Podcasts about dvt

Kiera is joined by the tooth-healer himself, Jason Dent! Jason has an extensive background in pharmacy, and shares with Kiera where his pharmaceutical experience has bled over into dentistry. This includes the difference between anti-quag and anti-platelet and which medications are probably safe, what to do to shorten the drag time in the pharmacy, how to write prescriptions most efficiently, and more. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: The Dental A Team (00:00) Hello, Dental A Team listeners. This is Kiera and today is a really awesome and unique day. It is, think the second time I've had somebody in the podcast studio with me live for a podcast and it's the one and only Jason Dent. Jason, how are you? I'm doing well. Good morning. Thanks for having me. It is crazy. I I watch Instagram real like this all the time where people are like in the podcast and they're hanging out on two chairs and couches and now look at us. We're doing it. Cheers. Cheers.   That was a mic cheer for those of you who are only listening, but yeah, Jace, how does this feel to be on the podcast? It's weird. Like I was not nervous at all talking about it. I got really nervous as soon as you hit play. So if I stumble over my words, please forgive me ahead of time. Well, Jason, I appreciate you being on the podcast because marketing had asked me to do a topic about teledentistry and I was like, oh shoot, that's like not my forte at all. so   You and I were actually chatting in the hot tub. call it Think Tank session and you and I, we have a lot of good ideas that come from that Think Tank. A lot of business. no phones. That's why. We do leave our phones out. But I was talking to Jason and this is actually a podcast we had talked about quite a while ago. Jason has a lot of information on pharmacy. And if you don't know, Jason isn't really, we were going through all of it last night. It's kind of a mock in the tub. And I think it's going to be great because I feel like this is an area, I'm working at Midwestern and   knowing about how dentists, pharmacology was surely not your favorite one. Jason actually helps a lot of dentists with their clearances. And so we were talking about it and I like it will just be a really awesome podcast for you guys to brush up on pharmacology, different things from a pharmacist's side. So Jason, welcome. Thank you. Yeah, no, we were talking about it and here's like, what should I talk about on the podcast next? I have all these different topics and she's like, what do you know? And the only real interaction I have with dentists is doing clearances for procedures. We get them all the time, which makes sense.   Lots of people are on blood thinner, I've always told Kiera, like, hey, I could talk about that. Like, that's kind of a passion of mine. I'm not a dentist. Or my name is Jason Dent. So in Hebrew, Jason means tooth. No, no, no, sorry. Nerves are getting to me. Jason means healer and Dent means tooth. So my name means tooth healer. So, here's a little set. Hold on, on, hold Can we just talk about? I brought that up before you could talk about it more. So.   My name means tooth healer but I did not become a dentist. I know you wanted me to become a dentist. did. I don't know why. I enjoy medicine. I know what you're going to get to already. The things you're going to ask me. There's been years of this. But nevertheless, that's my name. We'll get that out of the way. But you did give me a great last name. So I mean, it's OK. You're All is fair and love here. SEO's up for that. But yeah, Jason, I'm going to get you right into the show. And I'm going to be the host. And we're going to welcome to the podcast show. Jace, how are you?   Good, good, good. Good, good, good. So by getting into clearances, right? This is what you're kinda talking about with you know, before we get to clearances, I actually wanted Jason, for the listeners who don't know you, who haven't talked to you, who don't know, let's kinda just give them like, how did you go from, Kiera wanted you to be a dentist, to now Jason, you are on the podcast talking as our expert on pharmacy. fantastic. I've always really loved medicine, a ton. As a kid getting headaches and taking Excedrin, like you just feel like a miserable pile of crap.   and then you take two pills and all of a sudden you feel better. Like that's amazing, like how does that happen? Also getting ear aches as a kid, just being in so much pain and then taking some medicine and you start feeling a lot better. I always had a lot of appreciation for that. I've always been mechanically inclined. I went to, started doing my undergrad and took biology and learned about ATP synthase, which is a spinning enzyme that's inside the mitochondria, like a turbine engine. I used to work on small engines on my dirt bike and thought that is so cool. So I really got wrapped up into chemistry.   All the mechanics of chemistry really pulled me in. I'm not getting goosebumps. checking. I usually get goosebumps when I think about chemistry. But it's so cool. You think an engine's awesome, like pistons and camshafts and pressures, the cell is the same thing. It's not as loud, so it's not as cool. But it's fascinating. that's why we're like. ⁓   chemistry and really got into coagulation. So I did my residency after pharmacy school. we went to Arizona for three years. ⁓ You did and your main focus, you were never wanting to be the guy behind the counter. No, I haven't done that. Yeah. No, I love them though. I've always really want to go clinical. ⁓ But I love my retail ⁓ pharmacists. They're amazing resources. And ⁓ I use the retail pharmacist every day still to this day, but I went more the clinical route, really love the chemistry aspect of it.   did my doctorate degree and then I did my residency in Reno. Reno's kind That's how we got here everybody. Welcome to Reno. Strategically placed because I was really interested in critical medicine and where we're located we cover a huge area. So we pull in to almost clear, we go clear to Utah, clear to California, all of Northern Nevada. We get cases from all over. So we actually are kind like the first hub of care for lot of areas. So we really get an eclectic mixture of patients that come in that need-   all kinds of different cases that are coming to them. So it's what I really wanted. So I did my residency in critical care there. And then for the next 10 years, I worked in vascular medicine with my final five years being the supervisor of the clinic. Ran all the ins and outs of that. So my providers, two doctors were on our view. So when we talk about dentistry, talk about production, those kinds of things, totally get it. My doctors were the exact same way, my vascular providers. ⁓   There's some pains there, right? You wanna be seeing patients as much as possible, being able to help as many people, keeping the billing up. And had other nurse practitioners, four practitioners, a fleet of MAs, eight pharmacists. We also had that one location we had, going off the top of my head, I think we had eight locations running as well. And we took care of all the different kinds of vascular cases that came to us. Most common was blood clots, ⁓ which is just a...   which is an easier way of saying VTE. There's so many different ways to say a blood clot. Like you might hear patients say, I've had a PE or a DVT or a venous thromboembolism or a clot in my leg, right? They're all clots, but in different locations. Same with an MI, and MI can be a clot as well. ⁓ there's a lot of, everybody's kind of saying the same thing, but sometimes the nomenclature can make it sound hard, but it really is actually pretty simple.   No. And Jason, I love that you went through, you've been in like, and even in your, ⁓ when you were getting your doctorate, you were in the ER. You also worked in retail pharmacy. remember you having a little sticker on your hand. And retail pharmacy, I have a lot of respect for those guys. They have a lot of pressure on them. and then you also, ⁓ what was that test that you had to take that? I don't know. You were like studying forever for it. ⁓ board certification for, ⁓ NABP. Yeah. So I did that board certification as well.   And now you've moved out of the hospital side onto another section in your career. Now in the insurance, right? So it's really, really interesting. So now I'm on the other side reading notes and evaluating clinical appropriateness and trying to help patients with getting coverage and making those kinds of determinations. So yeah, I've really jumped all over. Really love my clinical days. I know. don't I don't I do miss them. But yeah, kind of had a good exposure to a lot of.   pharmacy a lot a lot of dentists actually with all the places that come through which Jason I really appreciate that and honestly I know you are my spouse and so it's fun to have you on but when I go into conversations like this I don't know any of this information and so finding experts and Jason I think here's me talk more about dentistry and my business than I do hear about him on pharmacy so as we were chatting about this I really realized you are a wealth of knowledge because you've been on the clinical side so you've done a lot of patient care and you've seen how   medications interact and I know you've had a few scares in your career and ⁓ you've known some physicians that have had a few scares and ⁓ you've seen plenty of patients pass away working in the ER and gosh in Arizona drownings were such a big deal. I remember when you were in the ER on your rotations I'd be like who died today? Like tell me the stories and you've really seen and now going on to the insurance side I felt like you could just be such a good wealth of knowledge because I know dentists are sometimes so   I would say like maybe just a little more anxious when it comes to medications. I know that dental students from Midwestern were like here was like four months and we had to like pass it, learn it. And Jason, you've done four years plus clinical residency, plus you've been in it. And something I really love about Nevada Medicine is they've been so collaborative with you.   like your heart, your cardiologist, they diagnose and then they send to you to treat with medicine and... Yeah, I've been really lucky being here in Reno too. The cardiology team has been amazing to work with. We started a CHF program, sorry, congestive heart failure program for patients. So we would collaborate with cardiologists. They'd see the cardiologists and then they send them to the pharmacist to really manage all the medications. So there's pillars of therapy ⁓ called guideline directed medical therapy and the pharmacist would take care of all that. So that's gonna be your...   your beta blockers, your ACEs, your ARBs, your Entresto, which would be a little bit better, spironolactone. So just making sure that all these things are dosed appropriately, really monitoring the heart, and make sure that patients are getting better. we've had real positive outcomes when the, sorry, this is totally off topic. do, talk about that study. When we looked at when patients were coming to see our pharmacists in our clinic that we started up, the patients were half as likely to be readmitted. And this was in 2018, and our pharmacists,   We're thinking about all the medications. We're usually adjusting diabetes medications too at the same time. Just kind of naturally just taking care of all the medications because we kind of got a go ahead from the providers, a collaborative practice agreement that we could make adjustments to certain medications within certain parameters. So we weren't going rogue or maverick, but we were definitely trying to optimize our medications as much as possible. And then years later, some studies came out with, I'm sure you've seen Jardins and Farseegh. not trying to, I'm not.   I don't get any kickback from them. I have no conflicts to share. But because our pharmacists were really optimizing that medication, those medications were later shown to reduce hospitalizations and heart failure, even though they're diabetes medications. Fascinating. So it wasn't really the pharmacists. It was just the pharmacists doing as much as they can with all the tools that were in front of them. And then we found out that the patients were going back to the hospital.   half as much as regular patients. So, yeah, being here, it's been so amazing to work with providers here. the providers here want help, want to help patients, don't have an ego. I mean, I just, it's awesome. I love it. I do love how much I think Jason sees me geek out about dentistry and I watching Jay's geek about his pharmacy and how much he loves helping patients. And ⁓ really that was the whole idea of, all right.   Dentistry has pharmacy as a part of it. And I know a lot of dentists are sending in clearances and I know working in a chair side, it would be like, oh no, if they're on warfarin or on their own blood clot, you guys, honestly don't even know half of what I'm talking about because this is not my jam, which is why Jason's here. But I do know that there was always like, well, we got to talk with their provider. And so having Jason come in and just kind of explain being the pharmacist that is approving or denying or saying yes or no to take them off the blood thinners in different parts, because you have seen several dental   I don't know what they're called. What is it? Clarence's? that what comes to you? don't even know. All day my mind, it's like, here is the piece of paper that gets mailed to you to the pharmacist and then you mail it back. So whatever that is. But Chase, let's talk about it because I think you can give the dentist a lot of confidence coming from a pharmacist. What you guys see on that side. When do you actually need to approve or disapprove? Let's kind of dig into that. Yeah. Well, first of all, I think I'm not a replacement for any kind of clinical judgment whatsoever. Every patient's different. But the American Diabetes Association, you   I work with diabetes a lot. American Dental Association has some really great guidelines on blood thinners and I would always reference them. I actually looked at their website today. Make sure I'm up to speed before I get back on this again. They have resources all around making decisions for blood thinners. And I think the one real important thing in putting myself in the shoes of a dentist or any kind of staff that's around a patient that's in a chair, if they say I'm on a blood thinner, right, a flag goes up. At least in my mind, that's what goes up.   Like, okay, how do we get across this bridge? And I think the important thing to really distinct right then when they say they're on a blood thinner is that is kind of a slang word for a lot of different medications, right? Like it's the overarching word that everybody pulls up saying, I'm on a blood thinner. It's like, okay, but I don't know what say. It's like, I have a car. You're like, okay, do you have a Mazda? Do you have?   Toyota, Honda, what do you have? or even worse it'd be like saying I have a vehicle, right? So when somebody says they're on a blood thinner, it opens up a whole box of possibilities of what they're Blood thinners are also, doesn't, when they're taking these types of medications that are quote unquote a blood thinner, it doesn't actually thin the blood, like adding water to the blood, if that makes sense, or like thinning paint, or like thinning out a gravy, right? It doesn't do the same thing. Blood thinners, really what they're doing is they're working on the blood, which.   which is really cool, try not to tangent on that. ⁓ When they're working on the blood, it's not thinning it per se, but it's making it so that the proteins or platelets that are in it can't stick together and make a cloth quite as easy. So whenever somebody's on a blood thinner, I usually ask, what's the name of the blood thinner that you're on? It's not bad that they use that slang, that's okay, on the same page, but it's really broken into two different classes. There's anticoagulant and antiplatelet.   And a way to kind of remember which is which, when residents would come through our clinics, the way that I teach them is a clot is like a brick wall. You know, it's not always a brick wall. Usually the blood is a liquid going through. But once they receive some kind of chemical message, it starts making a brick wall with the mortar, which is the concrete between the and the bricks, the two parts. When it's an anti-quagent, it's working on that mortar part. When it's an anti-platelet, it's working on the bricks part, right? You need both to make a strong clot or strong brick wall.   But if you can make one of them not work, obviously like if your mortar is just water, it's not working, right? You're not gonna make a strong brick wall. So that's kind of the two deviants right there. So that's what I do in my mind real quickly to find out because antiplatelets are usually, so that's gonna be like your Plavix, Ticagrelor, Brilinta. And hold on, antiplatelets are bricks? Good job, bricks. They're the bricks. And so the reason I was thinking you could remember this because I'm, antiplatelets, it's a plate and a plate is more like a brick.   And anti coagulant, I don't know why quag feels like mortar to me, like quag, like, know, it's like slushy in the blood, like it's coagulating. It's a little bit of that, like, honestly, I'm just thinking like coagulated blood is a little bit more mortar-ish. And so platelet is your plate, like a brick, and anti-quag is like.   the gilly between the bricks. Okay, okay, I got it. Yeah, so there's an exception to every rule, but when they're on that Don't worry, this is Kiera, just like very basic. You guys are way smarter listening to this, and that's why Jason's here. No, no, you helped me pass pharmacy school. When we were doing all the top 200, you helped me memorize all know what flexorill is, all right? That's a muscle relaxant. Cyclo? I don't know that part. It's a cyclo, because you guys are cycling and flexing. I don't actually know. just know it's a muscle relaxant, so that's about as far as I got. When we're looking at antitick platelets, so that's the brick part, so that's going to be your, you know,   Hecagrelor, Breitlingta, Clopidogrel is the most common one. It's the cheapest one, so probably see that one the most. Those, I mean, there's an exception to every rule, but that's generally being used after like a stent's placed in the heart. It can be used for VTE, there's some out there, but that's pretty rare. But also for some valves that are placed in the hearts, it can be used for that as well. So antiplatelet, really thinking more like a cardiac event, right? Like I said, there's always an exception to every rule, but that's kind of where my mind goes real quickly, because we're gathering information from the patient.   They're on anticoagulant. Those are like going to be the new ones that you see commercials for all the time. So Xeralto, Alequis, those are the two big ones right now. They're replacing the older one. And also we were supposed to do a disclaimer of this is current as of today because the ADA guidelines do change. this will be current as of today. And Jason, as a pharmacist, is always looking up on that. I had no clue that you are that up to speed on dental knowledge. so just throwing it out there that if you happen to catch his podcast,   a few years back that obviously check those guidelines for sure. But the new ones are the Xarelto and Eloquist. They're replacing the older ones of warfarin. Warfarin's been around for a really long time. We've seen that one. Those are anti-coagulants. So when you're looking, when a patient says that, generally they're on that medication because they've possibly had a clot in the past or they have a heart condition called atrial fibrillation. Those are kind of the two big ones. Like I said, there's always caveats to it, but that's kind of where my mind goes real quickly. And then,   as far as getting patients cleared, the American Dental Association has really good resources on their website. You can look at those and they're always refreshing that up. They even say in their own words that there's limited data around studying patients in the dental chair and with anticoagulants or anti-platelets. It's pretty limited. There's a few studies, some from 2015, some from 2018. There's one as recent as 2021, which is nice. But really, all of those studies come together and it's really more of an expert consensus.   And with that expert consensus, they have kind of simplified things for dentistry, which is really nice. ⁓ comparing that to, we have more data for like total hip replacement, total knee replacement. We have a lot of data and we know really what we should be doing around then. But going back to dentistry, we don't have as much information, so they always say use clinical judgment, but they do give some really great expert guidance on that. So if a patient's on an anticoagulant, ⁓   they generally recommend that it doesn't need to be stopped unless there's a high bleeding risk for a patient. as a provider or as a clinician in the practice, you can be looking at high bleeding risk. Some things that make an oral procedure a little bit lower risk is one, it's in the compressible site, right? Like we can actually put pressure on that site. That's the number one way to stop bleeding is adding pressure. It's not like it's in the abdominal cavity where we can't get in and can't apply pressure. So number one, that kind of reduces the bleeding risk.   is number one. Two, we can add topical hemostatic agents. Dentists would know that better than me. There's a lot of topical ways to do that. So not only pressure, but there's those things as well. And also, but there are some procedures that are a little bit more likely to bleed. And that's where you and dentists would come in hand in What's the word in APO? Oh, the APOectomy. I got it right. Good job. like, didn't you tell me last night that the ADA guideline was like what?   three or four or more teeth? great question. So you can extract one to three teeth is what their expert consensus One to three teeth without. Without really managing or stopping anticoagulation or doing anything like that. I think that's some good guidance from them. I'm gonna add a Jasonism on that though. So with warfarin, I do see why dentists would be a little bit more conservative or worried about stopping the warfarin because warfarin isn't as stable as these newer agents. Warfarin, the levels.   quote unquote levels can go really high, they can go really low. And if the warfarin levels are high, they're more likely to bleed. So I do think it makes sense to have a really recent INR. That's how we measure what the warfarin's doing. I think that makes a lot of sense, but the ADA guidelines really go into the simplification version of all these blood thinners. Generally, it's recommended to not stop them because the risk of stopping them outweighs the benefit of stopping them in almost every case. Almost every case.   ⁓ So when you're with that patient, right, they say I'm on a blood thinner, finding out which kind of blood thinner that they're on, you find out that they're on Xeralto, right? How long have you been on Xeralto for? I've been on it for years. You don't know exactly why, but if they haven't had any recent bleeding, you're only gonna remove one tooth. ⁓ You can do what's called a HasBlood score. That kind of looks at the bleeding risk that they'd have. That'd be kind of going a notch above, but in my mind, removing one tooth isn't a real serious bleeding risk. I'd love to hear from my dentist friends if they...   disagree, right, but ADA says one to three tooth removals, extractions, that's the fancy word. Extractions, yeah, for extracting teeth out. Is not really that invasive. Sure. It's not that high risk, so it's usually perfectly fine. So if a patient was on Xarelto, ⁓ no other, this is in a vacuum, right? I'm not looking at any other factors, which you should be looking at other factors. I would be perfectly fine to just remove one to two.   And when those clearances come in, because dentists do send them, talk about what happens. You guys were working in the hospital and you guys would get these clearances all the time. do. We get them so often. I mean, we get like four or five a day. We'd love to give it to our students, student pharmacists, and ask them what to do. And they would usually look up the American Dental Association guidelines and come up with something. We're like, yep, that's what we say too. In fact, we say it so many times a day that we have a smart phrase.   which just blows in the information real quickly and faxes it right back to the So it's like a copy paste real quick. So what I wanted to point out when Jason told me this is dentists like hearing this and learning this, this can actually save you guys a ton of time to be able to be more confident, to not need to send those clearances on. And we were actually talking last night about how I think this might be a CYA for dentists. like, as we were talking, I think Jason, you seeing so many other aspects of medicine, like you've literally seen patients die, you've seen other areas.   And so coming from that clinical vantage point, we were realizing that dentists, we are so blessed to live in an injury. I enjoy dentistry because possibly there's someone dying, not super high, luckily in dentistry. The only time that I have actually had a doctor have a patient pass away, and it was only when they were completely sedated and doing ⁓ some other things, but that was under the care of an anesthesiologist. And so that's really our high, high risk. And so hearing this, Jason,   That was one of the reasons I wanted him to come on is to give you doctors more confidence of do we have to always send to a pharmacist? I mean, hearing that on the pharmacy side, they're just sending these back and not to say to not see why a to not cover this because you might be questioning like, well, do I really need to? But you also were talking about some other ways of so number one, you guys are just going to copy back the 88 guidelines. So so 88 guidelines. Yeah. And I think that that gives a lot of confidence to a provider or a dentist is that you can go to the 88 guidelines and read them, right? Like you're listening to some   nasally monotone pharmacist on a podcast. Rumor has it, people love him at the hospital. were like, you're the voice, he's been told he has a good radio So for the clinic, I was the voice. Like, yeah, you've reached the vascular clinic, right? And they're like, oh my gosh, you're the voice. But sorry, you me distracted. That'll be your next career, Jace. You're going to be a radio host. OK. I would love that. I love music. But you're hearing from a nasally guy, but you can actually read the ADA guidelines. You just go right to the ADA, click on Resources, and under Resources, it has the   around anticoagulants, I think that's the best way to get a lot of confidence about it because they have dentists who are the experts making calls on these. I'm just reiterating what they say, but I think it makes a lot of sense to help providers. And the reason why my heart goes out to you as well is having the providers that used to work underneath me, they're always looking for our views, which is a fancy way of making sure that they're drilling and filling. Can I say that? Yeah, can say drilling and filling. They're being productive, right? They're being productive, right?   They're always looking to make sure if a patient's canceling, like get somebody in here. Like I need to be helping people all day long. That's how I, we keep the lights on. That's how I help as many people. And so if you have a patient coming in the chair and it has an issue, they say I'm on Xeralto. Well, you can ask real quickly, why are you on Xeralto? I had a clot 10 years ago. my gosh. Well, yeah, we're pretty good to go. Then I'm not worried. We're only removing one tooth or we're just doing a cavity or a cleaning. Something like that. Shouldn't be an issue whatsoever because there's experts in the dental. ⁓   in the dental society, the ADA guidelines that recommend three teeth or less, minimally invasive. They really recommend if it's gonna be really high bleeding risk. And clinically, that's where you would come in, ⁓ or yourself. know, apioectomy is one that's like on the fence line. I don't know where implants set. though, and like we were talking, implants aren't usually like a date of procedure. Most people aren't popping in, having tooth pain, and we're like, let's do an implant. Now sometimes that can be the case, but typically that one's gonna have   a few other pieces involved. And so that is where you can get a clearance if you want to. ⁓ But we were really looking at this of like so many dentists that I know that you've seen will just send in these clearances because they are. And I think maybe a way to help dentists have more confidence is because you know, I love routines. I love to not have to remember things. So why don't we throw it in, have the team member set it up where every quarter we just double check the ADA guidelines. Are there any updates? Are there any other things that we need to do on that? That way you can just see like   getting into the language of this, of what do I need to do? Because honestly, you guys, know pharmacy was not a big portion for it, so, recommending different parts, but I think this is such a space where you can have confidence, and there's a few other things I wanna get to, and I you- I some pearls too. Okay, go. I'm so when she get me into talking about drugs, I'm not gonna stop. So, some other things around that too is these newer blood thinners like Xarelto Eloquist, they now have reversal agents, so a lot of providers in the past were really worried about bleeding because we can't turn it off. We can turn those off. Warfarin has reversal as well, right?   So I'm looking at these patients. It's really low risk. It's in the mouth, generally speaking. Very rarely are they a high bleeding risk. Now if you're doing maxillofacial surgery, this does not apply, right? This does not apply whatsoever. you're like general dentist, you're pediatric dentist. Yeah, yeah, and it's kind of on the fly. So just trying to really help you to be able to take care of those patients on the moment, have that confidence, look at the ADA guidelines, have that in front of you. I don't think it's a bad thing to ever...   check with their provider if you need to. If you're thinking, I feel like I should just check with the provider, I would never take that away from you. But I just want to kind of steer towards those guidelines that I have to help. But what did you want to share? No, yeah, I love that. And I think there were just a few other nuggets that we were chatting about last night that can help dentists just kind of get things passed a little bit easier. So you were mentioning that if they were named to their cardiologist, what was it? was like, who is the last? Great question. Yeah, when a patient's on a blood thinner,   It could be prescribed by the cardiologist. It could be prescribed by the family provider or could have been punted to like a vascular clinic like where I was working. It can go to any of those. And when you send that fax, right, if it goes to the cardiologist and it's supposed to go to the family care provider, like it just kind of goes, goes nowhere, right, from there. So I think it's a really good idea to find out who prescribed it last. If the patient doesn't know who prescribed their blood thinner last, you can call their pharmacy. I call pharmacies all day long.   I have noticed in the last year, they are way easier to get a hold of, which has made my job a lot easier, working on the insurance portion. So reaching out to the pharmacy, finding out who that provider is and sending it to them, because they should be able to help with that. I thought that was a good shift in verbiage that you had of asking instead of like the cardiologist, because that's who you would assume was the one. But you said like so many times you guys would take care of them, and then they go back to family practitioner, and you guys would get the clearances, but you couldn't clear because you weren't overseeing. So just asking the patient.   who prescribed their medication for them last time. That way you can send the clearance to the correct provider. then- And they might not know. You know patients, right? They're like, I don't know, my mom's or else, I don't know who gave it to me. Somebody told me I need to be on this. But at least that could be another quick thing. And then also we were talking last night about-   ⁓ What are some other things that dentists can do when like writing scripts to help them get what I think like overarching theme of everything we discussed is one how to help dentists have less I think drag through pharmacy. ⁓ Because pharmacy can take a little while and so perfect we now know the difference between anti-quag and anti-platelet. We know which medications are probably safe. We know we can check the ADA guidelines so that we were not having to do as many clearances. We also know if they're on a medication to find out and we do need a clearance.   who we can go to for the fastest, easiest result. And now, in talking about prescriptions, you had some really interesting tips that you could share with them. Yeah, so with writing prescriptions, right, pharmacies are pharmacies. So I'm not gonna say good thing or bad thing. There are challenges working with pharmacies. I'm not gonna play that down at all. ⁓ If you're writing prescriptions and having issues and kickbacks from pharmacies, there's some interesting laws around ⁓ writing prescriptions. Say that you're trying to ⁓ prescribe   augmentin, you know, 875 BID, and you tell the patient, hey, I want you to take this twice a day for seven days, and then you put quantity of seven, because you're moving fast, right? You want it for seven days, quantity of seven. Quantity would actually be 14, right? It's not that big of a deal. Anybody with common sense would say if you're taking a pill for twice a day for seven days, you need 14 tablets. But LAHA doesn't allow pharmacists to make that kind of a change, unfortunately. They have to follow what you're saying there. So you're going to get a...   An annoying callback that says, you wrote for seven tablets. I know you need 14. Is that OK? Just delays things, right? So ⁓ I really like the two letters QS. That's Q isn't queen. S isn't Sam. Yeah. It stands for quantity sufficient. So you don't have to calculate the amount of any medication that you're doing. So for me, as a pharmacist, when I was taking care of patients, I hated calculating the amount of insulin they would need for an entire month. So I would say.   Mrs. Jones needs 15, I'd say 15 units ⁓ QD daily. ⁓ And then I say QS, quantity sufficient, ⁓ 90 day supply through refills. So the pharmacy can then go calculate how much insulin that they need. I don't have to even do that. So anytime you're prescribing anything, I like that QS personally. So that lets the pharmacy use ⁓ common sense, as I like to call it, instead of giving you a call. I think that's super helpful. I also thought of one thing too.   going back to blood thinners is when it's kind of like a real quick, like they're not gonna have you stop the blood thinner at all. like you're seeing if you can stop the blood thinner for a patient, there's some instances it's just not gonna happen. And that's whenever they've been, they've had a clot or a stroke or a heart attack within the last three months. Three months. Yeah, that's kind of like the.   Because so many people are like, they had a heart thing like six years ago. And so I think a lot of my dentists that I worked with were like, we got to stop the blood thinners. But it sounds like it's within three months. Yeah, well, I'm just the time. Like this is general broad strokes. What I'm just trying to say is when you want to expect a no real quick. Got it. Right. So because benefits of stopping a blood thinner within those first three months of an event is very, very risky versus the, you know, the benefit of reducing a little bit of blood coming out of the mouth. Right. Like that's not that bad.   when somebody's had a stroke or a heart attack or pulmonary embolism, a clot in the lung, like we can't replace the lung, heart or brain very easily. We can replace blood a lot better. We've got buckets of it at most hospitals have buckets of it, right? So I'm always kind of leaning towards I'd rather replace blood than tissue at all times. So that's kind of a quick no. If they've had one those events in the last three months, we are really, really gonna watch their brain instead of getting.   root canal, right? Like really worried about them. So you'll just say no. And they could the dentist still proceed with the procedure or would you recommend like a three month wait? Or is it provider specific way the pros and cons because sometimes you need to get that tooth out. Great question. think then it's going to come into clinical. That's that's when you send in the clearance, right? Like, and it's great to reach out to the provider who's managing it for you. But I think it's kind of good to know exactly when you get a quick no quick no is going to be less than three months.   ⁓ Or when it's going to be like a kind of a typical, yeah, no problem. If it's been no greater than six months, they're on the typical anticoagulants or alto eloquence. Nothing crazy is going on for them. You're only removing two teeth. This is very, very low risk. But again, I'd urge everybody to read the ADA guidelines. That way you feel more comfortable with it. I'm not as eloquent as they do. They do a real good job. So I don't want to take any of their credit. I think they do a real good job of simplifying that and making you feel confident with providing.   more timely care for patients. Which is amazing. And Jayce, one last thing. I don't remember what it was. You were talking about the DEA and like six month rule. yeah. Let's just quickly talk about that and then we'll wrap this because this is such a fascinating thing for me last night. Yeah. So when comes to prescribing controlled substances, most providers have to have a DEA license. OK. First of all, though, what's your take on dentist prescribing controlled substances? ⁓ I don't think, you know, I worked on the insurance side of things. Right. And I look at the requirements for the   as the authorizations, what a patient, the criteria a patient needs to hit in order to qualify for certain medications. A lot of times for those controlled substances, they have pretty significant issues going on, like fibromyalgia or cancer-related pain or end-of-life care versus we don't, in all my scanning thread, I don't have a ⁓ perfect picture memory. Sure. But I don't usually see oral.   pain in there. There is some post-operative pain that can be covered for those kind of medications but I really recommend to keep those lower and in fact in a lot of our criteria it recommends you know have they tried Tylenol first, they tried, have they filled NSAIDs or are they contraindicated with the patient. So really they should be last line for patients in my two cents but there's always going to be a caveat to the rule right? Of course. comes through that has oral cancer and you're taking   like that would make sense to me. Got it, so then back to the DEA. Yeah, okay. Okay, ready. So as a provider, you should be checking the, if you're doing controlled substances, you should be checking the prescription drug monitoring program, or sometimes called the PDMP, looking to see if patients are getting ⁓ controlled substances from another provider. So it's really just a check and balance to make sure that they're not going from provider to provider to getting too many narcotics and causing self harm or harm to others.   And so with checking that PDMP before prescribing, I think a lot of providers do that. A lot of softwares that I'm aware of, EMRs, electronic medical records, sometimes have links so that you can do that more quickly. However, I don't think it's as intuitive that they need to be checking that every six months in some states. And like here in Nevada, you're supposed to be checking it every six months, not for a patient, but for your actual DEA registration to see if anybody else is prescribing underneath you. Because if you don't check that every six months, you could get in some serious trouble with...   not only DEA, but even more the Board of Pharmacy and your state. Now, I don't know all 50 states, so I check with your state to see if you need to be checking that every six months, but set an alarm just to check that real quickly, keep your nose clean. ⁓ I've had providers, I've had to remind to do that. And if somebody was using your account, prescribing narcotics, you'd never know unless you went and checked that PDMP.   Yeah, I remember last night you were like, and if that was you, I would not want to be you. The Board of Pharmacy is going to be real excited to find you. So that was something where I was like, got it. So, and we all know I'm big on let's make it easy. And Jason, I love that you love this so much and you just brought so much value today. And like also for me, it's just fun to podcast. fun. Yeah. But I got a nerd out on my world a little bit. Bring it into yours. I work with dentists or at least you know, when I was working in Vascular Clinic all day long. Great questions that would come through. Yeah.   So I think for all of us, as a recap on this is number one, I think setting yourself ⁓ some cadences. So maybe every quarter we check our ADA guidelines and we check our, what is it, PDMP. PDMP. so each state, so they call it Prescription Drug Monitoring Program. We need that. Yeah, but there are different acronyms in different states, though. That's just what it's called in Nevada. I forget what it is in California, but you can check your state's prescription monitoring program, make sure that opioids aren't being prescribed under your name. Got it. So we just set that as a cadence.   We know one to three teeth most likely if they're on a blood thinner is According to the 88 as of today is good to go You know things that are going to get a quick know are going to be within the last three months of the stroke the heart attack or the Clot I'm thinking like the pulmonary embolus. Yeah, that's what we're trying to prevent   Those are gonna be quick knows and then if we're prescribing, let's do QS. We've got quantity is sufficient so that we're not getting phone calls back on those medications that we are. And then on narcotics, just being a bit more cautious. Of course, this is provider specific and in no way, or form did Jason come on here to tell you you are the clinical expert.   Jason's the clinical expert on medications. And if you guys ever have questions, I know Jason, you geek out and you want to talk to people so that anyone wants to chat shop. Be sure to reach out and we'll be able to connect you in. we've even talked about possibly, so let me know listeners. You can email in Hello@TheDentalATeam.com of ask a pharmacist anything. I talked to Jason. I was like,   We'll just have them like send in questions and maybe get you back on the podcast or we do a webinar. But any last thoughts, Jace, you've got of pharmacy and dentistry as we as we wrap up today? No, I think that's pretty much it. So check the ADA guidelines. I think it's really good to have cross communication between professions. Right. If you're working with the pharmacy, CVS, Walgreens or something like that or Walmart, I know that it can be challenging. Right. They're under different pressures. You're under different pressure. So I think ⁓ just coming in with an understanding, not being angry at each other.   you know what mean, is super beneficial and working together. When it comes to it, every dentist that I've talked to is actually worried about their patient. Every pharmacist that I've worked with is really worried about the patient as well. So we're trying to accomplish the same thing, but we have different rules and our hands are bound in different ways that annoy each other, right? Like I know Dr. Jones, want 14 tablets, but you said seven. And I know Common Sense says I should give them 14, but I've got to make that change.   knowing that their hands are tied by the law. They can't use as much common sense, which is aggravating. I mean, that's why I love what I gotta do here. I gotta just kind of help a lot more and use common sense and improve patient care. But those kinds of things I think are really beneficial as you work together and then not being so afraid of blood thinners, right? So I think those guidelines do a great job of giving you confidence and not worrying about the side effects. And there's a lot of things that you can do locally for bleeding.   You have a lot of control over that. I think that's pretty cool, the tools they have. Yeah. And at the end of the day, yes, you are the clinician. You are the one who is responsible for this. so obviously, chat, but I think collaborating, talking to other pharmacists, talking to them in your state, finding out what are the state laws, things like that I think can be really beneficial just to give you peace of mind and confidence. And again, dentistry, are maybe a bit more risk adverse because luckily we don't have patients dying That's great thing. Yeah, that's fantastic. I want my dentists to be risk adverse. I think so too. But Jason, I appreciate you being on the podcast today.   And for all of you listening, ⁓ more confidence, more clarity, more streamline to be able to serve and help our patients better. if we can help you in any way or you've got more questions, reach out Hello@TheDentalATeam.com. And as always, thanks for listening. I'll catch you next time on the Dental A Team podcast.  

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I have so much to share from my facelift healing, my DVT scare, my trip to D.C. with my kids, a story time about my pet sitter and running into an ex who saw my new face for the first time!  Also, a very special letter from a very special lady at the very end (of course I cried because if you know you know).  Love you guys!  Have a great Monday!  xoxox Discreet Personal HIV Risk Assessment from Jennifer: 1. Pay at https://linktr.ee/PozJenn 2. DM me at Instagram: https://www.instagram.com/unfilteredjennifer 3. I will respond within an hour

Dr. Alison Loren and Dr. Ann Partridge share the latest guideline from ASCO on the management of cancer during pregnancy. They highlight the importance of this multidisciplinary, evidence-based guideline and overarching principles for the management of cancer during pregnancy. Drs. Loren and Partridge discuss key recommendations from each section of the guideline, including diagnostic evaluation, oncologic management, obstetrical management, and psychological and social support. They also touch on the importance of this guideline and accompanying tools for clinicians and how this serves as a framework for pregnant patients with cancer. The conversation wraps up with a discussion on the unanswered questions and how future evidence will inform guideline updates.  Read the full guideline, "Management of Cancer During Pregnancy: ASCO Guideline" at www.asco.org/survivorship-guidelines TRANSCRIPT This guideline, clinical tools, and resources are available at www.asco.org/survivorship-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO-25-02115   Brittany Harvey: Hello and welcome to the ASCO Guidelines Podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today I am interviewing Dr. Alison Loren from the Perelman School of Medicine of the University of Pennsylvania and Dr. Ann Partridge from Dana-Farber Cancer Institute, co-chairs on "Management of Cancer During Pregnancy: ASCO Guideline." Thank you for being here today, Dr. Loren and Dr. Partridge. Dr. Alison Loren: Thanks for having us. Dr. Ann Partridge: It's a pleasure. Brittany Harvey: And then just before we discuss this guideline, I would like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Partridge and Dr. Loren who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then to dive into the meat of this guideline, to start us off, Dr. Loren, could you provide an overview of the scope and purpose of this new guideline on the optimal management of cancer during pregnancy? Dr. Alison Loren: Sure, thanks, Brittany. So this was really born out of I think a lot of passion and concern for this really vulnerable patient population. We have observed, and I am sure it is not any surprise to your audience, that the incidence of cancer in young people is increasing. And simultaneously, people are choosing to become pregnant at older ages, and so we are seeing more and more people with a cancer diagnosis during their pregnancy. And for probably obvious reasons, there is really no way to do randomized clinical trials in this population. And so really trying to assemble and articulate the best evidence for safely managing the diagnosis of cancer, the management of cancer once it is confirmed, being thoughtful about obviously the health of the mom, but also attending to potential risks to the developing fetus, and really just trying to be really comprehensive and balanced about all the choices for these patients when they are facing some really challenging decisions in a very emotionally fraught environment. And I think it is really emotionally fraught for the providers, too. You know, this is obviously an extremely intense, very emotional set of decisions, and so trying to provide a rudder essentially to sort of help people frame the questions and trying to make as evidence-based a set of recommendations as possible. Dr. Ann Partridge: And I would just add that "evidence-based" is a strong word here because typically our, as you just heard, our gold standard evidence is a randomized trial, but you can't do that in this setting, in general. And so, what we were able to do with the support of the phenomenal ASCO staff was to pull together kind of the world's literature on the safety and outcomes of treatments during pregnancy, as well as consensus opinion. And I think that is a really, really critical difference about this particular guideline compared to many of the other ones that ASCO does, where consensus and good judgment needed to kind of rule the day when evidence is not available. So, there is a lot of that in our recommendations. Dr. Alison Loren: That is such a good point. And I just, before we move forward, I just want to reflect that the composition of the panel was really broad and wide-ranging. We had maternal medicine specialists, we had legal and ethical experts, we had representatives who understand pharmaceutical industries' perspectives, and then medical oncologists representing the full spectrum of oncology diagnoses. And so it was a really diverse, in terms of expertise, panel, internationally composed to try to really get the best consensus that we could in the absence of gold standard evidence. Brittany Harvey: Absolutely. That multidisciplinary panel is really key to developing this guideline and, as you said, looking at the evidence and even though it does not reach the level of randomized trials, still critically evaluating it and reviewing that along with consensus to come up with optimal management for diagnosis and management of cancer during pregnancy. So then to follow that up, I would like to next review the key recommendations of the guideline across the main sections that the expert panel provided. First, I will throw this out to either of you, but what are the important general principles for the management of cancer during pregnancy? Dr. Ann Partridge: I think there were three major principles that we hammer home in the guidelines. One is that this is a team sport. It is multidisciplinary care that is necessary in order to optimize outcomes for the patient and potentially for the fetus. And that you really need to, from the beginning, bring in a coordinated team, including not just oncologists but obstetricians, maternal-fetal medicine specialists, neonatologists, ethics consultants, and obviously the patient and potentially her family. So that, I think, is one of the most important things. Second would be that obviously in a pregnancy, there are two potential patients and that the nuances of safety and risk from treatment is really wrapped up in where in the trimester of the pregnancy the patient is diagnosed, along with the kind of cancer that it is, both the urgency of treatment and the risk of the cancer, as well as the potential risks of any given intervention across the cancer continuum. It is a broad guideline in that regard. And then finally, and this is particularly timely given what is going on from a sociopolitical standpoint in the U.S., really thinking about informed consent and potential ethical as well as legal implications of some of the choices that patients might have when they are thinking about, in particular, continuing a pregnancy or potential termination. Dr. Alison Loren: And I will just add that I think that the key to all of this guidance is nuance and individualization and also making sure that patients and their care providers understand all the choices that are available to them and also the consequences of those choices. You know, nobody would choose to receive chemotherapy during pregnancy if that wasn't necessary. So there are risks to treatment, but there are also risks to not treatment. And making sure that in a suboptimal situation where you do not have a lot of evidence, trying to weigh, the best you can, the risks and benefits of all of the choices so that the patient can come to a decision about the treatment plan that is right for her. Brittany Harvey: Definitely. And those core concepts really set the stage for individualized care on what is necessary for appropriate multidisciplinary care, prioritizing both patient autonomy and informed decision making. With those core concepts and key principles in mind, I would like to move into the recommendations section of the guideline. So what are the key recommendations regarding diagnostic evaluation for pregnant patients with signs or symptoms of cancer? Dr. Alison Loren: I think the most important thing is to not delay, that there are very careful and well-thought-out recommendations for how to evaluate a potential cancer. And while there are certain things that we know can be harmful, particularly when certain dose thresholds are exceeded - for instance, abdominal imaging, there are certain radiographic thresholds that you don't want to exceed because of risk of harm to the embryo or fetus - there are still lots of options for diagnosing cancer during pregnancy. And again, thinking about the costs of not doing versus the cost of doing, right? It is really important to make the diagnosis of cancer if that is a consideration or a concern. And sometimes going directly to biopsies or getting definitive studies, even if there is a small risk to the developing fetus, is really essential because if the mom does not survive, of course, the fetus is also not going to survive. And so we need to be thinking first about the patient who is sitting in front of us, the woman who needs to know what is going on in her body so she can make good decisions about her health. So, I think that is a key principle in thinking about this. Brittany Harvey: Absolutely. So, following that diagnosis of a new or recurrent cancer, what is recommended for oncologic management of patients who are diagnosed with cancer during their pregnancy? Dr. Ann Partridge: So, I think the general principle is, again, cancer is such a wide number of diseases and even within diseases, a range of stages and risks and associated opportunities for risk reduction and/or treatment depending on the type of cancer. Just by example, in the work that I do, which is breast cancer, once someone has had a surgery in the early-stage setting, a lot of our treatment is about risk reduction. And that is very different than from what Alison does, which is treating people with leukemia, where it is kind of binary. If you do not treat, including with cytotoxic drugs, the patient and an unborn fetus will die, especially early in the pregnancy, obviously. So this is where cancers are very, very different. So I think taking the approach of what would you do if the patient were not pregnant? And what is the best treatment for that particular patient with that particular kind of cancer? And then applying the pregnancy and where the patient is in that pregnancy in terms of the trimester of the pregnancy, and what is safe and what is unsafe from the options that you would give her if she were not pregnant. And then if the patient is choosing to keep the pregnancy, which in my practice, many people come and they come to me because they want to hold onto their pregnancy and want to figure out how to make it work, coming up with a regimen that tries to give them kind of the best bang for the buck, the best possible breast cancer therapy with the least harm, when possible, to the fetus. It is a bit of a balance, right? And then we cannot always give people the best approach. And sometimes it comes down to making a decision to give up something that may improve their survival so as not to harm the fetus. And sometimes it goes the opposite direction where a patient will say, "Oh, that is going to improve my survival by 5% and you can't give it to me now? I am going to choose to terminate." Even though that is obviously a very, very difficult and challenging decision to make in this setting because they want to optimize their survival and ideally live on to potentially have another pregnancy in the future if that is something that is of interest to her. So these are really, really hard conversations as you can imagine, but that is kind of where we go. Dr. Alison Loren: Yeah, and I think this is where the need for more research and understanding is really key because sometimes questions come up. I guess I am thinking about like HER2-directed agents, which we know are contraindicated in pregnancy. But what about sequencing? Does it matter when you get it? Can you get it later? I think that is something that we don't really fully understand. And similarly, again, this is obviously like a breast cancer and blood cancer focused discussion because that is what we do, but thinking about managing blood cancers, certainly with acute lymphoblastic leukemia, there is actually a lot of options now that, you know, you could potentially use to temporize or sort of get somebody through a pregnancy relatively safely. I am focusing on the word "relatively" because we do not know what the long-term impact might be of potentially not optimal therapy in the long run. And then thinking about other things like timing of a bone marrow transplant relative to either delivery or termination. I mean, again, we really do not know what are the right sets of sort of timing considerations for those. So there are just a lot of unknowns. And I think trying to be sort of self-aware and humble and honest about those unknowns so that the patient can engage in the conversation in a way that is meaningful to her and make the decisions that make the most sense for her. I think the most important thing is to make sure that the patient feels supported and safe to make those decisions with as little regret as possible. Brittany Harvey: Yes, I think it is really important that you mentioned that there is a wide range of cancers here, and that means that care really needs to be individualized for each patient. I will also note, just in this section, that I found really informative while reading through the guideline the list of oncologic agents that may be offered in each individual trimester, whether it is contraindicated or it can be used with caution, or if there is relatively good safety data on it for prioritizing maternal treatment needs and balancing fetal safety at the same time. I think that is, that is really key. And I think readers will really like that section of the guideline to provide concrete information for them and their patients. Dr. Alison Loren: Thank you. We actually spent a lot of time on that table and just thinking about what it should look like, what the format ought to be, what the language ought to be. Because of course, at the end of the day, everything should be used with caution. So what does that actually mean? And we sort of tried to explicate that a little bit in like the footnotes. We really tried to leverage what we know from clinical experience, from package labels, from mechanism of action to try to be as clear and definitive as we could be without overstating or understating what we know. Dr. Ann Partridge: Yeah, and I think we are focusing on breast and leukemia because that is what we do. But the truth is much of the data comes from those two areas. Leukemia, not because it is so common, but because you do not really have choices to treat or not treat. And so for decades, they have been treating and saying, "We hope the progeny comes out okay." And for many agents it does. The babies are okay. And so, we have reasonable observational data. And then in breast cancer, there have been actually some prospective registry-type studies where people have been followed and treated when pregnant, and the progeny have been accounted for, and so we have some good experience in that way too. Again, not randomized trials, but at least data that suggests certain agents are safe. And increasingly, because of that, when we have had to treat patients, we have said, "Okay, let us do it on this registry so that we can at least learn from every patient that comes in in this situation." And so, I think we will have more and more data given the growing number of young adults with cancer and the delays in childbearing that are happening around the world, and particularly in Westernized countries. I wish we did not. We wish we did not see this problem, but of course, when we do, we have to make sure that we learn from it and try and get patients enrolled in these registries and any kinds of studies that are available. Dr. Alison Loren: Yeah, I will just underscore that to say that, you know, there is outcomes of pregnancy and then there is outcomes of pregnancy, right? So there is like, "Okay, the baby was born with 10 fingers and 10 toes, and they passed their Apgar, and they are doing all their developmental processes along the way." But what happens when they are 10 or 15 or 20? Are they maturing normally? Are they cognitively intact? And then, of course, it is really inseparable from what is the impact on a family of having the mom with cancer? And how does that impact childhood development and intellectual development? And so these are really, really important questions that are very difficult to answer given the longitudinal information that you need, but it is a really critical question that, you know, patients ask and we do not know the answer. Dr. Ann Partridge: Yeah, that actually leads me to one of the important principles in the guideline that is a little bit of a change from when I first started practicing, which is we have learned from the wider neonatology literature, as they have followed up on the children that were born prematurely, that it is actually better not to be premature and to keep the baby in utero as long as it is safe for the fetus and the mother as long as possible, ideally to term rather than delivering early and then giving the chemo after that or separating the chemo from before and after. We used to try and deliver early and then give agents, but now we typically will give agents that are safe to be given at the end of pregnancy, ideally close to term, a couple weeks out, to allow for the ability of count recovery, and you do not want to go into preterm labor with chemotherapy on board, but we used to go much earlier and have an argument with our maternal-fetal medicine doctors. "How early can you get them out?" And they would say, "How long can they stay in?" And increasingly, we have been able to try and compromise to go even later and allow the fetus to go to term because of the neonatal outcomes that in longer term there is a suggestion that the children are developing better in the long run if they are kept in utero for as long as possible. Dr. Alison Loren: Yeah, that is such a great point. I think that is probably the most important thing for people to take away. For anyone who sort of does this, I mean, no one does this regularly because it is a rare event, although I think it is increasing as I mentioned. But this idea that the third trimester is, most of us know, is primarily a time for growth. Most of the critical development has already occurred, and so administering most chemotherapy agents towards the end of the third trimester seems to be preferable long term than delivering them early. So that is a really big change. I think we used to try to sort of, "Oh, get them to 30 or 32 weeks and then deliver," but we really are trying to get them closer to term, 37 weeks or more, and then coordinating the treatment so that they are not nadiring, as Ann said, at the time of planned delivery. Brittany Harvey: Yes, and that is a really important point related to evidence-based care and why we have changed that practice. And so then that actually leads nicely into my next question. But as you both mentioned, this is an important collaboration between oncologists and obstetricians. So the next section of the guideline addresses obstetrical practice. And so beyond what is standard, what additional recommendations are there in obstetrical management for pregnant patients with cancer? Dr. Alison Loren: That is a great question. So I will say we were really struggling with like how much do we cover? Like this is an oncology guideline. We are not obstetricians. We certainly had great representation from our maternal-fetal medicine colleagues on the panel. But really trying to sort of give useful information without overstepping. And so I think that the main recommendations are to increase the frequency of fetal monitoring, make sure that there is close attention to blood counts in the patient. But I think there is really still a gap in terms of what we know about optimal management of a pregnant person who is receiving therapy and how to handle the pregnancy itself. The delivery should be a usual delivery. Our colleagues did not recommend a planned C-section. They recommended usual care in terms of planning for the delivery. Obviously, if a C-section is indicated, then it should be done, but it should not be planned this way because of the cancer diagnosis. And I guess the other thing that we mentioned in the guideline, although we were reluctant to push it too hard because of access to these specialized services, was evaluating the placenta after birth to ensure that there were no metastases in the placenta itself. Dr. Ann Partridge: Those are the main things, and judicious and prudent obstetrical care, as I think, you know, is trying to be practiced regularly with MFM. Typically these patients should be followed not by your average OB/GYN, but a maternal-fetal medicine specialist because these patients will have special concerns, especially if they are sick. So oftentimes, especially Alison's patients, are actually sick with leukemia. And so you are monitoring them a lot, whereas, you know, a breast cancer patient typically isn't sick, although they could get sick with their chemotherapy. And so we really want to hand-in-hand manage these patients with our MFM colleagues. Dr. Alison Loren: I think we also highlighted in the guideline just for the refresher purposes of the oncology community, generally which drugs that would be given in a normal oncology setting are safe to be given to a pregnant person. So we talked a little bit about what kinds of steroids are recommended, antiemetics, DVT prophylaxis, peripartum. These are things that we think about a lot in oncology, but just want to make sure that it sort of intersected appropriately with the care of a pregnant patient. Brittany Harvey: Definitely. That specialized care is really important for patients who are pregnant and have cancer. And then the last section of the recommendations addresses psychological and social support. As you both mentioned before, this is a highly emotional time and it can be difficult and challenging to make decisions. So what is recommended for the psychological and social support of pregnant patients with cancer? Dr. Ann Partridge: Well, as I said, it is really something that needs to be considered at the beginning, through the diagnostic period, all the way into survivorship. Ironically, even though it is a highly fraught, emotional situation, I find that my pregnant patients actually are extraordinarily resilient, and what they are really focused on often is the safety of the fetus, because again, many of the people that come to me, it is a highly wanted pregnancy. They are also focused on their own health, of course, and often you need to bring in social work, sometimes a psychologist, professionals who are there just to help manage their emotions while we are focusing on what do they need medically to be as healthy as possible, both for the again, the mother, the patient, and the fetus. It is very tricky, and I will say also bringing in sometimes people on the ethics team in the hospital to help, both from the "Are you recommending and giving something that is safe?" That is number one. And then number two, sometimes patients want to be treated with drugs that we do not have any safety data for in pregnancy. What are our obligations? I think most of us would say we would not treat someone if we do not have safety data and there is suspicion for concern. But where is that line in terms of the right thing to do by that patient? And so we are all beholden to our ethics colleagues to help us when we make decisions like that. You know, we all want to do right by the patient, but we have to uphold our oaths and legal obligations. I don't know if you have to add on that because it's very tricky. Dr. Alison Loren: It is, it is very hard. I mean, I think, you know, there is a lot of emotion, obviously any cancer diagnosis is extremely charged and people are already at sort of a heightened, you know, they are anticipating a new baby and planning around that. And so it is just an extremely disruptive is the smallest word I can think of to describe it. And I think that often there is a co-parent, there might be parents and in-laws and other siblings, and then there is care after delivery. And so it is just a very complex set of dynamics. And having both our ethics colleagues and our psychology and social work colleagues to sort of just pitch in and make sure that the patient is being supported. I think there are sometimes really difficult situations where maybe what the patient wants is different from what the father of the baby wants or what the rest of the family wants. And so that can be really challenging. And you never really know where those landmines are going to pop up. So it is good to have the team on board early and often. Dr. Ann Partridge: Yeah, I would add to that, the other thing here that I think is really important, like in all of medicine but especially in situations like this, this is where we have to be very careful as professionals not to impose our own ethical, moral, emotional, personal views on the patient and to try to reserve judgment as much as possible. We are their navigator with the most important evidence and information that we can provide in the current situation. And that is where this guideline is extraordinarily helpful, we hope, for clinicians in the years to come. And at the same time, we cannot necessarily impose our own views and what we would do on a patient or what we tell our daughters, sisters, friends, family members. It is very tricky in that way. And so sometimes not just support for the patient, but support for the care team may be warranted in some of these very fraught situations. Dr. Alison Loren: Yeah, that is such a great point. And I was sort of thinking that too. I mean, it is, of course, the patient is front and center, but these are really difficult situations to navigate. And I will just add also that a lot of times these patients end up in academic centers, which I think is that's where the expertise or even just the experience may be. But the downside of that is that, you know, the teams are constantly changing. You have a new resident, you have a new intern, you have a new attending, a new fellow. And so, you know, the patients may be subjected to lots of different ways of communicating and sometimes those perceived differences can be really challenging. So sort of team huddles to sort of make sure that everybody is reading from the same script and everyone is comfortable with how the information is being presented so that the patient does not feel more confused or more overwhelmed, that they are kind of getting a consistent message from the whole team that, "This is what we know, this is what we are recommending, here are your other choices, and here are the pros and cons of each of these options." Brittany Harvey: Yes, I think you have both touched on this and that bringing in appropriate experts to support both clinicians and patients and their decision-making and their mental health is really important for this section of the guideline. We have already discussed this a fair bit throughout our conversation, but in your view, what is the importance of this guideline and how will it impact both clinicians and pregnant patients diagnosed with cancer? Dr. Ann Partridge: I could start with that. We just talked about experts and having them all around, but the fact is most people do not have the experts all around when they are dealing with this. And I think this is, you know, an expert-based, evidence-based guideline where having this in one's back pocket, whether you are in rural Montana or at a major cancer center on either coast, you will be armed with the latest and the greatest in terms of what we know and what we do not know, and some very helpful algorithms for how to think through the process of dealing with a patient who is diagnosed during pregnancy, whichever type of cancer it is. We could not cover every single specific thing about every cancer, although it is a pretty long guideline and there is a lot of nuance in there. So you might find a lot about specific cancers. And I think that that will be very, very helpful for people who are faced with this situation in the clinics just to frame it out, think through. Sometimes there is no answer that is the perfect answer and then, you know, using this as kind of a scaffolding and phoning a friend who may have more experience to help guide you and guide the patient, most importantly. I think it will be very helpful in that regard. Dr. Alison Loren: Yeah, I think so too. And I have talked about that we are working on this guideline and the anecdotal feedback has been, "This is so helpful." Like there really has not been, I think, an all-in-one place, diagnostic considerations, radiographic considerations, staging, treatment, all the modalities, surgical, radiation, systemic chemotherapy. We tried to include, when we could, novel agents including targeted agents and monoclonal antibodies and bispecifics and cellular immunotherapies and non-cellular immunotherapies. We really, really tried to cover in 2025 what are people using to treat cancer and to try to give the most balanced view of what we think is is safe or reasonably safe and what we think is either unproven or known to be risky, really to have it be kind of a go-to, like all-in-one, as much information as we have about these really challenging cases. We tried to include, Ann mentioned, you know, specific cancers, and I think when there were specific things to shout out with specific cancers, we really tried to highlight that. Like, "Okay, lots of young patients with cancer have Hodgkin's lymphoma, so what is safe and what is not for that specific case?" Or, "What is safe or what is not when you are thinking about colon cancers?" And we have a shout-out in here about considering checking for DPD deficiencies in patients who are pregnant. And I know it is generally recommended nowadays, but certainly for people who are pregnant, you know, you really want to avoid excess toxicity. So I think just really trying to be attentive to specifics about certain cancers in young patients and what would be valuable for a practicing oncologist and obstetrician to know when you are faced with this situation. Dr. Ann Partridge: Yeah, and I think the other critical thing that is great about this guideline is it's a starting place. And I anticipate that we will be building on this guideline for many years to come. And remember that when first, I was not around then, but probably three or four decades ago, when chemotherapy was just coming out and patients were coming in pregnant, there was a feeling I am sure that was, "We cannot give this to this person because it is purposefully going to destroy cells. And when you destroy cells in a growing fetus, you are going to destroy or harm that fetus." And yet, people did not have great choices. It was get treated or die, especially with things like leukemia early on. And bold patients along with their oncologist said, "Bring it on." And that is how some of this literature has been born. And so moving forward, there will be either purposeful exposures or inadvertent exposures of some of our therapies where we will learn ultimately. And this is a place where we can update these guidelines. That is the beautiful thing about the ASCO guidelines is that they are constantly being thought about to be updated. And then when there is enough of a change in practice, they will be updated such that they will continue to inform how we do this in the years to come for patients who come in pregnant. Dr. Allison Loren: Yeah, and I will say I have been doing this long enough now, we were just talking about a different guideline, the fertility guideline earlier today, and over the 20 years that the fertility guidelines have been out, just the amount of research has really skyrocketed. And you can see as you look at each guideline how much we have learned, what we can say, "Yes, this is working," "No, this is not working." Like, it is stuff that we used to say, "Oh, we do not really know," and now we have answers.  I think I speak for both of us when I say that we are hopeful that this will serve as, as Ann said, as a starting off point and really inspire people to ask the questions and do the research so that we can give better guidance moving forward, really trying to think about, you know, mechanisms and leaning on our colleagues in pharma and in the government who sort of think about safety and efficacy, to sort of make sure that they are contemplating not just non-pregnant patients, but also pregnant patients or as they are thinking about marking the package inserts with safety guidelines around this. Brittany Harvey: Yes, this is a critically important first guideline on the management of cancer during pregnancy, and we will look forward to continuing to build on that. I think as you mentioned, this guideline is far-reaching and has a lot of recommendations in it. And so both the full text of the guideline and those at-a-glance algorithms, figures, and tables will be really useful for clinicians in their clinic. Finally, to wrap us up, we have just been discussing this a little bit, but specifically, what are the outstanding questions on the management of pregnant patients with cancer, and where is this further research needed? Dr. Alison Loren: There are lots and lots and lots of unanswered questions. And I think if you look at the table, most of what we say is, "We are pretty sure this is okay, we are not so sure about this." I am paraphrasing, but we really just are operating in a paucity of what we would normally consider gold-standard evidence. It is hard to imagine, of course, there would ever be, as we mentioned in the beginning, randomized trials. But I think that preclinical data, mechanistic data, trying to think about including as we go through animal data, making sure that we are looking at female animals and pregnant animals so that we can sort of fully understand what the impact may be. And then I think thinking about more localized therapies around sort of radiation, you know, we are now moving into really hyper-focused radiation treatments like protons. Is that better because there is less scatter? Like I think those are real considerations that we just do not know the answer to. What do you think? Dr. Ann Partridge: I think so many unanswered questions, and this is a call to action to continue to and increase the documentation of the experiences and outcomes for patients diagnosed during pregnancy. Dr. Alison Loren: Yeah, and I think the long-term outcomes too are really going to be critical. Brittany Harvey: Yes, we will look forward to learning about more evidence across the spectrum of care to inform future updates to this guideline. So I want to thank you both so much for your work to develop this guideline, to review the extensive amounts of literature that you did, and work to create this guideline. And thank you also for your time today, Dr. Loren and Dr. Partridge. Dr. Alison Loren: Thanks. It was fun. Dr. Ann Partridge: Yeah, thank you. Brittany Harvey: And finally, thank you to all of our listeners for tuning into the ASCO Guidelines Podcast. To read the full guideline, go to www.asco.org/survivorship-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you have heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. 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. 

Are you up to date with the latest guidelines on deep venous thrombosis (DVT) management? Dr. Steven Abramowitz, vascular surgeon at MedStar Health, joins host Dr. Chris Beck for a deep dive into emerging clinical data in DVT management, where they review the evolving indications for mechanical thrombectomy and the implications of studies like the ATTRACT trial, the CLOUT registry, and the ongoing DEFIANCE trial. --- This podcast is supported by: Inari Medicalhttps://www.inarimedical.com/artix-system --- SYNPOSIS Dr. Abramowitz reviews recent data comparing outcomes of mechanical intervention versus lytic-based therapy, outlining how each approach fits into current practice. He underscores the critical role of IVUS in determining treatment endpoints, while noting the ongoing challenge of an absent standardized definition. The conversation also offers practical insights on procedural techniques and the evolving role of anticoagulation, emphasizing the importance of close collaboration and open communication with referring physicians. --- TIMESTAMPS 00:00 - Introduction00:45 - Overview of DVT Management02:50 - New Guidelines for DVT Treatment07:30 - Technical Endpoints in DVT Treatment13:26 - Clout Registry and Its Findings17:57 - Anticoagulation and DVT23:05 - Defining Acute DVT Management27:00 - Evolving Approaches to Acute DVT28:19 - Patient Experience and Quality of Life31:08 - Referring Providers and Data Impact37:01 - Single Session Treatments and Stenting41:07 - Chronic Venous Disease Management --- RESOURCES (ATTRACT) Weinberg I, Vedantham S, Salter A, et al. Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial. Vasc Med. 2019;24(5):442-451. doi:10.1177/1358863X19862043https://pubmed.ncbi.nlm.nih.gov/31354089/ (CLOUT) Shaikh A, Zybulewski A, Paulisin J, et al. Six-Month Outcomes of Mechanical Thrombectomy for Treating Deep Vein Thrombosis: Analysis from the 500-Patient CLOUT Registry. Cardiovasc Intervent Radiol. 2023;46(11):1571-1580. doi:10.1007/s00270-023-03509-8https://pubmed.ncbi.nlm.nih.gov/37580422/ (DEFIANCE) Abramowitz SD, Marko X, D'Souza D, et al. Rationale and design of the DEFIANCE study: A randomized controlled trial of mechanical thrombectomy versus anticoagulation alone for iliofemoral deep vein thrombosis. Am Heart J. 2025;281:92-102. doi:10.1016/j.ahj.2024.10.016https://pubmed.ncbi.nlm.nih.gov/39491572/

What if the “wait six weeks” rule after a C-section is holding you back more than it's keeping you safe? We unpack a smarter, kinder approach to recovery that treats movement like medicine—careful, progressive, and tailored to your body and your birth story.We start by confronting a hard truth: post-cesarean recovery is wildly variable. Some moms coast, others struggle, and most get blanket restrictions that ignore physiology and context. Drawing on clinical experience and current research, we explain how early, appropriate movement can reduce complications, calm inflammation, and help scar tissue remodel with purpose. You'll hear why gentle walking on the ward lowers DVT risk, how stacked posture protects the incision, and which core drills build stability without tugging on healing tissue.Then we map a practical framework you can adapt with your care team. Around week two, focus on breath-led bracing, diaphragmatic control, dead bug and bird dog progressions, light pallof presses, and short EMOMs or Tabatas that fit newborn life. By weeks four to five, many can reintroduce neutral-position strength—kettlebell deadlifts, goblet squats, and light barbell work—while watching for pain, swelling, or bleeding changes. At six weeks, we test careful spinal motion: gentle hanging, small beat swings, yoga Sphinx and controlled extensions, advancing only if symptoms stay quiet. Throughout, we emphasize changing one variable at a time and honoring fatigue from blood loss and sleep.This is a call to replace fear with informed freedom. We center emotional recovery, validate traumatic birth experiences, and offer clear red flags and green lights so you can move with confidence. Whether you're a barbell lover or a brisk walker, you'll leave with a step-by-step path to rebuild strength safely and reclaim your routine. If this resonates, subscribe, share with a friend who needs it, and leave a review with the one restriction you'd love to see rewritten.___________________________________________________________________________Don't miss out on any of the TEA coming out of the Barbell Mamas by subscribing to our newsletter You can also follow us on Instagram and YouTube for all the up-to-date information you need about pelvic health and female athletes. Interested in our programs? Check us out here!

In this week's “Heart to Heart” episode, Dr. Trey Baucum discusses how travel factors like cabin pressure, prolonged sitting, disrupted routines and dehydration can affect your heart. He explains how deep vein thrombosis (DVT) can form during long trips. He shares simple tips to reduce risk, such as calf raises, staying hydrated and walking when […] The post Travel Tips for Heart Health first appeared on Advanced Cardiovascular Specialists.

Most people assume that if you've ever had a blood clot, plastic surgery is off the table forever.But is that actually true?In this powerful episode of Plastic Surgery Uncensored, Dr. Rady Rahban sits down with Lori — a 60-year-old woman who survived multiple blood clots, including two pulmonary embolisms, and still safely underwent a tummy tuck.This conversation dives into:The real risks of surgery after DVT or PEWhy most doctors automatically say no — and why sometimes, that's not the whole storyHow a true team approach between surgeon + hematologist can make previously “impossible” cases possibleThe emotional journey of choosing your own quality of life — even when others try to talk you out of itThis is not a story about vanity.  It's a story about courage, medical nuance, and reclaiming your confidence at any age. If you've ever wondered, “Can I have plastic surgery if I've had a blood clot?” — this episode is your answer.✨ If you enjoyed this episode of Plastic Surgery Uncensored:✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.✔️ Rate & Review—your feedback helps more people find us.✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:Instagram: @drradyrahbanTikTok: @radyrahbanMDYouTube: @Rady RahbanFacebook: @Rady Rahban✔️ Share this episode with someone considering plastic surgery—the right knowledge can save a life.

This week, Gary, Kate, Mark and Henry discuss the optimal duration of anticoagulation after a provoked DVT, using low doses of mirtazapine or amitriptyline in adults with insomnia, whether a lower dose of semaglutide is still effective for weight loss, and adding aspirin for patients with coronary heart disease, a stent and who are also on a DOAC for another indication.Links:NICE Barrett Esophagus guideline: https://pubmed.ncbi.nlm.nih.gov/38553042/ Essential Evidence Plus: www.essentialevidenceplus.comDuration of anticoagulation: https://pubmed.ncbi.nlm.nih.gov/40888734/ Mirtazapine or amitriptyline for insomnia: ttps://pubmed.ncbi.nlm.nih.gov/39814428/ Lower dose semaglutide for obesity: https://pubmed.ncbi.nlm.nih.gov/40934115/ Adding aspirin: N Engl J Med . 2025 Oct 23;393(16):1578-1588https://pubmed.ncbi.nlm.nih.gov/40888725/

Welcome back to the EUVC Podcast, where we bring you the people and perspectives shaping European venture.Today we're joined by Lucanus Polagnoli (Founding Partner & CEO) and Stephanie Urbanski (Managing Director) of Calm/Storm — a specialist early-stage fund backing software-only digital health across Europe. Fresh off the close of Fund II, we dive into how they've evolved from a solo-GP experiment into a community-powered platform, why they keep the scope digital-only, and how they navigate regulation, AI and the post-COVID reality without losing the plot.

Send us a message with this link, we would love to hear from you. Standard message rates may apply.We share newlywed joy, wild plane moments, and a clear plan for beating jet lag using light timing, hydration, naps, and simple habits that work. Direction matters, and we explain how to prep differently for eastward and westward travel so your body clock adjusts faster.• wedding highlights and travel• plane etiquette and seat recline awareness• jet lag basics and circadian rhythm cues• symptoms that signal body clock mismatch• westward strategies: evening light and short naps• eastward strategies: morning light and earlier sleep• hydration, caffeine timing, and melatonin• DVT prevention: movement and compression socks• practical packing and flight timing choices• simple arrival routines for faster adjustmentYou can reach out to us by sending us an email, yourcheckuppod@ gmail.com, find us on Instagram, but most importantly, stay healthy, my friendsSupport the showSubscribe to Our Newsletter! Production and Content: Edward Delesky, MD & Nicole Aruffo, RNArtwork: Olivia Pawlowski

TWiP solves the case about the female who traveled to Brazil and upon returning home felt movements under her scalp on the back of her head, and present another case for your solving, a man with abnormal brain MRI. Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula Guest: Eyal Leshem Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join the MicrobeTV Discord server Life cycle of Dermatobia hominis (CDC) Letters read on TWiP 267 New Case Man in his 40s, married with 2 children, on Eliquis for a prior DVT, diet-controlled diabetes, who is admitted for evaluation of an abnormal brain MRI. He left AMA but then developed vomiting and returned. CT- Large peripherally enhancing mass lesion in the deep left cerebral hemisphere is associated with considerable vasogenic edema/infiltrative nonenhancing tumor. Mass effect results in left-to-right subfalcine herniation and entrapment of the right lateral ventricle. Findings are typical for glioblastoma. Intracranial abscess tumefactive multiple sclerosis and brain metastasis may mimic this appearance. Recommend supplemental imaging evaluation including gadolinium-enhanced MR brain. MRI- Dominant heterogeneously enhancing mass in the left basal ganglia/peri-insular region measuring 3.1 cm AP by 2.8 cm TR by 2.9 cm cc, with surrounding vasogenic edema resulting in mass effect and midline shift, as detailed above, concerning for high grade glial neoplasm versus metastasis. Additional leptomeningeal nodule in the right postcentral sulcus. Additional smaller peripherally enhancing lesion in the right lateral temporal region with suggestion of leptomeningeal component and measures approximately 0.8 x 0.8 cm, with mild surrounding vasogenic edema. They do a biopsy and pathology comes back as: – Brain tissue with extensive necrosis acute chronic inflammation, and rare microorganisms (on permanent section) -Brain, designated “left brain lesion”, excision: – Brain tissue with extensive necrosis acute and chronic inflammation, reactive gliosis and occasional microorganisms Become a patron of TWiP  Send your questions and comments to twip@microbe.tv

When Coach Prime, Deion Sanders, left a recent Colorado game in pain from another blood clot, headlines focused on his toes and his comeback. But few understood what his story actually exposes: the difference between arterial and venous clots — and why that distinction can mean the difference between life, limb, and legacy. On this week's Heart of Innovation, I sat down with Dr. Esteban Henao of Albuquerque, NM, and Dr. John Phillips, interventional cardiologist and co-host, to unpack the science, the stories, and the stakes behind blood clots — timed to World Thrombosis Day. We discuss: – Why Deion's “perfect storm” of diabetes, aneurysmal disease, and hereditary hypercoagulability makes his case so complex – How arterial clots (often linked to PAD and plaque buildup) differ from venous clots that can cause deadly pulmonary embolisms – What warning signs too many patients and clinicians still miss – Why who you are can determine how quickly you're treated — and how equity in vascular care could save thousands of limbs As Dr. Henao said on the show: “If Deion wasn't Deion, there's a good chance he would have lost his leg.” And that's exactly why these conversations matter. Listen to the full show! If you have additional questions about blood clots, call the Global PAD Association's Leg Saver Hotline at 1-833-PAD-LEGS or go to PADhelp.org #deionsanders #coachprime #bloodclots #arteryclot #DVT #peripheralarterydisease #legsaverhotline #globalpadassociation

A client was prescribed oral birth control to help manage symptoms of perimenopause. The medication caused a deep vein thrombosis (DVT), which then caused a pulmonary embolism (PE). Altogether this forms a potentially deadly phenomenon called venous thromboembolism (VTE). She survived, and she's fine. But here's the thing: her PE was just two weeks ago, and she wants to receive deep massage to her neck, back, and shoulders. Yikes, right? Or maybe not? Listen in for some key decision points about this question. Resources:  A Doctor's Note is Not Good Enough… and what is better: online self-paced continuing education course, available here. Massage & Bodywork magazine, “Helping Clients with Complex Conditions”, Jan/Feb 2023, available here.   Host Bio:                    Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner's books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com.      About our Sponsors:   Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. The principles of Anatomy Trains are used by osteopaths, physical therapists, bodyworkers, massage therapists, personal trainers, yoga, Pilates, Gyrotonics, and other body-minded manual therapists and movement professionals. Anatomy Trains inspires these practitioners to work with holistic anatomy in treating system-wide patterns to provide improved client outcomes in terms of structure and function.                      Website: anatomytrains.com                        Email: info@anatomytrains.com             Facebook: facebook.com/AnatomyTrains                       Instagram: www.instagram.com/anatomytrainsofficial   YouTube: https://www.youtube.com/channel/UC2g6TOEFrX4b-CigknssKHA     

How the low-fat food craze of the 80s set Gen X women up for an astounding rate of ultra-processed food addiction; Is there a replacement for scarce Wobenzyme for vein blood clots? Wrong type of vitamin D may shortchange body of its immune benefits; Beyond “gas station Viagra”—new testosterone support supplement harnesses safe, natural ingredients.

We review the diagnosis, risk stratification, & management of acute pulmonary embolism in the ED. Hosts: Vivian Chiu, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Acute_Pulmonary_Embolism.mp3 Download Leave a Comment Tags: Pulmonary Show Notes Core Concepts and Initial Approach Definition: Obstruction of pulmonary arteries, usually from a DVT in the proximal lower extremity veins (iliac/femoral), but may be tumor, air, or fat emboli. Incidence & Mortality: 300,000–370,000 cases/year in the USA, with 60,000–100,000 deaths annually. Mantra: “Don't anchor on the obvious. Always risk stratify and resuscitate with precision.” Risk Factors: Broad, including older age, inherited thrombophilias, malignancy, recent surgery/trauma, travel, smoking, hormonal use, and pregnancy. Clinical Presentation and Risk Stratification Presentation: Highly variable, showing up as anything from subtle shortness of breath to collapse. Acute/Subacute: Dyspnea (most common), pleuritic chest pain, cough, hemoptysis, and syncope. Patients are likely tachycardic, tachypneic, hypoxemic on room air, and may have a low-grade fever. Chronic: Can mimic acute symptoms or be totally asymptomatic. Pulmonary Infarction Signs: Pleuritic pain, hemoptysis, and an effusion. High-Risk Red Flags: Signs of hypotension (systolic blood pressure < 90 mmHg for over 15 minutes),

Let's start your week strong with a quick tip you can incorporate right away. In this Mo's Monday Minute shortie episode, I'm talking about key tests that may be ordered if your patient is suspected of having a DVT. This is a common condition that definitely shows up in the clinical setting and on exams! ___________________ FREE CLASS - If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES...you can thrive in nursing school without it taking over your life! 20 Secrets of Successful Nursing Students – Learn key strategies that will help you be a successful nursing student with this FREE guide! All Straight A Nursing Resources - Check out everything Straight A Nursing has to offer, including free resources and online courses to help you succeed!

In this episode, Drs William J. Gradishar, Heather McArthur, and Joanne Mortimer address audience questions from a recent live event on the use of CDK4/6 inhibitors in patients with early and metastatic breast cancer, including:Genomic testing options for assessing risk of recurrenceAdjuvant treatment duration and holidays with CDK4/6 inhibitorsManaging renal toxicities, prophylaxis for DVT, and asymptomatic ILDCDK4/6 inhibitors with inavolisib and fulvestrantPresenters:William J. Gradishar, MD, FACP, FASCOBetsy Bramsen Professor of Breast OncologyRobert H. Lurie Comprehensive Cancer CenterNorthwestern UniversityChicago, IllinoisHeather McArthur, MD, MPH, FASCOProfessor, Department of Internal MedicineClinical Director, Breast Cancer ProgramKomen Distinguished Chair in Clinical Breast Cancer ResearchUT Southwestern Medical CenterDallas, TexasJoanne Mortimer, MD, FACP, FASCOVice Chair, Medical OncologyProfessor, Division of Medical Oncology & Experimental TherapeuticsAssociate Director for Education and TrainingBaum Family Professor of Women's CancersCity of Hope Comprehensive Cancer CenterDuarte, CaliforniaLink to full program:https://bit.ly/4osHLTm

In this episode, a multidisciplinary panel of PE experts take learners on a deep dive into Deep Vein Thrombosis (DVT). Listen as they cover the latest in DVT diagnosis and treatment, exploring both clinical considerations and ever-evolving approaches.

Natural alternatives for Trump's chronic leg swelling problems; How certain blood and urine tests can help predict osteoporosis; Dark chocolate enhances cognitive function—with lasting effects; caffeinated black coffee reduces risk of death by 14%; NY Times misses the boat again on supplements for immunity; Man dies after being pulled into MRI machine.

In this exclusive Now Spinning Magazine interview, I sit down with Ian Anderson from Jethro Tull for a wide-ranging conversation covering the Curiosity concert series, setlist creation across 24 albums, upcoming deluxe box sets, and the spiritual significance of the annual Christmas concerts.Ian opens up about the physical demands of performance, his views on health and aging, and why he's speaking out on men's health topics like prostate exams and DVT awareness. He also shares strong thoughts on AI in music and the importance of preserving artistic legacy with integrity.

In part one of Red Eye Radio with Gary McNamara and Eric Harley, Tim Walz decides not to run for President in 2028 (whew!). Also the guys discuss music and guitarists..especially military missle expert Jeff "Skunk" Baxter, PBS/NPR defunded (for now), dossier 2.0 for the Epstein files, a potential lawsuit between President Trump and the WSJ, President Trump to sign the first "claw-back" bill in decades as Congress delivers $9B cut, audio from Stephen Colbert on CBS cancelling his show, Astronomer CEO Andy Byrona and his chief People Officer Kristin Cabot caught cheating on the "kiss-cam" at a Coldplay concert, President Trump diagnosed with rare vein condition (not DVT) and the guys discuss their epitaphs. Also frantic audio from Joy Reid on Piers Morgan on Obama's deportation numbers and more fan fallout on the Steve Miller Band's "climate change" tour cancellation. For more talk on the issues that matter to you, listen on radio stations across America Monday-Friday 12am-5am CT (1am-6am ET and 10pm-3am PT), download the RED EYE RADIO SHOW app, asking your smart speaker, or listening at RedEyeRadioShow.com. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Send us a textIn this episode of CLOT Conversations, Dr. Gregoire Le Gal, University of Ottawa, in an interview with Dr Vicky Mai, shares insights from his groundbreaking study on age-adjusted D-dimer cutoffs for diagnosing deep vein thrombosis (DVT). Previously validated for pulmonary embolism (PE), this new approach significantly improves DVT diagnostics. By adjusting D-dimer thresholds based on patient age, the study found a safe and reliable method to rule out DVT without reliance on additional imaging. Though results showed a smaller incremental increase in negative D-dimer results compared to PE, the safety of the approach was confirmed. This research simplifies DVT diagnostics, making it easier for clinicians, especially in emergency settings.Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

We've tried, but this time, it just wasn't possible. With so many secrets flying around, we had no choice but to continue the theme and split the party for Action Surge too.On the plus side, all that getting up and down from the table probably means none of us are getting a DVT. Silver linings.As you may have guessed, these episode descriptions are written by someone who is not the DM, which means this person was neither in the room for all of episode 31 nor for all of Action Surge. So, in this episode, we break down everything we can from episode 31, reflecting on the highs, the lows, and the revelations in between.It's a tale of two halves, or three. And quite honestly, unless you're Harry, you should be grateful you even got that much. Hosted on Acast. See acast.com/privacy for more information.

In this episode, Simon chats with Martin Whitaker — a performance coach and PhD researcher specialising in blood flow restriction (BFR) training — about powerful tools for boosting performance, enhancing recovery, and staying fit for life. Topics Discussed: What is blood flow restriction training and how does it work? Strength and hypertrophy gains with lower loads Case studies from ACL rehab and elite football clubs VO₂ Max development using low-intensity interval training with BFR Using BFR for recovery, tapering, and mid-competition maintenance Who should not use BFR (health contraindications like DVT or AFib) Why VO₂ Max matters for longevity (Peter Attia's “Centenarian Decathlon” idea) How to structure high-intensity VO₂ Max intervals for over-50s The importance of fat max, fractional utilisation, and fuelling strategy Quotes: “VO₂ Max is a bit of a vanity number for athletes… but it's also one of the strongest predictors of longevity.” — Martin Whitaker “BFR lets you get the same strength gains at 20–40% of 1RM that you'd usually need 70% for.” “High-intensity work gets harder with age — but it also gets more important.” Call to Action: If this episode inspired or helped you, please: Leave us a ⭐️⭐️⭐️⭐️⭐️ review Subscribe to the High Performance Human Podcast on your favourite platform Share this episode with a friend who's racing soon! Resources & Links: Saga Fitness BFR cuffs Research paper on BFR safety - https://pmc.ncbi.nlm.nih.gov/articles/PMC6530612/ VO₂ Max tables and fat oxidation graphs (shared by Martin) Join Simon's SWAT Inner Circle: [Insert link] Learn more about Martin Website - https://onetakefitness.com/ Facebook - OneTakeFitness Instagram: Personal - MartinWhitaker                     Business - OneTakeFit   Looking for more content from me? Check out my Instagram  and YouTube  channels Sign up for Simon's weekly newsletter Sign up for Beth's weekly newsletter Some FREE Downloads for you Click here fore the Race Day Execution Checklist Click here to get your copy of 7 steps to swimming faster Infographic To get a free copy of my personal daily mobility routine, please click HERE To download your FREE infographic ‘6 key daily health metrics', please click HERE  Ready to Take Action? If you want to build a stronger, healthier, more resilient version of yourself, there are two ways to get started: 1-1 Coaching with Simon Ward – Get a personalised programme designed for your lifestyle and goals. Book a call today Join the SWAT Inner Circle – Our exclusive training community focused on real-world strength, health, and performance You can watch a brief video about the group by going to our website here, and join our SWAT High Performance Human tribe here.   To contact Beth regarding Life Coaching, please visit her website at BethanyWardLifeCoaching.uk.   For any questions please email Beth@TheTriathlonCoach.com.

Sigma Prime introduces the Anchor DVT client. Unichain launches a Conditional Funding Markets experiment. Sunnyside Labs sustains 50 blobs on a PeerDAS Devnet. And BiT Global drops its lawsuit against Coinbase. Read more: https://ethdaily.io/716 Disclaimer: Content is for informational purposes only, not endorsement or investment advice. The accuracy of information is not guaranteed.  

This week, Aebhric O'Kelly speaks with Jason Jarvis, a former Special Forces medic and current PhD student, about his experiences in military medicine, the evolution of prolonged field care, and the development of the 'SHEEP VOMIT' mnemonic for patient care in austere environments. They discuss the importance of nursing care, the practical applications of medical knowledge in the field, and the challenges medical practitioners face in remote settings. This conversation delves into critical aspects of patient care, particularly in prolonged field care settings. It emphasises the importance of managing pressure points, understanding vital signs, monitoring core temperature, maintaining oral hygiene, preventing DVT, and ensuring proper input and output monitoring. The discussion also highlights the significance of turning, coughing, and deep breathing for patient recovery, culminating in the legacy of the 'sheep vomit' concept in medical training.TakeawaysJason Jarvis has a master's in infectious disease and is pursuing a PhD.Military experiences shaped his interest in tropical medicine.Prolonged field care is a systematic approach to patient care in remote settings.The 'SHEEP VOMIT' mnemonic was developed to aid in prolonged field care.Skin protection is crucial in austere environments.Hypothermia prevention is a key focus in field care.Patient mobility and exercises are essential for recovery.Checklists help ensure comprehensive patient care.The evolution of medical mnemonics reflects advancements in field medicine. Pressure sores develop in specific areas when supine.Vital signs must be documented and trended over time.Core temperature is crucial for assessing trauma patients.Oral hygiene prevents infections that can lead to pneumonia.DVT prevention is essential for immobilised patients.Urine output is a key indicator of hydration and health.Turning and coughing help maintain lung function.The 'SHEEP VOMIT' concept aids in prolonged field care training.Training should prepare providers for practical challenges.Community impact is a goal of medical training.Chapters00:00 Introduction to Jason Jarvis 00:46 Jason Jarvis: Background and Current Work02:37 Military Experiences and Deployments05:58 Transitioning to Civilian Life and DMI09:52 Prolonged Field Care: Concepts and Evolution13:45 Developing the Sheep Vomit Mnemonic18:35 Understanding the Sheep Vomit Mnemonic21:58 Practical Applications of Prolonged Field Care26:12 Exercises and Patient Mobility29:35 Managing Pressure Points in Patient Care30:05 Understanding Vital Signs and Their Importance31:10 The Role of Core Temperature in Patient Assessment32:40 Oral Hygiene and Its Clinical Significance36:02 Preventing Deep Vein Thrombosis (DVT) in Immobilised Patients40:44 Monitoring Input and Output: A Vital Sign49:04 The Importance of Turning, Coughing, and Deep Breathing55:00 The Legacy of Sheep Vomit in Medical Training

In this week's Podiatry Legends Podcast, I had the pleasure of sitting down with James Ferrie, a sports and musculoskeletal podiatrist from My Sports Podiatry in Docklands, Victoria, to discuss point-of-care ultrasound and its benefits for our patients.  Whether you're just starting out in practice or looking to enhance your existing clinic, this episode will give you the tools and knowledge to incorporate ultrasound into your diagnostic toolkit. Nine Key Takeaways from the Episode: Point-of-care ultrasound enhances diagnostic accuracy by providing real-time imaging of soft tissues and bones. Ultrasound helps podiatrists make clinical decisions immediately during patient appointments. It's a powerful tool for ruling out common diagnoses, such as plantar fasciitis, and identifying rare conditions like stress fractures or DVT. Ultrasound improves patient outcomes by helping podiatrists tailor treatments to individual needs. The learning curve for ultrasound can be steep, but with practice and proper training, it becomes an invaluable skill. Podiatrists can use ultrasound for more than just musculoskeletal injuries, including nerve assessment and injection guidance. The handheld ultrasound devices are a good starting point, but may not be sufficient for complex procedures or advanced diagnostics. The ability to visualise structures during patient care makes ultrasound an extension of the clinical exam. Proper training and practice are essential for interpreting ultrasound images accurately and avoiding common errors. If you want to know where and when James Ferrie's workshops are being held, I suggest contacting him on LinkedIn.  My Upcoming Events - https://www.podiatrylegends.com/upcoming-events/ If you have any questions about this episode or want to contact me, please email me at tyson@podiatrylegends.com. Do You Want A Little Business Guidance?  A podiatrist I spoke with in early 2024 earned an additional $40,000 by following my advice from a 30-minute free Zoom call. Think about it: you have everything to gain and nothing to lose, and it's not a TRAP. I'm not out to get you, I'm here to help you.  Please follow the link below to my calendar and schedule a free 30-minute Zoom call. I guarantee that after we talk, you will have far more clarity on what is best for you, your business and your career. MY SCHEDULE  Yes, I Do Business Coaching I offer three coaching options: Hourly Sessions, Monthly Ongoing Sessions, and On-Site Training Days.   But let's have a chat first to see what best suits you. ONLINE CALENDAR Subscribe to my YouTube Channel – Tyson E Franklin  FACEBOOK GROUP - Podiatry Business Owners Club  MY BOOK is available on AMAZON - It's No Secret, There's Money in Podiatry 

Welcome to our new series – the AI Journal Club! In this series, we'll cover some interesting studies and evidence-based applications of artificial intelligence in surgery in a case-based format. Surely AI can find a DVT by now … or can it? Stay tuned and find out! Hosts: - Ayman Ali, MD Ayman Ali is a Behind the Knife fellow and general surgery PGY-3 at Duke Hospital in his academic development time where he focuses on data science, artificial intelligence, and surgery. - Ruchi Thanawala, MD: @Ruchi_TJ Ruchi Thanawala is an Assistant Professor of Informatics and Thoracic Surgery at Oregon Health and Science University (OHSU) and founder of Firefly, an AI-driven platform that is built for competency-based medical education. In addition, she directs the Surgical Data and Decision Sciences Lab for the Department of Surgery at OHSU.  - Marisa Sewell, MD: @MarisaSewell Marisa Sewell is a general surgery PGY-4 at Oregon Health and Science University.  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Listen to our latest podcast as we break down Jimmy Butler's return, Damian Lillard's Achilles tear, and the 49ers draft.

Season FOUR Episode FIFTEEN of the Your Story Our Fight® podcast welcomes Chantelle Chandler. Chantelle is a resilient lupus warrior who has been navigating life with systemic lupus erythematosus (SLE), hypothyroidism, rheumatoid arthritis, and Raynaud's syndrome for over three decades. In addition to managing these autoimmune conditions, she has also lived with jugular deep vein thrombosis (DVT) for the past 28 years. Through it all, Chantelle continues to embody strength, perseverance, and advocacy for others living with chronic illness.

Milwaukee Bucks legend (on and off court) Marques Johnson joined Ti Windisch and Rohan Katti on a VERY special Milwaukee Bucks NBA Playoffs preview podcast to discuss the key Bucks topics heading into the series. Marques opines on the growth of Giannis Antetokounmpo over the years, how Damian Lillard got back earlier than anticipated from his DVT to hopefully play in this first round, the challenge for Doc Rivers to re-integrate Dame plus manage a deep rotation throughout the series, knowing Doc since the 80s (including an incredible Don Nelson story), the fabled Giannis and friends fourth quarter lineup and if more of those players should start, his 10-year stint as Bucks broadcaster and why he brings advanced stats to the broadcast, and of course his series prediction.Thank you to today's sponsor: PrizePicks! – Go to PrizePicks.com/Gyrostep and use code GYROSTEP for a $50 bonus when you play $5 for the first time! GSPN's Bucks podcasts are presented by PrizePicks – Go to PrizePicks.com/Gyrostep and use code GYROSTEP for a $50 bonus when you play $5 for the first time! Pick more. Pick less. It's that easy.Visit GSPN.info to find GSPN's homebase, including the new GSPN Premium! For $8 per month, GSPN Premium subscribers get a bonus podcast episode from the GSPN Crew each week, access to a premium podcast feed with commercial-free versions of Gyro Step, Win in 6, Crewsing for a Brewsing, and Talk of the Tundra, bonus premium content including videos and written articles, and more. GSPN Premium Founding Members get all other GSPN Premium benefits as well as a shoutout here! Thanks to Michael McQuide, South Loonier, Justin Saeian, and Ben Kolp for being Founding Members.GSPN is proud to call Blue Wire's network of podcasts home. You can (and should) follow Rohan, Ti, Adam, Jordan, Andrew, Numac, and the Gyro Step , Win In 6, Crewsing for a Brewsing, and Talk of the Tundra on Twitter. Don't forget to leave a 5 star rating on Apple Podcasts or Spotify!

Dr. Julie Siemers is a healthcare leader with 40+ years of experience who teaches people how to survive hospital stays and avoid becoming a statistic. New episodes of Welcome to Wellness every Friday!Not listening on Spotify? Show notes at: https://www.ashleydeeley.com/w2w/drjuliesiemersEpisode brought to you by: ApolloNeuroEpisode brought to you by:⁠⁠⁠⁠⁠⁠ VieLight⁠⁠⁠ - ⁠⁠⁠Code: DEELEY10Episode brought to you by:⁠⁠⁠⁠⁠⁠Dry Farm Wines⁠⁠⁠⁠⁠⁠ 8:57: Surviving Your Hospital Stay - book13:31:  Hospital Hierarchy: NurseCharge nurseHouse supervisorAdministrator14:59: CUSS words: Tell your nurse, "I feel..."ConcernedUncomfortableScaredSafety22:55: The 3 P'sBe presentBe politeBe persistent 24:39: Find the ranking of hospitals! https://www.hospitalsafetygrade.org/28:38: Patient left with a retractor insider her body30:48:  1 out of 4 Medicare patients that enter the hospital have some kind of harm happened to them34:35: Vital signsBlood pressure: normal is considered to be less than 120/80 mmHgHeart rate: normal resting heart rate is between 60 and 100 beats per minute (bpm)Respiratory rate: this is THE MOST SENSITIVE  and earliest indicator of patient deterioration; normal range is 12 to 20 breaths per minute 37:24: 80% of nurses don't count respiratory rate 38:51: Blood pressure cuff40:04: Opioids, Sleep Apnea, and Surgery44:11: The best thing to do if you need surgery - GET MOVINGIt boosts blood flow to your extremities, helping prevent deep vein thrombosis (DVT) or blood clots, which often start in the legs. It also supports lung expansion and overall circulation45:14: Invest in an  incentive spirometer (to ensure you have it after surgery)47:52: Symptoms of  low or high blood pressure, heart rate, respiratory issuesDizzyDehydratedTemperature irregularitiesHeart beat irregularities55:21: Protocol for a feeding tube58:08: Medication errors are a top problem in hospitals58:30: ALWAYS ask for test results/lab results/pathology reports1:02:59: Patient Safety Checklist1:04:33: Always double check that your name and patient details are correct on all forms, blood samples, etc.,1:08:28: Why Dr Siemers is against statins (as am I!)Where to find Dr. Julie Siemers⁠Website⁠InstagramFacebookYouTubeWhere to find Ashley Deeley:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠YouTube⁠⁠⁠⁠⁠⁠⁠⁠⁠hello@ashleydeeley.com

Grant reacts to the news of Damian Lillard's clearance from his DVT and breaks it down with Justin Garcia. Rodgers spoke on the McAfee Show about his current status (so-so content) and blasts the Jets over his exit interview (electric content). See omnystudio.com/listener for privacy information.

We welcome the newest member of the Virtua/Reconstructive sports team, Dr. David Webner, MD. Dr. Webner is currently the team physician for the Philadelphia Union MLS soccer team and joins us to discuss a fairly rare but potentially catastrophic issue for athletes, deep vein thrombosis. We discuss exactly what a DVT is and why it is so dangerous. Dr. Webner explains why people get these and why, in particular, athletes like Victor Wembanyama and Damian Lillard, can be predisposed. An exceedingly helpful and insightful discussion about an important topic for all sports related medical professionals.

Welcome back to the Konfidence in the Klutch Podcast with Donald Nelson.  Konfidence in the Klutch's Deezus gives his Konfident Service Announcement on the gym (5:30). Deezus talks Politics as usual with thoughts on Trump, who has only been in office two months, and nothing but controversy has ensued.  If that's Trump's national security council and they're that careless with the signal app text chain, we are not secure.  Elon is trying to buy a Supreme Court seat in Wisconsin due to his lawsuit against the state. (8:00). Deezus then gives his  NBA news with a four-pack: Celtics sold for a record $6.1B with no arena in the deal,  Dame Dolla is diagnosed with DVT and is sidelined indefinitely, and the great LeBron interview on McAfee is marred by Bron fanning the fames at Stephen A, Dante was not playing with them Detroit cats (14:40).  Deezy gives his updated NCAA Mens and Womens Final Four picks and National Champions (21:00).  Deezy gives his quick ones: Lions are still tripping, A woman's choice, 23 and me going into bankruptcy, Jayden Daniels and Ma Dukes, Mind the Game pod changeup, ESPN is shutting down Sportscenter LA (24:45).  This podcast was recorded at 6:30 p.m. CT on Tuesday, April 1st, 2025.  Host: Donald Nelson Producer/Engineer: Donald Nelson Music by: Konfidence in the Klutch Productions Subscribe, Stream, or Download:

On this episode of The Big Number, Tom Haberstroh and Dan Devine weigh in on why Anthony Davis is THE most important player with 10 games remaining in the NBA regular season. Patrick Dumont and Nico Harrison get to see whether their high-stakes gamble pays off in the short term, as AD currently has an outside shot to drag the Dallas Mavericks into the Play-In and then perhaps the Playoffs. Plus, Dan explains how the next tier of "most important players" with 10 games to go includes Aaron Gordon, Devin Booker, Jaden McDaniels and Kawhi Leonard — with the Western Conference Playoff picture heating up more each day. And the guys discuss Damian Lillard's DVT diagnosis and how it impacts the Milwaukee Bucks in the short-term, and perhaps additionally impacting Giannis Antetokounmpo's future with Milwaukee in the long run.(1:00) - Big Number: Can Anthony Davis carry the Dallas Mavericks?(16:45) - Aaron Gordon elevates the Denver Nuggets defense(21:20) - Devin Booker's impact on the Phoenix Suns(25:30) - Kawhi Leonard surging with the Los Angeles Clippers(29:00) - Jaden McDaniels is sinking 3's for the Minnesota Timberwolves(33:45) - Over/under scoreboard update(37:15) - LeBron says Giannis could score 250 a game in the 1970's(41:10) - Where do the Milwaukee Bucks go from here?Subscribe to the The Big Number on your favorite podcast app:

Damian Lillard has a DVT and will miss a bunch of time - how much exactly, we don't yet know - but it's safe to assume it's most of the remaining regular season (if not all). That sucks, but we have some adds to soften the blow. Donate directly to Palisades Elementary's Fire Recovery Fund: https://palielementary.kindful.com/?campaign=1345495 Follow Dan Besbris on Twitter: https://x.com/danbesbris Find Dan on the brand new BlueSky social network: https://bit.ly/3Vo5M0N Check out Dan's Buckets, Weekly Schedule Charts & Yahoo Rank Tracker Sheet FREE! https://bit.ly/3XrAdEW Listen and subscribe on iTunes: https://apple.co/3XiUzQK Listen and subscribe on Spotify: https://spoti.fi/3ACCHYe Float on over to the new Old Man Squad Sports Network YouTube page to watch videos from the network's top talent: https://bit.ly/46Z6fvb Join the Old Man Squad Discord to chat with Dan and all the other hosts: https://t.co/aY9cqDrgRY Follow Old Man Squad Fantasy on Instagram for all our short videos: https://bit.ly/3ZQbxrt Podcast logo by https://twitter.com/freekeepoints Beats by https://twitter.com/slickrach

This recording features audio versions of April 2025 Journal of Vascular and Interventional Radiology (JVIR) abstracts:Adverse Events After Percutaneous Transhepatic Biliary Drainage: A 10-Year Retrospective Analysis ReadEndovascular Therapy versus Anticoagulation Alone for Subacute Iliofemoral Deep Vein Thrombosis ReadImprovement of Hypoalbuminemia and Hepatic Reserve after Stent Placement for Postsurgical Portal Vein Stenosis ReadSafety and Effectiveness of Yttrium-90 Radioembolization in People Living with Human Immunodeficiency Virus ReadRadiation Segmentectomy and Modified Radiation Lobectomy for Unresectable Early-Stage Intrahepatic Cholangiocarcinoma ReadComparison of Liquid with Particle Embolics in a Translational Rat Model of Hepatocellular Carcinoma: Histologic and Radiographic Responses ReadJVIR and SIR thank all those who helped record this episode. To sign up to help with future episodes, please contact our outreach coordinator at millennie.chen.jvir@gmail.com.  Host:Sonya Choe, University of California Riverside School of MedicineAudio editor:Hannah Curtis, Loma Linda University School of MedicineOutreach coordinator:Millennie Chen, University of California Riverside School of MedicineAbstract readers:Millennie Chen, University of California Riverside School of MedicineTheodore Addo, Warren Alpert Medical School of Brown UniversityIpek Midillioglu, Western University of Health SciencesDaniel Roh, Loma Linda University School of MedicineSunil Balamurugan, Western University of Health SciencesMark Oliinik, Loma Linda University School of MedicineSIR thanks BD for its generous support of the Kinked Wire.Contact us with your ideas and questions, or read more about about interventional radiology in IR Quarterly magazine or SIR's Patient Center.(c) Society of Interventional Radiology.Support the show

A stubborn cough, shortness of breath, or swollen legs—are these just random symptoms, or could your body be trying to warn you about something more serious? In this powerful episode, Dr. Andrea McSwain explores the life-saving connection between the lungs, heart, and circulatory system. From the impacts of COPD and pulmonary hypertension to the risks of deep vein thrombosis (DVT) and pulmonary embolism (PE), you'll learn why these symptoms should never be ignored. This episode covers: The heart-lung connection and why dysfunction in one affects the other When a cough or fatigue might signal heart failure—not asthma What your legs and a pulse oximeter can reveal about your health Dr. McSwain's personal story of losing her mother to a pulmonary embolism How functional medicine approaches root cause prevention Action steps to protect your circulation and overall health

In this episode, country music artist Kaylee Bell shares her remarkable journey to motherhood - from managing chronic health conditions to an unexpected pregnancy while touring, and navigating a challenging birth due to a DVT diagnosis. Her story beautifully illustrates how life's biggest surprises can lead to the most meaningful experiences. You can follow Kaylee's journey on Insta here Listen to Kaylee's music on SpotifyListen on Apple MusicWatch on YouTube For more birth stories, follow us on Instagram hereSee omnystudio.com/listener for privacy information.

Antonia Roberts and Howard Herrell review several new articles: • Epifoam for postpartum pain lacks evidence of effectiveness compared to simple ice packs while costing nearly $100 per unit• AMH levels above 5.39 are associated with PCOS diagnosis, providing a specific threshold for clinical use• External aortic compression demonstrated as a life-saving technique during severe obstetric hemorrhage• Vaginal estrogen in breast cancer survivors shows no increased risk of cancer recurrence or mortality• Delayed cord clamping in preterm twins reduces mortality by 30% and significantly decreases transfusion needsThen they discuss new birth control options while questioning the value of expensive pharmaceutical products compared to established, less costly alternatives.• New birth control options like Balcoltra ($280/month), FemLyv ($215/month), and Nextstellis ($250/month) offer minimal innovation over generic alternatives costing $10-15/month• Marketing terms like "bioidentical" and "plant-based" are often misleading as all hormonal contraceptives are synthesized from plant precursors• Progestin-only pills like Slynd provide only marginal DVT risk reduction (5 vs 4 per 100,000 person-years) compared to low-dose combined pillsCheck our Instagram for more information and join us again in two weeks for our next episode.00:00:00 Introduction and Epifoam Discussion00:06:27 Financial Impact of Unnecessary Treatments00:11:09 AMH Levels for PCOS Diagnosis00:15:11 External Aortic Compression for Hemorrhage00:20:22 Vaginal Estrogen and Delayed Cord Clamping00:21:51 New Birth Control Products Overview00:31:05 Analyzing Dissolvable Birth Control Pills00:34:22 Slynd: Drosperinone-Only Pill Evaluation00:42:09 Nextstellis and "Bioidentical" Estrogen Claims00:56:37 History of Birth Control DevelopmentFollow us on Instagram @thinkingaboutobgyn.

Blood clots can be life-threatening, but understanding their causes and treatments can save lives. In Part 2 of our Hematology Series, Dr. Andrew Jenzer, DDS, dives deep into thrombosis, breaking down the three key contributing factors and the most common hypercoagulable conditions. We carefully dissect the pathophysiology of pulmonary embolisms, the most important guidelines to know and follow, the difference between provoked and unprovoked hypercoagulable conditions, and everything you need to know about the perioperative management of antithrombotic therapies. To close, Dr. Jenzer highlights the critical risk factors of preoperative anticoagulation and key takeaways from our conversation that should never be forgotten. If you're a healthcare professional or simply someone who values life-saving knowledge, this episode is packed with insights you won't want to miss. Tune in to sharpen your expertise and improve patient outcomes!Key Points From This Episode:Three contributors to thrombosis and the most common hypercoagulable conditions.Unpacking the pathophysiology of pulmonary embolisms.Wells' Criteria, CHEST, and other crucial guidelines to follow. The difference between provoked and unprovoked hypercoagulable conditions.  Anticoagulation therapies and important surgical considerations.Risk factors associated with the perioperative management of antithrombotic therapy. Recapping the key takeaways from today's conversation. Links Mentioned in Today's Episode:Dr. Andrew Jenzer Email — andrew.jenzer@gmail.com Dr. Andrew Jenzer | Duke Surgery — https://surgery.duke.edu/profile/andrew-clark-jenzer  ACOMS | Annual Winter Meeting — https://www.acoms.org/Events/Winter-Meeting/About Wells' Criteria for Pulmonary Embolism — https://www.mdcalc.com/calc/115/wells-criteria-pulmonary-embolism Wells' Criteria for DVT — https://www.mdcalc.com/calc/362/wells-criteria-dvt  American College of Chest Physicians — https://www.chestnet.org/  ‘Perioperative Management of Antithrombotic Therapy' — https://www.chestnet.org/guidelines-and-topic-collections/guidelines/pulmonary-vascular/perioperative-management-of-antithrombotic-therapy  ‘Perioperative Management of Patients with Atrial Fibrillation Receiving a Direct Oral Anticoagulant' — https://pubmed.ncbi.nlm.nih.gov/31380891/  ‘Perioperative Optimization and Management of the Oral and Maxillofacial Surgical Patient' — https://pubmed.ncbi.nlm.nih.gov/38103577/ Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

Lots of NBA injury news this past week with Wembanyama's blood clot, complex surgical options being discussed for Joel Embiid, and a loose cartilage fragment for Jalen Suggs. Listen to our latest podcast as we break it all down from a sports medicine perspective.

In this episode of the OHM Podcast, We explore the critical phases of product development: Engineering Validation Test (EVT), Design Validation Test (DVT), and Production Validation Test (PVT). We discuss the importance of each phase in transforming a bare-bones concept into a market-ready product and emphasize the need for structured validation processes to ensure that products meet their intended specifications and can be effectively mass-produced.Join us as we delve into:The significance of product validation and the role of the Product Requirement Document (PRD)The differences and objectives of EVT, DVT, and PVTHow empirical testing and user feedback shape product developmentInsights into managing engineering teams and collaboration across disciplinesReal-world examples from their experiences at Form Labs and OpuloSources:----------------------------------Do you have any questions, comments, or topic suggestions? Email us at podcast@opulo.io. We'd love to hear from you!To find out more about what we do, check out Opulo.ioTo see everything else we do, including social media, check out Opulo.start.pageO.H.M. Podcast Merch is now here!Intro song:Complicate Ya - Otis McDonald (Creative Commons Attribution License)Ad song:Forever Young - Otis McDonald (Creative Commons Attribution License) Hosted on Acast. See acast.com/privacy for more information.

Columnist Mike Finger and Spurs beat reporters Jeff McDonald and Tom Orsborn discuss how Victor Wembanyama's diagnosis with DVT changes the Spurs' trajectory this season and what it means for the team going forward.   Suggested reading: Finger: With loss of Wembanyama, surreal season takes another sobering turn On Victor Wembanyama's long road back, a bright side remains Spurs big men Bismack Biyombo, Charles Bassey bond over injury history Is 'caring too much' hurting Spurs' Devin Vassell? Catch us everywhere:  More episodes: https://www.expressnews.com/projects/podcasts/spurs-insider/ Spurs Nation Newsletter: https://www.expressnews.com/newsletters/spurs-nation/ Finger on X (Twitter): https://twitter.com/mikefinger Become a subscriber: https://exne.ws/sub Sign up for our Subtext: Text GSG to (210) 934-9628 for San Antonio Spurs news delivered via SMS: https://www.expressnews.com/sports/spurs/article/san-antonio-spurs-text-alerts-20041086.php Learn more about your ad choices. Visit megaphone.fm/adchoices

Yes, Wemby has been sidelines with a DVT and San Antonio is in mourning, but it will get better folks. We talk some Spurs fallout and then we wax nostalgic about SNL.