Podcasts about Freeman Hospital

Dr Charlie Andrews talks to Dr John Leeds. John Leeds is a Consultant Pancreaticobiliary Physician and Endoscopist based at the Freeman Hospital in Newcastle and an Honorary Clinical Senior Lecturer based in the Population Health Sciences Institute at Newcastle University. He is involved in research in pancreaticobiliary disorders including benign and malignant conditions as well as outcomes from therapeutic/advanced endoscopy.John is a member of the British Society of Gastroenterology and Pancreatic Society of Great Britain and Ireland. He serves on the endoscopy and Pancreas committees for BSG and is the website lead for PSGBI.He is also a founder member of the BSG Pancreas Clinical Research Group which is coordinating research for the society.Key Learnings from this episode:Challenges in Early Detection of Pancreatic Cancer • Pancreatic cancer is often diagnosed at an advanced stage due to the deep location of the pancreas and the lack of early symptoms. • Tumors in the body and tail of the pancreas can grow significantly before causing symptoms, often invading major arteries or veins, making them inoperable. • Tumors in the head of the pancreas may present earlier due to bile duct obstruction, leading to jaundice, but even these are often detected late. Early Symptoms and Red Flags • Early symptoms are vague or absent, making early diagnosis difficult. • Possible early indicators include: • Weight loss (often a sign of advanced disease). • New-onset diabetes, particularly in individuals with a normal BMI or without typical risk factors for type 2 diabetes. • Jaundice, which is a significant red flag and often indicates a serious underlying condition. • Classic signs like painless jaundice and Courvoisier's sign (palpable gallbladder) are important but not always present. Limitations of Current Screening Methods • There is no reliable biomarker or screening test for pancreatic cancer: • CA19-9 is not suitable as a screening tool due to its lack of specificity (elevated in other conditions). • Imaging techniques like CT scans or MRIs are used but have limitations, including incidental findings that may lead to unnecessary anxiety (“scanxiety”) and over-investigation. • Screening is currently limited to high-risk groups, such as those with familial pancreatic cancer syndromes or hereditary pancreatitis. High-Risk Groups for Screening • Familial pancreatic cancer accounts for less than 10% of cases. Criteria for screening include: • Multiple family members with pancreatic cancer, especially diagnosed under age 50–60. • Genetic syndromes like BRCA mutations, familial adenomatous polyposis (FAP), and Peutz-Jeghers syndrome. • Hereditary pancreatitis patients have an increased risk but are harder to screen due to pre-existing pancreatic abnormalities. Emerging Research and Future Directions • Studies are exploring potential biomarkers, such as microbiome signatures in the pancreas, which might help identify high-risk individuals in the future. • Trials like the EuroPAC study focus on surveillance protocols for high-risk individuals using imaging techniques like MRI or endoscopic ultrasound. • Research into new-onset diabetes as a potential marker for pancreatic cancer is ongoing but currently has a low yield due to the high prevalence of type 2 diabetes unrelated to malignancy. Considerations for Screening and Surveillance • Screening should be carefully targeted to avoid over-diagnosis and unnecessary investigations. • The psychological impact of screening (e.g., anxiety from incidental findings) must be considered. • Smoking cessation is emphasized as smoking is a significant risk factor for pancreatic cancer. Advances in Treatment Approaches • PET-CT scans are increasingly used to detect systemic disease that might not be evident on standard CT scans. • Neoadjuvant treatments (therapy before surgery) are being... Chapters (00:00:00) - Ingest(00:00:53) - Pancreatic Cancer(00:04:03) - New diabetes and pancreatic cancer(00:08:01) - Pancreatic Cancer: Screening(00:15:42) - Determining breast cancer early is hard(00:16:03) - Pulmonary neuroendocrine tumors of the pancreas(00:22:26) - Pancreatic cancer 20, Management(00:29:00) - Pancreatic cancer, management principles(00:33:48) - Primary Care Take Home: Pancreas, pain(00:40:29) - Primary Care: Pancreas Cancer Episode 2

Dr Charlie Andrews talks to Dr John Leeds. John Leeds is a Consultant Pancreaticobiliary Physician and Endoscopist based at the Freeman Hospital in Newcastle and an Honorary Clinical Senior Lecturer based in the Population Health Sciences Institute at Newcastle University. He is involved in research in pancreaticobiliary disorders including benign and malignant conditions as well as outcomes from therapeutic/advanced endoscopy.John is a member of the British Society of Gastroenterology and Pancreatic Society of Great Britain and Ireland. He serves on the endoscopy and Pancreas committees for BSG and is the website lead for PSGBI.He is also a founder member of the BSG Pancreas Clinical Research Group which is coordinating research for the society. Chapters (00:00:01) - Ingest: pancreatic lesions(00:01:09) - Pancreas(00:05:39) - Chronic Pancreas disease, early signs and symptoms(00:11:54) - Pulmonary pancreatitis, diagnosis and management(00:17:52) - Diarrhea, weight loss(00:18:29) - Pancreatic disease, ultrasound and the best treatment(00:23:49) - Pancreatitis, chronic pancreatitis in primary care(00:26:19) - Pancreatitis 20, Surgery or drainage?(00:32:24) - Pancreatic Exocrine Insufficiency(00:38:05) - Pulmonary dysrhythmias, management tips(00:43:46) - PPI for cystic fibrosis patients 8,(00:46:16) - Pancreatic insufficiency 20, Detection and treatment(00:49:57) - Pancreatic cysts(00:55:32) - Choosing the right cyst for surgery(00:57:20) - autoimmune pancreatitis, presentation and treatment(01:03:34) - Pancreatic cancer: diagnosis and treatment(01:06:14) - Pancreatitis, part 1, unboxing

Joplin Mayor Keenan Cortez joined Newstalk KZRG to discuss the future of the old Freeman Hospital building, Joplin's work in becoming an area hub for the arts, and what is going on at this week's work session. Join Ted and Steve for the KZRG Morning Newswatch!

Host: Kevin Smith Dives into the weekly news most impactful to the HeartlandHEADLINESSecretary Cardona Says, Teachers Need More Than Just Pay Raises Education Week - https://www.edweek.org/teaching-learning/teachers-need-more-than-just-pay-raises-secretary-cardona-says/2023/05State takeover of St. Louis police, prosecutor's office blocked by Senate DemocratsMissouri Independent - https://missouriindependent.com/2023/05/02/state-takeover-of-st-louis-police-prosecutors-office-blocked-by-senate-democrats/LIGHTNING ROUNDTexas,U.S. Rep. Colin Allred, D-Dallas, announced Wednesday he is challenging U.S. Sen. Ted Cruz, R-Texas, for reelection. Texas Tribune - https://www.texastribune.org/2023/05/03/ted-cruz-colin-allred-2024/Three out of four Texas voters support the idea of enacting stricter gun control measures KXAN Texas - https://www.kxan.com/news/texas/poll-76-of-texas-voters-support-raising-gun-purchase-age/Montana,Republican governor, Greg Gianforte, signed a bill banning gender affirming healthcare despite plea from own son.Mother Jones - https://www.motherjones.com/politics/2023/04/david-gianforte-greg-gianforte/Missouri,A federal investigation found that two hospitals violated federal law by denying a Joplin woman an emergency abortion when her water broke at 17 weeks. Springfield News-Leader - https://www.news-leader.com/story/news/local/missouri/2023/05/01/cms-mo-ks-hospitals-violated-law-by-denying-joplin-woman-abortion-mylissa-farmer/70170053007/Indiana,New bills in IndianaIndiana Capital Chronical - https://indianacapitalchronicle.com/2023/05/02/indiana-bills-on-birth-control-speed-cameras-military-tax-exemptions-are-latest-to-become-law/Kansas,A top Republican election lawyer tells GOP donors that the party should work to make it harder for college students to vote in key states. Kansas Reflector - https://kansasreflector.com/2023/04/30/a-top-gop-lawyer-wants-to-crack-down-on-the-college-vote-states-already-are/Ohio,The resolution to make it harder to amend the Ohio constitution is not being voted on this week.Ohio Capital Journal - https://ohiocapitaljournal.com/2023/05/03/vote-on-proposal-to-make-it-harder-to-amend-oh-constitution-delayed-as-some-house-gop-members-express-concern/And lastly, An Anti-Trans Doctor Group seems to have Leaked 10,000 Confidential FilesWired - https://www.wired.com/story/american-college-pediatricians-google-drive-leak/Lastly, lastly a send off for our teachers!

Host: Kevin Smith Dives into the weekly news most impactful to the HeartlandHEADLINESSecretary Cardona Says, Teachers Need More Than Just Pay Raises Education Week - https://www.edweek.org/teaching-learning/teachers-need-more-than-just-pay-raises-secretary-cardona-says/2023/05State takeover of St. Louis police, prosecutor's office blocked by Senate DemocratsMissouri Independent - https://missouriindependent.com/2023/05/02/state-takeover-of-st-louis-police-prosecutors-office-blocked-by-senate-democrats/LIGHTNING ROUNDTexas,U.S. Rep. Colin Allred, D-Dallas, announced Wednesday he is challenging U.S. Sen. Ted Cruz, R-Texas, for reelection. Texas Tribune - https://www.texastribune.org/2023/05/03/ted-cruz-colin-allred-2024/Three out of four Texas voters support the idea of enacting stricter gun control measures KXAN Texas - https://www.kxan.com/news/texas/poll-76-of-texas-voters-support-raising-gun-purchase-age/Montana,Republican governor, Greg Gianforte, signed a bill banning gender affirming healthcare despite plea from own son.Mother Jones - https://www.motherjones.com/politics/2023/04/david-gianforte-greg-gianforte/Missouri,A federal investigation found that two hospitals violated federal law by denying a Joplin woman an emergency abortion when her water broke at 17 weeks. Springfield News-Leader - https://www.news-leader.com/story/news/local/missouri/2023/05/01/cms-mo-ks-hospitals-violated-law-by-denying-joplin-woman-abortion-mylissa-farmer/70170053007/Indiana,New bills in IndianaIndiana Capital Chronical - https://indianacapitalchronicle.com/2023/05/02/indiana-bills-on-birth-control-speed-cameras-military-tax-exemptions-are-latest-to-become-law/Kansas,A top Republican election lawyer tells GOP donors that the party should work to make it harder for college students to vote in key states. Kansas Reflector - https://kansasreflector.com/2023/04/30/a-top-gop-lawyer-wants-to-crack-down-on-the-college-vote-states-already-are/Ohio,The resolution to make it harder to amend the Ohio constitution is not being voted on this week.Ohio Capital Journal - https://ohiocapitaljournal.com/2023/05/03/vote-on-proposal-to-make-it-harder-to-amend-oh-constitution-delayed-as-some-house-gop-members-express-concern/And lastly, An Anti-Trans Doctor Group seems to have Leaked 10,000 Confidential FilesWired - https://www.wired.com/story/american-college-pediatricians-google-drive-leak/Lastly, lastly a send off for our teachers!

Surgery along with chemotherapy is the mainstay of treatment for patients with osteosarcoma. In order to achieve a cure, during surgery healthy tissue surrounding the tumour is also removed. Whilst this reduces the chances of the cancer returning, it can also result in added pain and disability for patients, impacting their quality of life in the longer-term. Advancements in surgical technology and technique offer the hope of improved outcomes for patients. Recent developments have led to the introduction of fluorescence guided surgery (FGS), a technique which harnesses the emission of light to identify a tumour's precise location and boundaries during surgical removal. This improves a surgeon's ability to successfully remove the entire tumour, which can be identified as a ‘glowing' area of tissue, decreasing the likelihood of any cancer cells remaining, while limiting the removal of too much healthy tissue. This upcoming clinical trial, led by Kenneth Rankin, a leading Consultant Orthopaedic Surgeon and bone sarcoma researcher, is looking to assess the effectiveness of a particular fluorescent dye, indocyanine green or ‘ICG', which can be given to patients safely before surgery and leads to the sarcoma tumour fluorescing green. The SarcoSIGHT trial will recruit 500 patients undergoing surgery for bone and soft tissue sarcoma, aiming to test whether the use of ICG in FGS can help to accurately identify the tumour, aid in complete removal and reduce the amount of healthy tissue removed. This presentation will include the findings to date from fluorescence guided surgery in osteosarcoma patients with some initial results indicating that the amount of fluorescence may predict response to chemotherapy and that the osteosarcoma tissue can be studied in detail post-operatively with the latest fluorescence microscopy techniques. --- Mr Kenneth Rankin is a Consultant Orthopaedic Surgeon at Newcastle's Freeman Hospital where his specialist interests are in orthopaedic oncology including fluorescence guided surgery for sarcoma resection, and hip and knee replacement for arthritis. Mr Rankin graduated in 1999 from the University of Dundee. His basic surgical training was in Newcastle followed by an MD investigating the cellular biology of bone metastases. Mr Rankin completed his higher specialist training in Perth and Dundee followed by a return to the North East as NIHR Academic Clinical Lecturer. His current post as Consultant Orthopaedic Surgeon and Honorary Senior Lecturer is comprised mainly of orthopaedic oncology including the surgical management of bone and soft tissue sarcomas and metastatic bone disease. He also carries out hip and knee replacements for arthritis. As a Clinical Scientist Mr Rankin has developed an international reputation for translational research for the detection of circulating tumour cells in sarcoma patients and carried out the world's first case series of fluorescence guided surgery in sarcoma. Working in close collaboration with scientists at Newcastle University, he leads on basic and translational sarcoma research at the Newcastle Centre for Cancer.

Breast cancer specialist, Dr Tony Branson returns to the Dr Louise Newson podcast two years since his first appearance. Tony is a Consultant Clinical Oncologist at the Northern Centre for Cancer Care, based at the Freeman Hospital in Newcastle upon Tyne. In this episode the experts discuss the current situations women can find themselves in when having treatments for breast cancer and experiencing the onset of menopausal symptoms. Tony supports the women he sees through some challenging decisions around managing the risk of cancer recurrence while for some, treating menopausal symptoms with HRT to improve the quality of their lives.

Professor Chris Harding is a Consultant Urologist working at the Freeman Hospital in Newcastle upon Tyne and at Newcastle University. He has a particular interest in bladder dysfunction, continence and urinary tract infections (UTIs). In recent years, his research has focused on non-antibiotic treatments for recurrent UTIs and developing targeted treatments for specific patient groups. In this episode, Professor Chris talks to Dr Louise about the challenges of diagnosing UTIs accurately, the severe impact recurrent UTIs can have on your life, how antibiotics can be used appropriately, and how to prevent UTIs occurring. The experts share some of their plans to study the effects of systemic HRT and vaginal hormone treatments on UTIs in women. Chris's advice if you have recurrent UTIs: You don't need to put up with UTIs in the perimenopause and menopause; there are many proven treatments available Acknowledge that current tests for UTIs are not 100% accurate. If you think you have a UTI, you probably have, even if your test was negative - the diagnosis can always be questioned Discuss with your doctor how you can prevent infections if you have had 2 episodes within 6 months, or 3 within a year Hormone replacement, particularly vaginal treatments, are significantly protective and preventative against UTIs. Follow Prof Chris Harding on social media at @chrisharding123

Hour 2 -  Happy Halloween! Here's what Nick Reed covers this hour: Senate candidate John Fetterman will appear Friday on The View. It appears Democrat Pennsylvania Lt. Gov. John Fetterman's “Trump-voting Republican” parents are not Trump-voting Republicans, but card-carrying Democrats. In what seems to be an attempt to paint himself as an everyman candidate who is more Pennsylvanian than partisan, Fetterman apparently talked his parents into claiming they are Trump voters and Republicans in one of his senate campaign ads. Police arrested Democratic nominee for Arkansas auditor, Diamond Arnold-Johnson, on allegations of felony terroristic threatening Friday morning. Missouri House Rep. Crystal Quade has filed Sunshine Law requests with Attorney General Eric Schmitt, Gov. Mike Parson and the Department of Health and Senior Services to request records regarding an alleged investigation into Freeman Hospital in Joplin and Joplin resident Mylissa Farmer, who was unable to get treatment in Missouri in August when her water broke early and put her health at risk.

Hour 3 -  Happy Halloween! Here's what Nick Reed covers this hour: Missouri House Rep. Crystal Quade has filed Sunshine Law requests with Attorney General Eric Schmitt, Gov. Mike Parson and the Department of Health and Senior Services to request records regarding an alleged investigation into Freeman Hospital in Joplin and Joplin resident Mylissa Farmer, who was unable to get treatment in Missouri in August when her water broke early and put her health at risk. After the FBI interfered in the 2016 presidential election through Russia hoaxing and the 2020 presidential election by suppressing the legitimate Hunter Biden laptop story, it looks like the notoriously corrupt federal agency is election meddling again ahead of the 2022 midterms. An FBI whistleblower alleged in a leaked document that the FBI lists “misinformation” as a potential “election crime,” Project Veritas reported on Thursday.

HEADLINE 1: Contamination in Springfield's groundwater, and Missouri knew for Decades - STLPRAn investigation by the Midwest Newsroom and St. Louis Public Radio has found that the Missouri Department of Natural Resources and the company Litton Systems, a former defense contractor that had employed thousands of people in Springfield to make circuit boards for the Navy and telecommunications industry, knew as early as 1993 that contamination beyond the company's property into the surrounding community “had undoubtedly occurred,”. Litton used a toxic solvent called trichloroethylene (TCE) to wash the circuit boards and for years improperly disposed of it. The pollutant leached into the groundwater and into aquifers deep below the ground. It then spread to nearby properties, where it made its way into wells that supplied water to those who lived and worked near Litton. A review of thousands of pages of government records and interviews found that DNR employees raised concerns about the contamination and implored the agency to force Litton to investigate further. But in the years that followed, neither the company nor DNR sought to determine the extent of the problem or alert the public about the potential risks, our examination found. Instead, both relied on a remediation system to remove the TCE, a measure that the government later determined did not work to effectively contain the contamination.The problem was not broadly known in Springfield until TCE was detected and publicized in 2018 at Fantastic Caverns, a tourist destination about five miles north of the former Litton site. As a result, some people bought property without knowing that they would be exposed to a chemical linked to cancer and other medical conditions. Others are left wondering how long they've been drinking and bathing in water tainted with TCE. And people are upset that an agency tasked with protecting the environment did not do more to warn the public about the risks of contamination. When you hear a story like this there's a lot of anger and frustration to be had. The carelessness of Litton cannot be overstated, but we have come to expect a company to hide in the shadows on issues like this. The thing that hits me hard is the fact that the DNR failed to adequately do its job, and there should be consequences. It may be tempting to point to the failure of the DNR as an example of how government doesn't work, but take a step back and realize without that governmental body, this would have NEVER come to light. Yes, it functioned poorly, but that can be fixed and hopefully better handled in the future. Leave it to private enterprise and we never find out.HEADLINE 2: Joplin, MO woman left helpless with non-viable pregnancy - Springfield News-LeaderAt 6:30 a.m. on August 2, nearly 18 weeks into her pregnancy, Mylissa Farmer experienced what doctors call a preterm premature rupture of membranes — her water broke before labor, followed by vaginal bleeding, abdominal pressure and cramping.She went to Freeman Hospital in Joplin, where she'd been just the day before. Everything had been normal then. She and her boyfriend, Matthew McNeill, had already picked out a name for their daughter: Maeve.But the doctors had devastating news for them on Aug. 2.If Maeve was delivered right then, chances of survival at 17 weeks and 5 days were zero, according to the assessment and plan section of Farmer's medical records outlining the visit. And the outcome wasn't much better if they tried to hold off on delivery.The doctors recommended terminating the pregnancy, but 39 days after the state of Missouri banned abortions, that wasn't an option, at least not in Missouri.A year ago, the hospital could have offered a chance for the couple to say goodbye and hold their daughter, even though they knew she wouldn't survive outside the womb.Instead, Farmer and McNeill were left to make a series of trips across three states and countless phone calls.The couple wanted to be able to grieve the loss of their daughter, not sit at home or in a hospital "with a baby dying inside me," Farmer said."I know it sounds horrible, but we just wanted to finish the process," she said. In the end, Farmer didn't just lose Maeve; she lost her friends and her trust that Missouri would allow medical professionals to do their jobs."It was hard. You could tell the doctors were trying to tell us what we needed to do, but at the same time, trying to protect themselves. We're not angry with them," Farmer said.If her vitals plummeted or infection set in, or the fetus' cardiac activity stopped, the doctors could intervene, but not before then.At 41, Farmer worried that by the time there was an emergency, it would be too late for both her and Maeve. And even if Farmer did live through it, she worried about what her recovery would be like. She was already at "risks of maternal thrombosis given her history of (deep vein thrombosis during a COVID-19 infection), infection/sepsis, severe blood loss, hysterotomy, hysterectomy and even mortality," according to the medical record.Farmer then did something she, who describes herself as "pretty pro-life" and Christian, never thought she would do: She began to look for abortion clinics.Farmer and McNeill set out for Granite City, Illinois. Early in the morning on Aug. 5, Farmer began to have back pain while on their way to the place just 15 minutes outside of St. Louis. When she got to HOPE Clinic, she was in labor.After the fact, Farmer said it was almost reassuring that the labor came on. Friends in Joplin who knew of the situation had been telling her that she "could give birth at 17 weeks, that they knew people who have done it, that I was killing my child.""It did my heart good to know I was doing the right thing," she said, as if her body was telling her that it was OK.But still, the experience was harrowing. Protesters in front of the clinic echoed the things her friends had told her, "saying we were killing our baby and that we were evil.""It was awful, you know? We were just going through so much. We didn't want this ... but at the same time, we had no choice," Farmer said.Since their ordeal, Farmer has lost trust. While she still feels her obstetrician at Freeman Hospital in Joplin is a good doctor, she's worried about whether medical professionals in Missouri will be able to offer patients necessary care.Despite reaching out to various legislators, she has yet to receive an answer that satisfies her: Why is this law written this way? If it's to protect women, why did she have to be in danger before she could get care in-state? Why is it such a binary law?"The world is too nuanced to put such strict rules in place," Farmer said.HEADLINE 3: Supreme Court Considers Pork Producers' Plea - The InterceptOn Tuesday, oral arguments will begin in National Pork Producers Council v. Ross, a case in which the pork industry is challenging the constitutionality of a California law regulating the worst cruelties of mass meat and egg production. The pork producers are arguing that California's law ends up forcing them to change their procedures outside California's borders at significant cost.If the justices rule on the side of the pork producers, it will be only the latest case to expose the illusion of so-called states' rights that conservative legal forces have spent 200 years pushing on the public.There would also be widespread implications: Ruling in favor of industry would set yet another grim precedent, potentially curtailing the ability of states to enforce progressive industry regulations and protections. Everything from state laws on workers' rights to environmental standards to further animal welfare issues could be challenged. Meanwhile, there could be another layer of irony: With the court's provenselective federalism, we can be sure that any such precedent would be no barrier to conservative states enacting laws with economic consequences far beyond their state lines in future.THE LAW IN question at the Supreme Court this week is California's Prop 12, passed through a resounding 2018 ballot victory. The law bans the sale in California of meat and eggs from animals raised in extreme and brutal confinement, including in gestation crates where pregnant pigs are held, barely able to move, for most of their lives.Such confinement has been condemned by all major animal welfare and veterinary organizations, and has been deemed a “profound danger to food and public health,” given the rife spread of disease, according to a brief written by the American Public Health Association and the Infectious Diseases Society of America, among others, for the case.The pork producers contend that the law creates unconstitutional constraint on their business, as farmers in other states must change their practices to abide by Prop 12's standards if they hope to sell pork in the nation's most populous state and since most of the pork consumed in California is indeed produced out of state, and that the state is a market too big for major producers to forego, there's little doubt that the Californian regulations would indeed affect interstate practices. It's not a foregone conclusion that a majority of justices will side with the National Pork Producers Council. Both conservative justices Clarence Thomas and Samuel Alito have, from an originalist stance, previously criticized the dormant commerce clause. And, of course, all six of the court's right-wing justices have ruled in favor of state laws that have significant economic effects on the lives of those outside those states — such is the nature of living in an entangled national body politic. Just ask the abortion clinics now overwhelmed by out-of-state travel. Yet we should never underestimate the conservative majority's pro-business bent, and its unabashed desire to quash any and all liberation struggles — be they for human or nonhuman lives.If the pork producers succeed in overthrowing Prop 12, many millions of animals will continue to live and die in the most appalling suffering. The message will be sent too that when big business wants to challenge democratically passed state laws, they have several right-wing Supreme Court justices — those storied defenders of states' rights — on their side.This situation on the Federal scale reminds me immediately of Missouri's own quashing of local politics. The Missouri GOP claims to be the protector of local politics but when CAFOs in Missouri began polluting groundwater the State told counties they couldn't enact regulations locally to hinder big business. It's certainly evident the Right favors big government when it serves them. LIGHTNING ROUND:LR 1 - Lone Candidate shows up for Missouri's 3rd - News TribuneOnly one candidate was present for the News Tribune's election forum Tuesday night, but two issues emerged to dominate the discussion: the nation's response to the COVID-19 pandemic and federal student loan forgiveness. Bethany Mann, agricultural scientist and the Democratic challenger for Missouri's 3rd Congressional District, said the pandemic is ongoing and that student loan forgiveness isn't the ultimate solution to skyrocketing higher education costs, but a good policy nonetheless. Mann states that The country's student loan system is predatory, because it traps financially inexperienced young people into accumulating mass amounts of debt they don't know they can repay. The real issue is a lack of regulation on the banking industry, she said. Mann said more corporate regulations can insulate consumers from market shocks."We need to fix the root cause and not penalize people for trying to make a better life for themselves," she said.As far as Blaine Luetktemeyer, he couldn't be bothered to show up to the conversation.LR 2 - Kansas ranks among the worst in the country on both mental illness and its treatment - NPRA new report by Mental Health America tracking mental illness and the ease of accessing care found high rates of addiction among young people and mental illness and suicidal thoughts among adults put Kansas in last place.The report, based largely on data from 2019 and 2020, found 9% of Kansas youth had a substance use disorder, more than any other state. Over a quarter of adults had a mental illness and over 6% had serious thoughts of suicide, both well above national averages. In part, that's because the state doesn't have enough psychiatrists, therapists and other mental health care workers to go around. Compared with a national rate of one provider for every 350 people, Kansas only had one for every 470 people — and experts say the shortfall is particularly dire in rural areas. Kansas also got low marks on insurance rates and the ability to afford mental health care.Around 18% of adults with mental illness in Kansas had no insurance, compared with 11% nationwide. And only around 7% of youths with severe depression received consistent treatment for it, compared to 28% nationwide.LR 3 - Commission recommends salary increases to address Missouri teacher shortage - Missouri IndependentA state commission Tuesday laid out its recommendations to improve teacher recruitment and retention in Missouri, including a push to raise starting salaries that currently rank among the lowest in the nation. The State Board of Education approved the commission's nine recommendations and pledged to bring the findings to the public and lawmakers. Nearly 8% of available full-time teaching positions in the school year 2020-2021 were vacant or filled by not fully qualified individuals, according to the report. One of the commission's immediate recommendations was for the legislature to amend the state's base teacher salary, which is currently set by state law at $25,000 for a beginning teacher, to “at least $38,000” and to conduct annual reviews of the starting salary level.According to the National Education Association's review from earlier this year, Missouri's average teacher starting salary ranks second-to-last in the nation, at $33,234, higher only than Montana. At a public hearing in August, educators recounted taking on second jobs to get by.Per the Report, the legislature should also establish a state fund to help local school districts pay more competitive salaries overall, the report recommended. The average teachers salary in Missouri ranks 47th in the nation, at $51,557, according to the National Education Association. It's good to see that last bit tacked on, the focus on teacher pay in Missouri almost always centers on starting pay, which… is admittedly terrible, but we want to retain teachers too. A pay bump for every teacher in Missouri is way overdue.LR 4 - Will the next Farm Bill be climate friendly? Depends on the Midterms - Mother JonesThis year's midterm elections will decide the direction of a massive legislative package meant to tackle the nation's agricultural problems. Ahead of the November elections, House Republicans have already released insight into their priorities for this upcoming legislation. The Republican Study Committee, whose members make up 80 percent of all Republican members of Congress, released its draft budget in July. This draft document outlines a plan that completely defunds federal programs that support conservation efforts, as well as slashes federal food stamp and crop insurance programs. As Farm Bill debates continue, a group of over 150 progressive, agriculture, and environmental groups, from the nation's largest federation of labor unions to the Sierra Club environmental group, have urged President Joe Biden to add climate reforms in the upcoming legislative package. In a letter to Biden, organizations urged the President to pass a Farm Bill that would help mend economic and racial divides in the industry, increase access to nutrition, support fair labor conditions in farming communities labor conditions, as well as tackle the climate crisis with a focus on agriculture. LR 5 - Kansas Republicans downplay abortion in legislative races. Some change campaign sites - Kansas City StarMike Pence recently tweeted out “I've got news for President Biden. Come January 22nd, we will have Pro-Life majorities in the House and Senate and we'll be taking the cause of the right to Life to every state house in America!” Which sounds a little funny when hearing reports of   Multiple Kansas House GOP candidates removing anti-abortion material from their campaign sites in the wake of voters' rejection of the constitutional amendment in August. We keep seeing this play out, the Republicans, the proverbial dog in this idiom, have caught the car on Abortion and frankly don't know exactly how to move forward. Hopefully a full blown referendum is coming down the pipe in November!

HEADLINE 1: Contamination in Springfield's groundwater, and Missouri knew for Decades - STLPRAn investigation by the Midwest Newsroom and St. Louis Public Radio has found that the Missouri Department of Natural Resources and the company Litton Systems, a former defense contractor that had employed thousands of people in Springfield to make circuit boards for the Navy and telecommunications industry, knew as early as 1993 that contamination beyond the company's property into the surrounding community “had undoubtedly occurred,”. Litton used a toxic solvent called trichloroethylene (TCE) to wash the circuit boards and for years improperly disposed of it. The pollutant leached into the groundwater and into aquifers deep below the ground. It then spread to nearby properties, where it made its way into wells that supplied water to those who lived and worked near Litton. A review of thousands of pages of government records and interviews found that DNR employees raised concerns about the contamination and implored the agency to force Litton to investigate further. But in the years that followed, neither the company nor DNR sought to determine the extent of the problem or alert the public about the potential risks, our examination found. Instead, both relied on a remediation system to remove the TCE, a measure that the government later determined did not work to effectively contain the contamination.The problem was not broadly known in Springfield until TCE was detected and publicized in 2018 at Fantastic Caverns, a tourist destination about five miles north of the former Litton site. As a result, some people bought property without knowing that they would be exposed to a chemical linked to cancer and other medical conditions. Others are left wondering how long they've been drinking and bathing in water tainted with TCE. And people are upset that an agency tasked with protecting the environment did not do more to warn the public about the risks of contamination. When you hear a story like this there's a lot of anger and frustration to be had. The carelessness of Litton cannot be overstated, but we have come to expect a company to hide in the shadows on issues like this. The thing that hits me hard is the fact that the DNR failed to adequately do its job, and there should be consequences. It may be tempting to point to the failure of the DNR as an example of how government doesn't work, but take a step back and realize without that governmental body, this would have NEVER come to light. Yes, it functioned poorly, but that can be fixed and hopefully better handled in the future. Leave it to private enterprise and we never find out.HEADLINE 2: Joplin, MO woman left helpless with non-viable pregnancy - Springfield News-LeaderAt 6:30 a.m. on August 2, nearly 18 weeks into her pregnancy, Mylissa Farmer experienced what doctors call a preterm premature rupture of membranes — her water broke before labor, followed by vaginal bleeding, abdominal pressure and cramping.She went to Freeman Hospital in Joplin, where she'd been just the day before. Everything had been normal then. She and her boyfriend, Matthew McNeill, had already picked out a name for their daughter: Maeve.But the doctors had devastating news for them on Aug. 2.If Maeve was delivered right then, chances of survival at 17 weeks and 5 days were zero, according to the assessment and plan section of Farmer's medical records outlining the visit. And the outcome wasn't much better if they tried to hold off on delivery.The doctors recommended terminating the pregnancy, but 39 days after the state of Missouri banned abortions, that wasn't an option, at least not in Missouri.A year ago, the hospital could have offered a chance for the couple to say goodbye and hold their daughter, even though they knew she wouldn't survive outside the womb.Instead, Farmer and McNeill were left to make a series of trips across three states and countless phone calls.The couple wanted to be able to grieve the loss of their daughter, not sit at home or in a hospital "with a baby dying inside me," Farmer said."I know it sounds horrible, but we just wanted to finish the process," she said. In the end, Farmer didn't just lose Maeve; she lost her friends and her trust that Missouri would allow medical professionals to do their jobs."It was hard. You could tell the doctors were trying to tell us what we needed to do, but at the same time, trying to protect themselves. We're not angry with them," Farmer said.If her vitals plummeted or infection set in, or the fetus' cardiac activity stopped, the doctors could intervene, but not before then.At 41, Farmer worried that by the time there was an emergency, it would be too late for both her and Maeve. And even if Farmer did live through it, she worried about what her recovery would be like. She was already at "risks of maternal thrombosis given her history of (deep vein thrombosis during a COVID-19 infection), infection/sepsis, severe blood loss, hysterotomy, hysterectomy and even mortality," according to the medical record.Farmer then did something she, who describes herself as "pretty pro-life" and Christian, never thought she would do: She began to look for abortion clinics.Farmer and McNeill set out for Granite City, Illinois. Early in the morning on Aug. 5, Farmer began to have back pain while on their way to the place just 15 minutes outside of St. Louis. When she got to HOPE Clinic, she was in labor.After the fact, Farmer said it was almost reassuring that the labor came on. Friends in Joplin who knew of the situation had been telling her that she "could give birth at 17 weeks, that they knew people who have done it, that I was killing my child.""It did my heart good to know I was doing the right thing," she said, as if her body was telling her that it was OK.But still, the experience was harrowing. Protesters in front of the clinic echoed the things her friends had told her, "saying we were killing our baby and that we were evil.""It was awful, you know? We were just going through so much. We didn't want this ... but at the same time, we had no choice," Farmer said.Since their ordeal, Farmer has lost trust. While she still feels her obstetrician at Freeman Hospital in Joplin is a good doctor, she's worried about whether medical professionals in Missouri will be able to offer patients necessary care.Despite reaching out to various legislators, she has yet to receive an answer that satisfies her: Why is this law written this way? If it's to protect women, why did she have to be in danger before she could get care in-state? Why is it such a binary law?"The world is too nuanced to put such strict rules in place," Farmer said.HEADLINE 3: Supreme Court Considers Pork Producers' Plea - The InterceptOn Tuesday, oral arguments will begin in National Pork Producers Council v. Ross, a case in which the pork industry is challenging the constitutionality of a California law regulating the worst cruelties of mass meat and egg production. The pork producers are arguing that California's law ends up forcing them to change their procedures outside California's borders at significant cost.If the justices rule on the side of the pork producers, it will be only the latest case to expose the illusion of so-called states' rights that conservative legal forces have spent 200 years pushing on the public.There would also be widespread implications: Ruling in favor of industry would set yet another grim precedent, potentially curtailing the ability of states to enforce progressive industry regulations and protections. Everything from state laws on workers' rights to environmental standards to further animal welfare issues could be challenged. Meanwhile, there could be another layer of irony: With the court's provenselective federalism, we can be sure that any such precedent would be no barrier to conservative states enacting laws with economic consequences far beyond their state lines in future.THE LAW IN question at the Supreme Court this week is California's Prop 12, passed through a resounding 2018 ballot victory. The law bans the sale in California of meat and eggs from animals raised in extreme and brutal confinement, including in gestation crates where pregnant pigs are held, barely able to move, for most of their lives.Such confinement has been condemned by all major animal welfare and veterinary organizations, and has been deemed a “profound danger to food and public health,” given the rife spread of disease, according to a brief written by the American Public Health Association and the Infectious Diseases Society of America, among others, for the case.The pork producers contend that the law creates unconstitutional constraint on their business, as farmers in other states must change their practices to abide by Prop 12's standards if they hope to sell pork in the nation's most populous state and since most of the pork consumed in California is indeed produced out of state, and that the state is a market too big for major producers to forego, there's little doubt that the Californian regulations would indeed affect interstate practices. It's not a foregone conclusion that a majority of justices will side with the National Pork Producers Council. Both conservative justices Clarence Thomas and Samuel Alito have, from an originalist stance, previously criticized the dormant commerce clause. And, of course, all six of the court's right-wing justices have ruled in favor of state laws that have significant economic effects on the lives of those outside those states — such is the nature of living in an entangled national body politic. Just ask the abortion clinics now overwhelmed by out-of-state travel. Yet we should never underestimate the conservative majority's pro-business bent, and its unabashed desire to quash any and all liberation struggles — be they for human or nonhuman lives.If the pork producers succeed in overthrowing Prop 12, many millions of animals will continue to live and die in the most appalling suffering. The message will be sent too that when big business wants to challenge democratically passed state laws, they have several right-wing Supreme Court justices — those storied defenders of states' rights — on their side.This situation on the Federal scale reminds me immediately of Missouri's own quashing of local politics. The Missouri GOP claims to be the protector of local politics but when CAFOs in Missouri began polluting groundwater the State told counties they couldn't enact regulations locally to hinder big business. It's certainly evident the Right favors big government when it serves them. LIGHTNING ROUND:LR 1 - Lone Candidate shows up for Missouri's 3rd - News TribuneOnly one candidate was present for the News Tribune's election forum Tuesday night, but two issues emerged to dominate the discussion: the nation's response to the COVID-19 pandemic and federal student loan forgiveness. Bethany Mann, agricultural scientist and the Democratic challenger for Missouri's 3rd Congressional District, said the pandemic is ongoing and that student loan forgiveness isn't the ultimate solution to skyrocketing higher education costs, but a good policy nonetheless. Mann states that The country's student loan system is predatory, because it traps financially inexperienced young people into accumulating mass amounts of debt they don't know they can repay. The real issue is a lack of regulation on the banking industry, she said. Mann said more corporate regulations can insulate consumers from market shocks."We need to fix the root cause and not penalize people for trying to make a better life for themselves," she said.As far as Blaine Luetktemeyer, he couldn't be bothered to show up to the conversation.LR 2 - Kansas ranks among the worst in the country on both mental illness and its treatment - NPRA new report by Mental Health America tracking mental illness and the ease of accessing care found high rates of addiction among young people and mental illness and suicidal thoughts among adults put Kansas in last place.The report, based largely on data from 2019 and 2020, found 9% of Kansas youth had a substance use disorder, more than any other state. Over a quarter of adults had a mental illness and over 6% had serious thoughts of suicide, both well above national averages. In part, that's because the state doesn't have enough psychiatrists, therapists and other mental health care workers to go around. Compared with a national rate of one provider for every 350 people, Kansas only had one for every 470 people — and experts say the shortfall is particularly dire in rural areas. Kansas also got low marks on insurance rates and the ability to afford mental health care.Around 18% of adults with mental illness in Kansas had no insurance, compared with 11% nationwide. And only around 7% of youths with severe depression received consistent treatment for it, compared to 28% nationwide.LR 3 - Commission recommends salary increases to address Missouri teacher shortage - Missouri IndependentA state commission Tuesday laid out its recommendations to improve teacher recruitment and retention in Missouri, including a push to raise starting salaries that currently rank among the lowest in the nation. The State Board of Education approved the commission's nine recommendations and pledged to bring the findings to the public and lawmakers. Nearly 8% of available full-time teaching positions in the school year 2020-2021 were vacant or filled by not fully qualified individuals, according to the report. One of the commission's immediate recommendations was for the legislature to amend the state's base teacher salary, which is currently set by state law at $25,000 for a beginning teacher, to “at least $38,000” and to conduct annual reviews of the starting salary level.According to the National Education Association's review from earlier this year, Missouri's average teacher starting salary ranks second-to-last in the nation, at $33,234, higher only than Montana. At a public hearing in August, educators recounted taking on second jobs to get by.Per the Report, the legislature should also establish a state fund to help local school districts pay more competitive salaries overall, the report recommended. The average teachers salary in Missouri ranks 47th in the nation, at $51,557, according to the National Education Association. It's good to see that last bit tacked on, the focus on teacher pay in Missouri almost always centers on starting pay, which… is admittedly terrible, but we want to retain teachers too. A pay bump for every teacher in Missouri is way overdue.LR 4 - Will the next Farm Bill be climate friendly? Depends on the Midterms - Mother JonesThis year's midterm elections will decide the direction of a massive legislative package meant to tackle the nation's agricultural problems. Ahead of the November elections, House Republicans have already released insight into their priorities for this upcoming legislation. The Republican Study Committee, whose members make up 80 percent of all Republican members of Congress, released its draft budget in July. This draft document outlines a plan that completely defunds federal programs that support conservation efforts, as well as slashes federal food stamp and crop insurance programs. As Farm Bill debates continue, a group of over 150 progressive, agriculture, and environmental groups, from the nation's largest federation of labor unions to the Sierra Club environmental group, have urged President Joe Biden to add climate reforms in the upcoming legislative package. In a letter to Biden, organizations urged the President to pass a Farm Bill that would help mend economic and racial divides in the industry, increase access to nutrition, support fair labor conditions in farming communities labor conditions, as well as tackle the climate crisis with a focus on agriculture. LR 5 - Kansas Republicans downplay abortion in legislative races. Some change campaign sites - Kansas City StarMike Pence recently tweeted out “I've got news for President Biden. Come January 22nd, we will have Pro-Life majorities in the House and Senate and we'll be taking the cause of the right to Life to every state house in America!” Which sounds a little funny when hearing reports of   Multiple Kansas House GOP candidates removing anti-abortion material from their campaign sites in the wake of voters' rejection of the constitutional amendment in August. We keep seeing this play out, the Republicans, the proverbial dog in this idiom, have caught the car on Abortion and frankly don't know exactly how to move forward. Hopefully a full blown referendum is coming down the pipe in November!

On today's show, holistic nutrition coach and mother-of-four, Amanda, takes us on the journey that led her to freebirth her twin girls at home. Amanda experienced obstetric abuse during her first birth that caused a severe postpartum haemorrhage. Her second birth, although not as traumatic, solidified in her mind that any future babies would be born at home. When the urning for a third child started to arise, Amanda and her husband were given a 2% chance to conceive naturally due to his vasectomy reversal. Declining the IVF route, they instead chose to surrendered to what was meant for them; conceiving their twin girls only a short time later. Amanda threw herself into all research available around physiological twin birth. She innately knew her body was capable of birthing her babies but her options were limited when it came to support. With her extensive knowledge and understanding around twin birth, she knew the only place she could give her babies the time and presence they needed to come earthside, was undisturbed at home. Amanda shares the awe inspiring moments she bear witness to the power of her body's physiological dance to bring her transverse babies down to be born, and how she intwined her knowledge and instincts to navigate a pivotal point in her birth. Show Links: Instagram: @whole.health.coach Doula: @trish_birthalchemy

Miss Rachel Bell MS FRCS qualified from the UMDS in 1994 and trained in London and the South East Thames rotation. She was appointed as a consultant at Guy’s & St. Thomas’ in 2005. She was the clinical lead for vascular surgery from 2008-2016 and helped lead the reconfiguration of vascular services across South East London. She became the Clinical Director of Cardiovascular Services at Guys and St Thomas’s and the Vascular Network Director for South East London. After 15 years in London, she relocated back to the North East and is now based at the Freeman Hospital in Newcastle.   Nationally she is the current President of the British Society of Endovascular Therapy, Chair of the Circulation Foundation, and President-Elect of the Vascular Society of Great Britain and Ireland. Her clinical interests include aortic aneurysm repair, open thoracoabdominal aneurysm repair, and the surgery and management of vascular graft infection. She is also interested in sustainable and innovative healthcare system improvement, staff wellbeing and prevention of burnout.   Co-host: Lauren Shelmerdine is a Vascular Trainee in the North East of England currently doing research and is the Circulation Foundation representative for the Rouleaux Club. She enjoys exploring with her two huskies and living sustainably.   Resources: Diagnosis of Aortic Graft Infection: A Case Definition by the Management of Aortic Graft Infection Collaboration (MAGIC) British Society of Endovascular Therapy Circulation Foundation The Vascular Society for Great Britain and Ireland Please DM @leanna_erete on Twitter with any feedback

Kaylee Davidson-Olley was the United Kingdom's first successful heart transplant baby when she received a replacement heart at less than one year of age. In 2017 she celebrated her 30th year after the transplant operation; it was her 30th year as the longest surviving heart transplant baby in Europe. The operation was performed by cardiothoracic surgeon, Christopher McGregor, at the Freeman Hospital, Newcastle, which became one of only two UK centres performing transplants in children, and the main hospital in the UK carrying out transplants for adults born with congenital heart disease. She went on to become an advocate of the organ donor register and in 2013 won the gold medal for the 4 × 100 metres relay race at the World Transplant Games!   Ian & Kaylee discuss; Her story of being The First Successful Baby in the UK to have a Heart Transplant The Start of a Sporting Era Winning a gold medal in the World Transplant Games Being an advocate for organ donation Having a plaque on the Newcastle Quayside walk of fame Making sure transplantation is known within the North East How organ donation can save lives   For International Women's Day 2021, Ian wanted to do something special to help raise awareness, smash stereotypes and influence behaviour. Ian went live for three hours on Monday 8th March and interviewed seven fantastic women back to back !    Industry Angel Twitter Industry Angel Website Podcast Sponsors;- Far North Sales & Marketing Carpeway MrFarrar.com

Dr Chris Fox, Consultant hematologist at Nottingham University Hospital and Dr Wendy Osborne, Consultant hematologist, Freeman Hospital, Newcastle upon Tyne Hospital, talk to us about the American Society of Hematology 2020 conference, discussing the follicular lymphoma and diffuse large B cell data released at the conference.  This podcast is published open access in Advances in Therapy journal and is fully citeable. You can access the published commentary to go alongside this podcast through the Advances in Therapy website and by using this link. All conflicts of interest can be found online. This podcast in intended for medical professionals only. This podcast has been developed independently through an unrestricted educational grant by Novartis.

This panel discussion includes questions such as: In a prehabilitation service what screening tools should we use to assess nutritional risk? What tools are there related to patient self management? What advice would you give a patient about cannabis smoking cessation? Should denial of surgical procedures be used as a motivator for lifestyle change? Can the questions used in interventions sometimes be open to misinterpretation by patients? How do we assess and treat sleep disorders? If not a psychologist, what team members might handle psychological behaviour change? Does immunonutrition work? Are there sensitive approaches to addressing weight loss, physical activity and diet that the panel reccomend? Panel discussion chaired by Sandy Jack and Daniel Santa Mina, featuring, David Yates, Consultant in Anaesthesia and Critical Care Medicine at York Teaching Hospital, Chloe Grimmett, National Institute of Health Research (NIHR) post-doctoral Research Fellow and Senior Research Fellow for the Macmillan Survivorship Research Group at the University of Southampton, Chris Snowden, Consultant Anaesthetist, Freeman Hospital, Newcastle upon Tyne and Senior lecturer at the Institute of Cellular Medicine at Newcastle University, Chelsia Gillis, Registered Dietitian, Canadian Vanier Scholar, and PhD Candidate in Epidemiology at the University of Calgary, Canada, she is leading the first prehabilitation program for colorectal surgery in Alberta.

Professor Stephen Clark, Consultant Cardiac and Transplant Surgeon from the Freeman Hospital in Newcastle, takes us through the fundamentals of Cardiac Transplantation.Contact: SCTSEducationpodcast@gmail.com 

"Perioperative medicine is an opportunity; it's multidisciplinary and its developing around a culture of trust between anaesthetists, surgeons and perioperative physicians" The future of perioperative medicine embraces the full scope of medical advancement and is therefore difficult to predict, as a result truly informed shared decision making is both crucial and more complex. Variability of practice is a key factor; usually caused by the overuse or underuse of a facility and its resources. The former being a particular problem in America with the financial incentives associated with some forms of treatment and care. Learn how a pilot study regarding orthopedics lead ultimately to variability becoming a widely recognised crucial area of improvement in medicine. More on this can be found on The British Orthopaedic Association's website here: https://www.boa.ac.uk/standards-guidance/getting-it-right-first-time.html This talk empowers you with the detail regarding an area that now looks set to become a huge opportunity for perioperative practitioners world wide. Sharing processes, standardising care and allowing our focus to go where the evidence leads. How can we help as implementation teams are assembled both in the UK and elsewhere? When it comes to patients; "we play a very small part in their life ... but that part can be massive if we get it wrong - so we have to get it right!" The Getting It Right First Time website (GIRFT) is here: https://gettingitrightfirsttime.co.uk/ Presented by Chris Snowden, Consultant Anaesthetist, Freeman Hospital, Newcastle upon Tyne and Senior lecturer at the Institute of Cellular Medicine at Newcastle University. - If you love this, you'll also enjoy this fantastic piece "EBPOM Highlight | Getting it right first time": https://www.topmedtalk.com/ebpom-highlight-getting-it-right-first-time/ Exclusive limited time only "EBPOM Chicago" ticket offer on now, go to: www.ebpom.org

Paula Baker with Freeman Hospital breaks some myths about medical care in our communities. The Hospital is open and if you need a surgical procedure, they are ready!

The healthcare profession has a mixed history when it comes to messaging around alcohol. Nowadays, from a public health perspective, it is clear that overall it is not helpful for our physiology and well being. How often do you have alcohol? How many units do you drink? How often do you have a binge? What are the age groups where drinking problems are most apparent? Where is the latest research regarding a perioperative approach to alcohol consumption? How effective is intervention for risky drinkers, should it also be considered for dependent drinkers? How have studies and evidence been arranged around this topic and where should it lead us? Is there a need for more research? Presented by Chris Snowden, Consultant Anaesthetist, Freeman Hospital, Newcastle upon Tyne and Senior lecturer at the Institute of Cellular Medicine at Newcastle University, he has recently secured grant funding from the NIAA (RCOA /BJA) to develop prehabilitative training in the elderly surgical patient.

Kevin and Adam interview four cutting edge outcomes researchers in vascular surgery, leading two international studies on the impact of COVID-19 on vascular surgery patients, the COVER Study and VASCC. (1:45) COVER Study: COvid-19 Vascular sERvice Study Dr. Ruth Benson (@R_A_Benson) Academic clinical lecturer funded by the National Institute for health research and a vascular surgery registrar at the University of Birmingham, UK.  She is the president of the Vascular and Endovascular Research Network (VERN) (@VascResearchNet). Dr. Sandip Nandra (@SandipNandhra) is also an Academic clinical lecturer funded by the National Institute for health research and a final year registrar in vascular surgery based at the Freeman Hospital and Newcastle University, UK and co-leads the COVER Study with Dr. Benson. Sign up here (16:26) VAscular Surgery COVID-19 Collaborative (VASCC) in partnership with the Vascular Low Frequency Disease Consortium (VLFDC) Dr. Max Wohlauer (@doctormaxw, max.wohlauer@cuanschutz.edu) is an assistant professor of surgery at the University of Colorado School of Medicine in Aurora, CO, and an accomplished health services researcher. Dr. Robert Cuff (@robcuffMD, robert.cuff@spectrumhealth.org) is an assistant professor and program director for the integrated vascular surgery residency and fellowship at Michigan State University in Grand Rapids, MI. Sign up Here

This panel discussion includes questions such as: In a prehabilitation service what screening tools should we use to assess nutritional risk? What tools are there related to patient self management? What advice would you give a patient about cannabis smoking cessation? Should denial of surgical procedures be used as a motivator for lifestyle change? Can the questions used in interventions sometimes be open to misinterpretation by patients? How do we assess and treat sleep disorders? If not a psychologist, what team members might handle psychological behaviour change? Does immunonutrition work? Are there sensitive approaches to addressing weight loss, physical activity and diet that the panel reccomend? Panel discussion chaired by Sandy Jack and Daniel Santa Mina, featuring, David Yates, Consultant in Anaesthesia and Critical Care Medicine at York Teaching Hospital, Chloe Grimmett, National Institute of Health Research (NIHR) post-doctoral Research Fellow and Senior Research Fellow for the Macmillan Survivorship Research Group at the University of Southampton, Chris Snowden, Consultant Anaesthetist, Freeman Hospital, Newcastle upon Tyne and Senior lecturer at the Institute of Cellular Medicine at Newcastle University, Chelsia Gillis, Registered Dietitian, Canadian Vanier Scholar, and PhD Candidate in Epidemiology at the University of Calgary, Canada, she is leading the first prehabilitation program for colorectal surgery in Alberta.

The healthcare profession has a mixed history when it comes to messaging around alcohol. Nowadays, from a public health perspective, it is clear that overall it is not helpful for our physiology and well being. How often do you have alcohol? How many units do you drink? How often do you have a binge? What are the age groups where drinking problems are most apparent? Where is the latest research regarding a perioperative approach to alcohol consumption? How effective is intervention for risky drinkers, should it also be considered for dependent drinkers? How have studies and evidence been arranged around this topic and where should it lead us? Is there a need for more research? Presented by Chris Snowden, Consultant Anaesthetist, Freeman Hospital, Newcastle upon Tyne and Senior lecturer at the Institute of Cellular Medicine at Newcastle University, he has recently secured grant funding from the NIAA (RCOA /BJA) to develop prehabilitative training in the elderly surgical patient.

Anne McElvoy debates at the Free Thinking Festival with intensive care doctor Aoife Abbey, GP & Prof Louise Robinson, Naeem Soomro expert in using robotic surgery and Michael Brown medical historian. Does emotion have any place in relationships with patients in a more open age? Medical professionals are trained to adopt “clinical distance” when dealing with patients. Tradition says that getting emotional weakens their judgement of medical evidence and can cause safeguarding issues. But how can those in caring roles prevent disinterest seeming like un-interest? Aoife Abbey is a doctor working in Intensive Care whose book Seven Signs of Life is an account of her experiences told through the emotions she encounters on a daily basis. Aoife previously wrote a blog as The Secret Doctor for the British Medical Association and works on a national training programme for doctors in intensive care medicine. She is a council member of the Intensive Care Society (UK). Michael Brown is a cultural historian at the University of Roehampton who is currently leading a project for the Wellcome Trust entitled Surgery & Emotion exploring this relationship from 1800 to the present. He is the author of Performing Medicine: Medical Culture and Identity in Provincial England, c. 1760-1850 Louise Robinson is Director of Newcastle University’s Institute for Ageing, Professor of Primary Care and Ageing and a GP. She leads one of only three Alzheimer Society national Centres of Excellence on Dementia Care and is a member of the national dementia care guidelines development group. Dr Naeem Soomro is Leading Consultant Urologist at Freeman Hospital, Newcastle. He has pioneered minimally invasive and robotic surgery in the North East and has developed the biggest multi-speciality robotic surgery program in the UK. Producer: Fiona McLean

In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Dr Vijay Kunadian from Newcastle University and the Freeman Hospital . They discuss the RITA SENIOR trial, designed to tell us the best way to manage older patients with a heart attack - invasive or medical. If you enjoy the show, please subscribe to the podcast to get episodes automatically downloaded to your phone and computer. Also, please consider leaving us a review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 Link to published paper: https://heart.bmj.com/content/102/6/416?ijkey=62261479a0ca4163d857d406efe131a5423c5aec&keytype2=tf_ipsecsha Dr Kunadian's Twitter - https://twitter.com/vijaykunadian?lang=en

"POETTS 2018 | CPET for Risk Stratification in Major Urological Surgery" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com Hear this excellent talk, for free, on this podcast. If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings If you have any comments or questions you'd like to send to the team email: contact@topmedtalk.com Presented by James Prentis, Consultant Anaesthetist, Freeman Hospital, Newcastle-upon-Tyne.

Dr Joe Cosgrove, Consultant in Anaesthesia and Intensive Care at Freeman Hospital in Newcastle upon Tyne discusses his two articles "Prehospital organisation and management of a mass casualty incident" and "Hospital response to a major incident: initial considerations and longer term effects", published in the October 2016 edition of BJA Education. Topics include understanding the prehospital phase, the wider response to major incidents within NHS organisations, and how individual practitioners fit within this highly organised structure.

La capacidad de los médicos de acceder a partes difíciles del cuerpo del paciente a través de los vasos sanguíneos ha supuesto un importante desarrollo en la atención sanitaria de las últimas décadas. Estas intervenciones endovasculares requieren de un acceso al interior de la arteria deben terminar con el cierre del agujero creado para introducirse en la arteria. Una nueva revisión Cochrane de marzo de 2016, cuya autora principal es Lindsay Robertson del Freeman Hospital de Newcastle upon Tyne del Reino Unido, estudia las pruebas sobre uno de estos dispositivos de cierre.Este podcast ha sido traducido y grabado por Andrea Cervera del Centro Cochrane Iberoamericano.

La capacidad de los médicos de acceder a partes difíciles del cuerpo del paciente a través de los vasos sanguíneos ha supuesto un importante desarrollo en la atención sanitaria de las últimas décadas. Estas intervenciones endovasculares requieren de un acceso al interior de la arteria deben terminar con el cierre del agujero creado para introducirse en la arteria. Una nueva revisión Cochrane de marzo de 2016, cuya autora principal es Lindsay Robertson del Freeman Hospital de Newcastle upon Tyne del Reino Unido, estudia las pruebas sobre uno de estos dispositivos de cierre.Este podcast ha sido traducido y grabado por Andrea Cervera del Centro Cochrane Iberoamericano.

La capacidad de los médicos de acceder a partes difíciles del cuerpo del paciente a través de los vasos sanguíneos ha supuesto un importante desarrollo en la atención sanitaria de las últimas décadas. Estas intervenciones endovasculares requieren de un acceso al interior de la arteria deben terminar con el cierre del agujero creado para introducirse en la arteria. Una nueva revisión Cochrane de marzo de 2016, cuya autora principal es Lindsay Robertson del Freeman Hospital de Newcastle upon Tyne del Reino Unido, estudia las pruebas sobre uno de estos dispositivos de cierre.Este podcast ha sido traducido y grabado por Andrea Cervera del Centro Cochrane Iberoamericano.

The Ultimate Triathlon - Climb, Row, Cycle. On 1st February 2014, James became the first and only person to have rowed across the Atlantic Ocean, successfully summited Mount Everest and cycled 18,000 miles around the world. Seven years prior to this, he was recovering from a serious motorcycle accident that left him with broken legs as well as a severely broken and dislocated ankle. The prognosis was that he was likely to suffer a permanent walking impairment and would certainly not be able to continue the active physical lifestyle he had enjoyed up to that point. James has continued pushing boundaries and in 2015 attempted to row 4,000 miles across the Indian Ocean with his Epileptic rowing partner. Their aim was to prove that despite having Epilepsy or a disability there is no barrier to pursuing ones goals. Two hundred and fifty miles offshore James’ rowing partner sustained a head injury resulting in a full-scale ocean rescue that was global news. James found himself clinging to a rope ladder on the side of a 100,000-ton crude oil tanker as he climbed to safety in storm force winds. James has raised tens of thousands of pounds for his chosen charities as he has climbed, rowed, and cycled his way around the world! James is also a keen supporter of Scouting and is a Scouting Ambassador. Ian and James Ketchell discuss:- Rowing the Atlantic - how to break it down Climbing Everest - Keeping your head Cycling around the world, speaking at schools & meeting people en route Obtaining Sponsorship from Nandos His new rowing around Britain project #gbrow  The new book 'Ultimate Triathlon' James can be found at jamesketchell.net Show Sponsors:- Phil 'The Colonel' Mustard Benefit 2016 Durham and England cricketer Phil will be working tirelessly this year to raise money for his chosen charities: The Children's Heart Unit at the Freeman Hospital in Newcastle, The Chronicle Sunshine Fund, and The PCA Benevolent Fund. There is a full year of events for you to support/invite guests to, there are dinners, golf days, cricket matches, race days just head over to colonelbenefit2016.com for the diary and join the mailing list. Help the colonel's charities and have a great time whilst at it!

The RunRunLive 4.0 Podcast Episode 4-323 – Adam – Running with a Heart Transplant (Audio: link) [audio:http://www.RunRunLive.com/PodcastEpisodes/epi4323.mp3] Link MarathonBQ – How to Qualify for the Boston Marathon in 14 Weeks - Hello there my friends, this is Chris your host and this is the RunRunLive Podcast Episode 4-323.  Got a calculator?  What's 323 X 60?  That's 19,380 minutes, 323 hours, 8.075 straight work weeks, 40+ straight 8 hour work days.  That's a big pile of narrative.   Isn't that funny?  How you can just start doing something, a session at a time and pretty soon it adds up?  And that's without any compounding of the interest. Try this experiment.  Every time you go for a run put a penny in a bowl.  Or maybe pick up a rock and put it on a pile at the trail head.   See what it looks like at the end of the year.  That's the power of practice. That little bit adds up.  That little handful of sand becomes a mountain to your perseverance. It's the same concept with time and money.  Anything can be done through daily or frequent little bits of practice.  I'm working through a book right now.  I don't find the book particularly entertaining but I feel I need to know the content.  I'm trying to give it 20 minutes a day.  I did the same thing when I wrote the MarathonBQ book last year.  I laid out the chapters in a table of contents format and worked on a chapter every day for a month – and just like that it was done. It took another 5 months of futzing around and editing, but I got it done.  Some people call this ‘chunking'.  Take something that seems overwhelming and chunking it down into bite size bits that you can chew off every day.  My training has been going very well.  I'm working in some consistent speedwork and tempo and building up my distance.  It's not perfect and I'm still feeling out the paces but it's progress and I feel strong.  We love the cool, dry fall weather, Buddy and I.  Even though we've lost the sun it's ok.  I'm no stranger to running with a head lamp in the woods.  It's a bit hard to stay on the trail when all the leaves fall and obscure the ground.  But that's why I have Buddy.  He knows the way and can see in the dark better than I can.  He's doing very well.  The cooler weather helps.  I've also started him on a regimen of joint supplements which seem to be surprisingly effective.  He used to barely be able to get up the day after a 6 miler in the trails but now he shows no sign of stiffness at all.  The product is called GlycoFlex by a company called VetriScience. I met the guy that runs their supply chain at a conference.  We got to talking and it turns out he's a veteran marathoner from Vermont.  I sent him a copy of my book and he sent me a bag of supplements for Buddy.  See how this networking thing works out? Today have an awesome interview with Adam the @transplant runner.  I met Adam on twitter.  I saw his twitter handle and asked a simple question “Are you really running with a heart transplant?” When he said ‘yes' I had to get him on the show.  Super cool - Super inspirational.  I love this guy and his attitude.  Reminds us that we really shouldn't be whining and that you can really do anything if you have the right attitude.  In the first section I'm going to rant about speedwork again.  Just because I've been doing more of it and remembering all the benefits first hand.  In the second section I'll give you some random advice on Blogging.  … Little things every day.  They count.  I've been in the office the last couple weeks.  I don't have to go to the office but I like the structure and the privacy of an office.  When I use the common rest room outside my office I notice the paper towels.  Specifically I notice the paper towels on the ground next to the trash receptacle. I think the scenario is that some guy before me washed his hands, (always a good habit) after using the rest room, then took a length of paper towel, dried his hands and tossed it towards the trash.  However in this case the used wad of toweling was off the mark and ended up on the floor.  In my head I wonder why they didn't pick it up?  Is their norm such that the effort to get it into the trash is the same as actually getting it in the trash?  Is this their way of ‘sticking it to the man'?  “I may have a crappy life but at least I have the power to throw paper on the ground!” Seems odd.  But I don't know what other people are thinking.  I'm in no position to judge.  I'm not saying this because it somehow makes me mad, but it does make me curious.  Curious as to the thought process.  Are they too rushed?  Is it somehow a health hazard to pick it up and try again?  Would they leave it there if there was someone else in the rest room to witness? I don't know.  Going back to our opening thought, if everyone left one towel on the ground we would all be up to our knickers in damp paper towels before long.  And it seems to be contagious.  As soon as there is one on the floor that seems to lower the threshold and then there are many.  The paper on the floor becomes a negative social proof.  This is the classic broken window syndrome. You can probably guess what I do.  I pick up all the paper towels on the floor and put them in the trash.  It's no extra effort for me and I feel like I'm giving some sort of gift to civil society in the process.  Do you know what else I do?  When I see the janitors I say hello and I thank them for doing what they do.   Because the way I see it when I pick up those towels and lay down those thank yous I'm putting bricks into a castle.  A castle of karma.  I don't want anything back.  It's my gift to those aim-challenged office workers and underappreciated sanitation engineers. It's karma. How's your aim? On with the show! Section one - Running Tips Speedwork saves the world - Voices of reason – the conversation Adam – The Transplant Runner A Brief History Of Me Hello Readers! Follow me on Twitter @xplantrunner Most people reading this will have probably followed me here from Twitter, where I have somehow amassed a brilliant troupe of followers! So this first blog is basically going to introduce me in a more in depth way, give an insight into my history, and a look at what running means to me! So let's go!! My heart transplant is obviously a big part of my life, so i'll start here, and how I came to need a heart transplant! When I was born, it was pretty obvious I was going to be trouble, I wasn't screaming and I was a strange shade of blue, I was diagnosed with  , in simple terms, oxygenated and non-oxygenated blood were mixing in the heart, and then being pumped around my body. At 9 months old I underwent my first surgery, a Waterman Shunt. They took arteries from my right arm and used them to 'fix' the defects in my heart. This was a stop-gap surgery, carried out purely to give me a chance to grow a bit and become strong enough for further, more complex surgery. At 2 years old I went under the knife for a 'full fix' to complete repairs to the heart and give me a normal lease of life. The surgery was initially successful, but 6/7 days later my natural pacemaker stopped working, deemed to be from the surgery. So I went under the knife again that week and had an  fitted. Surprisingly I was pretty well for 5 years! growing and developing normally as a child should. Just before my 8th birthday, on a routine hospital check up, the pacemaker needed replaced. It is effectively a battery, and it was out of juice! So the next day they fitted me a new pacemaker and I was good to go! All Going Wrong Shortly after my 9th birthday, it became apparent that things weren't quite right. I had no energy, very little appetite and basically wasn't myself. After a particularly lacklustre summer holiday my parents took me to our GP, who had me admitted to the local hospital. After 3 days in hospital, they decided nothing was wrong, perhaps I had a virus. Not trusting the diagnosis, my parents took me to The Freeman Hospital in Newcastle (where all my surgeries took place) I was immediately poked, prodded and x-rayed, and then the bad news came. My heart was 3 times larger than it should have been, and was operating at about 3% (pro athletes run at about 40% - its an odd measurement!) what they didn't know, was why. They assumed that the pacemaker had malfunctioned, and determined it was its proximity to my heart. That the signals had somehow become 'confused' and gone awry! I underwent another pacemaker replacement, and it was placed in the now common place of beneath the skin in the front of the left shoulder. Sadly the replacement didn't solve any problems, my heart was done, I was dying. Transplant The choice to undergo a heart transplant was mine. The Dr's told me the facts, I had less than 12 months without it, and possibly an extra 5-8 years if I had one. The choice was simple, and in my head, it was just another surgery! So I was assessed and placed at the top of the transplant list, I was the worst case on the list, so I would get first dibs on any heart that became available. 1 week later the phone rang - they had a viable heart. Cue mad panic and lots of tears! An ambulance arrived and off we shot on the 90 mile journey to the hospital. On the way there however, the call came in that the heart had died on route, and they wouldn't be able to restart it. Another 6 weeks passed and then the phone rang again, they had another viable heart. We made it to the hospital and started the pre op routine. By midnight I was being wheeled into the theatre, very drowsy, but still awake. 8 hours later I woke up in intensive care, the op was a success and the heart had restarted first time. I was the 21st child recipient in the UK A massive amount of thanks goes to the donor family, the donor was only 12 years old and I wouldn't even know how to imagine how harrowing that would be, to then allow the organs to be used for transplantation defies understanding, all I know is that I am eternally grateful to them. (In all, 8 people received organs from this donor - truly amazing) And Now? Fast forward almost 21 years to now, and its 2012! The 5-8 years I might have got from the transplant have turned into something more than anyone at the time would have thought possible! Obviously I am not the longest post op transplant recipient, there are people who are almost 30 years post transplant but it still feels pretty good to be this far out! Pretty much since my transplant i've tried to live a life that would hopefully make my donor and his family proud that I was the recipient. Nowadays, I use my running to help with that! I started running properly in April 2011, 7.5 miles (bearing in mind I ran maybe 2 miles once a month before hand!) over 3 local mountains. It took me about 4 hours, I was covered in cuts and bruises from slips and falls on the trails, I was caked in mud, ridiculously dehydrated and fairly peckish! I had no idea what I was doing! That same night I experienced DOMS for the first time in my entire life! Every time I sat down, I struggled to stand up again! And staircases were a massive no-no! So that's a fair old chunk of what makes my internal engine tick! In future blogs i will delve into my running more, and how living with a transplant affects me and what i've done since that night in 1992... Section two – Getting going with a blogging habit! Outro - Closing comments MarathonBQ – How to Qualify for the Boston Marathon in 14 Weeks - Well, my friends, thank you for your continued attendance.  I appreciate it.  Thank you.  We have been transplanted to the end of episode 4-323 (see what I did there?) My training has been going well.  I laid low for the month of September with all the travel but I started working in some speedwork.  I let coach have a break – and just to squelch any rumors – I'm not fighting with coach or anything dramatic like that – I'm just experimenting with some more intensity to see how my body responds.  If we add up the plantar fasciitis vacation and the Afib episodes I haven't been able to get a decent training cycle in since 2011!  The first thing I noticed is that my paces are off by a full 30 seconds a mile from where I used to be – some of that is due to age, but a lot of it is just being out of practice.  The speedwork feels hard and foreign to my body.  I'm like 3 weeks in now and I'm starting to see the results.  I started with 5 days a week to see if my body would be able to recover.  Sunday long, Monday recovery spin, Tuesday speed, Wednesday recovery run, Thursday Tempo, Friday recovery run and Saturday off to do house chores.   This put me in the mid-30's in terms of mileage.  I made sure to really focus on doing the stretching, warm-up, cool-down and maintenance core work.  Nothing really hurt, except the plantar fasciitis flared up at the end of the first hard week.  I thought I was toast.  (this was last week).  It was super sore after Friday's run.  So – I got the splint on for sleeping, I took my Saturday off, I taped the foot for Sunday's run and I got it under control… so far.  I think I isolated the problem.  I was wearing an old pair of ASICs E33's (basic neutral cushion shoes) to get a better feel of the track for speed work.  I don't keep very good track of mileage in shoes but I remember I wore these for two marathons a year ago – so they are probably toast.  We'll keep an eye on it.  I can always swap out the Friday recovery run with a recovery spin instead.  This Sunday I'll be volunteering at two local races. The Baystate marathon in the morning and the Groton Town Forest Trail Race in the afternoon.  If you're running either of those say ‘hi'. We'll be at the 7 mile water stop at Baystate – just before the bridge.  … I was coming back from getting tires on my Camry this past weekend.  I was sitting in a long line of cars at a red light.  I did what we all do at red lights.  I checked my phone.  Of course the next thing I know there's the blaring of a horn and the guy behind me is freaking out because I let a 20 foot gap expand in front of me.  I look in the review mirror and this guy is swearing at me and waving his hands – he's quite apoplectic.  My first reaction is to give him a big passive aggressive smile and wave.  I also feel that drip of adrenaline as my dinosaur brain prepares for a fight.  Can't help it.  As I think about it I wonder what is so wrong with this guy's life that he has gone off the deep end over 20 feet of pavement?  I just want to say “It's ok.”  I'm as guilty as the next guy.  It makes me super stressed out to get stuck in traffic.  Even though I know it has nothing to do with the traffic – it's me getting me stressed out because of the way I think about time. I think time is scarce.  In my mind I can only be successful if I get stuff done in the time I have.  How often do we think about time in this way?  I don't have enough time.  I don't want to waste time.  Is it worth my time?  My revelation is that this is all scarcity thinking.  As much as I talk about abundance I think in terms of scarce time.  That is a disconnect between thoughts and beliefs.  That's an incongruence between a belief in abundance and thought of scarcity. I wonder if you're not doing the same thing?  What if we thought of time as abundant? How would that change the way we approached adversity?  What abundance cold that bring into our lives? And the next time you're running late and you lean on that horn, I'll see you out there. MarathonBQ – How to Qualify for the Boston Marathon in 14 Weeks -

The RunRunLive 4.0 Podcast Episode 4-323 – Adam – Running with a Heart Transplant (Audio: link) [audio:http://www.RunRunLive.com/PodcastEpisodes/epi4323.mp3] Link MarathonBQ – How to Qualify for the Boston Marathon in 14 Weeks - Hello there my friends, this is Chris your host and this is the RunRunLive Podcast Episode 4-323.  Got a calculator?  What’s 323 X 60?  That’s 19,380 minutes, 323 hours, 8.075 straight work weeks, 40+ straight 8 hour work days.  That’s a big pile of narrative.   Isn’t that funny?  How you can just start doing something, a session at a time and pretty soon it adds up?  And that’s without any compounding of the interest. Try this experiment.  Every time you go for a run put a penny in a bowl.  Or maybe pick up a rock and put it on a pile at the trail head.   See what it looks like at the end of the year.  That’s the power of practice. That little bit adds up.  That little handful of sand becomes a mountain to your perseverance. It’s the same concept with time and money.  Anything can be done through daily or frequent little bits of practice.  I’m working through a book right now.  I don’t find the book particularly entertaining but I feel I need to know the content.  I’m trying to give it 20 minutes a day.  I did the same thing when I wrote the MarathonBQ book last year.  I laid out the chapters in a table of contents format and worked on a chapter every day for a month – and just like that it was done. It took another 5 months of futzing around and editing, but I got it done.  Some people call this ‘chunking’.  Take something that seems overwhelming and chunking it down into bite size bits that you can chew off every day.  My training has been going very well.  I’m working in some consistent speedwork and tempo and building up my distance.  It’s not perfect and I’m still feeling out the paces but it’s progress and I feel strong.  We love the cool, dry fall weather, Buddy and I.  Even though we’ve lost the sun it’s ok.  I’m no stranger to running with a head lamp in the woods.  It’s a bit hard to stay on the trail when all the leaves fall and obscure the ground.  But that’s why I have Buddy.  He knows the way and can see in the dark better than I can.  He’s doing very well.  The cooler weather helps.  I’ve also started him on a regimen of joint supplements which seem to be surprisingly effective.  He used to barely be able to get up the day after a 6 miler in the trails but now he shows no sign of stiffness at all.  The product is called GlycoFlex by a company called VetriScience. I met the guy that runs their supply chain at a conference.  We got to talking and it turns out he’s a veteran marathoner from Vermont.  I sent him a copy of my book and he sent me a bag of supplements for Buddy.  See how this networking thing works out? Today have an awesome interview with Adam the @transplant runner.  I met Adam on twitter.  I saw his twitter handle and asked a simple question “Are you really running with a heart transplant?” When he said ‘yes’ I had to get him on the show.  Super cool - Super inspirational.  I love this guy and his attitude.  Reminds us that we really shouldn’t be whining and that you can really do anything if you have the right attitude.  In the first section I’m going to rant about speedwork again.  Just because I’ve been doing more of it and remembering all the benefits first hand.  In the second section I’ll give you some random advice on Blogging.  … Little things every day.  They count.  I’ve been in the office the last couple weeks.  I don’t have to go to the office but I like the structure and the privacy of an office.  When I use the common rest room outside my office I notice the paper towels.  Specifically I notice the paper towels on the ground next to the trash receptacle. I think the scenario is that some guy before me washed his hands, (always a good habit) after using the rest room, then took a length of paper towel, dried his hands and tossed it towards the trash.  However in this case the used wad of toweling was off the mark and ended up on the floor.  In my head I wonder why they didn’t pick it up?  Is their norm such that the effort to get it into the trash is the same as actually getting it in the trash?  Is this their way of ‘sticking it to the man’?  “I may have a crappy life but at least I have the power to throw paper on the ground!” Seems odd.  But I don’t know what other people are thinking.  I’m in no position to judge.  I’m not saying this because it somehow makes me mad, but it does make me curious.  Curious as to the thought process.  Are they too rushed?  Is it somehow a health hazard to pick it up and try again?  Would they leave it there if there was someone else in the rest room to witness? I don’t know.  Going back to our opening thought, if everyone left one towel on the ground we would all be up to our knickers in damp paper towels before long.  And it seems to be contagious.  As soon as there is one on the floor that seems to lower the threshold and then there are many.  The paper on the floor becomes a negative social proof.  This is the classic broken window syndrome. You can probably guess what I do.  I pick up all the paper towels on the floor and put them in the trash.  It’s no extra effort for me and I feel like I’m giving some sort of gift to civil society in the process.  Do you know what else I do?  When I see the janitors I say hello and I thank them for doing what they do.   Because the way I see it when I pick up those towels and lay down those thank yous I’m putting bricks into a castle.  A castle of karma.  I don’t want anything back.  It’s my gift to those aim-challenged office workers and underappreciated sanitation engineers. It’s karma. How’s your aim? On with the show! Section one - Running Tips Speedwork saves the world - Voices of reason – the conversation Adam – The Transplant Runner A Brief History Of Me Hello Readers! Follow me on Twitter @xplantrunner Most people reading this will have probably followed me here from Twitter, where I have somehow amassed a brilliant troupe of followers! So this first blog is basically going to introduce me in a more in depth way, give an insight into my history, and a look at what running means to me! So let's go!! My heart transplant is obviously a big part of my life, so i'll start here, and how I came to need a heart transplant! When I was born, it was pretty obvious I was going to be trouble, I wasn't screaming and I was a strange shade of blue, I was diagnosed with  , in simple terms, oxygenated and non-oxygenated blood were mixing in the heart, and then being pumped around my body. At 9 months old I underwent my first surgery, a Waterman Shunt. They took arteries from my right arm and used them to 'fix' the defects in my heart. This was a stop-gap surgery, carried out purely to give me a chance to grow a bit and become strong enough for further, more complex surgery. At 2 years old I went under the knife for a 'full fix' to complete repairs to the heart and give me a normal lease of life. The surgery was initially successful, but 6/7 days later my natural pacemaker stopped working, deemed to be from the surgery. So I went under the knife again that week and had an  fitted. Surprisingly I was pretty well for 5 years! growing and developing normally as a child should. Just before my 8th birthday, on a routine hospital check up, the pacemaker needed replaced. It is effectively a battery, and it was out of juice! So the next day they fitted me a new pacemaker and I was good to go! All Going Wrong Shortly after my 9th birthday, it became apparent that things weren't quite right. I had no energy, very little appetite and basically wasn't myself. After a particularly lacklustre summer holiday my parents took me to our GP, who had me admitted to the local hospital. After 3 days in hospital, they decided nothing was wrong, perhaps I had a virus. Not trusting the diagnosis, my parents took me to The Freeman Hospital in Newcastle (where all my surgeries took place) I was immediately poked, prodded and x-rayed, and then the bad news came. My heart was 3 times larger than it should have been, and was operating at about 3% (pro athletes run at about 40% - its an odd measurement!) what they didn't know, was why. They assumed that the pacemaker had malfunctioned, and determined it was its proximity to my heart. That the signals had somehow become 'confused' and gone awry! I underwent another pacemaker replacement, and it was placed in the now common place of beneath the skin in the front of the left shoulder. Sadly the replacement didn't solve any problems, my heart was done, I was dying. Transplant The choice to undergo a heart transplant was mine. The Dr's told me the facts, I had less than 12 months without it, and possibly an extra 5-8 years if I had one. The choice was simple, and in my head, it was just another surgery! So I was assessed and placed at the top of the transplant list, I was the worst case on the list, so I would get first dibs on any heart that became available. 1 week later the phone rang - they had a viable heart. Cue mad panic and lots of tears! An ambulance arrived and off we shot on the 90 mile journey to the hospital. On the way there however, the call came in that the heart had died on route, and they wouldn't be able to restart it. Another 6 weeks passed and then the phone rang again, they had another viable heart. We made it to the hospital and started the pre op routine. By midnight I was being wheeled into the theatre, very drowsy, but still awake. 8 hours later I woke up in intensive care, the op was a success and the heart had restarted first time. I was the 21st child recipient in the UK A massive amount of thanks goes to the donor family, the donor was only 12 years old and I wouldn't even know how to imagine how harrowing that would be, to then allow the organs to be used for transplantation defies understanding, all I know is that I am eternally grateful to them. (In all, 8 people received organs from this donor - truly amazing) And Now? Fast forward almost 21 years to now, and its 2012! The 5-8 years I might have got from the transplant have turned into something more than anyone at the time would have thought possible! Obviously I am not the longest post op transplant recipient, there are people who are almost 30 years post transplant but it still feels pretty good to be this far out! Pretty much since my transplant i've tried to live a life that would hopefully make my donor and his family proud that I was the recipient. Nowadays, I use my running to help with that! I started running properly in April 2011, 7.5 miles (bearing in mind I ran maybe 2 miles once a month before hand!) over 3 local mountains. It took me about 4 hours, I was covered in cuts and bruises from slips and falls on the trails, I was caked in mud, ridiculously dehydrated and fairly peckish! I had no idea what I was doing! That same night I experienced DOMS for the first time in my entire life! Every time I sat down, I struggled to stand up again! And staircases were a massive no-no! So that's a fair old chunk of what makes my internal engine tick! In future blogs i will delve into my running more, and how living with a transplant affects me and what i've done since that night in 1992... Section two – Getting going with a blogging habit! Outro - Closing comments MarathonBQ – How to Qualify for the Boston Marathon in 14 Weeks - Well, my friends, thank you for your continued attendance.  I appreciate it.  Thank you.  We have been transplanted to the end of episode 4-323 (see what I did there?) My training has been going well.  I laid low for the month of September with all the travel but I started working in some speedwork.  I let coach have a break – and just to squelch any rumors – I’m not fighting with coach or anything dramatic like that – I’m just experimenting with some more intensity to see how my body responds.  If we add up the plantar fasciitis vacation and the Afib episodes I haven’t been able to get a decent training cycle in since 2011!  The first thing I noticed is that my paces are off by a full 30 seconds a mile from where I used to be – some of that is due to age, but a lot of it is just being out of practice.  The speedwork feels hard and foreign to my body.  I’m like 3 weeks in now and I’m starting to see the results.  I started with 5 days a week to see if my body would be able to recover.  Sunday long, Monday recovery spin, Tuesday speed, Wednesday recovery run, Thursday Tempo, Friday recovery run and Saturday off to do house chores.   This put me in the mid-30’s in terms of mileage.  I made sure to really focus on doing the stretching, warm-up, cool-down and maintenance core work.  Nothing really hurt, except the plantar fasciitis flared up at the end of the first hard week.  I thought I was toast.  (this was last week).  It was super sore after Friday’s run.  So – I got the splint on for sleeping, I took my Saturday off, I taped the foot for Sunday’s run and I got it under control… so far.  I think I isolated the problem.  I was wearing an old pair of ASICs E33’s (basic neutral cushion shoes) to get a better feel of the track for speed work.  I don’t keep very good track of mileage in shoes but I remember I wore these for two marathons a year ago – so they are probably toast.  We’ll keep an eye on it.  I can always swap out the Friday recovery run with a recovery spin instead.  This Sunday I’ll be volunteering at two local races. The Baystate marathon in the morning and the Groton Town Forest Trail Race in the afternoon.  If you’re running either of those say ‘hi’. We’ll be at the 7 mile water stop at Baystate – just before the bridge.  … I was coming back from getting tires on my Camry this past weekend.  I was sitting in a long line of cars at a red light.  I did what we all do at red lights.  I checked my phone.  Of course the next thing I know there’s the blaring of a horn and the guy behind me is freaking out because I let a 20 foot gap expand in front of me.  I look in the review mirror and this guy is swearing at me and waving his hands – he’s quite apoplectic.  My first reaction is to give him a big passive aggressive smile and wave.  I also feel that drip of adrenaline as my dinosaur brain prepares for a fight.  Can’t help it.  As I think about it I wonder what is so wrong with this guy’s life that he has gone off the deep end over 20 feet of pavement?  I just want to say “It’s ok.”  I’m as guilty as the next guy.  It makes me super stressed out to get stuck in traffic.  Even though I know it has nothing to do with the traffic – it’s me getting me stressed out because of the way I think about time. I think time is scarce.  In my mind I can only be successful if I get stuff done in the time I have.  How often do we think about time in this way?  I don’t have enough time.  I don’t want to waste time.  Is it worth my time?  My revelation is that this is all scarcity thinking.  As much as I talk about abundance I think in terms of scarce time.  That is a disconnect between thoughts and beliefs.  That’s an incongruence between a belief in abundance and thought of scarcity. I wonder if you’re not doing the same thing?  What if we thought of time as abundant? How would that change the way we approached adversity?  What abundance cold that bring into our lives? And the next time you’re running late and you lean on that horn, I’ll see you out there. MarathonBQ – How to Qualify for the Boston Marathon in 14 Weeks -