Podcasts about guillain barr

Send us a textBuckle up, Ones Ready fam, because this episode is a gut-punch of raw truth and unrelenting grit. We're sitting down with Drew Outstanding (@drewoutstanding on X), a badass Army vet who went from slinging Applebee's two-for-20s to slaying in Iraq, only to get sucker-punched by the DOD's “safe and effective” COVID vaccine mandate. Spoiler alert: it wasn't safe, and it damn sure wasn't effective. One day after the jab, Drew was paralyzed, thrown into a medically induced coma, and diagnosed with Guillain-Barré syndrome. He spent six months as a human vegetable in the VA, drowning in his own saliva while bureaucrats played CYA. But this guy? He's not just surviving—he's thriving, hitting extreme sports, speaking truth to power, and making sure the world never forgets the COVID clown show. With Peaches and Jared dropping their signature sarcasm, this episode is a middle finger to the machine and a battle cry for resilience. Don't miss it, unless you're cool with Big Pharma running your life.Key Takeaways:The Mandate Mess: Drew's story exposes the DOD's vaccine mandate as a reckless gamble that left him paralyzed and fighting for his life. “Safe and effective”? More like “shut up and comply.”Grit Over Everything: From a coma to scuba diving and sit-down skiing, Drew's recovery is proof that sheer will can flip the bird to even the darkest odds.No Apologies, No Accountability: The system that pushed the jab still hasn't owned up. Drew's on a mission to make sure we never forget the lies and lives wrecked.Speak Your Truth: Facing hate mail and censorship, Drew's advice? Show up, tell your story,省市 and let the world know what's what.Timestamps:00:00 - Intro: Ones Ready kicks off with Peaches' classic energy.00:07 - Welcome Drew Outstanding, the man who beat the odds.03:53 - Drew's military journey: From Applebee's to Iraq's dumpster fire.11:49 - Black Hawk Down vibes and the reality of modern warfare.15:37 - Post-Iraq life: Fort Campbell, college, and National Guard.23:46 - COVID chaos: The bat-pangolin-turtle conspiracy and mandate madness.29:30 - Vaccine fallout: Paralysis, coma, and GuillainSupport the showJoin this channel to get access to perks: HEREBuzzsprout Subscription page: HERECollabs:Ones Ready - OnesReady.com 18A Fitness - Promo Code: 1Ready ATACLete - Follow the URL (no promo code): ATACLeteCardoMax - Promo Code: ONESREADYDanger Close Apparel - Promo Code: ONESREADYDFND Apparel - Promo Code: ONESREADYHoist - Promo Code: ONESREADYKill Cliff - Pro...

Broadcast from KSQD, Santa Cruz on 5-08-2025: Dr. Dawn examines groundbreaking research on rising rates of early-onset colorectal cancer worldwide, explaining how researchers have identified a bacterial toxin called colibactin produced by specific E. coli strains that appears to cause early genetic mutations in cancer-controlling genes, potentially explaining why younger generations face significantly higher cancer risks. She discusses how modern medical practices like antibiotic overuse and cesarean deliveries may disrupt protective gut microbiomes, while diets low in fiber and high in animal fats create conditions where harmful bacteria thrive and damage the protective mucosal barrier, potentially exposing colon cells to cancer-causing mutations. Dr. Dawn explains fascinating research on transgenerational memory in C. elegans worms and mice, where learned aversions to specific odors are genetically passed down to offspring through epigenetic mechanisms involving methylation and RNA pathways, challenging traditional views on inheritance and suggesting implications for human genetics. Responding to an email about posterior tibial tendon disease (PTTD), she offers comprehensive management strategies including cross-massage with ice, proper footwear selection, careful stretching techniques, and anti-inflammatory approaches while cautioning against invasive procedures like steroid injections that might weaken tendons. She discusses promising research on rosemary's potential in Alzheimer's treatment, explaining how carnosic acid activates the NRF2 pathway that controls antioxidant proteins, with researchers developing a more stable chemical analog that reduced inflammation and improved memory in mouse models of Alzheimer's disease. Dr. Dawn provides updates on vaccination recommendations, noting that egg allergy questions are no longer needed before flu vaccines, pneumococcal vaccines are now recommended for all adults over 50, and explaining the small risk of Guillain-Barré syndrome with RSV vaccines compared to the much larger risk of RSV-related deaths. She shares information about a new hypertension risk calculator called PREVENT that reclassifies many patients to lower risk categories, potentially allowing 2.6 million Americans to manage their blood pressure through lifestyle changes rather than medication, particularly benefiting older women who face different risk profiles than men.

*The is the FREE archive, which includes advertisements. If you want an ad-free experience, you can subscribe below underneath the show description.A recent journal entry titled “Need for Validation of Vaccination Programs,” by Okamura Memorial Hospital Cardiovascular surgeon Dr. Kenji Yamamoto of Japan, is calling for an assessment of CoV-shot damage by halting their use temporarily, getting rid of evaluation/approval officials who have conflicts of interest, and figuring out what caused 600,000 excessive deaths in the country (with an elderly population factored in). Dr. Yamamoto writes: “Recent vaccines, including those for Japanese encephalitis, cervical cancer, and coronavirus, have shown a low but significant risk of serious autoimmune conditions, such as acute disseminated encephalomyelitis and Guillain–Barré syndrome, as potential adverse events.” He adds: “Moreover, there has been a rise in cases of shingles, monkeypox, syphilis, severe streptococcal infections, measles, sepsis, and post-operative infections in countries administering multiple vaccine doses… Ironically, mRNA vaccines, initially introduced as a solution for infection control, have instead triggered an increase in infections.”In simple terms, these shots were causing “infections” and triggering “autoimmune conditions.”  The definition of an “infection” is “contamination,” to put something foreign into a local body. The definition of a “virus” is “slimy liquid, poison,” which means any substance of the like that can cause harm. Therefore, these shots inject a virus-liquid into a body that then becomes infected.  A recent phase one trial of personalized cancer shots at Icahn School of Medicine at Mount Sinai, is based on “training the immune system to recognize unique cancer mutations, called neoantigens, and mount a stronger, targeted response.” But if the body is already reacting as it should to disease and one trains it to attack that process, it will certainly cause the body to attack itself, i.e., autoimmune disease. And if mRNA guides DNA, then gene therapy product might very well cause cancer by altering the body's regulation of gene activation and cellular reproduction. Dr. Yamamoto is right and his call for concern is simply logical and concerning. Japan also has one of the lowest vaccine trust indexes in the world when factoring in accessibility, and although most of the population reportedly took CoV-shots in particular, there is a high possibility that people just as easily reported to have taken them in order to maintain peace just as it is probably they actually took them for the same reasons, especially considering the overall hesitancy of the country. However, Japan has very low rates, or no increase, in blood clots.After all Japan banned MMR in the 1990s, pulled Moderna vaccines due to contamination, and revised their vaccine laws in the same decade to make vaccination a civic duty rather than a legal obligation. Perhaps this is why Japan got a special Japanese shot in 2024 called replicon, the first self-replicating CoV-shot. Don't trust those other ones, try the Japanese one they were told.-FREE ARCHIVE (w. ads)SUBSCRIPTION ARCHIVEX / TWITTER FACEBOOKMAIN WEBSITECashApp: $rdgable EMAIL: rdgable@yahoo.com / TSTRadio@protonmail.comBecome a supporter of this podcast: https://www.spreaker.com/podcast/tst-radio--5328407/support.

Are Brean deler siste nytt fra andre vitenskapelige tidsskrifter. Bakteriell vaginose rammer omtrent 1/3 av alle kvinner i reproduktiv alder – hjelper det om man også behandler deres mannlige partnere (1, 2)? Har det noe å si for utfallet om man opereres før eller etter helga (3)? Er det forskjell i mortalitet hos folk som inntar mye smør versus de som heller inntar mer plantebaserte oljer (4, 5)? Gir multivitamininntak helsemessige fordeler hos pasienter med diabetes (6)? En dyrestudie publisert i Cell Metabolism antyder at forstyrrelser i mors døgnrytme kan predisponere avkommet for metabolsk stress og vektøkning senere i livet (7). Akkumulering av beta-amyloid i hjernen er et tidlig kjennetegn ved Alzheimers sykdom – men kan det også være direkte knyttet til de første kognitive endringene (8, 9)? Det foregår for tiden et større utbrudd av Guillain-Barré-sykdom i India (10). Og hvor vanlig er det egentlig at barnets biologiske far er noen andre enn den registrerte faren (11, 12)? Se hele litteraturlista her: https://tidsskriftet.no/2025/03/podkast/redaktorens-hjorne-82-bakteriell-vaginose-epigenetikk-og-dognrytme-registrert-vs-biologisk-far Tilbakemeldinger kan sendes til stetoskopet@tidsskriftet.no.  Stetoskopet produseres av Caroline Ulvin Johansson, Are Brean, Ragnhild Ørstavik og Julie Didriksen ved Tidsskrift for Den norske legeforening. Ansvarlig redaktør er Are Brean.  Jingle og lydteknikk: Håkon Braaten / Moderne media  Coverillustrasjon: Stephen Lee  See omnystudio.com/listener for privacy information.

Cancer du côlon: quand les lipides peuvent prédire l'efficacité des traitements Les brèves du jour Le syndrome de Guillain-Barré: une urgence médicale paralysante et terrifiante Le comment du pourquoi: les nouvelles espèces

Pilar García Muñiz conoce en 'La historia de Javi Nieves' a Hernán Cortés, diagnosticado con la enfermedad Guillain-Barré. En la sección de 'Bienestar' aprende junto a Elisa Blázquez qué son las hormonas y cómo nos afectan. 

China's budget-friendly AI model, DeepSeek, is making waves, sparking debates on its impact on global AI competition. On the health front, we break down the Guillain-Barré Syndrome outbreak in Pune and what it means for public hygiene. Music lovers, Sonu Nigam has called out the Padma Awards for ignoring legends like Kishore Kumar, Alka Yagnik, and Shreya Ghoshal—was he right? Plus, we analyze his Instagram video that’s got everyone talking. Over in cricket, Travis Head's explosive 57 off 40 balls against Sri Lanka is making headlines, and we bring you live updates from the match. Tech enthusiasts, is JioCoin India's next big cryptocurrency or just another reward token? We decode its implications. Tune in for unfiltered takes, hilarious takes, and no-BS insights with Shreyas Manohar and Govind Menon on this edition of Cock & Bull. Don't forget to like, share, and subscribe! #RepublicDay2025 #Memes #DeepSeek #SonuNigam #Cricket #JioCoin #CyrusSays #CockAndBull #ShreyasManohar #GovindMenonSee omnystudio.com/listener for privacy information.

Bob Dylan a créé un compte TikTok, quelques jours à peine avant l'interdiction possible du réseau social aux États-Unis, avec une série de clips de différentes époques de l'artiste, accompagnés de chansons telles que "Like a Rolling Stone", "Knockin' on Heaven's Door" et "Hurricane". Dave Grohl, le frontman des Foo Fighters, vient souvent en aide à ceux qui sont dans le besoin et ce sont les victimes des incendies qu'il a voulu aider, en préparant des repas pour les familles touchées. Exclu du groupe The Offspring en 2021, le batteur Pete Parada s'est exprimé sur son licenciement du groupe suite à son refus du vaccin contre le COVID. On apprend que les Eagles ont fait don de 2,5 millions de dollars à FireAid, le concert de bienfaisance qui aura lieu le 30 janvier en Californie, devant 18.000 personnes. Robbie Williams s'est souvenu d'un jour où il a pris des champignons hallucinogènes dans la maison de Bono, le chanteur de U2. Mots-Clés : vidéo, posté, compte vérifié, @bobdylan, arrêt, plateforme, utilisateurs, téléchargé, manière, anniversaire, images partagées, Feed The Streets Los Angeles, Instagram, chanteur, guitariste, casserole, conteneur, trottoir, formation, vacciner, médecin, antécédents médicaux, syndrome de Guillain-Barré, enfant, profil, effets secondaires, actualité, forêt, Los Angeles, désolation, région, activité culturelle, musical, initiative, célèbre marque, guitares, Fender, instruments de musique, matériel, flammes, couloirs, tableau, magie, peinture, fenêtre. --- Classic 21 vous informe des dernières actualités du rock, en Belgique et partout ailleurs. Le Journal du Rock, en direct chaque jour à 7h30 et 18h30 sur votre radio rock'n'pop. Merci pour votre écoute Plus de contenus de Classic 21 sur www.rtbf.be/classic21 Ecoutez-nous en live ici: https://www.rtbf.be/radio/liveradio/classic21 ou sur l'app Radioplayer BelgiqueRetrouvez l'ensemble des contenus de la RTBF sur notre plateforme Auvio.be Et si vous avez apprécié ce podcast, n'hésitez pas à nous donner des étoiles ou des commentaires, cela nous aide à le faire connaître plus largement. Découvrez nos autres podcasts : Le journal du Rock : https://audmns.com/VCRYfsPComic Street (BD) https://audmns.com/oIcpwibLa chronique économique : https://audmns.com/NXWNCrAHey Teacher : https://audmns.com/CIeSInQHistoires sombres du rock : https://audmns.com/ebcGgvkCollection 21 : https://audmns.com/AUdgDqHMystères et Rock'n Roll : https://audmns.com/pCrZihuLa mauvaise oreille de Freddy Tougaux : https://audmns.com/PlXQOEJRock&Sciences : https://audmns.com/lQLdKWRCook as You Are: https://audmns.com/MrmqALPNobody Knows : https://audmns.com/pnuJUlDPlein Ecran : https://audmns.com/gEmXiKzRadio Caroline : https://audmns.com/WccemSkAinsi que nos séries :Rock Icons : https://audmns.com/pcmKXZHRock'n Roll Heroes: https://audmns.com/bXtHJucFever (Erotique) : https://audmns.com/MEWEOLpEt découvrez nos animateurs dans cette série Close to You : https://audmns.com/QfFankx

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDOCs cast with Brit Long, MD (@long_brit), we cover the management of Guillain-Barré syndrome. For the presentation and ED evaluation of GBS, please see Part 1. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

Guillain-Barré syndrome (GBS) is a rare disorder that causes muscle weakness and sometimes paralysis. It's caused by the body's immune system damaging nerves. While most cases are triggered by respiratory or gastrointestinal infections, vaccinations have also been linked to GBS pathogenesis. GBS can last from weeks to years, but most people start to recover within a few weeks. The earlier symptoms improve, the better the outlook. Physical therapy is important to prevent muscle contractures and deformities. Some people may experience long-term weakness, numbness, fatigue, or pain. A small percentage of people with GBS may have a relapse, which can cause muscle weakness years after symptoms end. On Jan 7, 2025, the FDA required and approved UPDATED safety labeling changes to the Prescribing Information for Abrysvo (Respiratory Syncytial Virus Vaccine) manufactured by Pfizer Inc. and Arexvy (Respiratory Syncytial Virus Vaccine, Adjuvanted) manufactured by GlaxoSmithKline Biologicals. Specifically, FDA has required each manufacturer to include a new warning about the risk for Guillain-Barré syndrome (GBS) following administration of their Respiratory Syncytial Virus (RSV) vaccine. Who is most at risk for GBS? Where pregnant women affected? This is important information….listen in for details.

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDOCs cast with Brit Long, MD (@long_brit), we cover Guillain-Barré syndrome focusing on the history, examination, and ED evaluation. Part 2 will cover management. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

Have you ever been told that you need to write a book? I have! But my gut response is always - who would read it? No one cares enough to read my story. I think many of us fall into that same trap. Thinking our story doesn't matter enough to tell it. My guest today is Storie Esquell, and yes, her name says it all—she has a story you won't want to miss. Story shares her incredible journey through serious health challenges like endometriosis and Guillain-Barré syndrome, balancing a career in real estate, and ultimately finding God's purpose through her experiences. As Stoie opens up about her battle with infertility and her miraculous pregnancy, she reminds us that every woman has a unique story to tell, one that can be used by God in powerful ways. Whether you're facing your own health battles, struggling with feeling “not enough,” or simply wondering how your story fits into God's bigger picture, this episode will resonate deeply. TAKEAWAYS: - How Stoie faced and overcame multiple life-threatening health challenges. - The emotional and spiritual journey of infertility and how faith played a role in her healing. - Why your story—no matter how hard or painful—is part of God's plan for greater purpose. - Practical tips for embracing vulnerability and sharing your story with others. - How God uses the wilderness seasons to prepare us for our greater calling. CALL TO ACTION: Ready to step into the power of your story? Whether it's time to open up about your journey or just reflect on the ways God is working in your life, this episode will inspire you to take the next step. Share your story with us, or send a DM—we'd love to hear it. And don't forget to leave a review and share this episode with a friend who needs a little encouragement today. CONNECT WITH STORIE: Facebook - https://www.facebook.com/storie.esquell Instagram - https://instagram.com/storieesquell_ NON+PROFIT PARTNER OF THE MONTH: Are you ready to step into this movement? Head over to ⁠⁠Bell and Sparrows' website⁠⁠ (https://belleandsparrows.org) to see how you can jump in—whether it's with your time, resources, or prayers. This is your chance to make a real difference, and we're so excited to do it alongside you. ⁠⁠Buy a candle⁠⁠ (or 10)! Remember - they have private label for your business as well. ⁠⁠Donate today!⁠⁠ STAY CONNECTED: Make sure you're subscribed to Her Faith at Work so you never miss an episode that inspires your walk with God and your journey in business. And let's keep the conversation going on Instagram and LinkedIn, where we're sharing daily encouragement, faith-based business tips, and community updates. GRAB THE TRANSCRIPT CONNECT WITH JAN: Here are all the best places and FREE stuff

“We go through life sometimes being so hyper-focused on that one negative thing that happened, and there's beauty all around us. Life is short. We've got to take it in,” said John Petrelli, Author of "Confessions of a Hollywood Trainer"  Today I am chatting with John Petrelli, personal fitness trainer and author of “Confessions of a Hollywood Trainer”. With over 30 years of experience working with Grammy-winning artists and A-list actors, John's journey to success is anything but ordinary. In 2021, life took a dramatic turn when John was paralyzed by Guillain-Barré syndrome, a rare autoimmune disease that forced him to rely on his mental resilience to recover. Out of that experience, John wrote his first book, which became an Amazon #1 new release, and in 2024, he followed it up with a teen edition. Join us as John shares how overcoming life's toughest challenges has shaped his mission to help others discover their inner strength.  Tune in for insights on perseverance, mental fortitude and how to unlock your potential, no matter the odds. The road to improvement starts with healing. Listen as John breaks down what he believes is the essential first step to kickstarting your journey. Focus on the present. While lying in a hospital bed, uncertain of his future, John had to confront a harsh reality—his only choice was to live moment by moment. Hear how he now incorporates this practice into his everyday life. Harness your impulses. Reflecting on a harrowing experience from his book—being stranded in a capsized boat in Alaska—John reveals how he mastered his fight-or-flight instinct to stay alive. Everything is connected. Imagine if every challenge and triumph you've faced was guiding you toward the person you were always meant to become. Ready to get inspired? Grab your headphones and join the conversation! P.S. Be sure to like, subscribe and share so we can continue to bring you incredible guests! With so much love & gratitude,  Grace

Max Gerall's journey from aspiring basketball player to founder of Reach is a testament to resilience and empathy. Struck by Guillain-Barré syndrome and forever changed by the support of Miss Melissa Martinez, Max focused on empowering service workers. A transformative encounter ignited his mission to bridge communities and improve lives. Key Questions Answered 1. How did Max Gerall's experience with Guillain-Barré syndrome influence his life and career path? 2. What is the mission of Max's nonprofit, Reach, and how does it impact the community? 3. What significant issue was discovered during the health fair organized by Max? 4. How did Max Gerall collaborate with academic institutions to address healthcare issues? 5. What was the impact of Tanja Mooring's death on Max's work and the Reach program? Timestamped Overview 00:00 Overcoming anxiety through kind connection with others. 04:03 Empowering students to serve and build bridges. 08:30 Partnered to offer diabetes care via interdisciplinary teams. 10:23 Clinic referral led to friendship and health advocacy. 15:23 Bridging infrastructure gaps: healthcare, education, business, homeownership. 17:00 Excited about new university hubs in South Texas 21:20 Highlighting custodians' unnoticed yet crucial roles. 23:21 Building trust and respect through student engagement. 26:25 Affordable housing near work with supportive resources. 29:38 Mission to find health referrals at campus. 32:35 Thankful for support and life-changing lessons. Support The Rose HERE. Subscribe to Let's Talk About Your Breasts on Apple Podcasts, Spotify, iHeart, and wherever you get your podcasts.See omnystudio.com/listener for privacy information.

TRANSLATION MENU: LOOK UPPER RIGHT BELOW THE SOCIAL MEDIA ICONS. IT OFFERS EVERY LANGUAGE AVAILABLE AROUND THE WORLD! ALSO, SOCIAL MEDIA AND PRINT ICONS ARE AT THE BOTTOM OF THIS POST! Pictured above: Western vaccines are retail bioweapons. Not just Covid-19. All of them. Sixteen years on the streets, living and working with the people...

Welcome to Highest Aspirations, an education podcast focused on providing educators with inspiration and strategies to help multilingual learners achieve their highest aspirations. We have a very special guest with us today, the co-founder of CoolSpeak, Ernesto Mejia. Mejia is the proud son of Mexican immigrants, and a true example of the American dream. Diagnosed with the rare disease of Guillain-Barré (ghee-yan bar-ray) Syndrome at the age of 16 that left him temporarily paralyzed, he was not supposed to be a successful student, much less a College Dean of Students. But through his hardships, Mejia learned to never give up on life. He now speaks to students, parents and teachers about overcoming obstacles and never giving up on the American dream of education.  In this episode, we cover the meaning and importance of youth empowerment, the work of his company CoolSpeak, and how we can align programs and speakers we bring into a district with the needs of the audience and goals of the school. Click here to download the ⁠full episode transcript ⁠. To find more podcast episodes and show notes/key takeaways, ⁠⁠visit our podcast resource page.⁠⁠ For additional free resources geared toward supporting English learners, ⁠⁠visit our blog.⁠ To expand your connection within the Ellevation community by join our⁠ ⁠⁠Ellevation Educator Facebook Group.⁠ To learn more about Mejia's work with CoolSpeak click here. 

Beyond the unpredictable symptoms, Dana's CIDP journey included misdiagnosis after misdiagnosis and many lessons in insurance coverage. All of which made frustration a frequent feeling. There are many challenges–beyond the fatigue, muscle tingling, and weakness–associated with CIDP. Dana shares her story of living with CIDP, starting with muscle numbness on a camping trip, followed by years of appointments with multiple specialists and navigating insurance hurdles. Learning from her own CIDP journey, today, Dana uses her experiences to inspire, help, and connect with others in the CIDP and Guillain-Barré syndrome (GBS) community.See omnystudio.com/listener for privacy information.

This month's cases both feature sudden onset neurological syndromes. The first case (1:23) is that of a 26-yo Brazilian man who awoke from sleep with weakness in all four limbs. The signs suggest a possibility of Guillain-Barré syndrome or polio. A normal cranial nerve examination follows, with no unusual findings - https://pn.bmj.com/content/24/4/342  A 69-yo woman is the subject of the second case (14:33), after she presents with sudden onset unsteadiness and slurred speech when getting out of bed. A stroke was initially examined for by CT head scan, proving unremarkable, but a subsequent MRI scan showed an intense midbrain lesion. The patient subsequently improved, but then returned three months later with occurrences of the same symptoms multiple times throughout the day - https://pn.bmj.com/content/24/4/310 The case reports discussion is hosted by Prof. Martin Turner (1), who is joined by Dr. Ruth Wood (2) and Dr. Xin You Tai (3) for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the August 2024 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Listen to the JNNP podcast, "Nutritional peripheral neuropathies, with Dr. Alexander Rossor" on Apple (https://apple.co/3WjTmrM), Spotify (https://spoti.fi/4bKOhNA), Web (https://bit.ly/4cYhx4m). Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. This episode was produced and edited by Brian O'Toole. Thank you for listening. 

4 COVID Twitter Clips and Funny JP Video. CONSPIRACY THEORISTS PROVEN RIGHT AGAIN! What's causing all this? Cancer Researcher Dr. William Makis "Stop taking the injections: no mRNA vaccines, no COVID vaccines, no flu vaccines. The Unvaccinated were being targeted and killed in Hospitals This is Criminal The RNC Wants You to Fall For This   Post “Sudden And Unexpected” @toobaffled CONSPIRACY THEORISTS PROVEN RIGHT AGAIN! Swelling of the brain and spinal cord: Almost 4 times (400%) increased risk • Myocarditis: 3.48 times increased risk • Pericarditis: 1.74 times increased risk • Myocarditis (Second shot): 6.1 times increased risk AstraZeneca: • Blood clots: 3.23 times (320%) increased risk • Guillain–Barré syndrome (could lead to paralysis): 2.49 times increased risk • Pericarditis (Third dose): 6.91 times increased risk Pfizer: • Myocarditis (First dose): 2.78 times increased risk • Myocarditis (Second dose): 2.86 times increased risk • Myocarditis (Third dose): 2.09 times increased risk Moderna (Further doses beyond the first): • Myocarditis from the second shot: 6.1 times increased risk • Pericarditis (Fourth dose): 2.64 times increased risk • Myocarditis from the third dose: 2.01 times increased risk Risk factors are calculated based on a single dose. When you consider many people took three shots or more, the results of the study become even more alarming. TG: @VigilantFox   Post Dane @UltraDane What's causing all this? It's simple: “Our TOXIC food system and our TOXIC environment.” • Autism rates in kids are 1 in 36 nationally, compared to 1 in 1500 in the not-so-distant past. • In California, it's even worse: Autism rates are 1 in 22. • 74% of American adults are overweight or obese. • Close to 50% of children are overweight or obese. • 50% of American adults have prediabetes or type 2 diabetes. • 30% of teens now have prediabetes. • Infertility is increasing by 1% per year. • Sperm counts are decreasing by 1% per year since the 1970s. • Young adult cancers are up 79%.   Post “Sudden And Unexpected” @toobaffled Radiologist, Oncologist, and Cancer Researcher Dr. William Makis "Stop taking the injections: no mRNA vaccines, no COVID vaccines, no flu vaccines. And I have to agree with doctor Peter McCullough on the childhood vaccines you should probably avoid them altogether. " "We need a complete reset of the entire area of vaccines. We got to scrap the vaccine schedule, the childhood vaccine schedule, start from scratch now."   Post “Sudden And Unexpected” @toobaffled The Unvaccinated were being targeted and killed in Hospitals This is Criminal   The RNC Wants You to Fall For This Watch this video at- https://youtu.be/lcAtHJzOUr8?si=TxhpcK0bzdxHoMXg AwakenWithJP 3.06M subscribers 107,204 views Mar 13, 2024 Get Your Red Light Therapy Device at https://boncharge.com/jp Use Code "JP" for 15% Off! Get your Freedom Merch Here - https://awakenwithjp.com/collections/all Upcoming LIVE shows - https://awakenwithjp.com/pages/tour Get updates from me via email here: https://awakenwithjp.com/joinme What is ballot banking and why does the RNC want us to do it? 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Join us for an inspiring conversation with Matt Cook, an ultra runner who defied the odds. After being nearly paralyzed by Guillain-Barré syndrome, Matt not only recovered but went on to win The Cherokee Ultra 70k. In this podcast, Matt shares his incredible story of resilience, determination, and the power of the human spirit. Discover how he overcame adversity, found his passion for running, and achieved extraordinary athletic feats. Learn about Matt's experiences in ultramarathons, the challenges he's faced, and the lessons he's learned along the way.

En juin 2023, le Pérou a fait face à une augmentation du nombre de cas de syndrome de Guillain-Barré, maladie rare et potentiellement mortelle, qui se traduit par une attaque du système immunitaire sur le système nerveux périphérique. Le syndrome de Guillain-Barré peut entraîner des faiblesses musculaires, des douleurs ou, dans les cas les plus graves, une paralysie des muscles des jambes, des bras ou des muscles respiratoires. S'il survient la majeure partie du temps après une infection, on ne connait pas précisément sa cause. Comment diagnostiquer la maladie et la prendre en charge ? Où en sont les recherches ? Comment limiter les séquelles ? Dr Clémence Marois, neurologue à l'Hôpital de la Pitié-Salpêtrière à Paris Dr Kossivi Apetse, neurologue au CHR d'Atakpame et maître de conférences agrégé à l'Université de Lomé, au Togo Anne-Cécile Maréchal-Becker, co-présidente de l'Association Belge contre les Maladies Neuro-Musculaires-Téléthon Belgique Iris Marolleau, masseur-kinésithérapeute spécialisé en neuro-rééducation à Saint-Maur-des-Fossés.(Rediffusion)

En juin 2023, le Pérou a fait face à une augmentation du nombre de cas de syndrome de Guillain-Barré, maladie rare et potentiellement mortelle, qui se traduit par une attaque du système immunitaire sur le système nerveux périphérique. Le syndrome de Guillain-Barré peut entraîner des faiblesses musculaires, des douleurs ou, dans les cas les plus graves, une paralysie des muscles des jambes, des bras ou des muscles respiratoires. S'il survient la majeure partie du temps après une infection, on ne connait pas précisément sa cause. Comment diagnostiquer la maladie et la prendre en charge ? Où en sont les recherches ? Comment limiter les séquelles ? Dr Clémence Marois, neurologue à l'Hôpital de la Pitié-Salpêtrière à Paris Dr Kossivi Apetse, neurologue au CHR d'Atakpame et maître de conférences agrégé à l'Université de Lomé, au Togo Anne-Cécile Maréchal-Becker, co-présidente de l'Association Belge contre les Maladies Neuro-Musculaires-Téléthon Belgique Iris Marolleau, masseur-kinésithérapeute spécialisé en neuro-rééducation à Saint-Maur-des-Fossés.(Rediffusion)

Rowdy Gaines is a three-time Olympic gold medalist, NBC's voice of swimming, and a living legend in the aquatic world. This conversation explores Rowdy's extraordinary journey from late-blooming swimmer to world record holder and beloved broadcaster. We dig into his mental resilience through setbacks like the 1980 Olympic boycott and a battle with Guillain-Barré syndrome, his perspective on the evolution of competitive swimming, and his passion for water safety advocacy. He offers a behind-the-scenes look at the Paris Olympics and much more along the way. Rowdy's infectious enthusiasm is a gift to the sport. He shows everyone how and why we love this sport, which means so much to us both. Enjoy! Show notes + MORE Watch on YouTube Newsletter Sign-Up Today's Sponsors:  Waking Up: Get a FREE month, plus $30 OFF 

Dr Leigh Richardson of The Brain Performance Institute and host of In Your Head with Leigh Richardson speaks with Caroline Lamont, a functional medicine health coach for Great In Great Out. They discuss how enjoyable nutrition and healthy eating can combat pain and inflammation, drawing from Caroline's personal experiences with autoimmune diseases such as rheumatoid arthritis and Guillain-Barré syndrome.

In this episode of Brain & Life podcast, Olympic swimmer and announcer Rowdy Gaines joins host Dr. Daniel Correa. He shares how he found his passion for swimming and how he dealt with Guillain-Barré syndrome in the height of his career. Dr. Correa is then joined by Dr. Mark Milstein, director of the Adult Neurology Residency Training Program at Montefiore and associate professor of Neurology and Medicine at Albert Einstein College of Medicine. Dr. Milstein explains exactly what Guillain-Barré is, who is at risk, and treatment options.   Additional Resources What is Guillain-Barré syndrome? Guillain-Barré Syndrome Didn't Stop this Marathoner Inside Out GBS/CIDP Foundation Support Groups   We want to hear from you! Have a question or want to hear a topic featured on the Brain & Life Podcast? ·       Record a voicemail at 612-928-6206 ·       Email us at BLpodcast@brainandlife.org   Social Media:   Guests: Rowdy Gaines @rowdygaines; Dr. Mark Milstein @monteneurology Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD

In this episode, Gordon Smith, MD, FAAN speaks with Casey S.W. Albin, MD, author of the article “Neuromuscular Emergencies,” in the Continuum® June 2024 Neurocritical Care issue. Dr. Smith is a Continuum® Audio interviewer and professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Albin is an assistant professor of neurology and neurosurgery in the departments of neurology and neurosurgery, division of neurocritical care at Emory University School of Medicine in Atlanta, Georgia. Additional Resources Read the article: Neuromuscular Emergencies Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Guest: @caseyalbin Transcript  Full transcript available here  Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the show notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the show notes. AAN members, stay tuned after the episode to hear how you can get CME for listening.   Dr Smith: Hi. This is Dr Gordon Smith. I'm super excited today to be able to have the opportunity to talk to Dr Casey Albin, who will introduce herself in a second. She's well known to Continuum Nation as the Associate Editor for Media Engagement for Continuum. She's also a Neurointensivist at Emory University and wrote a really outstanding article for the neurocritical care issue of Continuum on neuromuscular emergencies. Casey, thanks for joining us. Tell us about yourself. Dr Albin: Sure. Thank you so much, Dr Smith. So, yes, I'm Casey Albin. I am a Neurointensivist. I practice at Emory. We have a really busy and diverse care that we provide at the Emory neuro ICUs. Just at the Clifton campus, there's over forty beds. So, although neuromuscular emergencies certainly do not make up the bread and butter of our practice - I mean, like many intensivists, I spend most of my time primarily caring for patients with cerebrovascular disease - this is a really interesting and just kind of a fun group of patients to take care of because of the ability we have to improve their outcomes and that some of these patients really do get better. And that's a really exciting thing to bear witness to. Dr Smith: I love finding neurointensivists that are interested in neuromuscular medicine because I share your interest in these patients and the fact that there's a lot that we can do for them. You know, how did you get interested in neurocritical care, Casey? Dr Albin: You know, I was always interested in critical care. It was really actually the neurology part that I came late to the party. I was actually, like, gearing up to apply into emergency medicine and was doing my emergency medicine sub-I (like, that was the route I was going to take), and during that sub-I, I just kept encountering patients with neurologic emergencies - so, you know, leptomeningeal carcinomatosis and obstructive hydrocephalus, and then a patient with stroke - and I realized I was just gravitating towards the neuroemergencies more so than just any general emergencies. And I had really enjoyed my neurology rotation. I did not foresee that as the path I was going to take, but after kind of spending some time and taking care of so many neurologic emergencies from the lens of an emergency department, sort of realized, like, "You know, I should go back and do a neurology sub-I.” And so, kind of, actually, late in the game is when I did that rotation and, like, dramatically changed my whole life trajectory. So, I have known since sort of that fourth year of medical school that I really wanted to focus on neurocritical care and neurologic emergencies, and I love the blend of critical care medicine and the procedural aspect of my job while doing it with the most interesting of all the organ systems. So, it's really a great blend of medicine. Dr Smith: Did you ever think about neuromuscular medicine? Dr Albin: Uh, no. Dr Smith: I had to ask. I had to ask. Dr Albin: No, I mean, I do really love neuromuscular emergencies, but I've known for forever that like, really wanted to be in an acute care setting. Dr Smith: You know, I think it's such a great story, Casey, and I know you're an educator, too, right? And, um, we hear this from learners all the time about how they come to neurology relatively late in medical school, and it's been really great to see the trajectory in terms of fellowship determination dates and giving our students opportunities to make their choice, you know, later during their medical school career. And I wonder whether your journey is an example of what we're seeing now (which is more and more students going into neurology because we're giving them the free space to do that), and then also in terms of fellowship decisions as well (which was what I was alluding to earlier)? Dr Albin: Yeah, absolutely. I think having more exposure to neurology and getting a chance to be in that clinical environment - you know, when you are doing the “brain and behaviors” (or whatever your medical school calls the neurology curriculum) - it is so hard and it's so dense, and I think that that's really overwhelming for students. And then you get into the clinical aspect of neurology, and sure, you have to know neurolocalization - and that is fundamentally important to everything we do - but the clinical application is just so beautiful and so much fun and it's so challenging, but in a good way. So, I totally agree. I think that more students need more exposure. Dr Smith: Well, I mean, that's a perfect segue to something I wanted to talk to you about, which is you brought up the beauty of neurology - which is, I think, you know, neurologic formulation, really – and we talk a lot about the elegance of the neurologic examination. But one of the things I really liked about your article was its old-school formulation – you talk about the importance of history, examination, localization, pattern recognition – I wonder if, maybe, you could give us some pearls from that approach and how you think about acute neuromuscular problems and the ICU? Dr Albin: Absolutely. I really do think that this is the cornerstone of making a good diagnosis, right? I will tell you what's really challenging about some of these patients when they are admitted to the ICU is that we are often faced with sort of a confounded exam. The patient may have been rapidly deteriorating, and they may not be able to provide a good history. They may be intubated by the time that we meet them. And so not only are they not able to provide a history themselves, but their exam may be confounded by the fact that they're on a little bit of sedation, or they were aspirating and now they have a little bit of pneumonia. I mean, it can be really challenging to get a good neurologic exam in these patients. But I do think the history and the physical are really where the money is in terms of being able to send the appropriate test. And so, when I think about these patients who get admitted to the neuro ICU, the first thing that we have to have is someone who can provide a really good collateral history, because so much of what we're trying to determine is, "Is this the first presentation, and this is a de novo (new) neuromuscular problem?” or “Had the patient actually had sort of a subacute or chronic (even) decline and they've been undiagnosed for something that was maybe a little bit more indolent, but (you know, they had an abrupt decline because, you know, they got pneumonia, or they have bloodstream infection, or whatever it was allowing them to sort of compensate) they have no longer been able to compensate?”. And so, I really do think that that's key. And when I am hearing the story the first time, that's really one of the focuses of my history – is, "Was this truly a new problem?”. And then, when we think about, you know, "Where do we localize this within the nervous system?”, it's actually quite challenging because, you know, patients with acute spinal cord pathology may also not present with the upper motor neuron findings that are classic for spinal cord pathology. And so I think, again, it's a little bit recognizing that you can be confounded and we have to keep a broad differential, but I am sort of examining for whether or not there's proximal versus distal (like, the gradient of where they're weakest), is there symmetry or asymmetry, and then, are there other, sort of, features that go along with helping us localize to something to the nerves (such as sensory symptoms or autonomic symptoms)? So when I think about, you know, where we're putting this, you can put anything in sort of the anterior horn cells or to the nerves themselves, to the neuromuscular junction, and then to the muscles. And teasing that out, I put in some figures and tables within the article to help kind of help the reader think about what are features of my patient's exam, my patient's history, that might help me to put it into one of those four categories. Dr Smith: Yeah, I was actually going to comment on the figures in your article, Casey. They're really fantastic, and I encourage all of our listeners to check it out. There's, you know, figures showing muscle group involvement and different diseases and different muscle disorders and different forms of Guillain-Barré syndrome - it's a really beautiful way of visualizing things. I wonder if we could go back, though, because I wanted to delve down a little bit in this concept of patients who have chronic neuromuscular diseases presenting into the ICU. I mean, this happens surprisingly frequently with ALS patients or, like, myotonic dystrophy. I've seen this a number of times where folks are, just, they're not diagnosed and they're kind of slowly progressing and they tipped over the edge. Can you tell us more about how you recognize this? You talked a little bit about collateral history - other words of wisdom there? Dr Albin: I would say this is one of the hardest things that we encounter in critical care medicine, because quite frequently - and I see this more with ALS than myotonic dystrophies - but, I would say, like, I don't know, once every six months, we have a patient who's undiagnosed ALS present. And I think it can be extremely difficult to tease this out because there's something that's tipped them over the edge. And as an intensivist, you were always focused on resuscitating the patient and saving them from that life-threatening thing that pushed them over the edge, and then trying to tease out, “Well, were they hypercarbic and did they have respiratory failure because, you know, they've got a little bit of COPD, and is that what's going on here?” or, "Have they been declining and has there been sort of this increase in inability to ventilate actually because of diaphragmatic weakness and because of neuromuscular weakness?” Again, the collateral history is really important. One of the things that I think we are challenged by is how difficult - and I'm sure you can comment on this, as someone who is a neuromuscular guy - is how difficult it is to get a good EMG and nerve conduction study in the ICU in patients who may have been there for a little bit, you know? I think about this, sort of, the electrical interference, the fact that the patient's body temperature has fluctuated, the fact that they are, usually, by this time, like, they're a little volume overloaded – they're puffy. You know, it can be very frustrating. I think, actually, you probably would know more about, like, what it's like to do that exam on our ICU patients. Dr Smith: Sometimes, it's really challenging, I agree. And it's the whole list of things that you raised - and I think it goes back to the first question, really. You put a premium on old-school formulation, pattern recognition, localization, and taking a good history - you know, thinking of that ALS patient, right? I mean, one of the challenges, of course, that you have to deal with in that situation is prognostication and decisions regarding intubation, right? And that's very different from (I'll give another scenario that sometimes we run into, which is the other extreme) a patient with myasthenia gravis who, maybe we expect to be able to get off a ventilator very quickly, but sometimes they're reluctant to be ventilated because of their age or advanced directives and whatnot. I wonder if you could talk a little bit about how you approach counseling patients regarding prognosis related to their underlying neuromuscular disease and the need for intubation in a period of mechanical ventilation? Dr Albin: Just like you said, it really ranges from what the underlying diagnosis is. So, one of the things that, you know, like you said, myasthenia - these patients, when they're coming in in crisis, we know that there is a good chance that they're going to respond pretty quickly to immunotherapy. I mean, I think we've all seen these patients get plasma exchange, and within a day or two, they are so much stronger (they're lifting their head off the bed, they're clearing their secretions), and every now and then, we're able to temporize those patients with just noninvasive ventilation. You know, when we're having a discussion about that with the patient and with the care team, we really have to look at the amount of secretions and how well they're clearing them, because, again, we certainly don't want them to aspirate - that really sets people back. But, you know, I think, often in those cases, we can kind of use shared decision-making of, you know, “Can we help you get through this with noninvasive?” or, you know, "Looking at you, would you be all right with a short term of intubation?” Knowing that, usually, these patients stabilize not all the time, but quite frequently, with plasma exchange, which we use preferentially. The middle of that is, then, Guillain-Barré - those patients, because of the neuropathy features (the fact that it's going to take their nerves quite some time to heal, you know) - when those patients need to be intubated, a good 70% or more are going to require longer-term ventilation. And, so, again, it's working with a family, it's working with a patient to let them know, "We suspect that you're going to need to be on the ventilator for a long time. And we suspect, actually, you would probably benefit from early tracheostomy”. And there was a really nice guidance that was just presented in the Journal of Neurocritical Care about prognosticating in patients with specifically Guillain-Barré (so that's helpful). And then, we get to the, really, very difficult (I would say the most difficult thing that we deal with in neuromuscular emergencies) - is the patient who we think might have ALS (we are not positive), and then we are faced with this diagnosis of, “Would you like to be intubated, knowing that we very likely will never extubate you?” - and that, I think, is a very difficult conversation, especially given that there is a lot of uncertainty often in the diagnosis. I would say, even more frequently, what happens is they have been intubated at an outside hospital and then transferred to us for failure to wean from the ventilator and, "Can you work it up and say whether or not this is ALS?” – and that, I think, is one of the most difficult conundrums that we face in the ICU. Dr Smith: Yeah. I mean, that's often very, very difficult. And even when the patient wants to be intubated and ultimately receive a tracheostomy, getting them out of the hospital can sometimes be a real challenge. There's so much I want to talk to you about, and, you know, you talked about prognostication - really great discussion about tools to prognosticate in GBS, both strengths of things like EGRIS and the modified EGOS, and so forth – but, I wonder (given that I'm told time is limited for us) if you could talk a little bit about bedside guidance in terms of assessing when patients need to be intubated? You provide really great definitions of different respiratory parameters and the 20/30/40 rule that I'll refer listeners to, but I wonder if you could share, what's your favorite, kind of, bedside test - or couple of bedside tests - that we can use to assess the need for ventilatory support? And this could be particularly helpful in patients who have, let's say, bifacial weakness and can't get a good seal. So, what do you recommend? Is it breath count? Is it cough? Something else? Dr Albin: I think for me, anecdotally (and I really looked for is there any evidence to support this), but for me, anecdotally - and knowing that there is not really good evidence to support this - whether or not the patient could lift their head off the bed, to me, is a very good marker of their diaphragmatic strength. You know, if they've got good neck flexion, I feel a lot better about it. The single breath count test is another thing that I kind of went down a rabbit hole of, like, "Where did this come from?” because I think, you know, it was one of the first things I was taught in residency - like, “Oh, patient with neuromuscular weakness, have them take a deep breath and count for as many breaths as they can.” We have probably all done that bedside test. It's really important to recognize that the initial literature about it was done in myasthenia patients who were in clinic (so, these were not patients who are, like, abruptly going to need intubation), and it does correlate fairly well with their forced vital capacity (meaning how much they're able to exhale on bedside perimetry), but it is not perfect. And I put that nice graph in the article, and you can see, there's a lot of patients who are able to count quite high but actually have a very low FVC, and patients who count only to ten but have a very good FVC. So, I do like the test and I continue to use it, but I, you know, put an asterisk by it. It's also really important - and I would encourage any sort of neurology trainees, or trainees in any specialty - if you're taking care of these patients, watch the respiratory therapist come and do these at the bedside with them. You'll get a much greater sense of (a) what they're doing, but (b) how well the patient tried. And it is really, I mean, we have to interpret this number in the context of, "Did they give a really good effort?” So, I'll often go to the bedside with the RT and be the one coaching the patient - saying, like, you know, “Try again”, “Practice taking this”, “Do the best you can”, “Go, go, go! Go, go, go!” (you know, like, really coaching the patient) - and you would be surprised at how much better that makes their number. And when you're really appropriately counseling them, that we actually get numbers that are much better predicting what they're doing. Then, you also have a gestalt just from being at the bedside of what they looked like during this. Dr Smith: Yeah. I used to work with a neuromuscular nurse who was truly outstanding who was the loudest and most successful vital capacity coach ever. But, you know, she'd be doing it in one room, and you'd be in the next room with a patient. They'd be like, “What are they doing next door?” She was shouting and exhorting the patient to go harder and breathe better. So, it was always, “Wow, that sounds exciting over there”. All right, this is all in a prelude. What I really want to ask you, Casey, is, you know, whenever we do Continuum Audio interviews, we, like, look up people, and it's not hard to look you up because you're everywhere on the Internet. And come to find out, you're a fully credential neuro Twitter star - and that's the term I saw, a star. So, what's it like being a Twitter star? I guess it's an X star. I don't even know what we call it anymore. Dr Albin: I guess it's that. I don't know. I don't know, either. It's so funny, um, that that has become so much of my, like, academic work. I got on Twitter, or X (whatever it is) during the pandemic because, really, my interest is in, you know, innovatives and medical education, and I really had been trained to do simulation. So, I really wanted to develop simulation curriculum. I love doing sims with our medical students to our fellows. So, I was, like, developing this whole curriculum, and then the pandemic came along, and the sim lab at Emory was like, “Mm, yeah, we're not going to let people go in the sim lab. Like, that's not exposure that we want (people in a room together)”. So one of our fellows at the time was doing a lot on Twitter and he was like, "You would love this. You have cases that you want to teach about. You should really get on board”. And I, sort of, reluctantly agreed and have found the NeuroTwitter community to be, like, just a fantastic exchange of, you know, cases, wisdom, new studies - I mean, it's the way that I keep up with what is being published in the many fields that are adjacent to neurocritical care. So, it's very funny that that has ended up being sort of something that is a really big part of my academic time. But now that we're talking about it, I will give a plug for any of the listeners who are not on X. Dr Jones and I post cases, usually twice a week, that come directly from the Continuum articles or from our files (because, you know, sometimes we can spin them a little bit), but it's an amazing, sort of case-based, way to do some, like, microteaching from all of the beautiful Continuum articles, all the cases - and because there are free articles released from the issue, you know we'll link directly to those. So, for any of the listeners who have not, kind of, joined X for all the reasons that many people cite of not joining, I would say that there's so much learning that happens - but Dr Jones and I are people to follow because of our involvement with Continuum and the great cases that we're able to showcase on that platform. Dr Smith: I think that's a great point. And, you know, there are certainly organizations that are questioning their engagement with X, and I'm on a board of an organization that's talked about not actually participating, and I brought up this point that I think the NeuroTwitter (NeuroX) community is really amazing. You'll have to give me some tips, though, I'm at, like, 498 followers or something like that. Do you know how many followers you have? I looked it up yesterday. I've got it for you if you don't know. Dr Albin: I don't know recently. Dr Smith: Yeah, 18,200 as of yesterday. That's amazing! Dr Albin: Yeah, it's worldwide. We're spreading knowledge of Continuum across the globe. It's fantastic. Dr Smith: That's crazy. Yeah, that's great work. It's really great to see the academic, kind of, productivity that comes of that. And I agree with you - Continuum has a really great presence there, and it's a great example of why you're the Associate Editor for Media Engagement. I think we're going to have to, I guess, gamify would be the right thing? Maybe we should, uh, see what the Las Vegas book is on the number of followers between you and Lyell Jones, I think. Dr Albin: Totally. Dr Smith: Yeah. Hey, Casey, this has been awesome. I've been so excited to talk to you - and I could keep talking to you for hours about your NeuroTwitter stardom – but in particular, neuromuscular weakness. I really encourage all of our listeners to check out the article. It's really, really, really, great - really enjoyed it. I learned a lot, and it reminded me a lot of things that I had forgotten. So thank you for the great article, and thanks for a really fun discussion. Dr Albin: Thank you, Dr Smith. It was truly a pleasure.   Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, please consider subscribing to the journal. There's a link in the episode notes. We'd also appreciate you following the podcast and rating or reviewing it. AAN members, go to the link in the episode notes and complete the evaluation to get CME for this article. Thank you for listening to Continuum Audio.

In this episode we interview four current artists in residence at St. Joseph's Home for Artisans, the only operating Catholic artist residency in the United States, in Boston, MA. We talk through how to balance filmmaking with other aspects of vocation, how faith can help in the pursuit of a creative career, and overcoming our individual obstacles (from healing from Guillain Barré syndrome, to navigating being a first-generation Mexican American storyteller). BREAKDOWN: 2:47 - FERNANDO J. LIMBO III - Residency Co-Founder from Boston, MA  5:44 - Finding peace to cultivate creative freedom 6:35 - Co-creating with your Creator 9:18 - Co-founding an artist residency: the origins of St. Joseph's Home for Artisans 15:35 - Fernando's ongoing recovery from Guillain-Barré syndrome 19:20 - CLARE MCCALLAN - Residency Founder, author, TV writer & host from Boston, MA 19:53 - Work-life balance?  20:35 - Consideration of family goals vs/and career goals, especially for women  22:48 - Advantages of having faith in artistic careers 29:04 - PATRICK LEHE - Screenwriter & producer from Los Angeles 30:28 - Not staking your entire identity on your career / successes and failures 39:11 - BENJAMIN SUAREZ - Filmmaker from Atlanta, GA 40:13 - Surrounding yourself with people who inspire you  30:50 - Atlanta vs. LA or NYC 44:37 - One question to ask yourself to discern filmmaking as part of your vocation  45:48 - Overcoming barriers to pursuing filmmaking as a first-generation Mexican American   CONNECT WITH THE RESIDENCE:  www.StJosephsHomeforArtistans.com IG: @stjosephsartisans CONNECT WITH FERNANDO:  IG: @fernandojlimbo CONNECT WITH CLARE:  www.ClareMcCallen.com IG: @clare_mccallen CONNECT WITH PATRICK:  www.patrickjlehe.com IG: @pjlehe CONNECT WITH BENJI:  IG: @benjisuarezfilms CONNECT WITH THE SHOW:  All platforms: @NoSetPathShow www.NoSetPathShow.com bio.site/nosetpath --- Support this podcast: https://podcasters.spotify.com/pod/show/rebecca-doyle3/support

In neurocritical care, the initial evaluation is often fast paced, and assessment and management go hand in hand. History, clinical examination, and workup should be obtained while considering therapeutic implications and the need for lifesaving interventions. In this episode, Aaron Berkowitz, MD, PhD FAAN, speaks with Sarah Wahlster, MD, an author of the article “The Neurocritical Care Examination and Workup,” in the Continuum June 2024 Neurocritical Care issue. Dr. Berkowitz is a Continuum® Audio interviewer and professor of neurology at the University of California San Francisco, Department of Neurology and a neurohospitalist, general neurologist, and a clinician educator at the San Francisco VA Medical Center and San Francisco General Hospital in San Francisco, California. Dr. Wahlster is an associate professor of neurology in the departments of neurology, neurological surgery, and anesthesiology and pain medicine at Harborview Medical Center, University of Washington in Seattle, Washington. Additional Resources Read the article: The Neurocritical Care Examination and Workup Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz Guest: @SWahlster Full Episode Transcript Sarah Wahlster, MD   Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by clicking on the link in the Show Notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the Show Notes. AAN members: stay tuned after the episode to hear how you can get CME for listening.  Dr Berkowitz: This is Dr Aaron Berkowitz, and today I'm interviewing Dr Sarah Wahlster about her article on examination and workup of the neurocritical care patient, which is part of the June 2024 Continuum issue on neurocritical care. Welcome to the podcast, Dr Wahlster. Can you please introduce yourself to the audience? Dr Wahlster: Thank you very much, Aaron. I'm Sarah Wahlster. I'm a neurologist and neurontensivist at Harborview Medical Center at the University of Washington. Dr Berkowitz: Well, Sarah and I know each other for many, many years. Sarah was my senior resident at Mass General and Brigham and Women's Hospital. Actually, Sarah was at my interview dinner for that program, and I remember meeting her and thinking, “If such brilliant, kind, talented people are in this program, I should try to see if I can find my way here so I can learn from them.” So, I learned a lot from Sarah as a resident, I learned a lot from this article, and excited for all of us to learn from Sarah, today, talking about this important topic. So, to start off, let's take a common scenario that we see often. We're called to the emergency room because a patient is found down, unresponsive, and neurology is called to see the patient. So, what's running through your mind? And then, walk us through your approach as you're getting to the bedside and as you're at the bedside. Dr Wahlster: Yeah, absolutely. This was a fun topic to write about because I think this initial kind of mystery of a patient and the initial approach is something that is one of the puzzles in neurology. And I think, especially if you're thinking about an emergency, the tricky part is that the evaluation and management go hand in hand. The thinking I've adapted as a neurointensivist is really thinking about “column A” (what is likely?) and “column B” (what are must-not-miss things?). It's actually something I learned from Steve Greenberg, who was a mutual mentor of us - but he always talked me through that. There's always things at the back of your head that you just want to rule out. I do think you evaluate the patient having in mind, “What are time-sensitive, critical interventions that this patient might need?” And so, I think that is usually my approach. Those things are usually anything with elevated intracranial pressure: Is the patient at risk of herniating imminently and would need a neurosurgical intervention, such as an EVD or decompression? Is there a neurovascular emergency, such as an acute ischemic stroke, a large-vessel occlusion, a subarachnoid hemorrhage that needs emergent intervention? And then other things you think about are seizures, convulsive/nonconvulsive status, CNS infection, spinal cord compression. But I think, just thinking about these pathologies somewhere and then really approaching the patient by just, very quickly, trying to gather as much possible information through a combination of exam and history. Dr Berkowitz: Great. So, you're thinking about all these not-to-miss diagnoses that would be life-threatening for the patient and you're getting to the bedside. So, how do you approach the exam? Often, this is a different scenario than usual, where the patient's not going to be able to give us a history or maybe necessarily even participate in the exam, and yet, as you said, the stakes are high to determine if there are neurologic conditions playing into this patient's status. So, how do you approach a patient at the bedside? Dr Wahlster: So, I think first step in an ICU setting (especially if the patient has a breathing tube) is you think about any confounders (especially sedation or metabolic confounders) - you want to remove as soon as possible, if able. I think as you do the exam, you try to kind of incorporate snippets of the history and really try to see - you know, localize the problem. And also kind of see, you know, what is the time course of the deterioration, what is the time course of the presentation. And that is something I actually learned from you. I know you've always had this framework of “what is it, where is it?” But I think in terms of just a clinical exam, I would look at localizing signs. I think, in the absence of being able to do the full head-to-toe neuro exam and interact with the patient, you really try to look at the brainstem findings. I always look at the eyes right away and look at, I think, just things like, you know, the gaze (how is it aligned? is there deviation? is there a skew? what do the pupils look like? [pupillary reactivity]). I think that's usually often a first step - that I just look at the patient's eyes. I think other objective findings, such as brainstem reflexes and motor responses, are also helpful. And then you just look whether there's any kind of focality in terms of - you know, is there any difference in size? But I think those are kind of the imminent things I look at quickly. Dr Berkowitz: Fantastic. Most of the time, this evaluation is happening kind of en route to the CT scanner or maybe a CT has already happened. So, let's say you're seeing a patient who's found down, the CT has either happened or you asked for it to happen somewhat quickly after you've done your exam, and let's say it's not particularly revealing early on. What are the sort things on your exam that would then push you to think about an MRI, a lumbar puncture, an EEG? You and I both spend time in large community hospitals, right, where “found down” is one of the most common chief concerns. In many cases, there isn't something to see on the CT or something obvious in the initial labs, and the question always comes up, “Who gets an MRI? Who gets an LP? Who gets an EEG?” - and I'm not sure I have a great framework for this. Obviously, you see focality on your exam, you know you need to look further. But, any factors in the history or exam that, even with a normal CT, raise your suspicion that you need to go further? Dr Wahlster: It's always a challenge, especially at a community hospital, because some of these patients come in at 1 AM where the EEG is not imminently available. But I think - let's say the CT scan is absolutely normal and doesn't give me a cause, but as an acute concerning deterioration, I think both EEG and LP would cross my mind. MRI I kind of see a little bit as a second-day test. I think there's very rare situation where an acute MRI would inform my imminent management. It's very informative, right, because you can see very small-vessel strokes. We had this patient that actually had this really bad vasculitis and we were able to see the small strokes everywhere on the MRI the day later, or sometimes helps you visualize acute brainstem pathology. But I think, even that - if you rule out a large-vessel occlusion on your CTA, there's brainstem pathology that is not imminently visible on the CT - it's nothing you need to go after. So, I do think the CT is a critical part of that initial eval, and whereas I always admire the neurological subspecialties, such as movements, where you just – like, your exam is everything. I think, to determine these acute time-sensitive interventions, the CT is key. And also, seeing a normal CT makes me a little less worried. You always look at these “four H” (they're big hypodensity, hyperdensity, any shift; is there hydrocephalus or herniation). I think if I don't have an explanation, my mind would imminently jump to seizure or CNS infection, or sometimes both. And I think then I would really kind of - to guide those decisions and whether I want to call in the EEG tech at 2 AM - I would, you know, again, look at the history and exam, see if there's any gaze deviation, tongue biting, incontinence - anything leading up towards seizure. I think, though, even if I didn't have any of those, those would strengthen my suspicion. If I really, absolutely don't have an explanation and the patient off sedation is just absolutely altered, I would still advocate for an EEG and maybe, in the meantime, do a small treatment trial. And I think with CNS infection - obviously, there are patients that are high risk for it - I would try to go back and get history about prodromes and, you know, look at things like the white count, fevers, and all of that. But again, I think if there's such a profound alteration in neurologic exam, there's nothing in the CT, and there's no other explanation, I would tend to do these things up front because, again, you don't want to miss them. Dr Berkowitz: Yeah, perfect. So many pearls in there, but one I just want to highlight because I'm not sure I've heard the mnemonic - can you tell us the four Hs again of sort of neurologic emergencies on CT? Dr Wahlster: Yeah. So, it's funny; for ages - I'm actually not sure where that's coming from, and I learned it from one of my fellows, one of our neurocritical care fellows - he's a fantastic teacher and he would teach our EM and anesthesia residents about it and his approach to CT. But yeah, the four H - he was always kind of like, “Look at the CT. Do you see any acute hypodensities, any hyperdensities?” And hypodensities would be involving infarct or edema; hyperdensities would be, most likely, hemorrhage (sometimes calcification or other things). Then, “Do you see hydrocephalus?” (because that needs an intervention). And, “Look at the midline structures and the ventricles.” And then, “Do you see any signs of herniation?” And he would go through the different types of herniation. But I thought that's a very good framework for looking at the “noncon” and just identifying critical pathology that needs some intervention. Dr Berkowitz: Yeah – so, hypodensity, hyperdensity, herniation, hydrocephalus. That's a good one – the four Hs; fantastic. Okay. So, a point that comes up a few times in your article - which I thought was very helpful to walk through and I'd love to pick your brain about a little bit – is, which patients need to be intubated for a neurologic indication? So, often we do consultations in medical, surgical ICUs; patients are intubated for medical respiratory reasons, but sometimes patients are intubated for neurologic reasons. So, can you walk us through your thinking on how to decide who needs to be intubated for the concern of depressed level of consciousness? Dr. Wahlster: It's an excellent question, and I think I would bet there's a lot of variation in practice and difference in opinion. There was actually the 2020 ESICM guidelines kind of commented on it, and those are great guidelines in terms of just intubation, mechanical ventilation of patients, and just acknowledging how there is a lack of really strong evidence. I would say the typical mantra (“GCS 8, intubate”) has been proposed in the trauma literature. And at some point, I actually dug into this to look behind the evidence, and there's actually not as much evidence as it's been put forth in guidelines and that kind of surprised me - that was just recently. I was like, “Actually, let me look this up.” I would say I didn't find a ton of strong evidence for it. I would say, as neurologist – you know, I'm amazed because GCS, I think is a - in some ways, a good tool to track things because it's so widely used across the board. But I would say, as neurologists, we all know that it sometimes doesn't account for some sort of nuances; you know, if a patient is aphasic, if a patient has an eyelid-opening apraxia - it can always be a little confounded. I'm amazed that GCS is still so widely used, to be frank. But I would say there is some literature - some school of thought - that maybe just blindly going by that mantra could be harmful or could not be ideal. I would say – I mean, I look at the two kind of functional things: oxygenation and ventilation. I think, in a neuro patient, you always think about airway protection or the decreased level of consciousness being a major issue (What is truly airway protection? Probably a mix of things). Then there's the issue of respiratory centers and respiratory drive - I think those are two issues you think about. But ultimately, if it leads to insufficient oxygenation - hypoxia early on is bad and that's been shown in several neurologic acute brain injuries. I think you also want to think about ventilation, especially if the mental status is poor to the point that the PCO2 elevates, that could also augment an ICP or exacerbate an ICP crisis. Or sometimes, I think there's just dysregulation of ventilation and there's hyperventilation to the point that the PCO2 is so low that I worry about cerebral vasoconstriction. So, I worry about these markers. I think, the oxygenation, I usually just kind of initially track on the sats. Sometimes, if the patient is profoundly altered, I do look at an arterial blood gas. And then there are things like breathing sounds (stridor, stertor [the work of breathing]). And I think something that also makes me have a lower threshold to intubate is if I'm worried and I want to scan, and I'm worried that the patient can't tolerate it - I want an imminent scan to just see why the patient is altered, or seizing, or presenting a certain way. Dr Berkowitz: All great pearls for how to think through this. Yeah - it's hard to think of hard and fast rules, and you can get to eight on the GCS in many different ways, as you said, some of which may not involve the respiratory mechanics at all. So, that's a helpful way of thinking about it that involves both the mental state, kind of the tracheal apparatus and how it's being managed by the neurologic system, and also the oxygen and carbon dioxide (sort of, respiratory parameters) – so, linking all those together; that's very helpful. And, related question – so, that's sort of for that patient with central nervous system pathology, who we're thinking about whether they need to be intubated for a primary neurologic indication. What about from the acute neuromuscular perspective (so, patients with Guillain-Barré syndrome or myasthenic crisis); how do you think about when to intubate those patients? Dr Wahlster: Yeah, absolutely - I think that's a really important one. And I think especially in a patient that is rapidly progressing, you always kind of think about that, and you want them in a supervised setting, either the ER or the ICU. I mean, there's some scores - I think there's the EGRIS score; there's some kind of models that predict it. I would say, the factors within that model, and based on my experience, often the pace of progression of reflex motor syndrome. I often see things like, kind of, changes in voice. You know, myasthenia, you look at things like head extension, flexion - those are the kind of factors. I would say there's this “20/30/40 rule” about various measures of, like, NIF and vital capacities, which is great. I would say in practice, I sometimes see that sometimes the participation in how the NIF is obtained is a little bit funky, so I wouldn't always blindly go by these numbers but sometimes it's helpful to track them. If you get a reliable kind of sixty and suddenly it drops to twenty, that makes me very concerned. But I would say, in general, it's really a little bit the work of breathing - looking at how the patient looks like. There's also (at some point) ABG abnormalities, but we always say, once those happen, you're kind of later in the game, so you should really - I think anyone that is in respiratory distress, you should think about it and have a low threshold to do it, and, at a minimum, monitor very closely. Dr Berkowitz: Yeah, we have those numbers, but so often, our patients who are weak, from a neuromuscular perspective, often have facial and other bulbar weakness and can't make a seal on the device that is used to check these numbers, and it can look very concerning when the patient may not, or can be a little bit difficult to interpret. So, I appreciate you giving us sort of the protocol and then the pearls of the caveats of how to interpret them and going sort of back to basics. So, just looking at the patient at the bedside and how hard they are working to breathe, or how difficult it is for them to clear their secretions from bulbar weakness. Moving on to another topic, you have a really wonderful section in your article on detecting clinical deterioration in patients in the neuro ICU. Many patients in the neuro ICU - for example, due to head trauma or large ischemic stroke or intracerebral hemorrhage, subarachnoid hemorrhage, or status epilepticus - they can't communicate with us to tell us something is getting worse, and they can't (in many cases) participate in the examination. They may be intubated, as you said, sedated or maybe even not sedated, and there's not necessarily much to follow on the exam to begin with if the GCS is very low. So, I'd love to hear your thoughts and your pearls, as someone who rounds in the neuro-ICU almost every day. What are you looking for at the bedside to try to detect sort of covert deterioration, if you will, in patients who already have major neurologic deficits, major neurologic injury or disease that we're aware of? I'm trying to see if there is some type of difference at the bedside that would lead you to be concerned for some underlying change and go back to the scanner or repeat EEG, LP, et cetera. Dr Wahlster: Yeah. I think that's an excellent question because that's a lot of what we do in the neuro ICU, right? And when you read your Clans, your residency, like, “Ah, QNR neuro checks, [IG1]  ” right? We often do that in many patients. But I think in the right patient, it can really be life or death a matter, and it is the exam that really then drives a whole cascade of changes in management and detects the need for lifesaving procedure. I would say it depends very much on the process and what you anticipate, right? If you have, for example, someone with a large ischemic stroke, large MCA stroke, especially, right, then there's sometimes conversations about doing a surgical procedure before they herniate. But let's say, kind of watch them and are worried that they will, you do worry about uncal herniation, and you pay attention to the pupil, because often, if the inferior division is infarcted, you know, you can see that kind of temporal tickling the uncus already. And so, I think those are patients that I torture with those NPi checks and checking the pupil very vigilantly. I would say, if it's a cerebellar stroke, for example, right, then you think about, you know, hydrocephalus. And often patients with cerebellar stroke - you know, the beauty of it is that if you detect it early, those patients can do so well, but they can die, and will die if they develop hydrocephalus start swelling. But I think, often something I always like to teach trainees is looking at the eye movements in upgaze and downgaze because, often, as the aqueduct, the third ventricle gets compressed and there's pressure on the colliculi – you kind of see vertical gaze get worse. But I would say I think it's always good to know what the process is and then what deterioration would look like. For example, in subarachnoid hemorrhage, where you talk about vasospasm - it's funny - I think a really good, experienced nurse is actually the best tool in this, but they will sometimes come to you and say, “I see this flavor,” and it's actually a constellation of symptoms, especially in the anterior ACA (ACom) aneurysms. You sometimes see patients suddenly, like, making funky jokes or saying really weird things. And then you see that in combination with, sometimes, a sodium drop, a little bit of subfebrile temperature; blood pressure shoot up sometimes, and that is a way the brain is sometimes regulating. But it's often a constellation of things, and I think it depends a little on the process that you're worried about. Dr Berkowitz: Yeah, that's very helpful. You just gave us some pearls for detecting deterioration related to vasospasm and subarachnoid hemorrhage; some pearls for detecting malignant edema in an MCA stroke or fourth ventricular compression in a large cerebellar stroke. Patients I find often very challenging to get a sense of what's going on and often get scanned over and over and back on EEG, not necessarily find something: patients with large intracerebral hemorrhage (particularly, in my experience, if the thalamus is involved) just can fluctuate a lot, and it's not clear to me actually what the fluctuation is. But you're looking for whether they're developing hydrocephalus from third ventricular compression with a thalamic hemorrhage (probably shouldn't be seizing from the thalamus, but if it's a large hemorrhage and cortical networks are disrupted and it's beyond sort of the subcortical gray matter, or has the hemorrhage expanded or ruptured it into the ventricular system?) And yet, you scan these patients over and over, sometimes, and just see it's the same thalamic hemorrhage and there's some, probably, just fluctuation level of arousal from the thalamic lesion. How do you, as someone who sees a lot of these patients, decide which patients with intracerebral hemorrhage - what are you looking for as far as deterioration? How do you decide who to keep scanning when you're seeing the same fluctuations? I find it so challenging - I'm curious to hear your perspective. Dr Wahlster: Yeah, no - that is a very tricky one. I mean, unfortunately, in patients with deeper hemorrhages or deeper lesions - you know, thalamic or then affecting brainstem - I think those are the ones that ultimately don't have good, consistent airway protection and do end up needing a trach, just because there's so much fluctuation. But I agree - it's so tricky, and I don't think I can give a perfect answer. I would say, a little bit I lean on the imaging. And for example - let's say there's a thalamic hemorrhage. We recently actually had a patient - I was on service last week - we had a thalamic hemorrhage with a fair amount of edema on it that was also kind of pressing on the aqueduct and didn't have a lot of IVH, right? But it was, like, from the outside pushing on it and where we ended up getting more scans. And I have to say, that patient actually just did fine and actually got the drain out and didn't need a shunt or anything, and actually never drained. We put an EVD and actually drained very little. So, I think we're still bad at gauging those. But I think, in general, my index of suspicion or threshold to scan would be lower if there was something, like, you know, a lot of IVH associated, if, you know, just kind of push on the aqueduct. It's very hard to say, I think. Sometimes, as you get to know your patients, you can get a little bit of a flavor of what is within normal fluctuation. I think it's probably true for every patient, right? - that there's always some fluctuation within the realm of like, “that's what he does,” and then there's something more profound. Yeah, sorry - I wish I could give a better answer, but I would say it's very tricky and requires experience and, ideally, you really taking the time to examine the patient yourself (ideally, several times). Sometimes, we see the patient - we get really worried. Or the typical thing we see the ICU is that the neurosurgeons walk around at 5 AM and say, like, “She's altered, she's different, she's changed.” And then the nurse will tell you at 8 AM, like, “No, they woke up and they ate their breakfast.” So, I think really working with your nurse and examining the patient yourself and just getting a flavor for what the realm of fluctuation is. Dr Berkowitz: Yeah - that's helpful to hear how challenging it is, even for a neurocritical care expert. I'm often taking care of these patients when they come out of the ICU and I'm thinking, “Am I scanning these patients too much?” Because I just don't sort of see the initial stage, and then, you know, you realize, “If I'm concerned and this is not fitting, then I should get a CT scan,” and sometimes you can't sort it out of the bedside. So, far from apologizing for your answer, it's reassuring, right, that sometimes you really can't tell at the bedside, as much as we value our exam. And the stakes are quite high if this patient's developed intraventricular hemorrhage or hydrocephalus, and these would change the management. Sometimes you have these patients the first few days in the ICU (for us, when they come out of the ICU) are getting scanned more often than you would like to. But then you get a sense of, “Oh, yeah - these times of day, they're hard to arouse,” or, “They're hard to arouse, but they are arousable this way,” and then, “When they are aroused, this is what they can do, and that's kind of what we saw yesterday.” And yet, as you said, if anyone on the team (the resident, the nurse, the student, our neurosurgery colleague) says, “I don't think this is how they were yesterday,” then, very low threshold to just go back and get a CT and make sure we're not missing something. Dr. Wahlster: Exactly. Yeah. I would say the other thing is also certain time intervals, right? If I'm seeing a patient that may be in vasospasm kind of around the days seven to ten, for the first fourteen day, I would be a little bit more nervous. Or with swelling - acute ischemic stroke says that could peak swelling, when knowing which [IG2]  , I would just be more anxious or have a lower threshold to scan. Yeah. Dr Berkowitz: Yeah - very helpful. Well, thank you so much for joining me today on Continuum Audio. Dr Wahlster: Thank you very much, Aaron. Dr Berkowitz: Again, today we've been interviewing Dr Sarah Wahlster, whose article, “Examination and Workup of the Neurocritical Care Patient” appears in the most recent issue of Continuum, on neurocritical care. Be sure to check out Continuum Audio episodes from this and other issues. And thank you so much to our listeners for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practice. And right now, during our Spring Special, all subscriptions are 15% off. Go to Continpub.com/Spring2024 or use the link in the episode notes to learn more and take advantage of this great discount. This offer ends June 30, 2024. AAN members: go to the link in the episode notes and complete the evaluation to get CME. Thank you for listening to Continuum Audio.

Join us for a special Father's Day episode featuring the dynamic father-son duo, David and Andrew Olshine! They share their inspiring journey of writing and publishing the book Fearless As A Honey Badger, Brave Like A Wolverine. Learn about the lessons they've learned, the message of hope and resilience they aim to share with the world, and how Andrew's remarkable recovery from Guillain-Barré syndrome inspired him to write the book. They also discuss the inspiration behind the powerful quotes included in the book, drawn from movies, Eleanor Roosevelt, Nelson Mandela, and Bible verses. Enjoy an excerpt read by Andrew himself and hear about his plans for his next book. This is a fun and heartfelt episode you don't want to miss! ---- SHOW NOTES Get your copy of Fearless As A Honey Badger, Brave Like A Wolverine Follow David & Andrew on Instagram Get your copy of David's book Mystery Of Silence Check out Mercedes' recommendation: All Creation Waits JOIN THE MOVEMENT Join us in celebrating and supporting The Lucky Few Podcast! For just $0.99, $4.99, or $9.99 a month, you can help us continue shouting worth and shifting narratives for people with Down syndrome. Your support makes a difference in our ability to create meaningful content, enable us to cover production costs, and explore additional opportunities to expand our resources. Become an essential part of The Lucky Few movement today!  THANK YOU TO OUR SPONSOR: Thank you, Enable SNP for sponsoring this episode! 47. Planning for the Future w/Phillip Clark from Enable SNP 191. Future Planning for the WHOLE Family - ft. Phillip Clark, Enable SNP DISCOUNT CODE Friends, grab your narrative shifting gear over on The Lucky Few Merch Shop and use code PODCAST for 10% off! HELP US SHIFT THE NARRATIVE Interested in partnering with The Lucky Few Podcast as a sponsor? Email hello@theluckyfewpodcast.com for more information! LET'S CHAT Email hello@theluckyfewpodcast.com with your questions and Good News for future episodes. --- Send in a voice message: https://podcasters.spotify.com/pod/show/theluckyfewpod/message Support this podcast: https://podcasters.spotify.com/pod/show/theluckyfewpod/support

Publican Programa de Certificación Cero Residuos de Alimentos 2023 fue el año con mayor conflictos armados desde 1946 

On this week's listener series, we welcome Brittany. She found out they were pregnant in 2022 after dealing with several early losses. Nearing the end of her pregnancy, Brittany started to notice some symptoms that weren't normal and she was diagnosed with the flu - however, something felt off even after that. They returned to the hospital after she noticed her face was drooping and she was told that she had Guillain-Barré syndrome. Things escalated very quickly from there. Brittany shares her experience navigating a 10+ month healing journey that included learning how to eat, drink, and walk again. On this episode you will hear:- Early losses- Gestational diabetes- Guillain-Barré syndrome- Challenging postpartum- NICU stay for her son- 5-month hospital stay - Re-learning to eat again, drink again, walk If you have a birth trauma story you would like to share with us, click this link and fill out the form. For more birth trauma content and a community full of love and support, head to my Instagram at @birthtrauma_mama.Learn more about the support and services I offer through The Birth Trauma Mama Therapy & Support Services.

In the United States, more than 64 million men identify themselves as fathers.Yet, 7 million American dads are absent from the lives of their minor children, and 17.4 million children live in fatherless homes!Philip Lower, technically, grew up as one of these statistics.His biological father took his own life when Phil was five years old, leaving him with the question: "Why did Daddy have to leave me?"Five years later his mother met and married a wonderful man who became Phil's stepfather. But, it wasn't until until he was 25 that Phil stopped treating his stepdad as a “butthead,”– that was his own term.As an adult, Phil became dad to two daughters and worked for a Fortune 250 company managing leadership development and training for 2,000 employees. It seemed like everything was fine - but Fine is a 4-Letter Word.There was a reorganization and the development team got whacked – and in the meantime, Phil was diagnosed with Guillain–Barré syndrome.Due to his condition, he couldn't get another job, even as a Walmart greeter, for the same reason. He and his family ended up homeless for almost three years, with a period of time where they lived apart before he was able to figure out a way to afford to live with them in hotel rooms.Not only was he physically separated from his daughters, but because of the impact of Guillain–Barré on his nervous system, he couldn't even feel them when touching them on the cheek.For Phil and his daughters, as well his career, this experience led to a new beginning. The dad jokes he told to his girls turned into the first published Dad Quote of the Day book. The second book was a collection of recipes they developed in the kitchenette of their Extended Stay hotel room.Phil is now on an endeavor to translate concepts and principles of leadership and empathy into language kids can easily understand. From the Trees of Leadership sprung the Grandpa Owl series, which features a wise owl who teaches family values in a way that relates to historical events in a unique, holistic approach you've not seen before.Phil's hype song is "Strength of a Thousand Men" by Two Steps from Hell.Resources:Philip Lower's website: https://dqotd.com/welcome-to-grandpa-owl/ LinkedIn: https://www.linkedin.com/in/lowerphil Facebook: https://www.facebook.com/dadquoteoftheday Instagram: https://www.instagram.com/dadquoteoftheday To learn more about Granda Owl, e-mail Phil at grandpa@grandpaowl.com. Invitation from Lori:If, like Phil, you find yourself in a place where you either physically or metaphotically lose touch, the 5 Easy Ways to Start Living The Sabbatical Life guide can be the restorative vitamin that brings back the feeling.Once you read it, you'll ✅ Discover a counter-intuitive approach to making intentional changes in mindset and lifestyle.✅ Learn how to own your feelings and your struggles so you can address them.✅ Find out how to face fears, step out of your comfort zone, and rewire your beliefs.It's only 7 pages, so it won't take you long to get through. When you're ready to say F*ck Being Fine, this guide is the place to start. It's time to reach out and feel the power

Dr. Paul Alexander Liberty Hour – I delve into the complex aftermath of Pfizer's mRNA injection. Chronic myopericarditis, coagulopathy, and Guillain-Barré syndrome surface as haunting realities. Through a gripping case study, we unravel the intricate manifestations of post-acute COVID-19 vaccination syndrome. The journey of diagnosis and treatment unveils challenges and triumphs, urging heightened awareness in the realm of healthcare...

Seguro escucharon en las noticias sobre el aumento de casos de Síndrome de Guillain Barré en México, sobre todo en Tlaxcala, donde murieron 3 personas a causa de esta enfermedad. Hoy les traemos a un picudazo en el tema y por supuesto, el testimonio de una mujer que nos va contar su historia con esta enfermedad. Hosted on Acast. See acast.com/privacy for more information.

Fiscalía de Guerrero investiga homicidio de Ana, presunta secuestradora de CamilaTlaxcala suma 4 muertes por Guillain-Barré 

Travis opens up about his battle with Guillain-Barré syndrome - what it is, how & when he discovered he had it, what went through his mind before it was diagnosed, and his journey to recovery.

Controlan al 100% incendios en Huiloapan y Soledad Atzompa, en Veracruz Se incendia un barco en el puerto de Alvarado, Veracruz Autoridades de Guerrero afirman que no habrá impunidad en el caso de Camila 

Juan Carlos López Hernández, médico Neurólogo, especialista en Enfermedades Neuromusculares, trabaja en el Instituto Nacional de Neurología Dr. Manuel Velasco Suárez

Are you ready to become a healthier, stronger you? We're sharing a few secrets to help you reach this goal during today's podcast. Meet Kim Rahir: a former journalist turned health coach, and a true inspiration. Despite overcoming the challenges of Multiple Sclerosis and Guillain-Barré, Kim has risen to become a European Champion in Master Weightlifting. Kim's journey is not just about personal triumph; it's about empowering others, especially women, to embrace muscle and strength as a solution to various health issues. With her unique blend of experience and expertise, she transforms scientific knowledge about human health into practical, actionable steps to help others live their best lives. Join us for a conversation about building both muscle and resilience to improve your health and create the life you truly deserve. Subscribe & ReviewSubscribing and leaving a rating and review are important factors in helping the Reshape Your Health Podcast and the YouTube Channel reach more people. If you haven't already subscribed, please do that today.We would also be grateful if you left a rating and review, too. In your listening app, scroll to the “Ratings and Reviews” section, then click “Write a Review” and let us know what you enjoy about our show. We appreciate you taking the time to show your support. Thank you!Resources From This Episode>> Insulin Resistance Diet Starter Course>> Join Zivli>> Test Your Insulin at Home>> Free Low Insulin Food Guide>> Free Master Your Macros Training Videos>> Kim's Website

En aumento los casos de Guillain Barré en Tlaxcala Anuncian concurso de plazas de consultor al derechohabiente en el IMSS 

Rubén Rocha, gobernador de Sinaloa confirmó que 66 personas fueron secuestradas Tlaxcala confirma 3 muertes por Síndrome Guillain-Barré 

From Wheelchair To Weightlifting: Fighting MS With Strength and Resilience Click Here for a FREE 15 min Zoom Consultation With Brad: In this podcast interview between Brad Williams of Over 40 Fitness Hacks and Kim Rahir from Fabulous In 15, Kim shares her inspiring journey from being struck down by Guillain-Barré syndrome to living with multiple sclerosis (MS) and how weightlifting transformed her life. At 45, Kim thought she had achieved her life's pinnacle with a successful career and three children. However, she was suddenly paralyzed from the hip down due to Guillain-Barré syndrome. After a lengthy recovery, she was diagnosed with MS, a lifelong condition. Determined to regain control, Kim turned to weightlifting for both physical and mental strength. She embraced heavy lifting and experienced significant improvements in her physical and mental well-being. Despite ongoing challenges with MS, Kim found stability and confidence through her fitness journey. She emphasizes the importance of muscular strength for overall health and believes in its potential to positively impact immune system function. Kim's story highlights the transformative power of exercise, resilience, and maintaining a positive outlook in the face of adversity. Her journey serves as an inspiration for others, especially women over 40, facing similar health challenges. If you're interested in online personal training or being a guest on my podcast, "Over 40 Fitness Hacks," you can reach me at brad@over40fitnesshacks.com or visit my website at: www.Over40FitnessHacks.com Additionally, check out my Yelp reviews for my local business, Evolve Gym in Huntington Beach, at https://bit.ly/3GCKRzV

Gobernadores, Guillain-Barré y Comisión Presidencial del Congreso para ley Anticompetencia.

O Ministério da Saúde já conta mais de 500 mil casos da doença nas primeiras semanas desse de 2024 – desse total, são pelo menos 75 mortes confirmadas. O ano caminha para ser o pior de todos os tempos: o governo federal estima 4,2 milhões de registros, um salto de 2,5 vezes em relação a 2015, ano que detém o recorde de quase 1,7 milhão de casos. A doença tem como sintomas febre, dor nas articulações e dor de cabeça. Quando evolui para dengue hemorrágica há riscos de lesão no fígado e no cérebro. Os perigos da doença, contudo, podem aparecer no longo prazo e se manifestar em efeitos neurológicos: a neurologista Marzia Puccioni alerta que entre 1% e 20% dos pacientes da dengue podem desenvolver encefalite (inflamação no cérebro), mielite (inflamação na medula), meningite (inflamação na meninge) e até síndrome de Guillain-Barré (quando o sistema imunológico ataca parte do sistema nervoso). Para explicar todos esses riscos, Marzia Puccioni, que também é professor da Escola de Medicina da Unirio e da pós-graduação em doenças infeccionais e parasitárias da UFRJ, é a convidada de Natuza Nery neste episódio.

This episode covers Guillain-Barré syndrome.Written notes can be found at https://zerotofinals.com/medicine/neurology/guillainbarre/ or in the neurology section of the 2nd edition of the Zero to Finals medicine book.The audio in the episode was expertly edited by Harry Watchman.

La tertulia semanal en la que repasamos las últimas noticias de la actualidad científica. En el episodio de hoy:Cara B:-Argumentos contra la presencia de atmósferas en Trappist-I (00:00)-La causa autoinmune del síndrome de Guillain-Barré (en algunos pacientes) (38:12)-El agujero negro de Markarian 817 observado por XMM-Newton and NuSTAR (1:05:02)-Enormes agujeros negros (que son pequeños puntos rojos) en 4

Dr. Gordon Smith and Prof. Mike Lunn discuss the relationship between COVID-19 vaccinations and Guillain-Barré syndrome using the National Immunoglobulin Database. Read the related article in BRAIN.

Dr. Gordon Smith talks with Prof. Mike Lunn about the relationship between COVID-19 vaccinations and Guillain-Barré syndrome using the National Immunoglobulin Database. Read the related article in Brain.  Disclosures can be found at Neurology.org.

Dr. Gordon Smith talks with Dr. Haya Bishara about the association between GBS and both SARS-CoV-2 infection and the COVID-19 vaccine. Show references: https://n.neurology.org/content/early/2023/10/18/WNL.0000000000207900

Dr. Gordon Smith talks with Dr. Haya Bishara about the association between GBS and both SARS-CoV-2 infection and the COVID-19 vaccine. Read the related article in Neurology. Disclosures can be found at Neurology.org.