POPULARITY
25 episodes with GFR
21 episodes with GFR
9 episodes with GFR
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Episode 213: HIV PrEP Review H. Nicole Magaña, medical student, reviews the history of PrEP and outlines the currently FDA-approved medications used for HIV prevention. Dr. Arreaza provides additional perspective on long-acting injectable options, including how quickly they begin to protect patients after initiation. Written by Nicole Magana, MSIV, American University of the Caribbean. Comments and edits by Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice. Pre-exposure prophylaxis for HIV. Previous episodes related to HIV: -Episode 67, HIV history (September 2021) -Episode 68, HIV transmissibility (October 2021) -Episode 70 (October 2021), HIV prevention (including HIV Prep with oral medications) -Episode 98 (June 2022), we introduced Apretude, the first injectable for HIV PrEP. Apretude was approved in December 2021. What is Pre-Exposure prophylaxis (PrEP)? Pre-exposure prophylaxis, or PrEP, is the use of antiretroviral medications taken by individuals who are HIV-negative to prevent HIV acquisition. There are 30,000 new HIV infections annually in the US. How effective is it? When taken as prescribed, PrEP is highly effective at reducing the risk of HIV transmission through sexual exposure and injection drug use. Patients who are adherent to PrEP can lower their risk of contracting HIV by 99%. The effectiveness of oral PrEP is highly adherence dependent. In trials with 70% adherence, the relative risk of HIV acquisition was 0.27, compared to 0.51 with 40-70% adherence and no significant benefit with adherence ≤40%. How does PrEP work? PrEP works by maintaining therapeutic drug levels in the bloodstream and in target tissues. If HIV exposure occurs, viral replication is inhibited, preventing the establishment of infection. Brief History of PrEP. The concept of PrEP originated from early animal studies demonstrating that antiretroviral medications could prevent retroviral transmission when administered before exposure. In 2010, the iPrEx trial showed that daily oral tenofovir disoproxil fumarate (known as Truvada) with emtricitabine significantly reduced HIV acquisition among men who have sex with men and transgender women. This was the first large clinical trial to demonstrate the effectiveness of PrEP. In 2012, the FDA approved oral Truvada, which is TDF/FTC (tenofovir disoproxil and emtricitabine) for HIV prevention. Since then, additional studies have expanded indications and introduced new formulations, including long-acting injectable options. Who Should Be Offered PrEP? PrEP should be considered for any HIV-negative individual at increased risk of HIV acquisition, including Men who have sex with men, transgender individuals, heterosexual men and women with an HIV-positive partner, individuals with recent bacterial sexually transmitted infections, people who inject drugs, individuals engaging in condomless sex with partners of unknown HIV status. Remember that PrEP should be offered in a nonjudgmental, patient-centered manner, make it a safe space to talk openly about prevention of HIV. Available HIV PrEP Options. Daily Oral PrEP: There are 2 formulations of Tenofovir. There is Tenofovir disoproxil fumarate (TDF)/ Truvada and Tenofovir alafenamide (TAF)/ Descovy. Each is available in a tablet combined with Emtricitabine a nucleoside reverse transcriptase inhibitor. Truvada: It is approved for all populations at risk through sexual exposure or injection drug use. Something to look out for before starting this medication is for pre-existing CKD. Do not give to patients who have an estimated glomerular filtration rate of less than 60 mL/min. (6) Descovy: This option is approved for men who have sex with men and transgender women but is not approved for individuals at risk through receptive vaginal sex. It has less impact on renal function and bone mineral density compared to Truvada. It can be used in moderately reduced kidney function (GFR between 30-60 mL/min). Truvada and Descovy are taken orally once a day. After patients start taking these medications, when are they considered to be protected? Nicole: With daily oral PrEP, guidelines differ with WHO and International Aids Society-USA stating it takes about 7 days, while CDC states 21 days to allow for adequate concentration in tissues (1). Adherence is critical for efficacy. Injectable HIV PrEP. In 2021, the FDA approved the first Injectable PrEP option Long-acting cabotegravir (CAB-LA)- known on the market as Apretude. Cabotegravir is an integrase strand transfer inhibitor administered as an intramuscular injection.Dosing consists of an initial injection, a second injection one month later, and then maintenance injections every two months (1). Another option is Lenacapavir (Yeztugo). The Yeztugo as a pre-exposure prophylaxis (PrEP) for HIV in Oct 2024. Yeztugo is the first and only FDA-approved HIV prevention treatment that requires just two injections per year, offering a long-acting option for people who weigh at least 35kg. It is given as 2 injections every 6 months. First dose is given with 2 tablets on Day 1 and Day 2, then every 6 months 2 injections on the same day. Clinical trials, including HPTN 083 and HPTN 084, demonstrated that injectable cabotegravir is superior to daily oral PrEP in preventing HIV infection. This advantage is largely due to improved adherence rather than differences in intrinsic drug potency. There have been no head-to-head comparisons between Yeztugo and Apretude, but they are both very effective. Apretude starts protecting 7 days after the first dose, and Yeztugo starts protecting 2 hours after Day 2 (if patient takes the oral loading dose) or 3-4 weeks if no oral load is taken. Injectable PrEP is particularly beneficial for patients who struggle with daily pill adherence, have trouble swallowing pills, prefer a discreet option, have difficulty storing their medication or have renal or bone disease that limits the use of tenofovir-based regimens like Truvada and Descovy (6). In one unpublished report by Medline, patients who received Apretude had an increase in bone mineral density compared to those who received Truvada (1). Tests prior to starting PrEP. Before initiating PrEP, patients must be confirmed to be HIV-negative. Baseline evaluation includes HIV testing with a fourth-generation antigen/antibody assay, HIV RNA testing if acute infection is suspected, renal function testing for oral PrEP, Hepatitis B screening, sexually transmitted infection screening, and pregnancy testing when appropriate. PrEP should not be started in individuals with known or suspected acute HIV infection. Monitoring for patients on HIV PrEP. Monitoring typically includes HIV testing every 2 to 3 months, STI screening every 3 to 6 months, renal function monitoring for those on oral PrEP (tenofovir- based), ongoing adherence and risk-reduction counseling. And for injectable PrEP, adherence to the injection schedule is essential, as delayed dosing may increase the risk of resistance if HIV infection occurs. HIV PrEP is not a prevention for other STIs. Screening for STIs and counseling about prevention is essential. Breakthrough HIV infections on PrEP are rare and most often associated with poor adherence or delayed diagnosis. Truvada is more studied in all populations and is considered safe during pregnancy and breastfeeding. There is less data regarding the injectable option in patients who are pregnant, may become pregnant, or whose primary risk factor is injection drug use (1). Injectable PrEP provides an important alternative for patients with chronic kidney disease and bone disease (1). Key Takeaway Pre-exposure prophylaxis is a safe, effective, and evidence-based strategy for HIV prevention. With both daily oral and long-acting injectable options available, PrEP can be individualized to meet patient needs. Normalizing PrEP discussions in clinical practice is essential to reducing new HIV infections and advancing public health goals. Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! References: Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society–USA Panel. The Journal of the American Medical Association. 2025. Gandhi RT, Landovitz RJ, Sax PE, et al. Long-Acting Lenacapavir Acts as an Effective Preexposure Prophylaxis in a Rectal SHIV Challenge Macaque Model. The Journal of Clinical Investigation. 2023. Bekerman E, Yant SR, VanderVeen L, et al. Pharmacokinetics and Safety of Once-Yearly Lenacapavir: A Phase 1, Open-Label Study. Lancet. 2025. Jogiraju V, Pawar P, Yager J, et al.
Środa z Braćmi Rodzeń---Witajcie w kolejnym odcinku programu „Środa z Braćmi Rodzeń”, w którym pomagamy Wam zdrowo schudnąć, wycofać choroby metaboliczne i po prostu pięknie żyć. Dzisiaj bierzemy na warsztat jeden z najczęstszych mitów dotyczących odżywiania niskowęglowodanowego i sprawdzamy, jak dieta keto oraz low-carb wpływa na kondycję naszych nerek. Czy rzeczywiście mamy się czego obawiać, czy wręcz przeciwnie – to właśnie zmiana modelu żywienia może uratować ich funkcję?. Z tego odcinka dowiesz się:· Czy białko w diecie faktycznie uszkadza nerki i skąd wzięły się obawy dotyczące „przebiałkowania” organizmu.· Jak dieta niskowęglowodanowa wpływa na wskaźnik GFR i dlaczego u osób w III stadium przewlekłej choroby nerek odnotowuje się jego istotny wzrost.· Dlaczego insulinooporność jest głównym wrogiem nerek i w jaki sposób jej wycofanie może zahamować postęp niewydolności.· Co aktualna nauka mówi o bezpieczeństwie diety keto w kontekście chorób nerek, opierając się na najnowszych badaniach amerykańskich stowarzyszeń.· Jakie kroki podjąć, aby chronić swoje nerki i dlaczego unikanie węglowodanów jest w tym procesie kluczowe. Zapraszamy do wysłuchania tej merytorycznej rozmowy, która odczarowuje lęki przed białkiem i pokazuje, że odpowiednie odżywianie to najlepsza polisa ubezpieczeniowa dla Twoich nerek. Pamiętajcie, że zdrowie zaczyna się od wiedzy!. ----
Episode 212: Managing HFpEFHyo Mun and Jordan Redden (medical students) explain how to manage HFpEF with medications and touch some basics about nonpharmacologic treatments. Dr. Arreaza asks insightful questions to guide the discussion. Written by Hyo Mun, MSIV, American University of the Caribbean; and Jordan Redden, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Treatment of HFpEFArreaza: Mike, if you had to name the one therapy everyone with HFpEF should be on, what is it?Mike: That's easy! SGLT-2 inhibitors. This is the one slam-dunk we have in HFpEF. Empagliflozin (Jardiance) or dapagliflozin (Farxiga) should be started in essentially every patient with HFpEF, and it doesn't matter if they have diabetes or not.Jordan: And that's worth repeating, because people still think of these as “diabetes drugs.” They're not anymore. In HFpEF, SGLT-2 inhibitors reduce heart-failure hospitalizations, improve symptoms, improve quality of life, and even reduce cardiovascular death.Dr. Arreaza: They're also simple. Empagliflozin 10 mg daily or dapagliflozin 10 mg daily. No titration, no drama. The effectiveness of these meds was established around 2019 with DAPA-HF and later with DELIVER. These were trials thatdemonstrated that dapagliflozin reduces worsening heart failure and cardiovascular events across the full spectrum of heart failure, from reduced to preserved ejection fraction, independent of diabetes status.Mike: And the number needed to treat is about 28 to prevent one heart-failure hospitalization. That's excellent for a disease where we historically had almost nothing that worked.Jordan: They're also safe in chronic kidney disease down to an eGFR of about 25, which makes them even more useful in this population.Dr. Arreaza: Alright. We got SGLT-2 inhibitor, what's next?Mike: Volume management. Loop diuretics are still the backbone of symptom control in HFpEF. If the patient is volume overloaded, you diurese, and you diurese aggressively.Jordan: The goal is euvolemia. Dry weight, no edema, no orthopnea, no waking up gasping for air. A lot of these patients end up needing chronic oral loop diuretics to stay there.Dr. Arreaza: Something to remember: HFpEF patients don't tolerate congestion well, and being “a little wet” is not benign. Let's move into RAAS inhibition. Where do ARBs and ACE inhibitors fit in?Mike: Between ARBs and ACE inhibitors, ARBs are the winners in HFpEF. They actually reduce heart failure hospitalizations—drugs like candesartan, losartan, valsartan. ACE inhibitors? Not so much. They showed minimal benefit in older HFpEF patients, which is why we go with ARBs instead.Jordan: But a lot of clinicians get nervous about ACE inhibitors and ARBs because of kidney function, so it's worth talking through how these drugs actually work in the kidney.Dr. Arreaza: Yes, misunderstanding may lead to unnecessary drug discontinuation.Jordan: Under normal conditions, the afferent arteriole brings blood into the glomerulus, and the efferent arteriole is constricted by angiotensin II. That constriction keeps pressure high in the glomerulus and maintains filtration.Mike: Here's what happens with an ACE inhibitor: you block angiotensin II, the efferent arteriole relaxes, glomerular pressure drops, and GFR dips slightly. Creatinine bumps up a little, and that scares people, but that's actually the whole point—that's how you get kidney protection long-term.Jordan: High intraglomerular pressure causes hyperfiltration injury and scarring over time. Lowering that pressure protects the kidney long-term. The short-term GFR drop is the price you pay for long-term benefits.Dr. Arreaza: So let's talk about CKD, because this is where people panic.Mike: Right. ACE inhibitors and ARBs are not contraindicated in chronic kidney disease. In fact, they're recommended even in advanced stages. They reduce progression to kidney failure by about a third.Jordan: The key is how you use them. Start low. Check creatinine and potassium one to two weeks after starting, then periodically. A creatinine rise up to 30% from baseline is acceptable. That's not kidney injury, that's physiology.Dr. Arreaza: And what about potassium creeping up?Mike: You adjust the dose or add a potassium binder. You don't just automatically stop the drug.Dr. Arreaza: Now there is one absolute contraindication everyone needs to know about! (board exam test)Jordan: Bilateral renal artery stenosis. This is the big one. In these patients, the kidneys are completely dependent on angiotensin II–mediated efferent constriction to maintain GFR. Take that away, and GFR collapses.Mike: Creatinine can jump dramatically within days. If you see a creatinine rise of 20% or more shortly after starting an ACE inhibitor, you should be thinking about bilateral renal artery stenosis and stopping the drug immediately.Dr. Arreaza: After revascularization, though, many patients can tolerate ACE inhibitors again, so this isn't always permanent. What about cardiorenal syndrome? That's where things get uncomfortable.Mike: It is uncomfortable, but cardiorenal syndrome isn't a contraindication. These patients have severe heart failure and kidney disease, and their mortality is actually higher than patients with heart failure alone.Jordan: ACE inhibitors still reduce mortality and slow kidney disease progression in this group. Studies show that stopping ACE inhibitors during acute heart-failure admissions increases in-hospital mortality three- to four-fold.Dr. Arreaza: So we are cautious, but we don't avoid it.Mike: Exactly. Start low, titrate slowly, monitor labs closely, accept up to a 30% creatinine rise. You only stop if kidney function keeps worsening, or potassium gets dangerously high.Dr. Arreaza: Alright. Let's move on. What about mineralocorticoid receptor antagonists… MRA?Jordan: Spironolactone or eplerenone might reduce hospitalizations in HFpEF, but the data is mixed. This is more of a “select patients” situation.Mike: And you have to watch potassium and kidney function carefully, especially if they're already on an ACE inhibitor or ARB.Dr. Arreaza: What about sacubitril-valsartan, also known as Entresto®?Mike: Entresto may help patients with mildly reduced EF roughly in the 45 to 57% range. It's not first-line for HFpEF, but in select patients, it's reasonable.Dr. Arreaza: Now let's clarify one of the biggest sources of confusion: beta blockers.Jordan: Beta blockers are not a treatment for HFpEF itself. They're only indicated if the patient has another reason to be on them, like coronary disease or atrial fibrillation.Mike: And timing really matters here. You absolutely do not start beta blockers during acute decompensated heart failure. Their negative inotropic effects can make things worse when patients are volume overloaded.Jordan: But, and this is critical, you also don't stop them if the patient is already taking one. Abrupt withdrawal causes a sympathetic surge and dramatically increases mortality.Dr. Arreaza: If a patient is admitted on a beta blocker, what do we do?Mike: Continue it at the same dose or reduce it slightly if they're really unstable. Once they're euvolemic and stable, you can carefully titrate up.Jordan: And watch for chronotropic incompetence. HFpEF patients often rely on heart-rate response to exercise, and beta blockers can worsen exercise intolerance.Dr. Arreaza: Beyond medications, HFpEF is really about treating comorbidities. Aerobic activity can be an initial strategy to improve exercise intolerance and has evidence of improving aerobic function and quality of life. Sodium restriction: improves symptoms, does not decrease risk of death or hospitalizations.Mike: Hypertension control is huge. For diabetes, the SGLT-2 inhibitors will perform double duty. For obesity, weight loss improves symptoms, and GLP-1 agonists like semaglutide are absolute gamechangers.Jordan: Don't forget sleep apnea, atrial fibrillation, and lifestyle. Exercise improves the quality of life, even if it doesn't change hard outcomes. Lifestyle is the main treatment. Dr. Arreaza: And when should you refer to cardiology?Mike: You should refer when the diagnosis isn't clear; symptoms are not responding to treatment, difficult volume management, end-organ dysfunction, or if you are concerned about advanced heart failure.Dr. Arreaza: So, it has been a great discussion. What is the takeaway?Mike: HFpEF treatment isn't about one magic drug -- it's about volume control, SGLT2 inhibitors, smart use of RAAS blockade, and aggressive management of comorbidities.Jordan: And it's understanding the physiology, so you don't withhold life-saving therapies out of fear.Dr. Arreaza: Well said. If you found this helpful, share it with a friend or colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Jordan/Mike: Thanks! Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.
Episode 211: Understanding HFpEF. Hyo Mun and Jordan Redden (medical students) explain the pathophysiology of heart failure with preserved ejection fraction (HFpEF) and how it differentiates from HFrEF. Dr. Arreaza asks insightful questions and summarizes some key elements of HFpEF. Written by Hyo Mun, MS4, American University of the Caribbean; and Jordan Redden, MS4, Ross University School of Medicine. Comments and edits by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is EF? Just imagine, the heart is a pump, blood gets into the heart through the veins, the ventricles fill up and then squeeze the blood out. So, the percent of blood that is pumped out is the EF. Let's start at the beginning. What is HFpEF?Mike: HFpEF stands for heart failure with preserved ejection fraction. Basically, these patients squeeze normally—their ejection fraction is 50% or higher—but here's the thing: the heart can't relax and fill the way it should. The muscle gets stiff, almost like a thick leather boot that just won't stretch. And because the ventricle can't fill properly, pressure starts backing up into the lungs and the rest of the body. That's when patients start experiencing shortness of breath, leg swelling, fatigue—all those classic symptoms.Dr. Arreaza: And this is where people get fooled by the ejection fraction.Mike: Exactly. The ejectionfraction tells you total left ventricular emptying, not just forward flow.Jordan: The classic example is severe mitral regurgitation. You can eject 60% of your blood volume and still be in cardiogenic shock because most of that blood is leaking backward into the left atrium instead of going into the aorta. So, you get pulmonary edema, hypotension, fatigue, all with a “normal” EF. Which is honestly terrifying if you're over-relying on echo reports without thinking clinically.Dr. Arreaza: And in HFpEF, functional mitral regurgitation often shows up later in the disease. It's not usually the primary cause; it's more of a marker of advanced disease. Moderate to severe MR in HFpEF independently predicts worse outcomes, including a higher risk of mortality or heart failure hospitalization. So, let's contrast this with HFrEF. How are these two different?Mike: HFrEF—heart failure with reduced ejection fraction—is a pumping problem. The heart muscle is weak and can't contracteffectively. Ejection fraction drops below 40%, and this is your classic systolic dysfunction.Jordan: HFpEF, on the other hand, is diastolic dysfunction. The heart muscle is thick, fibrotic, and noncompliant. It squeezes fine, but it just doesn't relax, even though the EF looks reassuring on paper.Mike: I like to explain it this way: HFrEF is a weak heart that can't squeeze. HFpEF is a stiff heart that can't relax. Totally different problems.Dr. Arreaza: And then there's the gray zone: heart failure with mildly reduced EF, or HFmrEF. That's an EF between 41 and 49% with evidence of elevated filling pressures. It really shares the features of both worlds. So, what actually causes HFpEF versus HFrEF?Jordan: HFpEF is basically what happens when all the problems of modern living catch up with you. You've got chronic hypertension, obesity, diabetes, metabolic syndrome, aging, systemic inflammation—all of these things slowly remodel the heart over years. The muscle gets thick and stiff, and eventually the ventricle just loses its ability to relax. So, HFpEF is really a disease of metabolic dysfunction and chronic stress in the heart. Mike: HFrEF is more about direct injury. Think about myocardial infarctions, ischemic cardiomyopathy, viral myocarditis, alcohol toxicity, chemotherapy like doxorubicin, genetic cardiomyopathies, or chronic uncontrolled tachycardia. These insults actually damage or kill heart muscle cells, leading to a dilated, weak ventricle that can't pump effectively.Dr. Arreaza: So the short version: HFpEF is caused by chronic metabolic and hypertensive stress, while HFrEF is caused mainly by myocardial damage. A question we get a lot: does HFpEF eventually turn into HFrEF? What do you guys think?Mike: In most cases, no. HFpEF patients usually stay HFpEF throughout their disease course. They don't just “burn out” and turn into HFrEF.Jordan: They're generally separate disease entities with different pathophysiology. A patient with HFpEF can develop HFrEF if they have a big myocardial infarction or ongoing ischemia that damages the muscle, but that's not the natural progression.Mike: Interestingly though, the opposite can happen. Some HFrEF patients actually improve their ejection fraction with good medical therapy—that's called HF with improved EF—and it's a great sign that treatment is working.Dr. Arreaza: Another question. How do HFpEF and HFrEF compare to restrictive cardiomyopathy and constrictive pericarditis?Jordan: Clinically, they can all look very similar: dyspnea, edema, fatigue, but the underlying mechanisms are completely different.Mike: In HFpEF, the myocardium itself is stiff from hypertrophy and fibrosis. The problem is intrinsic to the heart muscle, and EF stays preserved. Echoshows diastolic dysfunction with elevated filling pressures.Jordan: In HFrEF, the myocardium is weak. The ventricle is often dilated and contracts poorly, with a reduced EF.Mike: Restrictive cardiomyopathy is different. Here, the myocardium gets infiltrated by abnormal stuff—amyloid, iron, sarcoid—and that makes it extremely stiff. It can look like HFpEF on the surface, but it's usually more severe. On Echo You'll see biatrial enlargement, small ventricles, and preserved EF. And importantly, it's a pathologic diagnosis, so you need advanced imaging or biopsy to confirm it.Jordan: Constrictive pericarditis is another mimic, but here the myocardium is usually normal. The problem is that the pericardium is thickened, calcified, and rigid. This will physically prevent the heart from being filled. Imaging shows pericardial thickening, septal bounce, and respiratory variation in flow, and cath shows equalization of diastolic pressures, which is the hallmark of constrictive pericarditis.Dr. Arreaza: So the takeaway is: HFpEF is a clinical syndrome driven by common metabolic and hypertensive causes, while restrictive and constrictive diseases are specific pathologic entities. If “HFpEF” is unusually severe or not responding to treatment, you need to think beyond HFpEF. Which type of heart failure is more common right now?Mike: Good question, the answer is: HFpEF. It now accounts for up to 60% of all heart failure cases, and it's still rising.Dr. Arreaza: Why is that?Jordan: Because people are living longer, gaining weight, and developing more metabolic syndrome. HFpEF thrives in older, or people with obesity, hypertension, or diabetes: basically, the modern American population. At the same time, better treatment of acute MIs means fewer people are developing HFrEF from massive heart attacks.Mike: HFpEF is the heart failure epidemic of the 21st century. It's honestly the cardiology equivalent of type 2 diabetes.Dr. Arreaza: Let's talk aboutCOVID-19. (2025 and still talking about it) Does it actually increase heart failure risk?Mike: Yes, absolutely. COVID increases both acute and long-term heart failure risk.Jordan: During acute infection, COVID can cause myocarditis, trigger massive inflammation, and precipitate acute decompensated heart failure, especially in patients with pre-existing disease. It also causes microthrombi, which can injure the myocardium.Mike: And after infection, even mild cases are linked to a significantly higher risk of developing new heart failure within the following year. Both HFpEF and HFrEF rates go up.Dr. Arreaza: I remember seeing this in 2021, we had a patient with acute COVID and HFrEF, her EF was about 10%, I lost contact with the patient and at the end I don't know what happened to her. What's the pathophysiology of COVID and heart failure?Mike: COVID causes direct viral injury through ACE2 receptors, triggers massive inflammation that damages the endothelium and heart muscle, leads to microvascular clotting and fibrosis—all mechanisms that promote HFpEF.Jordan: Add autonomic dysfunction, persistent low-grade inflammation, and worsening metabolic syndrome, and you've got a perfect storm for heart failure.Dr. Arreaza: Bottom line: COVID is a cardiovascular disease as much as a respiratory one. If someone had COVID and now has unexplained dyspnea or fatigue, think about heart failure. Get an echo, get a BNP, start treatment. Last big question: why did we have so many therapies for HFrEF but essentially none for HFpEF for years?Mike: HFrEF is mechanistically straightforward. You've got a weak heart with excessive neurohormonal activation going on — so you block RAAS, block the sympathetic system, drop the afterload. The drugs make sense.Jordan: HFpEF is messy. It's not one disease. It's stiffness, fibrosis, inflammation, microvascular dysfunction, metabolic disease, atrial fibrillation, all overlapping. One drug can't fix all of that.Mike: And some drugs that worked beautifully in HFrEF actually made HFpEF worse. Take Beta blockers, for example. They slow heart rate, which is a problem because HFpEF patients rely on heart rate to maintain their cardiac output.Jordan: The breakthrough came with SGLT-2 inhibitors: diabetes drugs that unexpectedly addressed multiple HFpEF mechanisms at once: volume, metabolism, inflammation, and myocardial energetics.Dr. Arreaza: The miracle drug for HFpEF! Alright, let's wrap up.Mike: Bottom line: HFpEF is common, complex, and dangerous: even if the EF looks “normal.”Jordan: And if you're relying on ejection fraction alone, HFpEF will humble you every time.Dr. Arreaza: If you liked this episode, share it with a friend or a colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.
In this episode, Kara Umbarger discusses the latest updates in kidney care, including the exciting new GFR equation and the role of SGLT2 inhibitors in managing chronic kidney disease. Stay informed on how recent advances can improve outcomes for patients and the importance of timely referrals to nephrologists. Learn more about Kara Umbarger, APRN
When you live with a chronic illness, food restriction is often framed as “medical,” “necessary,” or “just being responsible.” But for many people, especially those with eating disorder histories, that kind of guidance doesn't support health. It fuels fear, shame, isolation, and disordered eating patterns that are hard to unwind. In this episode, Dr. Marianne is joined by Vanessa Connolly, a registered dietitian nutritionist and board-certified kidney nutrition specialist, for a grounded, compassionate conversation about what happens when restriction is prescribed rather than chosen and why that matters so deeply for eating disorder recovery. Together, they unpack how diet culture shows up in chronic illness care, how weight stigma and medical bias shape food advice, and why many people are quietly harmed by guidance that prioritizes control over nourishment. In This Conversation, We Explore This episode looks at how chronic illness care can unintentionally recreate the same dynamics that drive eating disorders, especially for people who have already spent years being told their bodies are the problem. We talk about how fear-based food rules around labs, numbers, and diagnoses often strip people of cultural foods, social connection, and bodily trust. You'll hear why blanket dietary restrictions are rarely neutral, how they can worsen food fear and disordered eating, and what a more supportive, humane approach to nutrition can look like. Vanessa also explains why focusing on what can be added rather than taken away, including fiber, balance, and satisfaction, supports both physical health and psychological safety. This episode names the emotional cost of food policing, family surveillance, and medical dismissal, especially for people in larger bodies and those navigating multiple marginalized identities. Topics Covered We discuss eating disorder recovery alongside chronic illness, including chronic kidney disease, diabetes, and high blood pressure, without defaulting to diet culture or weight-centric care. This conversation includes medical gaslighting and delayed diagnoses, how lab values like GFR are often misunderstood or minimized, and why many patients are never fully informed about what's happening in their own bodies. We also explore anti-fat bias in healthcare, intersectionality, cultural food loss, and how shame and restriction can isolate people from their communities at the very moment they need support the most. Why This Episode Matters If you've ever felt afraid to eat after a diagnosis, confused by conflicting medical advice, or worried that “doing everything right” is actually making things worse, this episode is for you. This is not a conversation about willpower, compliance, or perfect eating. It's about restoring agency, reducing harm, and finding ways to care for your body that don't require sacrificing your relationship with food. About the Guest Vanessa Connolly is a registered dietitian nutritionist and board-certified kidney nutrition specialist with over 20 years of experience supporting people with chronic kidney disease. Her work centers on helping clients preserve kidney function without unnecessary restriction, food fear, or shame. She is deeply committed to accessible, weight-inclusive, and judgment-free care. You can find Vanessa on Instagram and TikTok @grainandgreen.kidneys, where she shares practical, anti-diet education about kidney health and chronic illness. Related Episodes The Real Talk on Kidney-Friendly Diets & Disordered Eating With Vanessa Connelly, RD @grainandgreen.kidneys on Apple and Spotify. Chronic Illness, Wellness Culture, & Eating Disorder Recovery: Taking an Anti-Diet Approach With Abbie Attwood, MS, @abbieattwoodwellness on Apple and Spotify. Anti-Fat Bias in Healthcare & Chronic Illness: Healing Body Image in a Marginalized Body With Ivy Felicia @iamivyfelicia on Apple and Spotify. Support Beyond This Episode If eating feels complicated, unsafe, or overwhelming after years of restriction, diagnosis-driven food rules, or medical trauma, you don't have to navigate that alone. Dr. Marianne offers eating disorder therapy and support for people navigating binge eating disorder, ARFID, anorexia, bulimia, and long-term eating struggles, including when chronic illness or medical advice is part of the picture. Services are available in California, Texas, Washington, D.C., and worldwide. Go to drmariannemiller.com for more information.
A 60-year-old male with documented ASCVD, obesity with BMI of 34, and type 2 diabetes presents for care. The patient reports he's currently feeling well without episodes of hypoglycemia. Current laboratory assessment includes the following. A1C is 8.6 % and his estimated GFR is at 62. Current medications include metformin at optimized dose and a sulfonyl urea.Which of the following represents the nurse practitioner's next best action?A. continue on current therapy and arrange for a three month follow upB. discontinue the metformin and add a DPP4 inhibitorC. add a GLP-1 inhibitor and discontinue the sulfonyl ureaD. add basal insulin and titrate to fasting glycemic goals---YouTube: https://www.youtube.com/watch?v=8ybH1qcskq8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=124Visit fhea.com to learn more!
Vi följer upp Carin Wallquists genomgång av kunskapsläget kring CA/CI-AKI med att intervjua Maja Möllerström, ST-läkare i Skåne. Maja har varit med om att utarbeta nya lokala rutiner för jodkontrast till patienter med nedsatt njurfunktion. Numera är det GFR 30 som är gränsen för vad kräver bedömning av radiolog. Vad innebär detta i praktiken? Sen har Per gjort ett litet julquiz, där Jörgen får visa vad han kan om schlager, hårdrock och östgötska lokalkändisar. Länk till flödesschemat som Maja varit med om att utarbeta: https://drive.google.com/file/d/1B9PflDkcU-YLiLfwSn2BuEXl6RDZxwWn/view?usp=sharing Akutradiologikursens hemsida: www.akutradiologikursen.se Avsnittet presenteras i samarbete med Teleconsult. Läs mer om vad de kan erbjuda dig som radiolog, eller dig som chef på en underbemannad röntgenavdelning, på www.teleconsult.net !
If you enjoy a blend of online learning and podcast-style listening that you can fit into your busy life, then this podcourse is for you.Listen to this 3-part audio series, then go to MIMSLearning.co.uk to read the downloadable worksheets and complete the multiple-choice quizzes, to get up to speed with all the key points primary care professionals need to know about chronic kidney disease (CKD). In this episode (part 3), consultant nephrologist Dr Andrew Frankel discusses advanced management of CKD, using the case of a patient whose disease has progressed. He explains when the focus should shift from preventing disease progression to planning for end-stage kidney failure treatment, and outlines the options, including dialysis, transplant, and supportive care.Dr Frankel emphasises that ‘the management of heart failure needs to be prioritised over the management of a decline in GFR', and explains what this looks like in practice. He also offers tips on dealing with complications such as hyperkalaemia and anaemia.MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser. Educational objectivesAfter listening to this podcourse episode, healthcare professionals should be better able to:Recognise when to begin planning for end-stage kidney failure treatmentRecall the role of supportive care as a treatment option for some patientsAppreciate why heart failure management should be prioritised over preservation of GFR in cardiorenal diseaseDescribe the management of hyperkalaemiaUnderstand the investigation and management of anaemia in advanced CKDMIMS LearningSubscribe to MIMS LearningCKD podcourse with Dr Andrew Frankel, part 1: diagnosis and classificationCKD podcourse with Dr Andrew Frankel, part 2: monitoring and managementPsychotropic medication and renal impairmentManaging patients with combined heart and kidney diseaseCardio-renal-metabolic disease: clinical reviewDiabetes-related kidney disease: therapy optionsGuidance update: NICE guidelines on chronic kidney diseasePodcast: diagnosis and management of diabetes-related kidney diseaseDiabetes-related kidney disease: five steps to optimise management Hosted on Acast. See acast.com/privacy for more information.
If you enjoy a blend of online learning and podcast-style listening that you can fit into your busy life, then this podcourse is for you.Listen to this 3-part audio series, then go to MIMSLearning.co.uk to read the downloadable worksheets and complete the multiple-choice quizzes, to get up to speed with all the key points primary care professionals need to know about chronic kidney disease (CKD). In this episode (part 1), work through a typical primary care case with consultant nephrologist Dr Andrew Frankel. He outlines the diagnosis and classification of CKD and explains why and – importantly – how you should ‘look for kidney disease early and intervene rapidly'.MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser. Educational objectivesAfter listening to this podcourse episode, healthcare professionals should be better able to:Recall the classification of CKD using GFR and ACR Identify the key components of a ‘kidney health check' and state why this phrase is usefulRecognise the importance of early CKD detectionAppreciate the concept of ‘3 in 3' in the context of kidney disease outcomesUnderstand how to use the Kidney Failure Risk EquationRecall blood pressure targets for patients with CKDUnderstand the impact of early tightening of glycaemic control in patients with diabetes and CKDMIMS LearningSubscribe to MIMS Learning CKD podcourse with Dr Andrew Frankel, part 2: monitoring and managementCKD podcourse with Dr Andrew Frankel, part 3: advanced managementManaging patients with combined heart and kidney diseaseGuidance update: NICE guidelines on chronic kidney diseaseDiabetes-related kidney disease: prevalence, diagnosis, and impactPodcast: diagnosis and management of diabetes-related kidney diseaseCKD: the hidden public health emergency Hosted on Acast. See acast.com/privacy for more information.
Ace gave us the keys this week and we met up at the Townsquare studio to record this week's GFR. We're wrapping SDSU, talking South Dakota, and all things playoffs. Go Griz! The post Griz Fan Radio – Live in studio! appeared first on Montana Mint - The greatest website north of Wyoming..
Ace gave us the keys this week and we met up at the Townsquare studio to record this week's GFR. We're wrapping SDSU, talking South Dakota, and all things playoffs. Go Griz! The post Griz Fan Radio – Live in studio! appeared first on Montana Mint - The greatest website north of Wyoming..
This episode of the ASN Kidney Translation Podcast, hosted by Dr. Matthew Sparks, covers CT-based body composition and GFR estimates in cancer (CJASN), transdermal GFR measurement (JASN), and novel hemodynamic markers in acute heart failure (K360).
Dr. Pedro Barata and Dr. Ravin Garg discuss strategies to increase trial representation, including leveraging trial navigators and prioritizing pragmatic trial models, as featured in the ASCO Educational Book article, "Practical Guide to Clinical Trial Accessibility: Making Trial Participation a Standard of Care." TRANSCRIPT Dr. Pedro Barata: Hello, and welcome to By the Book, a podcast from ASCO featuring compelling perspectives from authors and editors of the ASCO Educational Book. I'm Dr. Pedro Barata. I am a medical oncologist at University Hospital Seidman Cancer Center and an associate professor of medicine at Case Western Reserve University in Cleveland, Ohio. I am also the associate editor of the ASCO Educational Book. We know that in recent years, the oncology community has increasingly prioritized the need to modernize clinical trial eligibility, reduce patient burden, and enhance diversity in trial participation. On that note, today we will be speaking about ways to enhance access to clinical trials with Dr. Ravin Garg. He is a hematologist oncologist at Maryland Oncology Hematology and also an assistant professor of oncology at Johns Hopkins Hospital in Baltimore. Dr. Garg is also the co-author of a fantastic paper in the ASCO Educational Book titled, "Practical Guide to Clinical Trial Accessibility: Making Trial Participation a Standard of Care." Dr. Garg, welcome. Thanks for being here, and congrats on your paper. Dr. Ravin Garg: Thank you for having me, Pedro. I am excited to be here. Dr. Pedro Barata: [KI1] Your paper is a wonderful, multidisciplinary piece that actually features perspectives from the different stakeholders, right? The patient advocacy, industry, community practice, and academia about these challenges in making trials more available. This podcast is a wonderful platform. It reaches out to a lot of folks within our community. So, I will start by asking you the obvious. Why do you think it is a must read for our community, for our listeners? Dr. Ravin Garg: So Pedro, thanks again for inviting me. You do a great job with these podcasts. So, I think first and foremost, oncologists right now are under a lot of stress, just in terms of clinical volume. There is concern for research money, and how we get the best care for our patients. So I think this article is very important because it helps bring together, as you had mentioned, the stakeholders throughout academic to community practice and everywhere in between, and try to find how, as a team with different oncologists who partake in different aspects of oncology, can come together to streamline the process to try to get our patients on trials, or certainly have them have availability of trials, just if they are interested in going on them. Being in practice, we have had several challenges that we can talk about throughout this podcast, but I think it is a very important paper because it recognizes that at the end of the day, it takes a team effort for all of us in academics, community, industry, and pharmaceuticals to really come together as a team to really help put forth the trials for our patients. Dr. Pedro Barata: So, from the perspective of a community oncologist, how do you put together, or maybe you can describe some of the challenges that you see to increase trial participation in the community? Dr. Ravin Garg: Yes, Pedro, that is a great question, and it is something that I keep on thinking about and trying to find ways to be better at it myself. But I will say some of the challenges as a community doctor that I have seen for myself and talking to other colleagues. Number one, I do think there is a lot of stress on doctors in the community in general, Pedro. Oftentimes we are tasked to see a wide smorgasbord of patients, so we may not have the luxury of being a specialist in any particular tumor subtype. Like oftentimes, we will have to see lung cancer, the next one will be breast cancer, the next one could be CML, the next one could be thrombocytopenia. And as you know better than I do, Pedro, the field in each one of these disciplines is changing so rapidly: molecular genomics, radioligand treatments, different imaging tests, MRD testing for some of our hematologic malignancies. And I think one challenge we have in community is just keeping up with the basics of Oncology 101. In the process of doing that, it can be very difficult to sometimes remember that we have very exciting trials available for our patients. So, I think a lot of it is the day in and day out of being an oncologist is so taxing at times that oftentimes a research trial is not the first thing in our head space when we see a patient. I think number two, Pedro, at least in the community, and perhaps this is with academics too, is that we are bombarded, I would say, by a lot of messaging these days. We have in-baskets to go through, labs to go through, things of that nature. And in the process of a patient visit, seeing them, doing an exam, taking a history, trying to go over the NCCN guidelines on best practice for how to manage their care, at least for me at times, it is very hard to remember, "Hey, there might be a great trial available, whether within our network or maybe partnering with an academic center." So getting through a day can be fraught with a lot of peril and just difficulties, I would say. And I would say number three, Pedro, at least as, you know, I am in a private practice where I do see a wide range of benign and malignant hematology and solid tumors, so I would not call myself a specialist. And I think the challenge with that, at least for trials, Pedro, is that when you are a specialist or perhaps you are focusing on a couple of disease subtypes, you become more of an authoritative voice in those types of tumors, and you might be more aware of the trials within your network or perhaps in proxy with an academic center that you can offer your patient. So I think when sometimes we spread ourselves too thin, it can be very hard to be a thought leader, if you will, in a particular subtype of a malignancy, let's say, and maybe not be aware of a trial that could be really well-suited for your patient. In terms of ideas that myself and colleagues have had in terms of helping mitigate against some of these, I would say, setbacks or issues in the practice for trial enrollment, some of the things we have talked about, Pedro, is, number one, is we do partner with academic centers. So we live here in Maryland. We have several really fantastic academic centers. So, you know, oftentimes, not just within our practice of Maryland Oncology Hematology, we have a lot of great trials available here too, for certain, but in addition to that, we will often times work with doctors at Georgetown, Johns Hopkins, and Maryland if they have a compelling trial that we do not have within our network. It is really of the patient's interest, Pedro, to reach out to them in a collaborative manner to see if they have a trial that might be really compelling for your patient. So I do find myself collaborating a lot with colleagues in, like talented like yourself in academics. You know, I think you do a lot of GU malignancies. So as an example, like partnering with colleagues who are GU experts and say, "Hey, we have a patient with stage IV renal cell. These are the standard options I know, but are there any trials that you might have available?" I think the other thing that has been very helpful for us is having navigators within research, Pedro. Like as an example, what has really helped the uptake of trial enrollment for our center in Annapolis is having a research navigator because often times what they can do is, a priori, Pedro, before you see the patient and you are kind of formulating a standard of care treatment plan perhaps, they might tug you on the shirt and say, "Hey, we have a great trial here through Sarah Cannon, or there might be something else out there." And being aware of that when you go into a patient's room really provides a nice arena, if you will, to go and say, "The standard of care is here, but hey, we have a trial option that might be well suited for you, maybe perhaps even better, that we can talk about, too." So having research support in the community is really a huge boon, I think, Pedro, for us to really increase our enrollment for patients onto trials. Dr. Pedro Barata: Yes, I really love that, Ravin. So, let me switch gears a bit. I would love for you to talk a little bit about patient advocacy because they do play a huge role in cancer, and they address many barriers. How do you think we should leverage the patient advocacy groups to reduce patient burden and maybe have them really leverage patient advocacies to improve representation in clinical trials? What do we think we can do more? Dr. Ravin Garg: Oh, Pedro, I think they are very critically important. As a clinical oncologist now, and I would say this is for anyone in the field of medicine, you are exactly right. I think patients are bombarded by information. There are a lot of things online, whether it be TikTok, Facebook, Google, Yahoo, and people really just have a lot of information given to them. And some of it is fact driven, and some of it is not, Pedro. And oftentimes, I do think there can be at times a mistrust with some medical personnel. I think we are in an era where we are seeing that to some degree with some attributes of medicine. And I think of it as an opportunity for education for the patient and for myself as a physician. And I think patient advocates, to your point, which was well taken, serve as a bridge to both. And what I mean is that, you know, patient advocates are wonderful. They are, I think, outstanding communicators. They almost are a neutral party, Pedro, where many patients feel that they are an independent source of information that is free of bias, if you will. They are there to provide support, emotional support, scientific support for patients so they can make an informed decision. So, in terms of our practice right now, patient advocates is something that we are evolving in that capacity, I would say, Pedro. I think now more than ever, having more people as bridges of communication with care providers along with patients is of critical importance. And I would venture a guess, and I think this has been published, where patient advocates really can help tremendously in familiarizing patients with trials and what they are all about and maybe clear up some misconceptions of what trials, what the mission of trials are. Because I do think some patients, at least I have had a few over the years, where when they hear the term trial, they almost think they are being experimented upon, when, in point of fact, they could really help advance their care. That messaging along the way for some can may be mixed up a little bit. And so I think patient advocates is a really great way to offer more information for patients with a source they find very independent and trustworthy, if you will. And it can really help expedite, and I think make a more fruitful conversation for care providers, whether academic or community, and they might be more open-minded in terms of enrolling onto a trial. Dr. Pedro Barata: Wonderful. Yes, I agree. I agree with you completely. So let's focus a little bit now on the folks designing the studies. We usually call them the sponsors. It might be an academic sponsorship, if you will, but we can also have pharma being the sponsor of a study. The angle from an academic design, it is not necessarily the same as what happens when we have pharma. And from that angle, how do you think a more inclusive research can be promoted? Dr. Ravin Garg: Oftentimes with trials, I think keeping them simple, as simple as we can. And what I mean by that is, often times for trials, Pedro, even for care providers who are enrolling, it can be daunting when there are a lot of different things involved, particularly, let's say, for investigator sponsored, which are incredibly brilliant science, incredible, but it can be a little bit daunting for patients and even the referring physician to talk about getting translational specimens, imaging, traveling to certain centers to get scans and biopsies and even different diagnostic testing like PSMA testing for, you know, prostate cancer. And it can, I think, be very intimidating for patients in terms of what might be required of him or her to enter onto a trial. Like, "This is not what I signed up for. This is laborious. This is a full time job for me. Do I have to pay for parking to go to a city? Do I have to pay for these imaging tests? And do I have to stay in a place for my family to enroll onto a trial?" So I think keeping trials as simple as possible, but yet cull the data we need as investigators where we can really advance the care, hopefully get approval for a drug, but also learn more about the medication and how it works for our patients. So I think simplifying language for trial is very important. I know when I have gone over studies for patients, Pedro, if it is a voluminous amount of information, they can right away get very intimidated. "Like, oh my goodness, this is like a term paper for college again," you know? I am joking, but you know, keeping language simplified is very important, I think, number one. And I feel that sometimes when they are asked to do a lot of different diagnostic testing, which is very important for translational work, I 100% understand, but I do think sometimes patients can get a little bit off put, if you will, and frustrated with the whole process of doing it. The second thing for our patients, Pedro, that they have mentioned to us when we put them on trials, not just within our own site but elsewhere, is that it takes a lot of time in terms of collecting information, perhaps a washout period from their last standard of treatment prior to enrollment onto a study. Many patients, Pedro, as you know better than I do, are in maybe crisis in terms of their health and their cancer might be growing, promulgating out of control, and they worry about not being able to expeditiously start onto a treatment, onto a trial. So that can lead to a lot of frustration. And one thing that you brought up, which was outstanding for me, is the enrollment criterion for some of our patients is felt to be somewhat strict. We have had some patients who may have had a remote history of a stage I malignancy that was by all accounts in remission, you know, let's say 4 or 5 years in the past, and the risk of recurrence at this point would be incredibly low, but they may not be able to enter onto a study because of some stringent criterion put forth. And that can be a little bit frustrating. In fact, I have had one or two patients who, as an example, with kidney issues, but the GFR was about 60, like right near a cutoff that oftentimes, as you know, we use where you can get into trial or not. And you know, if they are at 58, as an example, and otherwise they are a picture of health, a great candidate for a trial that will likely advance their care, and if the entry criterion is too stringent, that might be a lost opportunity for all parties involved, all stakeholders, if you will. I do appreciate the criterion for entry onto studies cannot be too liberalized. You have to have a certain baseline, but there is a little bit of a gray area and tension, of sorts, if you will, where the patient has a comorbid illness that is a disqualifying offense, but in practicality, perhaps it shouldn't be, especially if they are motivated and there is an opportunity to really advance their care. We have run into, not often, but sometimes in the past, I should say, where patients have been very off put because we try to get them onto a study and there may have been a particular feature or attribute in their underlying care that they couldn't get onto it. So I think having a little bit more thoughtfulness, perhaps, in terms of entry criterion and practicality, if you will, I think would really help enrollment onto studies. Dr. Pedro Barata: Really well said. Is there anything else that you would like to tell our listeners before we wrap up the podcast today? Dr. Ravin Garg: I would say just macroscopically speaking, it is really an honor to be an oncologist. I think I speak for both of us. Anyone listening who is thinking about the field, it is tremendous. Just the research, the bravery of our patients, and the thoughtfulness of our scientists like Pedro and translationalists and clinical trialists is really awe inspiring. So I have really loved this field. I will say from a trial perspective, we really need to enter as many patients as we can onto trials because the science is so brilliant now, the genomic underpinnings of the tumor, we are making great strides as a team of clinicians and scientists, translationalists. So the more that we can get people onto trials and get approved drugs, it is going to help them out in the end. So I think it is such an important time for all of us to come together as a community, find the best way to help our patients out. And clinical trials have to be at the forefront of how we can continue to advance care for our patients. Dr. Pedro Barata: Yeah, no Ravin, I really agree with you. We really need to increase access to clinical studies, and actually your paper is a great step in that direction by raising awareness, bringing up solutions, and again, collaboration, collaboration, collaboration is really a multidisciplinary effort to accomplish that. Thank you so much for sharing your fantastic thoughts and insights with us. Dr. Ravin Garg: Thank you, Pedro. I am- you do a wonderful job with these podcasts. I am really honored to meet you and to be part of this. Dr. Pedro Barata: And thank you to our listeners for your time today. I encourage you to check out Dr. Garg's article in the 2025 ASCO Educational Book. We will post a link to the paper in our show notes. And please join us again next month on By the Book for more insights on key advances and innovations that are shaping modern oncology. Thank you for your attention. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers: Dr. Pedro Barata @PBarataMD Dr. Ravin Garg Follow ASCO on social media: @ASCO on X ASCO on Bluesky ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. Pedro Barata: Stock and Other Ownership Interests: Luminate Medical Honoraria: UroToday Consulting or Advisory Role: Bayer, BMS, Pfizer, EMD Serono, Eisai, Caris Life Sciences, AstraZeneca, Exelixis, AVEO, Merck, Ipson, Astellas Medivation, Novartis, Dendreon Speakers' Bureau: AstraZeneca, Merck, Caris Life Sciences, Bayer, Pfizer/Astellas Research Funding (Inst.): Exelixis, Blue Earth, AVEO, Pfizer, Merck Dr. Ravin Garg: Patents, Royalties, Other Intellectual Property: Creator, editor, and writer of hemeoncquestions.com
This episode is for you if you're struggling with weight gain and tummy fat after 40. We are going to learn how the kidneys play a real role in how we age. Dr. Neetu Sharma, otherwise known as the kidney whisperer, helps patients shed unwanted belly fat and unravel their metabolic dysfunction. She is a board certified physician in internal medicine and nephrology as well as functional and metabolic medicine. She is the founder of Zeal Vitality, which empowers patients to reverse disease and extend longevity.We learn:✅Kidneys play a crucial role in detoxification and weight management✅GFR is a key indicator of kidney health and why you should pay attention to this on your annual labs✅Belly fat is linked to kidney function and metabolic health✅Hydration is essential for optimal kidney function✅Cranberry juice can help prevent urinary tract infections, but use sugar-free versions✅Electrolyte balance is important, especially for active individuals, but not everyone needs to supplement electrolytes✅Dark urine can indicate dehydration and kidney stress✅Protein intake is safe for healthy kidneys but should be monitored✅Phytonutrients from colorful vegetables support kidney health✅Regular check-ups are vital for monitoring kidney functionConnect with the Kidney Whisperer:https://www.instagram.com/thekidneywhisperer/Zeal Vitality YouTubeZeal Vitality FacebookShop Functional Moms Supplement Store, 25 PERCENT OFF top quality brands:https://us.fullscript.com/welcome/functional-momsThank you for listening, please FOLLOW the show on Apple Podcasts and Spotify. SUBSCRIBE to your YouTube channel:https://www.youtube.com/@functionalmomspodcast/#kidneyhealth #bellyfat #GFR #metabolichealth #menopause #functionalmedicine
Witam Państwa, nazywam się Jarosław Drożdż, pracuję w Centralnym Szpitalu Klinicznym Uniwersytetu Medycznego w Łodzi, skąd nagrywam podcast Kardio Know-How. W tym odcinku rozpoczynam omawianie doniesień z tegorocznego kongresu AHA.Koncepcja polypil ma długą historię — od klasycznych projektów Salima Yusufa, przez rewolucję w leczeniu nadciśnienia dzięki SPC, aż po nowsze dane dotyczące statyny z ezetymibem (https://www.jacc.org/doi/10.1016/j.jacc.2023.05.042). W prewencji wtórnej szybkie wdrożenie statyny + ezetymibu w jednej tabletce zmniejsza ryzyko zgonów, zawałów i rewaskularyzacji o około 25% w porównaniu z terapią sekwencyjną. Najnowsza, czwarta odsłona dotyczy niewydolności serca, gdzie teoretycznie idealnie pasuje model polypil obejmujący 4 filary terapii, choć dotąd utrudniały to liczne dawki β-blokerów i ACE-I. W badaniu POLY-HF (https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.125.012834) sprawdzono SPC zawierającą empagliflozynę 10 mg, spironolakton 12,5 mg i metoprolol 25–150 mg u pacjentów z HFrEF. Po 6 miesiącach częstość stosowania pełnej terapii wzrosła o 50%, a samodzielne odstawianie leków spadło z 18% do 4%. Poprawiła się EF (+3,5%), NT-proBNP spadło o 35%, zmniejszyła się hiperkaliemia i redukowano spadek GFR. Odnotowano także poprawę jakości życia i łączną redukcję powikłań oraz zgonów o 59%, a hospitalizacji o 60%. To niewielkie, ale przełomowe badanie pokazuje, że polypil może zmienić praktykę w niewydolności serca poprzez uproszczenie terapii. Co więcej, najnowsze wytyczne AHA/ACC dotyczące nadciśnienia po raz pierwszy jednoznacznie zaleciły stosowanie SPC (https://www.ahajournals.org/doi/10.1161/CIR.0000000000001356).Szczegółowy TRANSKRYPT do odcinka.Podcast jest przeznaczony wyłącznie dla osób z profesjonalnym wykształceniem medycznym.
GFR is back! This week we discuss the narrowing playoff picture, scout out Eastern Washington, and pick this weekend's games The post Griz Fan Radio – Week 10 appeared first on Montana Mint - The greatest website north of Wyoming..
GFR is back! This week we discuss the narrowing playoff picture, scout out Eastern Washington, and pick this weekend's games The post Griz Fan Radio – Week 10 appeared first on Montana Mint - The greatest website north of Wyoming..
Whoops! Wrong one went live first, here's the correct GFR that covers the Grizzlies success so far, scouting Weber State, and an early look at the FCS playoff picture The post Griz Fan Radio – Week 9, the correct one appeared first on Montana Mint - The greatest website north of Wyoming..
Whoops! Wrong one went live first, here's the correct GFR that covers the Grizzlies success so far, scouting Weber State, and an early look at the FCS playoff picture The post Griz Fan Radio – Week 9, the correct one appeared first on Montana Mint - The greatest website north of Wyoming..
GFR is back to talk Friday night lights in Sacramento! Who gave these guys a radio show The post Griz Fan Radio – Week 8 appeared first on Montana Mint - The greatest website north of Wyoming..
GFR is back to talk Friday night lights in Sacramento! Who gave these guys a radio show The post Griz Fan Radio – Week 8 appeared first on Montana Mint - The greatest website north of Wyoming..
The FiltrateJoel Topf @kidneyboy.bsky.socialSwapnil Hiremath @hswapnil.medsky.socialNayan Arora captainchloride.bsky.socialSopia Ambruso @sophia-kidney.bsky.socialSpecial Guests Brendon Neuen @brendonneuen.bsky.social Associate Professor and Program Lead, Renal and Metabolic at The George Institute for Global Health. Nephrologist and Director of Kidney Trials at Royal North Shore Hospital.Neuen has had three prior appearances on Freely Filtered: EMPA Kidney, DUPLEX and Sparsentan in FSGS, FLOW and SemaglutideMuthiah Vaduganathan @mvaduganathan on X. Cardiologist at Brigham and Women's Hospital and Harvard Medical School. Assistant Professor of Medicine.Editing byJoel TopfThe Kidney Connection written and performed by Tim YauShow NotesDONATE to NephJC! Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes NEJM | NephJC SummaryFIDELIO Bakris et al, NEJM 2020 | NephJC Summary; subgroup throws doubt on efficacy of finerenone in patients on flozinsFIGARO Pitt et al, NEJM 2021; subgroups clearly shows finerenone works, flozins or notNEJM editorial (wrongly) saying do not use Flozins unless on RASi Don't use dual RAS blockade ONTARGET Yusuf et al, NEJM 2008; VA NEPHRON-D Fried et al NEJM 2013Why we cannot study finerenone in HFrEF (RALES Pitt et al NEJM 1999) Muthu is jealous of GFR slope and albuminuria surrogate endpoints and wants to borrow them for HFpEF (Inker et al EHJ 2025)Combination therapy and CV outcomes in hypertension (Wang et al JAMA Card 2024 on low dose combinations and BP; Egan et al Blood Pressure 2022 review of topic) CONFIRMATION HF trial registry entry (Finerenone and Empagliflozin in hospitalized patients with HF)23:20: Nayan and Swap miss a chance to say ‘de-flozination' to discuss stopping a flozin which would allow a patient to be included in the trial Finerenone is a CYP3A4 substrate (Heinig et al Clin Pharmacokinetics 2023); Useful list of CYP3A4 inducers and inhibitors Everyone should get an ABPM (Bugeja et al CMAJ 2022)EASiKIDNEY study design Albuminuria mediates CKD benefits with Finerenone (Agarwal et al Ann Intern Med 2023)GFR slope and Albuminuria and the FDA (Taylor et al eClin Med 2025) Dapagliflozin and Eplerenone combination crossover trial (Provenzano et al JASN 2022)Joel gets promoted! (PBFluids reflection) Bluesky NephJC Chat discussion on ‘renal remission' Withdrawal of Finerenone and worse outcomes from FINEARTS (Vaduganathan et al JACC 2025)Combination therapies Analysis from Brendan and Muthu (Neuen et al Circulation 2024)Do not use KFRE when GFR > 60 (KDIGO Practice Point 2.2.4: Note that risk prediction equations developed for use in people with CKD G3–G5, may not be valid for use in those with CKD G1–G2) Finerenone vs Spironolactone trial in Primary Aldosteronism (Hu et al Circulation 2025)FIND CKD trial design (Heerspink et al NDT 2025) FINE-ONE trial design (Heerspink et al Diab Res Practice 2023) Tubular SecretionsNayan keeping his chin up as Yankees lose and Mariners follow (MLB Playoffs)Sophia's adventures with Beekeeping (Royal Jelly?) Brendon loves listening to ‘Susan' by Raye Muthu is back into Taekwondo Swap is still reading Martha Wells (Witch King on GoodReads)Joel will be hiking the Laugavegur trail in Iceland
GFR is back! This week Mike, Kyle, and Brint wrap up thoughts on the homecoming weekend and events and how UM marketing hit a home run. They discuss the Griz at the midway point of the season, and then scout out the Sacred Heart Pioneers The post Griz Fan Radio – Week 7 – Homecoming recap, midway point, Sacred Heart appeared first on Montana Mint - The greatest website north of Wyoming..
GFR is back! This week Mike, Kyle, and Brint wrap up thoughts on the homecoming weekend and events and how UM marketing hit a home run. They discuss the Griz at the midway point of the season, and then scout out the Sacred Heart Pioneers The post Griz Fan Radio – Week 7 – Homecoming recap, midway point, Sacred Heart appeared first on Montana Mint - The greatest website north of Wyoming..
Send us a textWelcome to Guilders-Ford Radio, a Necromunda podcast broadcasting from the East Gate Docks of Hive Primus (via Guildford Games Club, Surrey, UK).This episode of Guilders-Ford Radio lands hot on the heels of Rosco and Leigh's recent trip to Broxbourne Wargames Club's ‘Scratcher's Spill' narrative weekender.Joined by Broxbourne co-founder and returning guest of the show Adam Smith, the boys give a blow-by-blow account of the weekend's misdeeds, while Adam shares the challenges and triumphs of running your own Necromunda event.This month has seen Necromunda's hives reinforced with brand new Palanite Enforcer minatures and a fantastic new book, Bastions of Law. With precious little time with the tome ahead of recording, what do the GFR gang make of the post-Book of Judgement changes?As ever, we round up the episode with an update on our recent hobby - with Dixie literally surrounded by Prussians, and Leigh completely obsessed with the new AK-Interactive paint pens.We'd like to take the opportunity to thank all our listeners who have chosen to support us on Patreon & Buzzsprout - your contributions help us make a better show!• Flow • Denny Wright • Stefan Sahlin • Matt Miler • Matti Puh • Nick McVett •Warhammer in the Dark •From_Somewhere • Alfonso • The Traitor • Johnny DeVille • Stephan B • Jeff Nelson • Lankydiceroller • Morskul • Beau • Justin Clark • Dr.Toe • Mikael Livas • Josh Reynolds • StandStab • ChestDrain • Scott Spieker • Tucker Steel • Shaughn • Stewart Young • Goatincoat • Jason • Joseph Serrani • Billy • Phil • Stephen Griffiths • Søren D • Spruewhisperer • Kevin Fowler • Scott Spieker • Andy Tabor • TheMichaelNimmo • Tucker Steel • Dave Shearman • Shaughn • Stewart Young •Damien Davis • Wayne Jeffrey • Frawgenstein • Matthey Mulcahy • William Payne •Thomas Laycock • Stephen Livingston • Tyler Anderson • McGobbo • Jed Tearle • Gene Archibald • James Marsden • John Haynes • Ryan Taylor • Yuki van Elzelingen • Dick Linehan • Rhinoxrifter • Shawn Hall • Eric McKenzie • Paul Shaw • Jenifer • Drew Williams • Greg Miller • Andy Farrell • Nate Combrink • Don Johnson • Michael Yule • Joe Roberts • TheRedWolf • Lukasz Jainski • Aaron Vissers • One Punch Orlock (Tom) • Matt Price • ShnubutsSupport the showHelp us make better content, and download free community resources!www.patreon.com/guildersfordradioAny comments, questions or corrections? We'd love to hear from you! Join the Guilders-Ford Radio community oveSupport the showHelp us make better content, and download free community resources!www.patreon.com/guildersfordradioAny comments, questions or corrections? We'd love to hear from you! Join the Guilders-Ford Radio community over at;https://linktr.ee/guildersfordradiowww.instagram.com/guildersfordradiowww.facebook.com/guildersfordradioGuildersFordRadio@Gmail.com ** Musical Attribution - Socket Rocker by (Freesound - BaDoink) **
GFR is back! We put a final bow on the Indiana State blowout win and look ahead to the Idaho Vandals The post Griz Fan Radio – week 4, getting ready for Idaho appeared first on Montana Mint - The greatest website north of Wyoming..
GFR is back! We put a final bow on the Indiana State blowout win and look ahead to the Idaho Vandals The post Griz Fan Radio – week 4, getting ready for Idaho appeared first on Montana Mint - The greatest website north of Wyoming..
The GFR is back, this time we were on a new location and clearly need some better work in our noise reduction. We'll get better, we promise. This week's show has final thoughts from the thrilling UND game. From there we discuss what we'd like to see against Indiana State The post Griz Fan Radio – week 3, UND recap / Indiana State preview appeared first on Montana Mint - The greatest website north of Wyoming..
The GFR is back, this time we were on a new location and clearly need some better work in our noise reduction. We'll get better, we promise. This week's show has final thoughts from the thrilling UND game. From there we discuss what we'd like to see against Indiana State The post Griz Fan Radio – week 3, UND recap / Indiana State preview appeared first on Montana Mint - The greatest website north of Wyoming..
Famous last words by one of the GFP's contributors. Who, as of this recording has still not lived up to his promise. Stay tuned to the GFR this week to see if Brint comes through. In the meanwhile, we've got a hoot wine / GFP beer fueled 3 hour episode for you. This episode covers [&hellip The post Griz Fan Podcast – “If the Griz win this I'll swim in the Clark Fork” appeared first on Montana Mint - The greatest website north of Wyoming..
Famous last words by one of the GFP's contributors. Who, as of this recording has still not lived up to his promise. Stay tuned to the GFR this week to see if Brint comes through. In the meanwhile, we've got a hoot wine / GFP beer fueled 3 hour episode for you. This episode covers [&hellip The post Griz Fan Podcast – “If the Griz win this I'll swim in the Clark Fork” appeared first on Montana Mint - The greatest website north of Wyoming..
Welcome to Guilders-Ford Radio, a Necromunda podcast broadcasting from the East Gate Docks of Hive Primus (via Guildford Games Club, Surrey, UK).Summer has departed and few Necromunda previews have appeared, but GFR are back once again to discuss all things Underhive.This month we're joined by a genuine YouTube celebrity - Damon from Wellywood Wargaming! After his own successful delve into community and house rules, we thought we'd jump onto the Wellywood bandwagon and throw our two creds into the fighting pit.We reached out to you, our wonderful community, for your amendments to the current 'Munda ruleset, and you didn't disappoint. We've received a plethora of fantastic suggestions and changes, the highlights of which we discuss in-episode, as well as Dixie and Damon's own house rules.A massive thankyou to the following arbitrators for their contributions;Lee Reason (Basingstoke Necromunda)@morja477Jan Diemer (Poor Mans Haven)@myksminis@stinky_troll@jenovaprojecttabletop (Leodis Games)Mike Stuart@ShnubutsGreg Miller - (Sutton Templars Gaming Club)@adammbsmith (Broxbourne Wargames Club)Steve MonaghanStuart Hesketh@flugerhousegaming@Mcgobbo_paintsAs usual, we round out the episode with our team hobby updates, including just how little prep Rosco and Leigh have done ahead of Adam Smith's impending Scratcher's Spill event.We'd like to take the opportunity to thank all our listeners who have chosen to support us on Patreon & Buzzsprout - your contributions help us make a better show!• Flow • Denny Wright • Stefan Sahlin • Matt Miler • Matti Puh • Nick McVett •Warhammer in the Dark •From_Somewhere • Alfonso • The Traitor • Johnny DeVille • Stephan B • Jeff Nelson • Lankydiceroller • Morskul • Beau • Justin Clark • Dr.Toe • Mikael Livas • Josh Reynolds • StandStab • ChestDrain • Scott Spieker • Tucker Steel • Shaughn • Stewart Young • Goatincoat • Jason • Joseph Serrani • Billy • PhiSupport the showHelp us make better content, and download free community resources!www.patreon.com/guildersfordradioAny comments, questions or corrections? We'd love to hear from you! Join the Guilders-Ford Radio community over at;https://linktr.ee/guildersfordradiowww.instagram.com/guildersfordradiowww.facebook.com/guildersfordradioGuildersFordRadio@Gmail.com ** Musical Attribution - Socket Rocker by (Freesound - BaDoink) **
Title: One Family, Three Transplant Journeys: Life with Alport Syndrome
If you're curious as to if you have any stored emotions or trauma that might be causing your illness, preventing you from achieving your or even just showing up as the best, authentic version of yourself, I invite you to take my free Stored Emotions and Trauma Quiz How often do you think about your kidneys?In this episode, I sit down with Dr. Robin Rose, a longtime voyager and pioneer in conscious and holistic healing whose path went from nursing to nurse practitioner to medical school. Her passion for kidney health was sparked by her own experience with kidney cancer and kidney disease, and the decade-long recovery that led her to a new paradigm she calls phenology, the art and clinical science of kidney success.We talk about exactly what to look for in labs (including how to think about GFR), the emotional and spiritual energetics behind kidney dysfunction, and the top lifestyle moves to make when kidney function isn't where it should be. We also get into why kidneys are so often overlooked in medicine and how Dr. Rose rebuilt her health after a nephrectomy. You'll Learn:Labs to consider for assessing kidney healthWhat a healthy GFR level isEnergetics, emotional, and spiritual aspects underlying kidney dysfunction and diseaseTop 10 lifestyle changes for poor kidney functionThe hidden early signs of kidney decline most doctors missHow conventional and even functional medicine often overlook kidney healthKey lifestyle shifts that can improve kidney performance and energy levelsThe quiet damage high animal protein diets can cause in compromised kidneysWhat it feels like to rebuild health after losing a kidneyHow spiritual practices and mindset can influence physical healingThe overlooked role of kidney tubules and how to test their functionPractical ways to reduce kidney-toxic exposures in daily lifeTimestamps: [00:00] Introduction [05:44] Robin shares her journey through illness, surgery, and kidney cancer diagnosis [14:59] Discovering functional and regenerative approaches to improve GFR [24:53] Emotional, spiritual, and energetic aspects of kidney health [34:27] Why kidneys are often overlooked in conventional and functional medicine [42:58] Understanding kidney tubules and overlooked testing options [53:22] Diet changes that protect kidney function and common mistakes to avoid [1:02:47] Reducing toxins and environmental exposures that harm kidneys [1:12:55] Mindset, self-love, and adapting to support long-term healing [1:21:40] Key lifestyle factors for kidney regeneration and successResources Mentioned:Renology Peptides by Robin Rose | BookLearn more from Robin by checking out her websiteFind More From Dr. Stephanie Davis:Dr. Stephanie Davis | WebsiteQuantum Rx | InstagramQuantum Rx | Skool
In this episode of the Gladden Longevity Podcast, Dr. Jeffrey Gladden speaks with Dr. Robin Rose about her personal journey with kidney cancer and her insights into kidney health. They discuss the importance of understanding kidney function, the role of peptides and bioregulators in improving kidney health, and the impact of lifestyle choices on kidney function. Dr. Rose emphasizes the need for a positive mindset and proactive measures to optimize kidney health, including dietary changes and the use of specific peptides. The conversation also touches on the significance of measuring kidney function and the effects of toxins and TMAO on overall health. For Audience · Use code 'Podcast10' to get 10% OFF on any of our supplements at https://gladdenlongevityshop.com/ ! Takeaways · Dr. Robin Rose shares her personal journey with kidney cancer. · Understanding GFR is crucial for assessing kidney function. · Peptides can play a significant role in kidney health. · Bioregulator peptides help reverse kidney decline. · A positive mindset is essential for health improvement. · Lifestyle changes are necessary for kidney optimization. · Toxins in food can negatively impact kidney health. · TMAO is linked to cardiovascular risks in kidney disease. · Regular monitoring of kidney function is important. · Self-love and care are vital for health management. Chapters 00:00 Introduction to Kidney Health and Personal Journey 06:08 The Role of Lifestyle in Kidney Health 10:42 Bioregulator Peptides and Kidney Success 16:25 Innovative Strategies for Kidney Health 25:35 The Role of Peptides in Health 32:33 Kidney Function and Circadian Rhythms 39:10 Oxidative Stress and Inflammation in Kidney Health 45:00 Dietary Considerations for Kidney Health 49:33 Resources for Kidney Health and Patient Empowerment To learn more about Robin: Email: rosegardenmedicine@gmail.com Website: renologyiskidneysuccess.com Reach out to us at: Website: https://gladdenlongevity.com/ Facebook: https://www.facebook.com/Gladdenlongevity/ Instagram: https://www.instagram.com/gladdenlongevity/?hl=en LinkedIn: https://www.linkedin.com/company/gladdenlongevity YouTube: https://www.youtube.com/channel/UC5_q8nexY4K5ilgFnKm7naw
Welcome to Guilders-Ford Radio, a Necromunda podcast broadcasting from the East Gate Docks of Hive Primus (via Guildford Games Club, Surrey, UK).After a recording hiatus, GFR are back to our regularly scheduled programming. This month, we dive into Deepfort - Dixie's latest narrative campaign that saw three weeks of simultaneous multiplayer games spread across two battlefields. Did the guilder caravan make it to the embattled Precinct 19 outpost? Did the Ash Waste Nomads succeed in breaking through the entrenched defenders to plunder the spoils within? All will be revealed this episode!Recent Necromunda news from Warhammer has seen some fantastic Palanite Enforcer models and a new book previewed - hear the team's hot takes on the forthcoming reinforcements.As usual, we round out the episode with our hobby updates and discussion, including forthcoming community events, shiny new loot courtesy of Sump Lab, and Rosco's imminent departure back to his native Westcountry, and his newly adopted FLGS, Entoyment in Poole.We'd like to take the opportunity to thank all our listeners who have chosen to support us on Patreon & Buzzsprout. Your contributions help us make a better show! • Flow • Denny Wright • Stefan Sahlin • Matt Miler • Matti Puh • Nick McVett •Warhammer in the Dark •From_Somewhere • Alfonso • The Traitor • Johnny DeVille • Stephan B • Jeff Nelson • Lankydiceroller • Morskul • Beau • Justin Clark • Dr.Toe • Mikael Livas • Josh Reynolds • StandStab • ChestDrain • Scott Spieker • Tucker Steel • Shaughn • Stewart Young • Goatincoat • Jason • Joseph Serrani • Billy • Phil • Stephen Griffiths • Søren D • Spruewhisperer • Kevin Fowler • Scott Spieker • Andy Tabor • TheMichaelNimmo • Tucker Steel • Dave Shearman • Shaughn • Stewart Young •Damien Davis • Wayne Jeffrey • Frawgenstein • Matthey Mulcahy • William Payne •Thomas Laycock • Stephen Livingston • Tyler Anderson • McGobbo • Jed Tearle • Gene Archibald • James Marsden • John Haynes • Ryan Taylor • Yuki van Elzelingen • Dick Linehan • Rhinoxrifter • Shawn Hall • Eric McKenzie • Paul Shaw • Jenifer • Drew Williams • Greg Miller • Andy Farrell • Nate Combrink • Don Johnson • Michael Yule • Joe Roberts • TheRedWolf • Lukasz Jainski • Aaron Vissers • One Punch Orlock (Tom) • Matt Price • ShnubutsSupport the showHelp us make better content, and download free community resources!www.patreon.com/guildersfordradioAny comments, questions or corrections? We'd love to hear from you! Join the Guilders-Ford Radio community over at;https://linktr.ee/guildersfordradiowww.instagram.com/guildersfordradiowww.facebook.com/guildersfordradioGuildersFordRadio@Gmail.com ** Musical Attribution - Socket Rocker by (Freesound - BaDoink) **
Did you know that people who have received a kidney transplant are at a much higher risk for skin cancer? We sat down with experts to discuss how you can lower your risk. In this episode we heard from: Dr. Cerrene Giordano is a dermatologist and Mohs Micrographic surgeon at Roswell Park Comprehensive Cancer Center in Buffalo, New York. She specializes in treating skin cancers, particularly in patients who are high risk such as those who have received organ transplants, have weakened immune systems, or a genetic predisposition to skin cancer development. Her expertise includes skin cancer surgery, wound reconstruction, and the management of skin cancers such as melanoma, basal cell carcinoma, and squamous cell carcinoma, to name a few. Dr. Giordano is also involved in research aimed at improving pain management following dermatologic surgeries and exploring advanced imaging techniques to enhance surgical outcomes. Kent Bressler is a retired RN who was diagnosed with FSGS in 1984, and received a living donor transplant from his brother Kip in 1987. Kent is an active advocate for preemptive kidney transplant and has on the recommendation of NKF worked closely with the DoD and PCORI as a consumer peer reviewer. He is an NKF peer mentor and advocate who has collaborated on an editorial “Change in Albuminuria and GFR as End Points for Clinical Trials in Early Stages of Chronic Kidney Disease,” published in AJKD in 2019. He will also be participating in the development of the new NKF Patient Network serving on the Data Input and Integration Committee. He has been an active hill advocate for the NKF for six years and was the proud recipient of the 2017 Richard K. Salick Advocacy Award. Kent is also an Army Veteran and retired from the Veterans administration as an RN. He is the co-founder of Kidney Solutions a not for profit program in Texas that assists patients and families in the transplant process and in finding a donor. He is currently an assistant team leader for Region 7. Kent and Cathy Bressler have been married for 56 years and their family consists of Gretchen and Todd Rossington and their son Colt and Celeste and Alex Brown and their children John Banks, Catherine and Alexis Brown. Risa Simon is a passionate author, speaker, mentor, kidney patient coach and advocate. As the founder and CEO of The Proactive Path and the TransplantFirst Academy, her mission is to help all kidney disease patients advocate for their best life possible—the life she now lives. As a preemptive kidney transplant recipient, Risa was able to circumvent the need for dialysis. This is her hope for all eligible kidney patients. Risa gives back a good portion of her time by serving on various advisory committees, such as the National Kidney Foundation's (NKF's) Kidney Action committee, the American Association of Kidney Patients (AAKP) program and convention committees and she chairs the Phoenix Chapter's Polycystic Kidney Disease (PKD) education committee. She is also a member of the PKD Legacy Society and serves as a Peer Mentor for the National Kidney Foundation (NKF). Risa's message is all about empowering kidney patients to bring their voice to life. Additional Resources: Dr. Cerrene Giordano Protect the Skin You're In Do you have comments, questions, or suggestions? Email us at NKFpodcast@kidney.org. Also, make sure to rate and review us wherever you listen to podcasts.
Most people believe kidney decline is a one-way street to dialysis. But what if that's simply not true? In this episode of ReInvent Healthcare, Dr. Ritamarie is joined by Dr. Robin Rose, a pioneering physician who turned her own diagnosis of kidney cancer and stage four kidney disease into a journey of recovery—and a new medical paradigm called Renology. Discover what functional medicine gets wrong about kidneys and how practitioners can spot the early signs of decline before it's too late.What You'll Discover Inside:The Hidden Kidney Crisis: Why conventional medicine often misses the earliest signs of declineRenology Defined: A new, functional lens for understanding and healing kidney diseasePeptides & Kidney Repair: How bioregulators work, and why they're not a magic bulletThe Lab Markers That Matter: Functional ranges for GFR, phosphorus, cystatin C, and moreThe Kidney's Web of Influence: Why supporting the kidneys improves brain, thyroid, and cardiovascular healthRobin's Personal Healing Journey: A deep dive into her personal tools for reversing her diseaseResources and Links:Download the transcript hereDownload our FREE Metabolic Health Guide here.Join the Next-Level Health Practitioner Facebook group here for free resources and community support.Visit INEMethod.com for advanced health practitioner training and tools to elevate your clinical skills and grow your practice by getting life-changing results.Check out other podcast episodes here.Dr Robin's Resources:Website: RenologyIsKidneySuccess.comBook: Renology Peptides by Dr. Robin RoseAbout Dr. Robin Rose:Robin Rose MD has been a world traveler, a health food chef, journalist, professional dancer, and artist. After some years of collecting life experiences, she went to nursing school then became a family nurse practitioner while learning nutrition, herbal medicine, acupuncture, massage, homeopathy. Then she made the leap and went to university of Arizona college of medicine and then completed a family medicine residency- while continuing to study holistic and functional medicine. She practiced for many years in southern Oregon offering a holistic array of loveliness and healing medical guidance. After a series of intense stresses she found herself challenged with kidney cancer and severe kidney disease. In the past decade she has become agile in the realm of kidney regeneration and has created a new paradigm of kidney success - ways to engage nature and mind body spirit to achieve the innate healing that leads to thriving. Her recent book RENOLOGY Peptides is a text that dives into the root to succeed - using bioregulator peptides as a way to illuminate the path.
Bumper summer show coming up today with special guests Johnny Van Zant and Rickey Medlocke from Lynyrd Skynyrd talk about the new live release recorded at the Ryman Auditorium Nashville on what turned out to be the final live show of founding member Gary Rossington who sadly passed away just months after this recording.John Coghlan is the original drummer from Status Quo and the frantic four drummer joins me to look back to the very first live release from Quo in 77 the shows were recorded in Glasgow in October of 76 and these have just been released as a super deluxe edition with all three shows remastered and we talk about 50 years of "On The Level"And getting us underway today Mark Farner of Grand Funk Railroad looks back to this weekend back in 1969 when they opened the first mega festival it was "Atlanta Pop Festival" GFR opened the show that day and it went down so well they were invited back to play again on a later slot.
In this Thursday's 12 Minute Talk, Wade checks in with an update on the Geissele GFR. He breaks down the group sizes and range data using various 6mm ARC loads. Whether you're running a similar setup or just curious how the GFR is stacking up, this one's for you.Let us know in the comments what you're running in your GFR.#Geissele #GFR #AR15 #TexasPredatorHunting #PredatorHunting #RifleSetupListen to the Podcast:Texas Predator Hunting Podcast:
Our guest today is Reverend Kenn Blanchard. Kenn was once known internationally as the Black Man With A Gun. Before Google and Facebook existed, he played a monumental role in laying the groundwork for national concealed carry, the Heller Decision, and HR 218, the Law Enforcement Officers Safety Act. Today, he is a musician and caregiver for his wife. He has a new book called Finding Joy in the Blues available on Amazon. 1) You were our very first guest on GFR, and much has happened in the past ten years since we first met. But, one thing hasn't changed, and that is that you have been Serving others your entire life. From your time in the Military, law enforcement, 2A Advocacy, and now your wife in her time of health needs. What drives you to show up in all of these roles? 2) Your wife is still recovering from a brain tumor. Your retirement years have not worked out the way you planned. Yet, you write a book about joy. Tell us about that. 3) One of the chapters in your book is called “A Preacher and a Rabbi”. In a time when some are trying to sew division based on every conceivable metric – race, class, religion, political ideology, etc – you two found an amazing connection and friendship. What was your common bond? 4) Where does 2A Advocacy fit in your life nowadays? 5) Having already planned for a future that didn't quite work out, how do you now make plans for what is next? 6) How do people follow you and buy your books? Originally Aired 5.16.25
View the Show Notes For This Episode Dr. Robin Rose discusses Kidney Care with Peptides with Dr. Ben Weitz. [If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] Podcast Highlights In this episode of the Rational Wellness Podcast, Dr. Ben Weitz hosts Dr. Robin Rose to discuss crucial insights into kidney health. They explore the kidney's functions, including filtering blood, regulating electrolytes, and converting vitamin D. The conversation delves into chronic kidney disease, highlighting that symptoms can arise even in stage two when GFR drops below 60. Dr. Rose emphasizes the importance of early detection and intervention, discussing concepts such as uremic dysbiosis, endothelial damage, leaky gut, and the impact of toxins. They also touch on natural and supplemental approaches to support kidney health, like using bio-regulator peptides, nutritional therapy, and plant-based diets. Additionally, Dr. Rose shares her personal experience with kidney cancer and the insights she gained during her journey to recovery. 00:26 Understanding Kidney Functions and Chronic Kidney Disease 02:10 In-Depth Discussion with Dr. Robin Rose 02:34 The Complexities of Kidney Health 04:28 Kidney and Gut Health Connection 04:54 Challenges in Measuring Kidney Function 08:48 Managing Kidney Health Through Diet and Lifestyle 28:43 Nutritional Supplements for Kidney Health 33:23 Butyrate and Gut Health 33:56 Cardiovascular Markers and Genomics 34:59 Kidney Health Botanicals 37:31 Peptides and Their Benefits 43:06 Bio-Regulator Peptides 51:31 Personal Kidney Health Journey 52:48 Hydration and Herbal Teas 54:40 Final Thoughts and Resources ________________________________________________________________________________________________________ Dr. Robin Rose is a Medical Doctor and an expert at supporting kidney health using a wholistic approach and peptides. She has recently published a book, Renology Peptides: Kidney Success with Bioregulator Peptides. Renology Peptides is a comprehensive clinical volume that presents an evidence-guided scholarly tool to deepen understanding of regenerative kidney medicine and bioregulator peptides. Her website is Renology is Kidney Success. Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Howie and Harlan are joined by Joel Bervell, a recent medical school graduate who uses social media platforms to combat misinformation and explain racial biases in healthcare. Harlan discusses his new Wall Street Journal commentary highlighting the link between viral infections and chronic diseases; Howie reports on powerful new evidence for the effectiveness of the HPV vaccine and warns of the dangers of a vaccine-skeptical presidential administration. Links: Viral Infection and Chronic Disease Harlan Krumholz: “How to Lead a Chronic Disease Revolution” “A natural experiment on the effect of herpes zoster vaccination on dementia” “Unexplained post-acute infection syndromes” Joel Bervell Joel Bervell Joel Bervell on TikTok Joel Bervell on Instagram “TikTok's 'Medical Mythbuster' Helps Save Lives By Tackling Racial & Gender Disparities In Healthcare” “How the pulse oximeter became infamous on TikTok” “Racial Bias in Pulse Oximetry Measurement” Joel Bervell's TikTok on the pulse oximeter Joel Bervell: “The eGFR Equation” “Race Correction and the X-Ray Machine: The Controversy over Increased Radiation Doses for Black Americans in 1968” Joel Bervell: “For over 50 years, X-ray technicians were taught to administer higher radiation doses to Black patients” Joel Bervell's Instagram reel on bias in the measurement of lung capacity Made to Stick: Why Some Ideas Survive and Others Die Joel Bervell on LinkedIn Joel Bervell on YouTube: The Doctor Is In Kickstarter: The Doctor Is In “Medical mythbuster Joel Bervell, MD, on how to teach kids about medicine and address misinformation” Cleveland Clinic: Amyloidosis Joel Bervel's Instagram reel on the GFR equation “Abandoning a Race-biased Tool for Kidney Diagnosis” “OPTN Board approves elimination of race-based calculation for transplant candidate listing” “America's News Influencers” “85th Annual Peabody Awards Announce Nominees for the Arts, Children's/Youth, Entertainment, and Interactive & Immersive Categories Vaccines and the Federal Healthcare Agencies Health & Veritas Episode 165: “Aging in Bursts and Other News” “U.S. government researchers present ‘phenomenal' new data on HPV vaccines” “Invasive cervical cancer incidence following bivalent human papillomavirus vaccination: a population-based observational study of age at immunization, dose, and deprivation” “Kennedy played key role in Gardasil vaccine case against Merck” “RFK Jr. suggests some vaccines are risky or ineffective, downplays measles threat” “FDA chief says they're looking at whether to approve COVID shots for next winter” “How Marty Makary's FDA is embracing a more skeptical view of vaccines” Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.
Today, we're diving into one of the most misunderstood, wrongly demonized, and yet most important pieces of your nutrition strategy: PROTEIN.We're going deep into:Why so many people still believe protein is dangerous — especially for your kidneysWhere these outdated beliefs came fromThe role of protein in muscle gain, fat loss, aging, and long-term healthWhy the RDA is setting you up for failureWhat YOU can do today to get the benefits of a high-protein lifestyleResources:1. High-Protein Diets and Kidney Function in Healthy Adults:Study: A Systematic Review of Renal Health in Healthy Individuals Consuming High Protein DietsFindings: This review analyzed multiple randomized controlled trials and found that increased protein intake led to higher glomerular filtration rates (GFR), all within normal kidney function ranges. The data suggest that higher protein consumption does not adversely affect kidney health in healthy adults. Study: Effect of a High-Protein Diet on Kidney Function in Healthy Adults: Results from the OmniHeart TrialFindings: This study concluded that a healthy diet rich in protein increased estimated GFR. However, it noted that the long-term effects of high-protein diets on kidney health remain uncertain.2. Protein Intake and Sarcopenia (Muscle Loss) in Older Adults:Study: Protein Intake and Sarcopenia in Older Adults: A Systematic Review and Meta-AnalysisFindings: The meta-analysis indicated that older adults with sarcopenia consumed significantly less protein than their non-sarcopenic peers, suggesting that inadequate protein intake may be associated with muscle loss in the elderly. Study: Role of Dietary Protein in the Sarcopenia of AgingFindings: The study suggests that moderately increasing daily protein intake beyond 0.8 g/kg/day may enhance muscle protein anabolism, potentially mitigating age-related muscle loss. Protein & Kidney Health in Healthy IndividualsSystematic Review: High Protein Diets & Renal FunctionConclusion: No negative effects on kidney function in healthy adults.
Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I'm looking forward to sharing with you some of our community's questions that have come in over the past few weeks… Anne: Listen to your podcast everyday and I learned so many helpful health tips. Thank you. I have recently developed dry mouth at night while I'm sleeping. I drink a lot of water during the day and I have not started any new medication. What is the cause of dry mouth and what natural remedies would you suggest. Thank you Fred: Hi Dr Cabral My name is fred and have been listening to you for the last year I truly believe your are in this t help . I have recently purchased the vitamin. And heavy metal detox tests for my wife and myself I am 63 years old and unfortunately had h pylori and was on antibiotics for 2 weeks about 2 months ago I not sure the impact but it has seemed to have worked My concern is that I have a eGFR of 46 I have an enlarged liver I am a non drinker and starting to eat better I went off my statin and am on blood pressure medication I do not sleep well at all Hoping to afford to do the big 5 one day I am Canadian and our dollar is very bad What can I do to save my kidneys naturally Kristin: I've heard that Ashwaganda supplements are not good for those with Hashimotos. Is this accurate? I've also read and experienced so many benefits from it. Mandy: High creatinine level question. Hi, I greatly appreciate all the wonderful info that you and your team provide to those of us that want to live our best and healthy life!m Is there a causal relationship between menopause and an increase in creatinine? Recently had my labs done and my creatinine was 1.24, BUN 19, and GFR 54. Any advice and recommendations to bring my level down would be greatly appreciated. I'm an active 49 yr old. Thank you for your help. Mandy Mandy: Hi! Do you recommend mattress vacuums (specifically Jigoo, Jimmy, or Ranvoo)?Also, we just heard about the Apollo 2nd Generation Do you recommend it? Thank you for tuning into this weekend's Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes and Resources: StephenCabral.com/3292 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!
N Engl J Med 2006;355:2395-407Am Heart J 2011;161:611-21Background: Registry data suggests that 10-20% of patients with a STEMI present more than 12 hours after the onset of symptoms. The optimal treatment for such patients is unknown. In some cases, the inciting event may have occurred weeks prior and been mistaken for indigestion or another non-life threatening condition. Such patients may present to the hospital with a new diagnosis of congestive heart failure or atrial fibrillation. Echocardiography often reveals a a large wall motion abnormality, perfusion testing demonstrates an infarct with peri-infarct ischemia and an occluded vessel is seen on angiography. Should we try to open it? On the one hand, the damage has been done. Attempting to open an occluded vessel is associated with higher procedural risks and the patient's themselves are more often than not sub-optimal candidates for intervention; often having some combination of heart failure, LV dysfunction, older age, multimorbidity and hemodynamic instability. But on the other hand, revascularization restores blood flow and that has to count for something, right?The Occluded Artery Trial (OAT) tested the hypothesis that a strategy of routine PCI for total occlusion of the infarct-related artery 3 to 28 days after AMI would improve cardiac outcomes compared to medical therapy alone.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients: Patients were eligible if coronary angiography, performed 3 to 28 days after MI, showed a total occlusion of the infarct-related artery with poor antegrade flow and either an EF less than 50% or the occlusion was in the proximal portion of a major coronary vessel with a large risk region, or both. The qualifying period of 3 to 28 days was based on calendar days with day 1 being the onset of symptoms and thus, the minimal time from the AMI to angiography was just over 24 hours. [This is important, readers should not take the inclusion criteria of 3 to 28 days to mean that patients were not eligible if angiography was performed 2.5 mg/dl, left main or 3 vessel disease, angina at rest, and severe ischemia on stress testing (stress testing was required if the infarct zone was not akinetic or dyskinetic).Baseline characteristics: The trial included 2,166 patients - 1,082 randomized to PCI and 1,084 to medical therapy. The average age of patients was 59 years and 78% were men. Over 80% were white. The median time between AMI and randomization was 8 days. Patients had normal kidney function with an average GFR of 81 ml/min. The mean EF was 48% with 20% of patients having an EF
The FiltrateJoel TopfSwapnil HiremathAC GomezJordy CohenNayan AroraSpecial Guest Brendon NuenEditing bySimon Topf and Nayan AroraShow NotesFINEARTS-HF in NEJM FINEARTS Kidney outcomes in JACCFINE-HEART pooled analysis of cardiovascular, kidney and mortality outcomes in Nature Medicine discussion in NephJC BARACH-D: Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial (Nature Medicine)Live Freely Filtered at KidneyWkSwapnil comes out as a SpiroStan post to NephJC TOPCATTOPCAT primary publication TOPCAT North American results TOPCAT funny business explained AHA/ACC/HFSA Heart Failure Guidelines (PDF)SGLT2i are 2aMRA are a 2bARBs are a 2bARNI are a 2bClinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to SpironolactoneKansas city cardiomyopathy questionnaire in patients with CKD without a diagnosis of heart failure: https://pubmed.ncbi.nlm.nih.gov/21187260/GFR slope with steroidal MRAs in HF: https://onlinelibrary.wiley.com/doi/10.1002/ejhf.2635Why Has it Been Challenging to Modify Kidney Disease Progression in Patients With Heart Failure? (JACC)Tubular SecretionsSwap: Disclaimer on Apple TVAC: Duo Lingo Plushy (Amazon)Nayan: The Puzzle BoxJordy: Project Hail MaryBrendon has a podcast, The Kidney Compass with Shikha Wadhwani. And he recommends singer-songwriter, Maggie Rogers (YouTube)Joel: The Singularity Is Nearer: When We Merge with AI by Ray KurzweilClosing music, Tim Yau with The Kidney Connection
“The nurse's role in monitoring the lab values really depends on the clinics you're working at, but really when our patients are receiving treatment, especially in the infusion center, the nurses should be looking at those lab values prior to treatment being started,” Clara Beaver, DNP, RN, AOCNS®, ACNS-BC, clinical nurse specialist at Karmanos Cancer Center in Michigan told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS during a conversation about how to monitor and educate patients with cancer. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn [#] contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by November 29, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to monitoring labs and educating patients with cancer. Episode Notes Complete this evaluation for free NCPD. Oncology Nursing Podcast™ episodes: Episode 319: Difficult Conversations About Pregnancy Testing in Cancer Care Episode 311: Standardized Pregnancy Testing Processes in Cancer Care Episode 183: How Oncology Nurses Find and Use Credible Patient Education Resources Episode 179: Learn How to Educate Patients During Immunotherapy Episode 87: What Are the Biggest Barriers to Patient Education? Episode 43: Sharing Patient, Provider, and Caregiver Resources ONS Voice articles: Patient Education Reduces Barriers and Increases Adherence Rates Nurses Must Understand Health Disparities to Provide Effective Patient Education Oncology Nurses Can Improve Oral Medication Management With Patient Education Program ONS Course: ONS Fundamentals of Chemotherapy and Immunotherapy Administration™ Oncology Nursing Forum article: Antineoplastic Therapy Administration Safety Standards for Adult and Pediatric Oncology: ASCO-ONS Standards Clinical Calculations—ANC Huddle Card To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an Oncology Nursing Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. “Your traditional chemotherapy agents are the ones that we see the most lab abnormalities with, and we can predict those a little bit more with the advent of more of the advanced targeted therapies and immunotherapies, we still see lab values that are altered because of the way that the treatment works, but they may differ a little bit than what we traditionally saw with our normal chemotherapy agents.” TS 2:51 “I talked about the lifespan of all the other cells, and Neutrophils are usually what stop treatment, and part of that is, is that the lifespan of a neutrophil is 48 hours. It is proliferated very frequently in the bone marrow. But that is usually what we see. The cells that we see that stop treatment, and as you mentioned earlier, classic chemotherapy really the types of treatment that historically, we've been given and we have given to patients, and we've seen those blood counts really significantly impacted.” TS 6:21 “Kidney function, or renal function tests, are really determined whether the kidneys are functioning the way they should be. We look at an estimated glomerular filtration rate, or GFR, which is really based on the patient's protein level, their age, gender, and race. And the test really looks at how efficiently the kidneys are clearing the waste from the body. So that's really one that we need to look at, especially as we're giving agents that are excreted through the kidneys.” TS 12:23 “I think it's important for nurses to start looking at lab results with their patient very early on, you know, even before treatment starts, so they understand what the normals look like. So when they do get those lab results, because now pretty much everybody has patient portals, right? So the labs are reported in there, and they're seeing the labs before they're talking to their providers. if we can start early on and talk to them about what the normal lab values are, what they mean, and what we're looking at when we're drawing these labs. I think it's really important for the patient.” TS 27:00
The show opens with Adam talking to Jason “Mayhem” Miller about once again getting flipped off on the freeway, the glorious end to Mike August's “Brisket Quest”, and AOC & Tim Walz's reaction to Tony Hinchcliffe's appearance at a Donald Trump rally. Next, comedian Bret Ernst returns to the show to talk about his new special, Uncaged. They also discuss how songs about being in a band tend to be good, while songs about evil women are always bad. Then, Jason “Mayhem” Miller reads the news including stories about how Burlington, Vermont leadership is now calling for more officers after admitting that defunding the police was a mistake, towns setting an age limit on trick-or-treaters, and Philadelphia's D.A. suing Elon Musk to stop his million dollar giveaway. Finally, Mark Farner from Grand Funk Railroad joins the show to talk about his new solo album, why GFR isn't in the Rock & Roll Hall of Fame, what it's like hearing covers of his songs, opening for Led Zeppelin, his songwriting process, and the potential of a GFR reunion. For more with Bret Ernst: ● NEW SPECIAL: Pete Davidson Presents: Bret Ernst Uncaged - available on YouTube ● INSTAGRAM: @breternst ● TIKTOK: @breternst ● WEBSITE: bretcomedy.com For more with Mark Farner: ● NEW SOLO ALBUM: Closer to My Home - available November 8th ● INSTAGRAM: @farner_nine ● TWITTER/X: @farner_nine ● WEBSITE: markfarner.com Thank you for supporting our sponsors: ● http://SimpliSafe.com/Adam ● BotanicTonics.com, use code ADAM ● QualiaLife.com/Adam ● http://Sendthevote.org/Adam or text ADAM to 33022 ● http://OReillyAuto.com/Adam
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