocol but not the detox, so I am assuming these protocols should be completed separately. I am a 34yo female with hormonal acne issues and dealing with hypothyroidism and likley adrenal/cortisol issues based on what I have heard on your podcasts. I look forward to completing these protocols and eventually taking your tests to come up with a longer term game plan to achieving health and happiness. Merry Christmas to you, your family and staff! :) Mary: Hello Dr. Cabral. Thank you for your passion of getting your knowledge out to the masses. I very much appreciate it, as you have kickstarted my return to wellness. I recently got the results of a Genova GI effects test which came back relatively normal aside from a moderate microbe diversity (Euryarchaeota present and high E. Coli) and high Beta-glucuronidase. I know this is incomplete knowledge since you don't have all my labs/symptoms as I am not a patient, however, if only given this information would you consider this a possible dysbiosis that merits the use of your bacterial and yeast overgrowth protocol? Thank you. Also, what are your thoughts on calcium-D-glucarate to lower Beta-glucuronidase levels? Moderate microbe diversity ((higher than normal Euryarchaeota Phylum), (high Odoribacter spp., high anaerotruncus colihominis, high faecalibacterium prausnitzii, high lactobacillus spp. high pseudoflavonifractor app. high Veillonella spp. low collinsella aerofaciens, high E coli.)) low fecal fat cholesterol, low inflammation and immunology levels, high Beta-glucuronidase (9,000). Negative parasitology, non-pathogenic candida and sccharomyces levels. Thank you for tuning into this weekend’s Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes & Resources: http://StephenCabral.com/695 - - - Get Your Question Answered: http://StephenCabral.com/askcabral - - -    

We play two voicememos about hiding drugs in the place that doesnt shine. The first story is from Tim in Philly; he tells us about how he used to put heroin and xanax up his butt everytime he left the house because he thought he would get arrested and get sick in jail. The second voicememo is from Jason in Ontario; he tells about the time he got pulled over and the drug dealer in the backseat hid Diluadin up his rectrum... they got away and Jason did the drugs (obviously). We debate harm reduction and medication assisted treatment philosophy. Dave tells us about Star Wars and why he is so tired. We talk about Artie Lange's arrest and the "sludge" in his lung. 

Odysseus encounters the witch of the enchanted medroom and sights the demon of precipitated withdrawal just off shore. He considers the possibility of synthesizing Dilaudid from shampoo and decides to pay a visit to the damned in the underworld known as Cottage C.

  Jackie burnt his lips on some fried baloney again and can't talk. Who needs the news anyway? Shit on Trump.  Here's the story of Pharmacist Reynolds and Three Sticks of Candy. Also, remember when Jackie was on them pills?   Includes chunks of:   78: Repeal Star Wars Day (May 4, 2014) 80: Falling Down (May 19, 2014) 81: Jackie's on Dilaudid, Percocet, Valium (May 26, 2014) 82: Hard Choices (June 2, 2014) "The Magic Cowboy" courtesy of Seth Timbs. Check out 20 Minutes by Quick and Dirty!Red State Update theme "Tasty Sorghum Biscuit" by William Sherry Jr. 

I tell the nurse, “To my recollection, Adrienne was never given more than six milligrams of Dilaudid every four hours as a continuous drip except when she pushed the PCA for acute episodes of pain.” I speak these words, this medical mumbo jumbo, without thinking. I am one of them now, only without the degree. I hate it.

With the opioid crisis raging, patients with legitimate chronic pain are left wondering where they'll be when the pain pendulum swings back to "suck it up." Pain specialist Dr. Kathy Travnicek joins ZDoggMD to cohost and talk about solutions. It's Against Medical Advice CME Sunday!

Wess Haubrich, a self-trained visual artist and photographer from Quincy, IL, joins NOL to share how expressing emotions through art can effectively manage anxiety, depression and chronic migraines...all without medications.  He shares his journey through mood swings, depression, chronic pain and an addiction to Dilaudid, how he kicked it, and how anyone - even those who think they aren't artistic - can take real control over their own addictions, depression and/or anxiety through art. Wess and I discuss: his influences of film noir, crime scene photography, gothic literature, southern gothic what art brut is, and the advantages of self-training vs. formal art education understanding the rights you have to your art and successfully promoting your art his experience with the 12-step program for his former addiction his natural foray into film making I really enjoyed this conversation with Wess, and I hope it gets you thinking about the healing power of art too. To view and/or purchase Wess' incredible work, please visit his website at:  www.gemcitynoir.photography And if anyone would like to purchase one of those awesome cashmere scarves with Wess' art on them, please do.  FYI, I'm open to surprise cashmere holiday gifts :)   http://shopvida.com/products/the-cool-cashmere-scarf Pre-roll mentions: iTunes has submission deadlines with the holidays coming up, which means there will be delays with upcoming NOL episodes in terms of how quickly they push out to those of you who use IOS devices or apps.  The content will not stop!  So, even if you notice that new episodes aren't showing up on your phone or iPad every Sunday night as usual, you can still access the latest at www.ladyfoxentertainment.com/listen.  They'll show up on iTunes within a few days or so... Also, do you want financial freedom and the chance to enjoy your life, rather than staying attached to your cubicle or office?  Then check out how to start your own Amazon business and quit a day job you hate!  For more info, please visit the Resources page of my website and click on "Reliable Education", led by the amazing Adam Hudson:  www.ladyfoxentertainment.com/resourcespartners There are FREE LIVE WEBINARS coming up THIS WEDNESDAY NIGHT 11/23/16, if you'd like more info from Adam himself.  Check for your time zone here: @ 8:00PM Sydney time(AEDT) @ 8:00PM New York time(EST) @ 8:00PM LA time(PST)

In one of the most dramatic episodes of Memory Lane, Roger tells a story of love, divorce, & drug addiction. Roger came from a well-off family, & he is very aware that his trajectory, as well as his race, played a part in how his particular addiction story played out. For Roger, who was working as a nurse at the time, was prescribed Hydromorphone after an injury (which is commonly known under its German Brand name Dilaudid). Within 6 weeks of this prescription, Roger was shooting up Hydromorphone at dangerously high levels. And then he was caught. Listen to this extremely compelling edition of Memory Lane to hear one of the quickest falls I have yet to learn of into the pit of addiction. Roger is forthright & now can look back years later, but his addiction , he says, destroyed everything in his life. He is only now, almost a decade later, being able to reconstruct what addiction took from him. Share this story of addiction with someone who is in danger of developing this illness!

Generic Name hydromorphone Trade Name Dilaudid Indication moderate to severe pain Action alters the perception and reaction to pain by binding to opiate receptors in the CNS, also suppresses the cough reflex Therapeutic Class Opioid Analgesic, allergy, cold and cough… The post Hydromorphone: Dilaudid (opioid Analgesic, allergy, cold and cough remedies, antitussive) appeared first on NURSING.com.

Prince Was Murdered by the Pharmaceutical Industry; To my detractors that don't like what I have to say on MY show, you Can Go to HELL. You don't like it? Shove it! I don't need ANYONE to continue to do a successful talk show the way I want to. Nobody needs ya. Don't like it, don't listen.Prince's former drug dealer tells how the legend spent $40,000 at a time on six-month supplies of Dilaudid pills and Fentanyl patches Read more: http://www.dailymail.co.uk/news/article-3555292/Prince-s-former-drug-dealer-reveals-extent-addiction.htmlIntro Music: SnapCrack - Lilithhttps://soundcloud.com/snapcrack

Prince Was Murdered by the Pharmaceutical Industry; To my detractors that don't like what I have to say on MY show, you Can Go to HELL. You don't like it? Shove it! I don't need ANYONE to continue to do a successful talk show the way I want to. Nobody needs ya. Don't like it, don't listen.Prince's former drug dealer tells how the legend spent $40,000 at a time on six-month supplies of Dilaudid pills and Fentanyl patches Read more: http://www.dailymail.co.uk/news/article-3555292/Prince-s-former-drug-dealer-reveals-extent-addiction.htmlIntro Music: SnapCrack - Lilithhttps://soundcloud.com/snapcrack

Bienvenidos al episodio 39 de Mi Gato Dinamita, el podcast que no tiene ningún trauma resuelto ni por casualidad. Duración total: 1:00:12.0:00:01-0:15:20 - Susanette le da la bienvenida a Guille con una sesión de análisis enfocada en sus angustias como realizador cinematográfico. Es todo muy surrealista. Por suerte no le cobra.0:15:21-0:17:31 - Música: "Dilaudid", sospechoso cover por Entintado del hermoso original de The Mountain Goats.0:17:32-0:24:23 - Guille sospecha del aporte caramelístico de Susan, quien a su vez sufre la saña de sus gatos sobre su nueva cama. Se ningunea un poco a la pobre Pantera Rosa.0:24:24-0:29:26 - Entintado habla de la larga y fructífera carrera de Henry Mancini.0:29:27-0:31:52 - Música: "A Shot In The Dark", por Henry Mancini.0:31:53-0:37:43 - Guille propone un juego tecnológico que se desbanda. Todo vuelve al psicoanálisis, piedra fundamental de la civilización. Susanette y Guille, rarísimo, se pierden.0:37:44-0:41:30 - Música: "Let Me Entertain You", por Robbie Williams.0:41:31-0:48:25 - Guille cree que ya estamos en invierno, lo que deriva en un panegírico invernal por parte de Susan. Se habla de borrachos en la nieve y se le asigna una extraña tarea a Entintado.0:48:26-0:51:57 - Música: "Walter Reed", por Michael Penn.0:51:58-0:55:56 - Nos despedimos entusiasmados por la relación de nuestra oyente @belomagna con los Ayerza, nuestra familia favorita del Cementerio de la Recoleta. Guille se indigna por el costo de mantenimiento de las bóvedas.0:55:57-1:00:12 - Música: "Sympathy For The Devil (Fatboy Slim Remix)", remix de Fatboy Slim del original de The Rolling Stones.Ilustramos este episodio, como de costumbre, con algunas imágenes alusivas: émulos de Guille saliendo a la nieve desde un sauna; Henry Mancini y la Pantera Rosa; y una cama como la que los gatos de Susanette gustan de destrozar. Como siempre, podés disfrutar de este episodio online con el reproductor de acá arriba, bajártelo en formato .mp3 haciendo clic en donde dice "Download" o escucharlo en SoundCloud. Si querés suscribirte a este podcast con tu aplicación favorita, buscanos en iTunes o usá nuestro feed RSS.

The gang get a little sensational as they discuss an article on Norman Ohler's book The Total Rush: Drugs in the Third Reich. Learn how pretty much everyone was out of their gourds on drugs before, during and after World War II. We also have a discussion on how pervasive narcotics have been for war efforts.

BERT JANSCH. YARROW – 5:05Moonshine, Reprise, 1972 (réédition Fire records, 2015) DAVID BOWIE. SPACE ODDITY – 5:15David Bowie, Philips, 1969 GRANT-LEE PHILLIPS & THE SECTION QUARTET. ASHES TO ASHES – 5:00Ashes To Ashes (single), Zoe records, 2006 THE MOUNTAIN GOATS. DILAUDID – 2:10The Sunset Tree, 4AD, 2005 SUZANNE VEGA. LUKA – 3:10Close-Up (Volume 2, People […] Cet article Errance #48 : De Bert Jansch à Julee Cruise est apparu en premier sur Eldorado.

Jackie's on the floor on his napping towel with a pinched nerve and hopped up on Dilaudid and Percocet and Valium. The show, however, must go on, even if it's a podcast.  The boys talk about the VA scandal, Memorial Day, and the Murfreesboro dude who had sex with an ATM machine. This episode may not always make perfect sense or use words that exist or are audible, but we're dedicated. We're dedicated. Sponsored by 3 Sticks of Candy ("Watch out for the rabbits!") and Elmer's Jewelry ("Lado de la Plaza.")

Kris and Kole talk about opulence, celebrity, and gender. SUGGESTED TALKING POINTS: Scott Baio's real voice. Arrested Development Season 4. Wheel of Fortune spinnaz. A small bit of actual advice. Pam's World. Horse Port. PSH, on H. Hollywood Korner. Health food and hepatitis. Poop baby. Haunted by ghost chilis. Smooth Sailing. Chill baby. Dilaudid.

          We're addicted. Comic Con, movies, Olympics...and pharma. And bugs. But you'll have to listen. Dilaudid. Our new drug of choice. We missed Comic Con aka SDCC. We have the feels about it, but thinking a smaller Con is in our future. Neil Gaiman's commencement address. (Not Neil Diamond.) Kevin Smith loves Ritzy more than he loves TI. ;) We love the Olympics. USA! USA! And: SI MEXICO!

Featuring songs from The Buzzcocks and The Clash, a subtle tribute to the significance of the events on that Tuesday morning ten years ago today.  With some association, a narrative might be divined. None was intended. Concludes with Music For Airports.V. Here we go round the prickly pear Prickly pear prickly pear Here we go round the prickly pear At five o'clock in the morning. Between the idea And the reality Between the motion And the act Falls the Shadow For Thine is the Kingdom Between the conception And the creation Between the emotion And the response Falls the Shadow Life is very long Between the desire And the spasm Between the potency And the existence Between the essence And the descent Falls the Shadow For Thine is the Kingdom For Thine is Life is For Thine is the This is the way the world ends This is the way the world ends This is the way the world ends Not with a bang but a whimper.Track, Name, Artist, Album1, Everybody Knows, Leonard Cohen, I'm Your Man2, Dreamt For Light Years In The Belly Of A Mountain, Sparklehorse, Dreamt For Light Years In The Belly Of A Mountain3, Ever Fallen in Love (With Someone You Shouldn't've), Buzzcocks, Love Bites4, Atomic Garden, Bad Religion, Generator5, I'm So Bored With The U.S.A., The Clash, The Clash (U.K.)6, Manière de parler, Daniel Bélanger, L'échec du matériel7, Shiva, The Antlers, Hospice8, Love Will Tear Us Apart, Joy Division, Substance9, High and Dry, Radiohead, The Bends10, An Appeal to St. Peter, Pale Young Gentlemen, Pale Young Gentlemen11, Float On, Modest Mouse, Good News for People Who Love Bad News12, In the Aeroplane Over the Sea, Neutral Milk Hotel, In the Aeroplane Over the Sea13, Karma Police, Radiohead, OK Computer14, Dilaudid, The Mountain Goats, Dilaudid15, Dirty Old Town, The Pogues, Rum Sodomy & the Lash16, Homeward Bound, Simon & Garfunkel, Parsley, Sage, Rosemary and Thyme17, Burma Shave, Tom Waits, Bounced Checks18, The Hollow Men for Trumpet and Strings,  Op. 25, T.S. Eliot & Vincent Persichetti, The Estamos Unidos Project19, 1/1, Brian Eno, Ambient 1: Music for Airports20, 2/1, Brian Eno, Ambient 1: Music for AirportsLyrics to come:

How I learned to stop worrying and love the bomb. Music stuff with Einstein & Oppenheimer.Comments &c are more than welcome. Friends, I pray this podcast finds you and finds you well. I woke up at 0230 GMT-5 and gave up on trying to sleep, and recorded this very cast. There seems to be a thematic anchor of cinema, but my inspiration was drawn from an idea and experience of being a child and believing the world was to end imminently. "We can drink the water from the toilet reservoir, but not the bowl," and "We can cover the windows with telephone books (as if we had them)," are phrases I remember. Anyway, there is beauty in learning to love the bomb. As June has ended in my 33rd year, and I, at the mercy and grace of the Universe go on to live now, I think back on the certainty that I would never see these days. "I'm not going to be alive when I would be thirty." I said. I was so sure. It was my lot. And I was wrong. It's good to be wrong. I'm wrong at least once a day.Two days before the Trinity test, Oppenheimer expressed his hopes and fears in a quotation from the Bhagavad Gita:In battle, in the forest, at the precipice in the mountains,On the dark great sea, in the midst of javelins and arrows,In sleep, in confusion, in the depths of shame,The good deeds a man has done before defend him. ***Bonne Ecoute,Track,Name,Artist,Album,Time (Seconds)0,Brazil - Geoff Muldaur,Michael Kamen,Brazil,2061,Miracles,Bobby Johnston,Wristcutters: A Love Story,162,E=mc²- Einstein explains his famous theory,Einstein,None,583,Smoke and Mirrors,The Magnetic Fields,Get Lost,1884,Lament,Sonny Lester, His Orchestra & Chorus,Take It Off! Striptease Classics,1855,House of the Rising Sun,The Animals,The Singles Plus,2706,Velvety Instrumental Version,Pixies,Complete B Sides,1247,Occurrence on the Border (Hopping on a Pogo-Gypsy Stick),Gogol Bordello,Wristcutters: A Love Story,2068,Collapsing Stars,The Mountain Goats,Dilaudid,1499,Withnail and I - Hamlet Soliloquy,Richard E Grant,None,10510,Three Changes,The Good, The Bad & The Queen,The Good, The Bad & The Queen,25711,Clap Your Hands,Pale Young Gentlemen,Pale Young Gentlemen,17912,Clap Your Hands!,Clap Your Hands Say Yeah,Clap Your Hands Say Yeah,10813,The Card Cheat,The Clash,London Calling,22914,Ledmonton,Clues,Clues,26215,Sunflower,Nicolas Jaar,Space Is Only Noise,4816,Trinity Oppenheimer,Oppenheimer,None,9917,I'm on Fire (Bruce Springsteen cover),Chromatics,In The City 12",19818,We Built Another World,Wolf Parade,Wolf Parade,2030,Brazil - Geoff Muldaur,Michael Kamen,Brazil,20619,100,000 Fireflies,The Magnetic Fields,The Wayward Bus / Distant Plastic Trees,200Lyrics are in podcast.  Alternative solution forthcoming.