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Dive into practical, evidence-based approaches to managing pain in patients with opioid use disorder, bust common myths, and explore strategies to support patients. This episode will enhance your skills in providing holistic, patient-centered care. We're joined by Dr. Jessica Merlin, @JessicaMerlinMD (University of Pittsburgh). Claim CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Episodes | Subscribe | Spotify | iTunes | CurbsidersAddictionMed@gmail.com | CME! Credits Producer, Show Notes, Infographics: Carolyn Chan MD, MHS Hosts: Carolyn Chan, MD, MHS and Shawn Cohen MD Reviewer: Payel Jhoom Roy MD, MSc Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Jessica Merlin MD, PhD, MBA Sponsor: JournalFeed Try JournalFeed free for 7 days — and get 20% off your first year with code CURB25 at journalfeed.org/curb. Sponsor: Freed Usecode: CURB50 to get $50 off your first month when you subscribe at freed.ai Sponsor: Mint Mobile Get your summer savings and shop premium wireless plans at MINTMOBILE.com/CURB
Dr Erin Louise Bellamy founded Integrative Ketogenic Research and Therapies which uses principles of Metabolic Psychiatry to provide remote, highly personalized 1:1 Metabolic Therapy for both psychiatric conditions and overall metabolic health. Dr. Erin Bellamy has a PhD in Psychology, specializing in Ketogenic Diets & Depression from the University of East London. She also has an MSc in Psychiatric Research from the Institute of Psychiatry at King's College London. She is a Chartered Psychologist, an Associate Fellow of the British Psychological Society and an accredited member of the Society of Metabolic Health Practitioners. In this episode, Drs. Brian and Erin talk about… (00:00) Intro (01:36) How Dr. Erin became interested in Metabolic Psychiatry (05:38) Ketogenic diets and psychiatric conditions (15:39) Fasting and mental clarity (18:12) The areas in which clinical psychology is deficient in helping patients (23:46) Adverse childhood events, PTSD, and metabolic health (28:24) Binge eating, stress, and support groups (40:00) Food addiction and ketosis (43:59) Schizophrenia, autism, and ketosis (01:00:46) Outro/plugs For more information, please see the links below. Thank you for listening! Links: Please consider supporting us on Patreon: https://www.lowcarbmd.com/ Resources Mentioned in this Episode: Dr. Erin Bellamy on the Life's Best Medicine Podcast: https://lifesbestmedicine.com/podcast/episode-248-dr-erin-bellamy/ Dr. Erin Bellamy: Instagram: https://www.instagram.com/erinlouisebellamy/ X: https://x.com/erinlbellamy Integrative Ketogenic Research & Therapies: https://www.ikrt.org Dr. Brian Lenzkes: Website: https://arizonametabolichealth.com/ Twitter: https://twitter.com/BrianLenzkes?ref_src=twsrc^google|twcamp^serp|twgr^author Dr. Tro Kalayjian: Website: https://www.doctortro.com/ Twitter: https://twitter.com/DoctorTro Instagram: https://www.instagram.com/doctortro/ Toward Health App Join a growing community of individuals who are improving their metabolic health; together. Get started at your own pace with a self-guided curriculum developed by Dr. Tro and his care team, community chat, weekly meetings, courses, challenges, message boards and more. Apple: https://apps.apple.com/us/app/doctor-tro/id1588693888 Google: https://play.google.com/store/apps/details?id=uk.co.disciplemedia.doctortro&hl=en_US&gl=US Learn more: https://doctortro.com/community/
"Beneath the Lilypad" is singer-songwriter Alexandra Savior's third album, but her first in five years. Several years ago, she was diagnosed with bipolar disorder, type 1. That's a condition marked with manic highs that can last for weeks or months as well as crushing lows of depression, she's had both, you'll hear about that. She's also dealt with psychosis, and has spent time in an in-patient facility. That mental health journey has informed her work as a songwriter and a musician and inspired the songs on the new album. She just turned 30 but she's been performing since high school when she was more or less discovered on YouTube by Courtney Love who helped launch her career.Thank you to all our listeners who support the show as monthly members of Maximum Fun.Check out our I'm Glad You're Here and Depresh Mode merchandise at the brand new merch website MaxFunStore.com!Hey, remember, you're part of Depresh Mode and we want to hear what you want to hear about. What guests and issues would you like to have covered in a future episode? Write us at depreshmode@maximumfun.org.Depresh Mode is on BlueSky, Instagram, Substack, and you can join our Preshies Facebook group. Help is available right away.The National Suicide Prevention Lifeline: 988 or 1-800-273-8255, 1-800-273-TALKCrisis Text Line: Text HOME to 741741.International suicide hotline numbers available here: https://www.opencounseling.com/suicide-hotlines
In this episode of Insights into Technology, we dive deep into the dark web of cybersecurity as a new hacker collective takes a surprising aim at Russia in retaliation for geopolitical tensions. Discover how Microsoft is tightening its security belts by blocking over 120 risky email attachments in Outlook, aiming to shield users from malicious threats. We also explore a privacy oversight that left Google scrambling when their 'Find My Device' feature inadvertently became a tool for hackers to reverse-engineer user phone numbers. Join us as we unravel these digital dramas and their profound implications on global cyber landscapes.
With autoimmune disorder and impaired vision plaguing her she was in pain. The Lord promised her healing and she came into House of Glory believing that she would be healed. He touched her and healed her of pain and clouded vision! He is the healer and all glory goes to Him! www.cathycoppola.org www.houseofglorychurch.org
With autoimmune disorder and impaired vision plaguing her she was in pain. The Lord promised her healing and she came into House of Glory believing that she would be healed. He touched her and healed her of pain and clouded vision! He is the healer and all glory goes to Him! www.cathycoppola.org www.houseofglorychurch.org
In this episode of Insights into Technology, we dive deep into the dark web of cybersecurity as a new hacker collective takes a surprising aim at Russia in retaliation for geopolitical tensions. Discover how Microsoft is tightening its security belts by blocking over 120 risky email attachments in Outlook, aiming to shield users from malicious threats. We also explore a privacy oversight that left Google scrambling when their 'Find My Device' feature inadvertently became a tool for hackers to reverse-engineer user phone numbers. Join us as we unravel these digital dramas and their profound implications on global cyber landscapes.
Playlist: Strawbs - Autumn: Heroine's Theme, Deep Summer's Sleep, The Winter LongKing Crimson - EpitaphPink Floyd - EchoesCamel - IceGenesis - Supper's ReadyJethro Tull - Thick as a BrickJane - DaytimeGrobschnitt - Solar Music LiveEloy - The Light From Deep DarknessScorpions - Fly To the Rainbow
Join Tom Bilyeu and his co-host Drew as they tackle hot-button issues—from national protests and government response to the growing concerns of political polarization and economic instability. As the headlines scream about cities on fire and rumors of civil war swirl, Tom and Drew challenge each other's perspectives, debating how much of our current climate is real versus media-fueled overdramatization. They'll share their unique “inside the car vs. drone's-eye view” approach to understanding how local experiences and national trends collide. In this episode, they break down the waves of protest in LA, the government's response, and the political strategies at play—especially in the context of Trump's and Newsom's public standoff. Plus, they don't shy away from the hard questions: Are we witnessing the early signs of a larger societal unraveling? How do personal freedoms, law and order, and economic distress fit into the bigger picture? And what can history—and thinkers like Ray Dalio—teach us about what might come next? SHOWNOTES 00:00 Stuck in a Recurring Cycle 06:36 National Guard's Role in Riots 11:45 Managing Conflict in Tense Situations 16:02 Overreaction and De-escalation Challenges 21:50 "Addressing Riots and Armed Response" 28:42 Debate on Borders and Civil Order 35:08 Marxism Critique and Popularity Debate 40:36 "Avoidance: Theory vs. Practice" 46:20 State Moves Highlight Political Dynamics 51:48 "China's Economic Gamble at Risk" 55:22 "Disproportionate Rewards Drive Innovation" 01:02:44 Government Seizure of Bitcoin 01:04:31 "AI-Driven Reality Verification" CHECK OUT OUR SPONSORS Vital Proteins: Get 20% off by going to https://www.vitalproteins.com and entering promo code IMPACT at check out ButcherBox: New users that sign up for ButcherBox will receive their choice between steak tips, salmon, or chicken breast in every box for a year + $20 off their first box at https://butcherbox.com/impact Monarch Money: Use code THEORY at https://monarchmoney.com for 50% off your first year! Shopify: Sign up for your one-dollar-per-month trial period at https://shopify.com/impact iTrust Capital: Use code IMPACTGO when you sign up and fund your account to get a $100 bonus at https://www.itrustcapital.com/tombilyeu Jerry: Stop needlessly overpaying for car insurance - download the Jerry app or head to https://jerry.ai/impact Learn more about your ad choices. Visit megaphone.fm/adchoices
PREVIEW: Colleague Jeff Bliss of Pacific Watch reports that the seventh night of disorder in LA and other cities, including Las Vegas, was subdued and absent looting. More. 1900 POTLAND
Amanda Stern, author of the memoir "Little Panic: Dispatches from an Anxious Life," shares her story of growing up with an undiagnosed and unsupported panic disorder. Learn more about your ad choices. Visit podcastchoices.com/adchoices
While there are studies that show cannabis may be useful in alleviating pain, nausea, and other symptoms associated with certain medical conditions, some doctors and researchers are seeing a rise in unexpected and serious health problems linked to its use – including cannabis use disorder, cannabis hyperemesis syndrome, and even psychosis. In this episode, Dr. Rachel Wightman, an emergency physician who has been at the forefront of treating patients affected by these conditions joins Dr. Philip Chan to help us understand these emerging issues.
Come to a Dehoarding Accountability Zoom Session: http://www.overcomecompulsivehoarding.co.uk/ticket Subscribe to the podcast: https://www.overcomecompulsivehoarding.co.uk/subscribe Podcast show notes, links and transcript: http://www.overcomecompulsivehoarding.co.uk/ Today I'm looking at what happens if we forgive ourselves for past hoarding behaviours, why we maybe should, and how we can actually use that insight to make better choices and move forward. I talk honestly about the shame and guilt that keeps so many of us stuck. There's some reflection on the roots of hoarding, the importance of self-compassion, and why hating ourselves into action just doesn't work - plus a few practical suggestions for anyone trying to make a change, no matter where you're starting from. Buy your copy of Everything You Need to Know About Hoarding by Dr Lynne Drummond at cambridge.org/EverythingHoarding, and get 20% off with the discount code HOARDING20. #ad Forgiving Ourselves but Doing Better Exploration of guilt and shame related to hoarding and feeling overwhelmed. Reflection on self-blame, regret, and paralysis it can cause. Catholic upbringing: Confession, forgiveness, and the importance of genuine intent to change. Recognition that hoarding often stems from trauma, loss, fear, anxiety, or neurodivergence. Discussion of cause and effect - influences behind hoarding behavior. Emphasis that hoarders are not lazy or bad people, but in a complex situation. The cycle of self-judgement and the importance of self-compassion as an antidote to shame. Practical advice: Treat oneself with the compassion you'd offer others, challenging negative self-talk. How self-criticism can demotivate and hinder progress. Comparison: Encouraging someone else is more effective than berating oneself. Understanding mistakes, taking responsibility, and making amends when possible. The importance of learning from past experiences and committing to doing better. Practical Strategies for Moving Forward Suggestions for emotional and action-oriented progress: Journalling or talking to someone about feelings. Looking back with compassion to identify patterns and triggers. Start dehoarding by breaking tasks into small steps. Avoiding perfectionism; celebrating any progress. Reference to "towards and away moves" from episode 182 with Dr. Jan Eppingstall. Identifying values and making choices that align with them. Finding support from therapists, friends, family, support groups, or accountability sessions. Acknowledgement that forgiving oneself is challenging but necessary for progress. Emphasising persistence, compassion, and learning from mistakes. Encouragement and Validation Recognition of listeners at various stages of their journey - starting, struggling, making progress, or just listening for now. Assurance that small steps count and everyone is doing their best. Emphasis that listeners are not alone. Links Podcast ep 181: Past influences and future possibilities: cause and effect and hoarding disorder (plus Podcasthon) Podcast ep 95: Shame and hoarding with Professor Luna Dolezal Podcast ep 182: What are “towards and away moves” and what on earth do they have to do with hoarding recovery? With Dr Jan Eppingstall The Gray Area podcast Come to a Dehoarding Accountability Zoom session: Accountability Booking Form Website: Overcome Compulsive Hoarding Become a Dehoarding Darling Submit a topic for the podcast to cover Questions to ask when dehoarding: https://www.overcomecompulsivehoarding.co.uk/podquestions Instagram: @thathoarderpodcast Twitter: @ThatHoarder Mastodon: @ThatHoarder@mastodon.online TikTok: @thathoarderpodcast Facebook: Overcome Compulsive Hoarding with That Hoarder Pinterest: That Hoarder YouTube: Overcome Compulsive Hoarding with That Hoarder Reddit: Overcome Compulsive Hoarding with That Hoarder subreddit Help out: Support this project Sponsor the podcast Subscribe to the podcast Subscribe to the podcast here
'There's political forums for these discussions, that's where it should be - it should never descend into violence' - Jonathan Buckley warned those involved in disorder risk a criminal record. Frank also spoke to deputy mayor Jess Johnston Hosted on Acast. See acast.com/privacy for more information.
Dr. Piper Gibson, PhD is a Functional Medicine and Holistic Nutrition expert who helps overwhelmed parents naturally reduce their child's tic disorder symptoms. She founded the Tic Disorder Institute: Regenerating Health, and author of an international best-seller “Tic Talk: Common misconceptions, natural approaches, and real conversations about tic disorders.” Piper combines food, functional labs, and natural tools to guide families toward real, lasting change.Become a supporter of this podcast: https://www.spreaker.com/podcast/mission-evolution-with-gwilda-wiyaka--2888020/support.
As seen on Gutfeld!, Greg mocks the latest attempts of Democrats trying to distance themselves from wokeism. Plus, Greg calls Democrats for continuing to downplay the LA riots. Learn more about your ad choices. Visit podcastchoices.com/adchoices
This episode explores the psychological and financial side of retirement planning through the lens of entropy. Don and Tom dive into an article from Kiplinger that cleverly compares retirement to the second law of thermodynamics: left unmanaged, both money and purpose tend toward chaos. Only 4% of retirees say they're "living the dream"—and the duo explores why that number is so shockingly low. From maintaining routine and finding meaning to avoiding common money traps like over- or under-spending, this episode is packed with practical insights and sardonic banter. Plus, listener questions on Roth conversions for low-income parents and generating sustainable income in retirement portfolios. 0:04 Why we're talking thermodynamics on a money show1:40 The "Second Law" of Retirement: Life drifts toward chaos2:15 Only 4% of retirees say they're "living the dream"3:06 Why retirement can be scary—even for us4:44 Do something in retirement... but get paid for it?6:09 Volunteering vs. purposeful work (and airplane nostalgia)7:03 Retirement spending traps: splurging or hoarding8:09 The danger of financially supporting adult children9:43 Composer John Williams and the myth of retirement11:24 Three keys to a better retirement: social, purpose, activity12:04 Paul Merriman, semi-retirement, and finding meaning13:23 It all still comes down to money—and the freedom it brings14:42 Steve Martin's quote on money and dumb stuff15:30 Listener question: Tax-efficient Roth conversions for elderly parents20:07 Listener question: Income generation with ETFs vs. income funds22:51 Junk bonds, Franklin Income Fund risk, and total return25:48 Strategy tip: Keeping a year of cash to smooth out volatility26:11 Upcoming events and Apollo's July 9th appearance27:37 Free portfolio review offer and purpose in helping others28:51 Tom's boat motor saga and 1-star review nightmares Learn more about your ad choices. Visit megaphone.fm/adchoices
Recorded 2025-06-12 02:58:08
Subscribe in a reader Men divorcing a narcissist often encounter unique legal and emotional challenges that are rarely discussed openly. We're diving deep into how female narcissists operate during divorce and the unique challenges men face, including being falsely accused, alienated from their children, and financially manipulated. John and I discuss how toxic narratives hurt […] The post The Hidden Struggles Men Divorcing a Narcissist Face | Interview with John Nachlinger appeared first on Narcissist Abuse Support.
Conor Macauley, RTÉ Northern Correspondent, reports on the violence in Larne, Co. Antrim last night, after a local leisure centre was set on fire.
Unrest and violence continued for a third night this in Northern Ireland, with petrol bombs thrown, buildings and vehicles set ablaze, and dozens of police officers being injured. The violence initially erupted in Ballymena on Monday after two 14-year-old Romanian boys were charged with a serious sexual assault. Anti-immigration protestors gathered in towns across the north with some being peaceful, while others turned violent. Host; Ciarán Dunbar, Guests; Gabrielle Swan and Kevin Scott See omnystudio.com/listener for privacy information.
Jonathan Swain, Senior News Correspondent with ITV's ‘Good Morning Britain'
In Ballymena, police gathered to deter any rioters planning disorder for a third night in a row. Speaking to Newstalk Breakfast was Newstalk Reporter Josh Crosbie who is on the ground there and Alex Burghart, Conservative MP and Shadow Secretary of State for Northern Ireland.
In the 8 AM hour, Larry O'Connor and Julie Gunlock discussed: Continued Lawlessness and Disorder in Los Angeles Unhinged Wealthy, White Leftist Women WMAL GUEST: Kennedy Center Spokesperson Roma Daravi on Les Miserables' Opening Night Where to find more about WMAL's morning show: Follow Podcasts on Apple, Audible and Spotify Follow WMAL's "O'Connor and Company" on X: @WMALDC, @LarryOConnor, @JGunlock, @PatricePinkfile, and @HeatherHunterDC Facebook: WMALDC and Larry O'Connor Instagram: WMALDC Website: WMAL.com/OConnor-Company Episode: Wednesday, June 11, 2025 / 8 AM HourSee omnystudio.com/listener for privacy information.
Right-wing authoritarian and extremist movements are on the march worldwide. This podcast will host some of the globe's leading experts on the radical right to help us understand the development of these extremists. Each episode, hosts and guests bring their specialist insights to break down the critical people, places, organizations, actions, and ideas of the radical right. Produced by the Centre for Analysis of the Radical Right Special Guest: Bharath Ganesh.
Send us a textScott and John are joined by singer/songwriter Mark Knight from Mark Knight and the Unsung Heroes, and formerly of Bang Tango for a little chat about all things music. markknightandtheunsungheroes.comYoutube: https://www.youtube.com/@narcissisticmusicdisorderJoin us on Facebook at NMD podcast group.nmdpodcast@gmail.com to contact us.Tell your friends!!Be sure to Like and Subscribe. Thanks for listening!
At different engagements throughout the month, NATO allies will meet in Brussels and the Hague to discuss Ukraine and defense spending – with Trump's team putting pressure on the Europeans to up their spending to 5% of GDP. But with the Americans wavering on the alliance as a whole, and these unrealistic spending targets: Can NATO survive?To find out, Arthur Snell speaks with Sten Rynning, professor and director of the Danish Institute for Advanced Study, University of Southern Denmark, and author of ‘NATO: From Cold War to Ukraine, a History of the World's Most Powerful Alliance'. The duo discuss the origins and evolution of NATO, the significance of Article 5, NATO's complex relationship with France, and the challenges faced during the Afghanistan mission. Plus: the contentious issue of NATO's eastward expansion in the wake of the fall of the Soviet Union, and the Alliance's role in maintaining Order in the Post-War era. And as they conclude the discussion, they explore the future of European security architecture, the importance of America's role in NATO, and – to Order the Disorder – the need for a cohesive European defense strategy.Producer: George McDonaghSubscribe to our Substack - https://natoandtheged.substack.com/Disorder on YouTube - https://www.youtube.com/@DisorderShow Show Notes Links:Get Sten Rynning's book, NATO: From Cold War to Ukraine, a History of the World's Most Powerful Alliance - https://www.londonreviewbookshop.co.uk/stock/nato-from-cold-war-to-ukraine-a-history-of-the-world-s-most-powerful-alliance-sten-rynning Watch The Paradox of the Anti-Semitic Boulder attack - https://www.youtube.com/watch?v=R7zAO_5CtfE Check out our Bookshop.org affiliate site behindthelines and please sign up for my substack at arthursnell.substack.com and/or follow me on Bluesky@snellarthur.bsky.social. You can sometimes find me on other podcasts - most often Disorder which I am involved with in partnership with RUSI, the Royal United Services Institute, the world's oldest think tank. Hosted on Acast. See acast.com/privacy for more information.
In this Healthed lecture, A/Prof Daryl Efron addresses all the practical aspects of autism spectrum disorder as well as discuss different presentations, common comorbidities and how treatment priorities change over time for affected children.See omnystudio.com/listener for privacy information.
This week, Axe and Heilemann are joined by Marc Short—former Chief of Staff to Vice President Mike Pence and Director of Legislative Affairs under President Trump—for a jam-packed conversation. From his front-row seat in the Trump administration, Short reflects on what feels like a political Groundhog Day: National Guard troops on the ground in California. He opens up about working with Stephen Miller, hints at what Mike Pence might have planned next, and weighs in on the future of the Republican brand in a post-Trump era. Plus, the Hacks take on the national debt, the GOP's tug-of-war between cultural and economic messaging, Elon Musk's latest pivots, and peek into the crystal ball for today's primaries.
#PACIFICWATCH:POTUS DIRECTS US MARINES TO SUPPLEMENT CALIFORNIA NATIONAL GUARD AND LAPD THE FOURTH NIGHT OF DISORDER IN LA. @JCBLISS 1900 LA ALLIGATOR FARM
What should politicians in NI say in response to that kind of disorder?
In this episode, mental health advocates Shaley Hoogendoorn and Julie Kraft discuss hypomania. For them, hypomania has two sides- the bright but also the dark. In this follow-up to episode 11, they share what it feels like in their minds and bodies when the destructive side of hypomania rears its head. What are the problems & pitfalls? In what ways are their lives, and the lives of those around them, affected the most? Listen in as Shaley and Julie also share about how they spot warning signs and now manage the messy parts of hypomania. It is their greatest hope that this episode gives a real-life glimpse into the rocky side of the rollercoaster that is hypomania. This is bipolar... (00:03:42) The challenges of unmanaged hypomania (00:06:37) Before medication: Hypomania's effects (00:15:01) The journey of self-awareness (00:19:53) Understanding anger & rage (00:23:02) Balancing creativity & family (00:32:44) The importance of boundaries (00:38:12) Navagating self expectation & growth If you are listening and have stories or tips or practices that help you cope, I'd love to hear. DM me on @this.is.bipolar on instagram or find me at thisisbipolar.com. I'd love to connect. Thank you from the bottom of my heart for being here.It is my greatest hope that sharing journey living with bipolar disorder will comfort, educate and inspire others. If this episode or podcast means something to you and you want to give me the best birthday present ever- I would be forever grateful if you would follow/subscribe the ‘this is bipolar' podcast wherever you listen to your podcasts so you stay up to date. It would also mean the world to me if you gave a 5 ️ review- this helps the podcast reach those who need to hear it most. There is also an option on IG to become a subscriber to have access to exclusive 'going deeper' episodes of the podcast. Hope to see you there. We are all in this together. Love, Shaley *Note: Hypomania is a lesser form of mania and a symptom of Bipolar 2 Disorder. Neither Julie nor Shaley have had a full-blown manic episode and cannot speak to that experience. Mania and Hypomania have a shadow side and in no way do they want to glorify it. Please know that we take hypomania very seriously and are committed to their treatment plans, which for them includes medication. #thisisbipolar #thisisbipolarvlog #thisisbipolarpodcast
A Couple of Multiples: The Reality of Living with Dissociative Identity Disorder
Drew & Garden System discuss in-patient/hospitalization care for people living with dissociative identity disorder with Donna Earle, LPC, CCPT. They cover important topics such as helpful tips for hospital staff, the differences between the different levels of care, and identifying potential treatment centers. Please note that the hospitals and treatment centers listed are NOT recommended or endorsed by A Couple of Multiples/Mindful Multiplicity Institute LLC. Please research facilities before admittance.Facilities mentioned include: Sierra Tucson in Arizona: https://www.sierratucson.com/ Sanctuary Centers in Santa Barbara: https://sanctuarycenters.org/ The Meadows in Wickenburg, Arizona: https://www.themeadows.com/ The Meadows in Dallas, Texas: https://meadowsoutpatient.com/locations/dallas-tx/ River Oaks in New Orleans, Louisiana: https://riveroakshospital.com/ Khiron Clinics in the UK: https://khironclinics.com/Thank you to this episode's sponsors:Healing Selves TherapeuticsTo Life! CounselingSend us a textFollow us on Instagram: @acoupleofmultiples, @note_to_selves, @seidi_gardensystem Follow us on TikTok: @seidi_gardensystem, @note_to_selves Follow us on Facebook: A Couple of Multiples - https://www.facebook.com/profile.php?id=61556823127239 Visit our website: acoupleofmultiples.com to sign up for our mailing list, join our private, on-line community Hearts Multiplied, register for peer coaching, consultations, and workshops!
At different engagements throughout the month, NATO allies will meet in Brussels and the Hague to discuss Ukraine and defense spending – with Trump's team putting pressure on the Europeans to up their spending to 5% of GDP. But with the Americans wavering on the alliance as a whole, and these unrealistic spending targets: Can NATO survive? To find out, Arthur Snell speaks with Sten Rynning, professor and director of the Danish Institute for Advanced Study, University of Southern Denmark, and author of ‘NATO: From Cold War to Ukraine, a History of the World's Most Powerful Alliance'. The duo discuss the origins and evolution of NATO, the significance of Article 5, NATO's complex relationship with France, and the challenges faced during the Afghanistan mission. Plus: the contentious issue of NATO's eastward expansion in the wake of the fall of the Soviet Union, and the Alliance's role in maintaining Order in the Post-War era. And as they conclude the discussion, they explore the future of European security architecture, the importance of America's role in NATO, and – to Order the Disorder – the need for a cohesive European defense strategy. Producer: George McDonagh Subscribe to our Substack - https://natoandtheged.substack.com/ Disorder on YouTube - https://www.youtube.com/@DisorderShow Show Notes Links: Get Sten Rynning's book, NATO: From Cold War to Ukraine, a History of the World's Most Powerful Alliance - https://www.londonreviewbookshop.co.uk/stock/nato-from-cold-war-to-ukraine-a-history-of-the-world-s-most-powerful-alliance-sten-rynning Watch The Paradox of the Anti-Semitic Boulder attack - https://www.youtube.com/watch?v=R7zAO_5CtfE Listen to Arthur's Behind The Lines Podcast - https://podcasts.apple.com/gb/podcast/behind-the-lines-with-arthur-snell/id1704344656 Learn more about your ad choices. Visit megaphone.fm/adchoices
RTÉ Correspondent Conor McAuley reports from Ballymena on the incident which occurred there last night which left 15 officers injured.
This week Julie, and Chrissa are joined by Alexis Moore, a BHIS Provider at Heart and Solutions. Alexis has worked with a wide range of ages, from taking care of kids in a daycare, to taking care of old folks nursing homes, to working with youth and teens at a youth shelter! She is currently a BHIS provider through Heart and Solutions, and in the future plans to go back to school to pursue a master's degree in mental health counseling. In her free time she loves to play with and snuggle her cats!To start behavioral or mental health services in Iowa call Heart and Solutions at (800) 531-4236. Connect with Alexis:Web: https://heartandsolutions.net/providers/alexis-moore/ Connect with Heart and Solutions online at:Spotify: https://open.spotify.com/show/2dWKD6TenIMIC76ctq21YNYoutube: https://www.youtube.com/channel/UCPmrcmi5HUINpWEjHfHzTnQ/featuredPodcast Facebook: https://www.facebook.com/YouNeedaCounselorHeart and Solutions Facebook: https://www.facebook.com/HeartandsolutionsInstagram: https://www.instagram.com/you_need_a_counselor/Web: http://www.heartandsolutions.net
Listen in as Sergio & Katelynn discuss some interesting facts about reading. They also discuss their most recent book; A Flicker in the Dark by Stacy Willingham.
How do we navigate spiritual transformation when everything seems to be falling apart? In this episode, we're exploring Chapter 4 of Richard Rohr's final book, The Tears of Things: Prophetic Wisdom for an Age of Outrage, titled "Welcoming Holy Disorder: How the Prophets Carry Us Through." After our conversation with Richard, we're joined by Jungian psychologist and author Connie Zweig, who deepens our exploration into the role of the shadow, the hidden parts of ourselves and our communities that disorder brings to light. Connie, along with hosts and CAC staff Mike Petrow, Paul Swanson, and Carmen Acevedo Butcher, unpack the cyclical pattern of order, disorder, and reorder that Richard calls the Wisdom Pattern. Together, they explore how disorder is not only inevitable but sacred, a season of necessary unraveling that allows space for grace, healing, and transformation. This episode shows how the prophets help us see what we cannot, why true spiritual growth demands discomfort, and how embracing the dark night of the soul can lead to profound renewal—both personally and collectively. Connie Zweig, Ph.D. is a retired Jungian therapist and author of Meeting the Shadow and Romancing the Shadow. Her award-winning book, The Inner Work of Age: Shifting from Role to Soul, extends Shadow-work into midlife and beyond and explores aging as a spiritual practice. Her book, Meeting the Shadow on the Spiritual Path: The Dance of Darkness and Light in Our Search for Awakening, extends shadow-work into religion and spirituality. Her new podcast, Dr. Neil's Spiritual Awakening to Non-Duality, posts on all podcast platforms. See her new SUBSTACK for livestreams and new writing: https://www.shadowworkawareness.com/about.
In this episode of Daily Value, we look at the influence of B vitamins on mental health and neuropsychiatric disorders. The discussion is centered around a recently published meta-analysis suggesting a causal link between B vitamin deficiencies and the development of conditions such as Parkinson's disease, schizophrenia, and Alzheimer's disease. Talking points include the distinct impacts of vitamins B12, B6, and B9 (folate) on brain health, their role in one-carbon metabolism, and findings from various studies on their protective effects.00:00 Introduction to B Vitamins and Mental Health00:45 Understanding the Meta-Analysis02:07 The Role of B Vitamins in One Carbon Metabolism02:47 Homocysteine and Neuropsychiatric Disorders03:19 B Vitamin Supplementation and Cognitive Decline03:55 Vitamin B12 and Parkinson's Disease06:26 Vitamin B6 and Schizophrenia08:27 Folate and Alzheimer's Disease09:02 Conclusion and Key TakeawaysPMID: 39952338PMID: 26757190PMID: 32257364PMID: 30858560PMID: 32424116PMID: 33941768Support the show
424. Living with Bipolar Disorder: Cameron Esposito Stand-up comedian, actor, writer and friend, Cameron Esposito joins us for a conversation about being diagnosed and living with bipolar disorder. -Cameron takes us inside a manic episode and shares what it really felt like-The beauty and heartbreak of loving someone with a mental illness-What it means to be a witness to your own pain and your life-How comedy changes on and off medication for Cameron Cameron Esposito is a standup comic, actor & writer. A nationally and internationally touring headliner, Cameron has released three specials, including the culture-shifting Rape Jokes, and three albums, the award-winning Same Sex Symbol amongst them. As an actor, Cameron has been seen on Netflix, Max, Prime Video, Hulu & many more, as well as in big budget movies & Sundance indies. Cameron is the author of the bestselling book, Save Yourself, about growing up very religious and very gay and hosted the long-running podcast, Queery.Cameron will be on tour with their next hour of standup in select cities this year before it debuts at Chicago's famed Steppenwolf Theater in the fall. Cameron Esposito released their newest standup special, Four Pills—about being diagnosed with bipolar disorder at 40 – on comedy streaming service Dropout to broad acclaim; it was featured in Variety, the LA Times and People. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices
Subscribe in a reader To Learn About Liane’ s amazing course visit – https://education.lovefraud.com/cours… To email Dr. Liane – lleedom@bridgeport.edu Therapy After Narcissistic Abuse can be ineffective if therapists don't understand the unique challenges survivors face. In this interview, Dr. Liane Leedom shares her groundbreaking research on why traditional therapy often fails and what survivors […] The post The Truth About Therapy After Narcissistic Abuse | Dr. Liane Leedom's Research appeared first on Narcissist Abuse Support.
In this urgent and deeply moving episode, Michelle sits down with Emma Cloney and Diana Dimmock—two powerful advocates from Lipedema Canada—to talk about the medical condition most clinicians have never even heard of, despite its potential to affect 1 in 9 women.Together, they dive into:What lipedema actually is—and how it differs from lymphedema and obesityWhy lipedema is painful, progressive, and devastating when left untreatedThe staggering lack of awareness in Canadian medical schools and healthcare systemsHow fatphobia, gender bias, and medical gaslighting keep patients in the darkThe emotional and financial toll of living with an unrecognized conditionPractical resources for patients and cliniciansWhat needs to change—and how we can all be part of that changeThis episode is more than just a discussion—it's a rallying cry for justice, compassion, and recognition.Whether you're a clinician, patient, or simply someone who cares about women's health, you don't want to miss this conversation.Resources Mentioned:Lipedema Canada – For patient info, clinician resources, advocacy tools & supportLipedema.org (US-based) – Diagnostic tools and educational materialsFollow @LipedemaCanada on social media for shareable awareness contentMore About Our Guests:Emma Cloney Emma Cloney is a Women's Health Nurse and the Vice President and co-founder of Lipedema Canada / Lipœdème Canada, the national nonprofit association for lipedema dedicated to raising awareness, improving access to care, and advancing research for people living with lipedema—a chronic and often misdiagnosed fat disorder that primarily affects women.Emma brings over ten years of clinical experience and a deeply personal connection to this work. Diagnosed with lipedema in 2021, she became the first Canadian to receive multiple mobility-preserving surgeries for the condition funded through provincial healthcare—after successfully advocating for policy change in Manitoba. Her experience highlighted the serious gaps in diagnosis, treatment, and public awareness across Canada.In response, Emma co-founded Lipedema Canada in 2023 alongside a group of passionate patients from across the country. Today, she leads the organization's clinical outreach and education efforts, working to empower patients and healthcare providers alike. Whether she's speaking to policymakers, clinicians, or fellow patients, Emma is committed to changing the narrative around lipedema and ensuring that no one faces this condition alone.Lipedema CanadaDiana Dimmock Diana Dimmock is the founder of Accessibility 4 Every Body Consulting, a size-inclusive consulting firm based in Sherwood Park, Alberta. As an advocate, educator, and speaker, Diana is passionate about promoting accessibility and inclusivity for people of all body sizes and abilities. Through her work, she challenges the marginalization of larger bodies and assists organizations in creating more welcoming, inclusive environments. Through her business, Diana offers valuable insights into the intersection of size, ability, and access, making her a powerful voice in the push for equity and inclusion.Recently diagnosed with lipo-lymphedema, Diana has identified this condition as a long-standing aspect of her health since adolescence. While struggling to seek appropriate medical care and experiencing discrimination based on her body size, Diana became dedicated to ensuring that all individuals receive equitable healthcare. She is deeply committed to self-advocacy and raising awareness with the public and with healthcare professionals about lipedema in Canada. Diana is dedicated to supporting efforts in advocating for improved diagnosis and management strategies for this condition with Lipedema Canada.https://linktr.ee/accessibility4everybodyFind Diana on LinkedIn here.
Molly Puryear is the Executive Director of Malashock Dance and a lifelong believer in the healing, connective power of movement. With infectious joy and deep conviction, she champions dance not just as an art form but as a way to be more fully human. Under her leadership, Malashock is expanding the definition of what dance can do for the community. This is demonstrated through SD NeuroDance, a pioneering program blending movement, neuroscience, and care to support individuals living with ALS, Parkinson's, cerebral palsy, and more. This Episode: How can the joy and vulnerability of dance bring us closer to ourselves and each other? In this heartfelt conversation, Molly shares how Malashock Dance is helping SD NeuroDance participants and caregivers alike reconnect with joy, dignity, and embodiment through dance. The program shifts the focus from limitations to possibilities. Rooted in science and lived experience, SD NeuroDance creates a space where people can move, bond, and feel at home in their bodies. It's also a story of listening: to staff, to community, and to the wisdom that healing can look like rhythm, music, and mirroring movement with a loved one. Molly and Grant explore the deeper truth behind all of this—how dance, so often underfunded and undervalued, is core to who we are. From weddings to cultural traditions to spontaneous joy in the living room, dance is everywhere. And as Molly reminds us, in a world that teaches us to unlearn joy, movement can help us remember. Key Moments: [8:25] How dance can help people with different conditions connect with their body [14:17] Bridging science and art: finding balance between therapy and dance [18:45] How Malashock Dance evolved its mission through community feedback [29:14] Why dance is essential to the human experience [34:05] Federal arts funding cuts and their impact on dance's underrepresented artists and communitiesResources Mentioned in This Episode: Malashock Dance – San Diego-based dance organization emphasizing community, education, and inclusive performance Dance for PD – A program using dance to support those living with Parkinson's disease Prebys' Healing Through Arts and Nature Initiative – Grants improving well-being through arts, culture, and nature Take Action: Move Your Body – Try a dance class, stretch to music, or just let yourself move freely. Reconnect with what joy in motion feels like. Attend a Performance – Support local artists and discover the power of dance to inspire, challenge, and heal. Embrace Artful Living – As Dr. Maria Rosario Jackson reminds us, creativity is essential to well-being. Seek out everyday moments of artistic engagement. Stay Curious – Stay open and curious to trying new things, whether it's dance, healing, or new ways to connect and feel joy.Support Arts & Health Programs – Donate, volunteer, or spread the word about organizations using the arts to improve lives.
Many topics today! First: FDA tentatively approves Moderna's new mRNA shot for Covid. What? And also why? Bret has six main points, which include discussion of mucosal immunity, IgG4, auto-immunity, long-term consequences, statistical tricks, and homeopathy. Then: how do we know what is true, and how can we avoid jumping to conclusions when triggered by language or circumstances that seem familiar and frustrating?...As explored through the story of Algerian boxer Imane Khelif, who has a Disorder of Sexual Development, won Olympic gold for beating women, but is definitely male. Finally: brief discussions of Glenn Greenwald, and Richard Dawkins. No, Dawkins, religion is not a mental infection.*****Our sponsors:CrowdHealth: Pay for healthcare with crowdfunding instead of insurance. It's way better. Use code DarkHorse at http://JoinCrowdHealth.com to get 1st 3 months for $99/month.ARMRA Colostrum is an ancient bioactive whole food that can strengthen your immune system. Go to http://www.tryarmra.com/DARKHORSE to get 15% off your first order.Helix: Excellent, sleep-enhancing, American-made mattresses. Go to www.HelixSleep.com/DarkHorse for 20% Off sitewide.*****Join us on Locals! Get access to our Discord server, exclusive live streams, live chats for all streams, and early access to many podcasts: https://darkhorse.locals.comHeather's newsletter, Natural Selections (subscribe to get free weekly essays in your inbox): https://naturalselections.substack.comOur book, A Hunter-Gatherer's Guide to the 21st Century, is available everywhere books are sold, including from Amazon: https://amzn.to/3AGANGg (commission earned)Check out our store! Epic tabby, digital book burning, saddle up the dire wolves, and more: https://darkhorsestore.org*****Mentioned in this episode:Moderna press release: https://investors.modernatx.com/news/news-details/2025/Moderna-Receives-U-S--FDA-Approval-for-COVID-19-Vaccine-mNEXSPIKE/default.aspxKennedy on FDA and Moderna shot: https://x.com/seckennedy/status/1930012848056365294Mary Talley Bowden MD on the shots: https://x.com/mdbreathe/status/1927899248575545501Heather on Imane Khelif: https://x.com/HeatherEHeying/status/1929920193771516423Greenwald on the situation: https://x.com/ggreenwald/status/1928440222771015912Dawkins on religion: https://x.com/richarddawkins/status/1930184916190257320Support the show
Send us a textThe fog lifts momentarily, only to descend again. The lightning that fuels creativity brings thunder in its wake. This is the reality for millions living with bipolar disorder – not just mood swings, but profound shifts that can transform daily functioning into heroic acts of survival.Bipolar disorder remains one of the most misunderstood mental health conditions, carrying heavy stigma despite affecting countless lives. Through Jonah's powerful story, we witness the journey from despair to diagnosis, from isolation to community, from suffering to managing. His experience mirrors what many face: the electric highs of mania with its decreased need for sleep and grandiose thinking, followed by crushing depressive episodes that can last weeks.We carefully distinguish between bipolar I with its full manic episodes requiring hospitalization, and bipolar II with its less severe hypomanic states. The cycling between these poles creates a uniquely challenging experience that impacts relationships, work, and self-perception. What many don't realize is how frequently childhood trauma correlates with bipolar disorder development, as adverse experiences literally reshape developing brains and stress response systems.Treatment offers real hope – medication like mood stabilizers remains the cornerstone, while therapy provides essential coping strategies. Yet perhaps the greatest challenge lies in medication compliance, as feeling better often leads to abandoning treatment. For loved ones supporting someone with bipolar disorder, understanding this pattern becomes crucial, as does recognizing that people with this condition often have limited insight into their symptoms.Recovery doesn't mean cured – it means stable, self-aware, and equipped with tools to navigate life's challenges. Some of the most creative, resilient people manage this condition daily, finding strength through their struggles. Whether you're personally affected or supporting someone on this journey, remember this truth: bipolar disorder is part of someone's story, not their entire identity.Reach out for help if these conversations resonate with you. Through proper diagnosis, consistent treatment, and compassionate community, there is light even in the darkest storms. You are not your diagnosis. You are seen, you are known, you are heard, you are loved, and you are valuable beyond measure.You ARE:SEEN KNOWN HEARD LOVED VALUED
Spontaneous intracranial hypotension reflects a disruption of the normal continuous production, circulation, and reabsorption of CSF. Diagnosis requires the recognition of common and uncommon presentations, careful selection and scrutiny of brain and spine imaging, and, frequently, referral to specialist centers. In this episode, Gordon Smith, MD, FAAN speaks with Jill C. Rau, MD, PhD, author of the article “Clinical Features and Diagnosis of Spontaneous Intracranial Hypotension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Rau is an assistant professor of clinical neurology at the University of Arizona, School of Medicine-Phoenix in Phoenix, Arizona. Additional Resources Read the article: continuumjournal.com Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Full episode transcript available here Interview with Jill Rau, MD Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Smith: This is Dr Gordon Smith. Today I'm interviewing Dr Jill Rau about her article on clinical features and diagnosis of spontaneous intracranial hypotension, which she wrote with Dr Jeremy Cutsworth-Gregory from the Mayo Clinic. This article appears in the 2025 Continuum issue on disorders of CSF dynamics. I'm really excited to welcome you to the Continuum podcast. Maybe you can start by just telling our listeners a little bit about yourself? Dr Rau: Hi, thanks for having me. I'm really honored to be here, and I really enjoyed writing the paper with Dr Cutsforth-Gregory. I hope you guys enjoy it. I am the director of headache medicine at the Baba Bay Neuroscience Institute at Honor Health in Scottsdale, Arizona. I'm also currently the chair of the special interest group in CSF Dynamics at the American Headache Society, and I've had a special interest in this field since I first watched Dr Linda Gray speak at a conference where she talked about spinal CSF leaks and their different presentations. And they were so different than what I had been taught in residency. They're not just the post-LP headache. They have such a wide variety of presentations and how devastating they can be, and how much impact there is on someone's life when you find it and fix it. And I've been super interested in the field and involved in research since that time. And, yeah. Love it. Dr Smith: Well, thanks for sharing your story. And as I reflected on our conversation ahead of time and have been thinking about this issue… this is a cool topic, and every time I read one of these manuscripts and have the opportunity to speak with one of the authors, I learn a ton, because this was something that wasn't even on the radar when I trained back in the 1800's. So, really looking forward to the conversation. I wonder if you could really briefly just summarize or remind for everyone the normal physiology about CSF dynamics, you know, production, absorption, and so forth? Dr Rau: So, the CSF is the fluid that surrounds the brain and the spinal cord, and it's contained by the dura, which is like a canvas or a sac that covers that whole brain and spinal cord. And within the ventricles of the brain, the choroid plexus produce CSF. It's constantly producing and then being reabsorbed by the arachnoid granulations and pushed into the venous space, the cerebral sinuses, venous sinuses. And also some absorption and push into the lymphatics that we've just learned about in the past year. This is kind of new data coming out, so always learning more and more about CSF, but we know that it bathes the brain and the spinal cord, helps keep some buoyancy of the brain as well as pushing nutrients in and pulling out metabolic waste. And it sort of keeps the brain in the state of homeostasis that's happy. And so, when there's a disruption of that flow and the amount of fluid there, that disrupts that, that can cause lots of different symptoms and problems for people. Dr Smith: One of the many new things I learned is that even the name of this---spontaneous intracranial hypotension---is misleading. And I think this is clinically relevant, as we'll probably get to in a moment, but can you talk a little bit about this? Is this really like a pressure disorder or a volume disorder? Dr Rau: Yeah. It's almost certainly a volume disorder. We do see in some people that they have low pressure, and it's still part of the diagnostic criteria. But it's there because if you have a low pressure, if you measure an opening pressure and it's below six, if you're measuring it in the spine in the right place, then you have indication that there's low volume. But there's over 50% of people's opening pressure who have a spinal CSF leak, have all the symptoms and can be fixed. So, they have normal pressure in 50% of the people. So, it is an inaccurate term, hypotension, but it was originally discovered because of the thought that it was a low-pressure situation. Some of the findings would suggest low pressure, but ultimately, we are pretty sure it's a low-volume condition. Dr Smith: Another new thing that I learned that really blew me away is how bad this can be. I did a podcast with Mark Burish about cluster, and I was reminded many cluster patients are pushed to the point of suicidal ideation or committing suicide by the severity of pain. And this sounds like for many patients it's equally severe. Can you maybe paint a picture for our listeners why this is so clinically important? Dr Rau: A large number of people, even people who are known to have leaks because they've had them before or they've releaked, they have a lot of brain fog and cognitive impairment. They often have severe headaches when they're upright. So, orthostatic headache is probably the number one most common symptom, and those headaches are one of the worst headaches out there. When people stand up, their fluid is not supporting the brain and there's an intense amount of pain. And so, they spend a large portion of their lives horizontal. And there's associated symptoms with that, it's not just headache pain and brain fog. There's neck pain. There's often subsequent disorders that accompany this, like partial orthostatic tachycardia syndrome. We don't know if that's because of deconditioning or an actual sequela of the disease, but it's a frequent comorbidity. We have patients that have extreme dizziness with their symptoms, but many patients are limited to hours, if that, upright per day, combined, total. And so they live their lives, often, just in the dark, lots of photophobia, sensitive to the light, really unable to function. It's also very hard to find and so underrecognized that a lot of patients, especially if they don't have that really clinical symptom of orthostatic headache. So, it's often missed. So, they're just debilitated. You know, treatments don't work because it's not a migraine and it's not a typical headache. It's a mechanical issue as well as a metabolic issue and not found, not a lot helps it. Dr Smith: So, you know, I have always thought about this as really primarily an orthostatic symptom. I wonder if you can talk about the complexity of this; in particular, kind of how this evolves over time, because it's not quite that simple. And maybe in doing so, you can give our listeners some pearls on when they should be thinking about this disorder? Dr Rau: A large portion of people do have headache with spinal CSF leak, in particular, spontaneous intracranial hypertension- hypotension, excuse me. And that's something to be thought about, is that there are spontaneous conditions where people have either rupture of the dural sac, or an erosion of the dural sac, or a development of a connection between the dura and the venous system. And that is taking away or allowing CSF to escape. In these instances that patients have spontaneous, there may be a different presentation than if they have, like, a postdural puncture or a chronic traumatic or iatrogenic leak. And we're not sure of that yet, but we're looking into that. Still, the largest presentation is headache, and orthostatic headache is very dominant in the headache realm. But over time, patients' brains can compensate for that lack of CSF and start overproducing---or at least we think that's probably what's happening. And you may see a reduction in the orthostatic symptoms over time, and you may see an improvement in the radiographic findings. So, there are some interesting papers that have been published that look at these changes over time, and we do see that sometimes within that first three to four months; this is the most common time to see that change. Other patients may worsen. You may actually see someone going from looking sort of normal radiographically to developing more of a SIH-type of picture on the brain. And so it's not predictable which patients have gone from orthostatic to improvement or the other way around, both radiographically and clinically. So, it can be quite difficult to tell. So, for me, if I have a patient that comes to me and they're struggling with headache… if it's orthostatic, very clearly orthostatic: I lay down, I get considerably better or my headache completely goes away. And then when I stand up, it comes on relatively quickly, within an hour. And sometimes it's a worsening-throughout-the-day type of thing, it's lowest in the morning and it worsens throughout the day. These are the times that it's most obvious to think about CSF leak. Especially if that headache onset relatively suddenly, if it onset after a small trauma. Like I've had patients that say, you know, I was doing yoga and I did some twists and I felt kind of a pop. And then I've had this headache that is horrible when I'm upright but is better when I lay down ever since, you know, since that time. That's kind of a very classic presentation of spinal CSF leak or spontaneous intracranial hypotension. Maybe a less common presentation would be someone who comes to you, they've had a persistent headache for a couple years, they kind of remember it started in March of a couple years ago, but they don't know. Maybe it's, you know, it's a little better when they lay down. It may be a little worse when they're up moving around, but so is migraine, and it's a migrainous headache. But they've tried every migraine drug you can think of. Nothing is responding, nothing helps. I'm always looking at patients who are new daily, persistent headaches and patients who aren't responding to meds even if it's not new daily, but they have just barely any response. I will always go back and examine their brain imaging and get full spine to make sure I'm not missing. And you can never be 100% sure, but it's always good to consider those patients to the best of your ability, if that- have that in the back of your mind. Dr Smith: So obviously, goes without saying, this is something people need to have on their radar and think about. And then we'll talk more about diagnostic tools here in a second. But how common is this? If you're a headache doc, you see a lot of patients who have intractable headaches. And how often do you see this in your headache practice? Now you're- this is your thing, so probably a little more than others, but, you know, how common will someone who sees a lot of headache encounter these patients? Dr Rau: If you see a lot of headache, I mean, currently the thought is it's about 5 in 100,000. That was from a study before we were finding CSF venous fistulas. I think a lot of us think it's more common than that, but it's not super common. We don't have good estimates, but I would guess between 5 and 10 for 100,000 persons, not “persons who come to a tertiary headache clinic with intractable headaches”. So, it's hard to gauge how frequent it is, but I would say it's considerably more frequent than we currently think it is. There's still a group of people with orthostatic headaches that we can't find leaks on; that, once you treat other things that can cause or look for other things that can cause orthostatic headaches. So, there may be even still a pathophysiology out there that is still a leak type. Before 2014, we didn't even know about CSF venous fistulas. And now here we are; like, 50% of them are CSF venous fistulas. So, you know, we're still in a huge learning curve right now. Dr Smith: So, I definitely want to talk about the fistulas in a second. But before moving on, one of the things that I found really interesting is the wide spectrum of clinical phenotype. And we obviously don't have a lot of time to get into all of these different ones, but the one that I was hoping you might talk about---and there's a really great case, and you're on bunch of great case, a great case of this---is brain sagging dementia, not a term I've used before. Can you really briefly just tell our listeners about that, because that's a really interesting story and a great case in your article? Dr Rau: Yeah. So, brain sag dementia is a… almost like an extreme version of a spontaneous intracranial hypotension. Where there is clear brain sag in the imaging---so that's helpful---but the patients present kind of like a frontotemporal dementia. And when this was first started to being determined, you could turn the patient into Trendelenburg, and sometimes they would improve. There are some practitioners that have introduced fluid into the thecal sac and had temporary improvement. Patching has improvement, then they leak again, sometimes not. But the clinical changes with this have been pretty tremendous to be able to identify that that's a real thing. And in some cases, out of Cedars Sinai, you know, who does a lot of the best research in this, they've had lots of cases where they can't find the leak, but there's clear brain sag that fits with our clinical picture of CSF leaks. So, we're on a learning curve. But yeah, this- they really present. They have disinhibition and cognitive impairment that is very similar to frontotemporal dementia. Dr Smith: Well, so let's talk about what causes this. You mentioned CSF venous fistulas. I mean, that was reported now just over a decade ago, it's pretty amazing. That accounts for about half of cases, if I understand correctly. What are the other causes? And then we'll talk more about therapy in a minute, but what causes this? Dr Rau: So, within the realm of spontaneous, you know, we say it's spontaneous. But the spontaneous cases we account for, they can be tears in the dura, which are usually sort of lateral tears in the dura. They can be little places that rubbed a hole, often on an osteophyte from the spine. They can come from these spinal diverticuli. So, I always describe it to my patients like those balls that have mesh and squishy, and you squeeze them in the- through the mesh, there's the extra little bubbling out. If you think of like the dura bubbling, out in some cases, through the framing of the spine, right where the spinal nerve roots come out, they should poke out like wires from the dura. But in many cases they poke out with this extra dura surrounding them, and we call that spinal diverticuli. And if you imagine like the weakening of where you squeeze that, you know, balloon through your fingers, in those locations, that's a very common place to find a CSF leak, and you can imagine that the integrity of the dura there may be less than it would be if it were not being expanded in that direction. And that's often the most common place we see these CSF venous fistulas. So, you can get minor traumas; like I said, it can be spontaneous, like someone just develops a leak one day. It can be rubbed off, and it can be a development of a connection between the dura and the venous system. There are also iatrogenic causes, but we don't consider them spontaneous. But when you're considering your patients for spontaneous cases, you should consider if they've ever had chronic---even long, long time ago---had any spinal implementation, procedures near the spine, spinal injections, LPs in the past, and especially women who've had epidurals in pregnancy. Dr Smith: All right, so we see a patient, positional severe headache, who meets the clinical criteria. Next step, MRI scan? Dr Rau: Yeah. So, the first thing is always to get the brain MRI with and without contrast. Most places will have a SIH or a spinal CSF leak protocol, but you should get contrast because one of the most pathognomonic findings on brain MRI is that smooth diffuse dural enhancement. And that's a really fantastic thing when you find it, because it's kind of a slam dunk. If you find it, then you will see other findings. It almost never exists alone. But if you see that, it's pretty much a spinal CSF leak. But you're also looking for subdural collections, any indication of brain sag. We do have these new algorithms that have come out in the past couple of years that are helpful. They're not exclusionary---you can have negative findings on the brain and still have spinal CSF leak---but the brain MRI is extremely helpful. If it's positive for the findings, it really does help you nudge you in the direction of further investigations and treatments. Dr Smith: And what about those further investigations and treatments, right? So, you see that there's findings consistent with low pressure, and I guess I should say low intracranial CSF volume. Be that as it may, what's the next step after that? Dr Rau: Depends on where you are and what you can do. I almost always will get a full spine MRI: so, C spine, T spine, and L spine separately. Not, you know, we don't want it all in one picture, because we want to get the full view. And you want to get that with at least T2 highly- heavily T2 weighted with fat saturation in at least the sagittal and axial planes. It's really helpful if you can get it in the coronal planes, but we have to have- often have good talks with your radiologist to get the coronal plane. I spoke about the spinal diverticuli earlier, and I want to clarify a little bit of something. The coronal image will show those really nicely. It's interesting, but 44% of people have those. So just having the spinal diverticuli does not indicate that you have a leak. But if you have a lot of those, there may be more likelihood of having leak than if you don't have any of those. So, I will get all of those and I will look at them myself, but I've been looking at them myself for a long time. But a lot of radiologists in community hospitals, especially not- nonneuroradiologists, but even neuroradiologists, this isn't something that's that everybody's been educated about, and we've been learning so much about it so rapidly in the past ten years. It's not easy to do and it's often missed. And if it's not protocoled properly, the fat saturation's not there, it's very hard to see… you can have a leak and not see it. Even the best people, like- it's not always something that's visible. And these CSF venous fistulas that we talked about are never visible on normal MRI imaging. Nonetheless, I will run those because if I can find a leak---and 90% of the ones that are found on MRI imaging are in the thoracic spine. So that's where I spend the most of my time looking. But if you find it, that's another thing to take to your team to say, hey, look, here it is, let's try and do this, or, let's try and do that, or, I've got more evidence. And there are other findings on the spine; not just the leak, but other findings, sometimes, you can see on spine that maybe help you push you towards, yes, this is probably a leak versus not. Dr Smith: So, your article has a lot of great examples and detail about kind of advanced imaging to, like, find the fistula and what not. I guess I'm thinking most of our listeners are probably practicing in a location where they don't have a team that really focuses on that. So, let's say we do the imaging of the spine and you don't find a clear cause. Is the next step to just do a blood patch? Do you send them to someone like you? What's the practical next step? Dr Rau: Yeah, if your- regardless of whether you find a leak or not, if your clinical acumen is such that you think this patient has a leak or I've treated them for everything else and it's not working and I have at least a high enough suspicion that I think the risk of getting a patch is lower than the benefit that if they got a patch and it worked, I do send my patients for non-directed blood patches, because it currently does take a long time to get them to a center that can do CT myelograms or any kind of advanced imaging to look for sort of a CSF venous fistula or to get treated outside of a nondirected patch. You know, sometimes nondirected patches are beneficial for patients, and there's some good papers out there that sort of explain the low risks of doing these if done properly versus the extreme benefit for patients when it works. And, I mean, I can't tell you how many people come in and tell me how their lives are changed because they finally got a blood patch. And sometimes it works. And it's life-changing for those people. You know, they go back to work. They can interact with their kids again. Before, they didn't know what was wrong, just had this headache that started. So it's worth doing if you have a strong clinical suspicion. Dr Smith: Yeah. I mean, that was great. And, you know, to go back to where we began, this is severe. It's something like 60% of patients with this problem have thought about suicide, right? And you take this patient and cure the problem. I feel really empowered having read the article and talked to you today. And so, I'm ready to go out and look for this. Thank you so much for a really engaging conversation. This has been terrific. Dr Rau: Thank you. I appreciate it. I enjoyed being here. Dr Smith: Again, today I've been interviewing Dr Jill Rau about her article on clinical features and diagnosis of spontaneous intracranial hypotension---which I guess I should say hypovolemia after having talked to you---which she wrote with Dr Jeremy Cutsworth-Gregory. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Please be sure to check out Continuum Audio episodes from this really interesting issue and other interesting issues. And thank you, our listeners, again for listening to us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.
Uniting in a powerful conversation that bridges the gap between faith and mental health; host Eve McNair welcomes Deora Clairé, whose striking TikTok testimony caught Eve's attention, to share her journey with bipolar disorder.Deora candidly reveals how her mental health crisis emerged suddenly following a painful breakup in 2019. With remarkable clarity, she describes her first manic episode with psychosis—walking around vacant houses talking to them—which led to hospitalization and diagnosis at age 23. The raw details of her experiences, including believing she was invisible during a second episode, create a vivid picture of what psychosis actually looks like, demystifying a commonly misunderstood condition.What makes this conversation particularly powerful is the seamless integration of faith and professional treatment. Deora shares how she initially stopped her medication due to denial but eventually embraced both her faith and medical support. She references Scripture throughout, including Proverbs 11:14 about the "abundance of wise counselors," providing biblical permission for believers to seek specialized help without shame. As she puts it, "God is the ultimate healer, but He also provides people to help you through those issues too."Get in touch with the guest and I Eve's Linktree info - https://linktr.ee/IAMMSEVE?utm_source=linktree_profile_share
In this eye-opening episode, we sit down with Dr. Patrick McGrath, a renowned psychologist and Chief Clinical Officer for NOCD, to delve deep into the world of Obsessive-Compulsive Disorder (OCD). Dr. McGrath debunks common myths, explains the true nature of OCD, and discusses the impact it has on people's lives. He also talks about the myths of positive thinking and how positive thinking really only works with action. Plus, why superstitions are bogus, how Dr. Patrick wants to raise awareness that a 'little' OCD doesn't exist. And, Dr. Patrick discusses pedophile OCD, is it a real thing? Can people have obsessive compulsive sexual thoughts and how to overcome them. Timestamps: 00:00:00 - Introduction to Dr. Patrick McGrath and NOCD00:02:13 - What People Think OCD Is vs. Reality00:13:46 - Sexual Obsessions in OCD00:34:44 - Relationship OCD: Doubts and Insecurities00:42:55 - Hoarding: Its Connection to OCD MY Go Big Podcasting Courses Are Here! Purchase Go Big Podcasting and learn to start, monetize, and grow your own podcast. Use code MOM15 for 15% OFF until 5/31/2025 **SHOP my Amazon Marketplace - especially if you're looking to get geared-up to start your own Podcast!!!** https://www.amazon.com/shop/thesarahfrasershow Show is sponsored by: Download Cash App & sign up! Use our exclusive referral code TSFS in your profile, send $5 to a friend within 14 days, and you'll get $10 dropped right into your account. Terms apply Horizonfibroids.com get rid of those nasty fibroids Gopurebeauty.com science backed skincare from head to toe, use code TSFS at checkout for 25% OFF your order Nutrafol.com use code TSFS for FREE shipping and $10 off your subscription Quince.com/tsfs for FREE shipping on your order and 365 day returns Rula.com/tsfs to get started today. That's R-U-L-A dot com slash tsfs for convenient therapy that's covered by insurance. SkylightCal.com/tsfs for $30 OFF your 15 inch calendar Thrivecosmetics.com/tsfs Brighten a mom's day—especially if you're that mom. Go to thrivecausemetics.com/TSFS for 20% OFF your order Warbyparker.com/tsfs make an appointment at one of their 270 store locations and head to the website to try on endless pairs of glasses virtually and buy your perfect pair Follow me on Instagram/Tiktok: @thesarahfrasershow ***Visit our Sub-Reddit: reddit.com/r/thesarahfrasershow for ALL things The Sarah Fraser Show!!!*** Advertise on The Sarah Fraser Show: thesarahfrasershow@gmail.com Got a juicy gossip TIP from your favorite TLC or Bravo show? Email: thesarahfrasershow@gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices
Around 40 million people around the world have bipolar disorder, which involves cyclical swings between moods: from depression to mania. Kay Redfield Jamison is one of those people. She's also a professor of psychiatry at the Johns Hopkins School of Medicine and has written extensively about the topic, from medical textbooks to personal memoirs. Today on Short Wave, she joins us to talk about the diagnosis process, treating and managing bipolar disorder. Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave.Got a question about mental health? Let us know at shortwave@npr.org. Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy