Podcasts about ICU

In this episode of Oh My Heath ... There's HOPE! Jana talks with Julie DeLucca-Collins.   In a moment of grief and fear, Julie DeLucca-Collins finds the courage to face the unknown and launches Go Confidently Services, inspiring women business owners to take action and create simple habits to achieve their dreams.   "No matter where you are in your life, you have done the things that allow you to be who you are, and there is always that ability to really dig deep for that inner strength, that inner wisdom that carries us even when we feel that we can't do it." - Julie DeLucca-Collins.   Julie DeLucca-Collins is the founder and CEO of Go Confidently Services and the host of the popular Casa Deconfidence podcast. She is a business and life strategist coach who helps women business owners launch or grow their businesses, get clients, and achieve their dreams. Julie DeLucca-Collins was devastated when she found out her father was in the ICU with a rare blood disorder. Despite the hopelessness of the situation, Julie found strength in being present and facing her fears. This experience taught her that no matter what challenges life brings, she has the inner strength to face them. This pushed her to launch her business, Go Confidently Services, to help women business owners launch or grow their businesses, get clients to be productive, and achieve their dreams. Julie also hosts the popular Casa Decompetence podcast and Confident You radio show to share her story of hope and help others create simple habits to achieve goals and change their lives. Through her podcasts, Julie has created a powerful support group of women and men who lift each other up and help promote     In this episode, you will learn the following: Discovering inner strength and resilience in the face of a family tragedy Exploring the power of tiny habits to build confidence and achieve goals Recognizing the importance of a supportive community and legacy in business success.     Loved this episode? Leave us a review and rating at: https://podcasts.apple.com/us/podcast/oh-my-health-there-is-hope/id1477858454     The Casa DeConfidence Podcast: https://podcasts.apple.com/us/podcast/casa-deconfidence-podcast/id1510255268   Get in touch with Julie: Www.GoConfidentlyCoaching.com https://www.instagram.com/julie_deluccacollins/ https://www.facebook.com/jdelucca https://www.linkedin.com/in/goconfidentlyjulie/   Julie's Free Offer: Individuals wanting to learn more about Tiny Habits and increase their confidence can sign up here to get the free 5-day program. https://www.goconfidentlycoaching.com/quicklinks     Get in touch with Jana and listen to more Podcasts: https://www.janashort.com/   Show Music ‘Hold On' by Amy Gerhartz https://www.amygerhartz.com/music.   Get Your Free Copy of Best Holistic Life Magazine! One of the fastest-growing independent magazines centered around holistic living. https://www.bestholisticlife.com/ Grab your gift today: https://www.janashort.com/becoming-the-next-influencers-download-offer/ Connect with Jana Short: https://www.janashort.com/contact/

Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track! Check out today's questions:    Victoria: Hello Dr Cabral I want to thank you for the wonderful vitamins - I'm about to get a tooth implant Do you think holistic is the best ? What do you suggest ?   Laura: Hi Dr. Cabral - I've followed you for many years now, and need your advice. I am a healthy, 37 year old female who practices your foundational protocol along with quarterly detoxes. I had a routine laparoscopic surgery for endometriosis, and two days later was admitted to the hospital with septic shock due to Strep A in my uterine lining (found during surgery and biopsied) which turned systemic. Very long story short, I'm dealing with a whole host of issues in the ICU. This is very rare, and I'm on many different intense antibiotics and have developed an illeus in my colon. You won't see this until I'm released from hospital, but I'm wondering where to start to rebuild my system and repopulate my gut and build a healthy immune system. Any advice is appreciated!   Chelsea: Hello! I have a recurring blockage in my bowel on the lower right side (as in, my actual right side, not the right side if you were looking at me, so ascending colon I believe?). It comes and goes depending on the week. I've done many quarterly detoxes, intestinal cleanses, gall bladder cleanse, CBO twice, and it seems to keep coming back. I've worked with my health coach but am still struggling to understand why. I could still be eliminating daily, but it seems something is stuck and causes some bloating, pain, etc. Do you know what could be causing this? Sometimes I think it may be when I eat too much fat but overall my diet, supplementation, and hydration is healthy and stable. Thank you!   Anonymous: Dr. Cabral, I have an odd observation I was wondering if you could explain. When I sit in the sauna after lifting weights, the left side of body body sweats considerably more than the right side, being most notable on my arms. Is there something to this or am I just simply a left-handed sweater (if such a thing exists)? Thanks again for the time and continuing to stimulate my curiosity.   Pam: Hi Dr Cabral! A big thank you for all the valuable information you share. I've learned so much from listening to your podcast. My question is the following: My husband (60 yrs old) has lost the hair on his legs from the knee down. This area is also red. He doesn't mention any other symptoms (like pain or itching). He tells me the doctor told him that it's nothing to be worried about and that this sometimes happens as we age. My feeling is that his body is trying to tell him something. What do you think could possibly be causing this? Thank you so much!   Laurie: Can you discuss progesterone resistance? I am menopausal, estrogen dominant and had a partial hysterectomy. Bio identical progesterone of any kind makes my symptoms worse and disrupts my sleep. Most supplements to boost progesterone are for pre menopausal. Also, I was born with one kidney so I only have one adrenal gland. Thanks Laurie   Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community's questions!      - - - Show Notes and Resources: StephenCabral.com/2605 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

A Colorado Dentist charged with murder, accused of poisoning his wife, mother of their 6 children. Police say James Craig bought arsenic and cyanid, and secretly poisoned his wife's protein shakes. Angela Craig had made many recent hospital visits,  and checked into a hospital again,  complaining of a severe headache and dizziness. Around 2pm she had a seizure. Craig was then moved to ICU and placed on life support. Her condition quickly declined and she died.  After Craig's death, one of James Craig's co-workers told a nurse that the dentist had ordered potassium cyanide which was delivered to the office. There was no medical reason for the order. Police seized the husband's computer and found disturbing searches. It also came to light that James Craig had multiple affairs and a longstanding addiction to pornography, authorities said. Joining Nancy Grace today: Jarrett Ferentino - Pennsylvania prosecutor and principal at Pugliese, Finnegan, Shaffer & Ferentino, Facebook & Instagram: Jarrett Ferentino Dr. Chloe Carmichael PhD - Clinical Psychologist,, Author: ‘Nervous Energy: Harness The Power of Your Anxiety”, Twitter: @DrChloe, drchloe.com  Christopher Byers - former Police Chief Johns Creek Georgia, 25 years as Police Officer, now Private Investigator and Polygraph Examiner with Lancaster Information services in Atlanta, lancasterservices.com Dr. Maneesha Pandey  - Chief Forensic Pathologist for the Forensic Pathologists LLC in Ohio, Board certified forensic pathologist, theforensicpathologist.com  Jen Smith - Chief Reporter for DailyMail.com, Twitter: @Jen_e_smith   See omnystudio.com/listener for privacy information.

This is a bit of a tough episode for John and Darren, who recorded this one without their good friend, Andy Eide, who collapsed at the Kraken game Saturday. As of the posting of this episode, Andy remains in ICU, recovering from a stroke. So, John and Darren give some background on what has been going on on that front, share their favorite memories of their ongoing friendship with Andy, and give thanks for the incredible outpouring of support from the hockey community. That discussion lasts for about the first 17 minutes of the episode, so if you want to get to the more lighthearted stuff, you can jump ahead to that point in the episode. The guys hope you'll hang around, though, because there's some good, emotional conversation in there. Once they get through that, John and Darren shift their focus to hockey talk, because that's what Andy would want. So, they talk about the latest Kraken games against San Jose, Edmonton, and Dallas. Once they walk through those games, they go "Down on the Farm," where the Coachella Valley Firebirds have clinched a playoff spot in their first season. They then discuss the recent Wisconsin women's win of the NCAA tournament and the men's NCAA hockey bracket being released. Finally, they shift to segments, which this week include Bad Boys, Weekly One-Timers, Tweets of the Week, and Three Stars. SUBSCRIBE! ENJOY! REVIEW!

 I had so much fun talking with school nurse, Victoria Gutierrez! Honestly, I was enchanted by her excitement and enthusiasm, and I know you will be too. The skills she learned as an ICU nurse: critical thinking, organization, and delegation, have served her well in her role as a school nurse. Although she misses the acuity of the ICU, she's not missing out on the joy she has found in this niche nursing specialty. She schools us in the education required, responsibilities, challenges, and rewards, oh, and don't forget that awesome schedule! Her advice for those who are curious about school nursing? Try subbing part-time as she did, before you commit to becoming credentialed. I'd say that's a pretty good lesson.  In the five-minute snippet, get that garden growing girl! For Victoria's bio, visit my website (link below).Recognizing School NursesProfessional organizations: California School Nurses OrganizationNational Association of School NursesSchool Nurses of California FoundationContact The Conversing Nurse podcastInstagram: https://www.instagram.com/theconversingnursepodcast/Website: https://theconversingnursepodcast.comGive me feedback! Leave me a review! https://theconversingnursepodcast.com/leave-me-a-reviewWould you like to be a guest on my podcast? Pitch me! https://theconversingnursepodcast.com/intake-formCheck out my guests' book recommendations! https://bookshop.org/shop/theconversingnursepodcast Email: theconversingnursepodcast@gmail.comThank you and I'll see you soon!

On episode #24 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the previous two weeks, 3/1 – 3/22/23. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of Puscast! Links for this episode Re-emergence of Parechovirus: 2017-2022 national trends of detection in CSF (OFID) Screening and testing for hepatitis B virus infection (CDC) Changing epidemiology of carbapenemases among carbapenem-Resistant Enterobacterales (OFID) Comparison of a short vs long-course antibiotic therapy for ventilator-associated pneumonia (eClinicalMedicine) The impact of timing of infectious disease consultation for Staphylococcus aureus bacteremia (CID) Intravenous doxycycline, azithromycin, or both for severe scrub typhus (NEJM) Cronobacter sakazakii infections in two infants linked to powdered infant formula and breast pump equipment (CDC) Piperacillin/tazobactam vs cefepime or carbapenems for cefoxitin-non-susceptible bacteraemia in immunocompromised patients (JAC) Positive impact of [18F) FDG-PET/CT on mortality in patients with Staphylococcus aureus bacteremia (CID) Association of antibody immunity with cryptococcal antigenemia and mortality in a South African cohort with advanced HIV (CID) Practical guide to antifungal susceptibility testing (JPIDS) Risk of COVID-19 associated pulmonary aspergillosis based on corticosteroid duration in ICU patients (OFID) Emergence and Persistence of Candida auris in Western New York with no epidemiologic links (OFID) Music is by Ronald Jenkees

In this episode the Critical Care BTK Team tackles nutrition in the ICU. High-yield journal articles will be presented, discussed, and reviewed. ICU nutrition myths will be busted, and listeners will learn about enteral nutrition, parenteral nutrition and other ICU nutrition pearls. References 1.         Casaer, M.P., et al., Early versus Late Parenteral Nutrition in Critically Ill Adults. New England Journal of Medicine, 2011. 365(6): p. 506-517. 2.         Compher, C., et al., Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 2022. 46(1): p. 12-41. 3.         McClave, S.A., et al., Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient. Journal of Parenteral and Enteral Nutrition, 2016. 40(2): p. 159-211. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Surgical Critical Care episodes here: https://behindtheknife.org/podcast-category/surgical-critical-care/

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!_____________________________________________________________________________________Show notes, articles, and CME form can be found on our website: http://www.the-incubator.org/117/

This week on the podcast, Dr. Jack Cush recalls what life was like early on during COVID, March 2020, when his close friend, Larry, contracted COVID-19 and was hospitalized, intubated and put on mechanical ventilation in the ICU.  This is the preamble to the "Miracle Larry" story that will be told by Larry Kelly himself, the keynote speaker at RheumNow Live 2023 on Saturday March 18th. Come here Miracle Larry at RNL23.  https://rheumnow.live/rheumnow/ You can also read about Miracle Larry here: Faith  https://rheumnow.com/blog/faith NY Times: "51 Days on a Ventilator: How ‘Miracle Larry' Survived"  https://www.nytimes.com/2020/07/17/nyregion/coronavirus-ventilator-survivor.html

Sepsis in other words ‘life-threatening organ dysfunction' in response to infection is a leading cause of death worldwide and a global health priority recognised by the World Health Organisation. In Australia, for adults with sepsis admitted to the intensive care unit, the in-hospital mortality is estimated as 18–27%. Early recognition of sepsis, prompt administration of antibiotics and resuscitation with intravenous fluids for those with features of hypoperfusion or shock are the mainstays of initial treatment. Emergency departments often being the first point of contact for patients presenting with sepsis, are required to prioritise sepsis as a medical emergency. The “Sepsis Kills” program implemented across the nation aims to reduce unwarranted clinical practice variation in management of sepsis.   In a recent Australian based study conducted across four emergency departments in Western Sydney Local Health District, among 7533 patients with suspected infection, a reduction in risk of in-hospital mortality was observed for each 1000 mL increase in intravenous fluids administered in patients with septic shock or admitted to ICU. However, despite evidence showing mortality benefits, not all aspects of sepsis care have been given the needed attention. In the same setting, out of 4146 patients with sepsis, 45% of them did not receive intravenous fluids in the emergency departments within the first 24 hours. Younger patients with greater severity of illness and presented to smaller hospitals were more likely to receive fluids.    The unanswered questions regarding the facilitators and barriers influencing intravenous fluid administration in sepsis are being explored using qualitative methods. Several emergency physicians and nurses have provided insight into aspects that influence their ability to provide appropriate fluid resuscitation such as constantly overcrowded emergency departments with chronic staff shortages of skilled health professional, failure to recognise sepsis early, the complexity of the presentations and lack of resources. Awareness of these challenges among stakeholders is the need of the hour. Leaving no one behind and not disregarding the critical aspects of sepsis care are crucial. Recognition of these factors and sustainable interventions are necessary to improve clinical outcomes for patients.   For more head to our podcast page #CodaPodcast

Disclaimer, we are not giving medical advice, when looking into alternative health methods please do your own research and find what resonates with you. Karen :lucyk macdonald is a Clan Mother and uses Quantum Healing modalities to bring you health and wellness -- geniusbiofeedback.com/genius-mini-course (QBS, CHT, CBS,PEMF SCALAR RIFE RADIONICS) quantum medicine IQUIMuniversity speciality biofeedback (natural health training includes: biowarfare, herbology, aromatherapist, massage, vita-reflexology, sclera -iridology, kinesiology, matrix energy medicine reiki, prana, yoga, heirloom gardening, shaman, alchemy, crystal, spring water protection arrived in kamloops (1964), grew up in saskatoon, studied interior decorating saskatoon (1980-87), attending university of saskatchewan (1982), miss saskatoon runner up 1982, SIAST kesley technical college of nursing (1987), registered nurse & nurses union representative royal university hospital( NICU neo-natal ICU/post partum (1987-2001), passionately persuing freedom & peace, protection of children in courts from 1987 to the present from mind control MK ultra. the unlawful abductions of tribal/klan and international star nation children, removal of vaccines, SMART meters, non taxation, questioning and refusal to submit to the draconian illuminati judges and lawyers in the saskatoon saskatchewan canada provincial and queens bench courts led to her having her wrist broken in a court room by a sheriff, gained a following despite a news media black out on her & her children cases before the corpus juris secondum judges that had no jurisdication on her as a lan-tribe mother with higher authority and having them understand her openly now accepting & validating her position such as tribunal judge alfred webre. :karen also does in depth de colonization of her clients including off grid teaching up on reserves coast to coast and uses spring living photonic sound water as a healing in enemas, colon hydrotherapy with plant ormus minerals, scalar rife radionics and magnetics, the newest yoni-lingham (root chakra earth shattering, third eye opening peri prostate rezum/vaginal steams/pearl herb suppositories to tampons once hidden secret for emotional to sexual and ritual PSTD for chelation. radiation and now developing excellent water infusion protocols with dr. ariel policano ND and ryan william, pattie brassard tackling vaccine damage to lyme and morgellons with success. recently researching and developing LYME tick and venom virus anti dotes on a simple Iphone/pad/tab app called a GENIUSbiofeedback using sound & biophotonic scalar rife and cymatics solfeggio tera hertz as a pulsed electronic magnetic radio wave PEMF and dismantling it. https://www.facebook.com/karen.a.macdonald.1 if you found this content beneficial please consider donating: buymeacoffee.com/typicalskeptic Or maybe Join the Patreon for bonus content New Unreleased shows every week for less than a cup of coffee: Help me keep making videos! patreon.com/typicalskeptic Check out what I'm selling: Typical skeptic podcast t shirts: https://merc.li/KmGQPE9Nb?sv=0 For more typical skeptic podcast interviews go to: www.youtube.com/c/typicalskeptic www.anchor.fm/typical-skeptic www.rokfin.com/typicalskeptic www.rumble.com/typicalskeptic Affiliates: Tachyon Living - tachyonliving.com/rob.html and use code skeptic free gift for a free gift -Book a reading with Debra Moffit Intuitive readings:Use Code TSP2023 https://www.debramoffitt.com?cc=STP2023 -Natural Shilajit and Monoatomic Gold from Healthy Nutrition LLC.use code: ROB And my affiliate link to share: https://glnk.io/77v6/3 -Starseed Activators https://www.indigoangel222.com/starseed-activators?ref=GdvC0Vib Coupon Code TypicalSkepticP #quantum #biofeedback #consciousness #spirituality #healing #podcast #typical_skeptic #youtubepremiere --- Send in a voice message: https://anchor.fm/typical-skeptic/message Support this podcast: https://anchor.fm/typical-skeptic/support

Physiotherapists form a key part of the multi-disciplinary team in the Intensive Care, focusing on both respiratory care and optimisation of function. This talk will discuss the role of physiotherapy across the continuum specifically in the management of an acutely unwell septic patient. I will discuss the focus of a physiotherapy assessment, main treatment aims, some of the barriers for the implementation of physiotherapy in ICU, while identifying strategies to enable appropriate application of physiotherapy techniques. For more head to our podcast page #CodaPodcast

What should you do before CRNA? In today's episode, Colby W., a CSBA Community Member, sits with Jenny Finnell to gather insights on the steps before nursing school for CRNA. Jenny shares that you need to get practical hands-on experience as a nurse's aide, especially in ICU, to avoid having problems after graduation. Colby and Jenny also get to touch on extracurriculars, and as Jenny suggests, student organizations are not the only a good starting place to add to your resume but also outside the hospital. Join Colby and Jenny Finnell as they trek the path to prepare you for CRNA.Get access to planning tools, mock interviews, valuable CRNA Faculty guidance, and mapped-out courses that have been proven to accelerate your CRNA success! Become a member of CRNA School Prep Academy here!https://www.crnaschoolprepacademy.com/joinBook a mock interview, personal statement, resume and more at http://www.NursesTeachNurses.comJoin the CSPA email list here! https://www.cspaedu.com/podcast-emailSend Jenny an email or make a podcast request!Hello@CRNASchoolPrepAcademy.com

Brian sits with Dr. Kwadwo Kyeremanteng, an ICU Physician, and Head of the ICU Department, who also has a background in palliative care. Working on research into ways to make the healthcare system more sustainable, Dr. Kwadwo created the Resource Optimization Network and hosts the Solving Healthcare podcast. In his work Dr. Kwadwo noticed the relationship between metabolic syndrome or other underlying chronic conditions and covid outcomes. Following this, he took up a mission to empower patients with tools and knowledge to make healthy life choices that prevent and even reverse these diseases.   GET THE MEAT http://NosetoTail.org FREE SAPIEN FOOD GUIDE http://sapien.org   SHOW NOTES: (07:43) Facing the pandemic, Dr. Kwadwo's mission was to inform people about crucial factors that affect covid outcomes. (16:40) Many doctors are also struggling to balance their work with healthy living (19:35) How do doctors respond to the newer dietary recommendations as against the typical nutritional training? (17:34) The rigidity of doctors, whether due to ego or fear of being wrong, played out negatively in the pandemic. (24:57) Dr. Kwadwo has seen no case of a healthy patient ending up in the ICU due to covid-19. (35:53) The protein hack. (46:55) How can all these health strategies be passed across to the larger public? (54:00) How do families implement these changes?   GET THE MEAT http://NosetoTail.org FREE SAPIEN FOOD GUIDE http://sapien.org   Follow along: http://twitter.com/FoodLiesOrg http://instagram.com/food.lies http://facebook.com/FoodLiesOrg  

Sepsis is a common presentation in the prehospital and retrieval environment, with most cases having a respiratory, urinary or soft tissue origin. However the best practice for identifying and management sepsis in the prehospital environment remains unclear.  Despite sepsis having been a priority for in hospital guidelines and protocols for decades now, relatively little attention has been paid to prehospital sepsis management. Traditional teaching is that early antibiotics in sepsis save lives, however trials examining this are observational and confounded by outdated ICU care. An appropriately sensitive and specific tool for the prehospital identification of sepsis remains elusive. NEWS2 is common and lactate-modified QSOFA emerging (although prehospital lactate measurement remains difficult). The role of prehospital antibiotics, and the most appropriate one are also unclear. Most ambulance services that carry antibiotics use ceftriaxone. The retrieval environment is similar, with sepsis probably being the single commonest reason to call a retrieval service.   For more head to our podcast page #CodaPodcast

My guest on today's walk has experienced burnout personally and has been on a multi-year journey of healing and compassion that brought her back together again.  Avery Thatcher is the CEO and founder of The Truth About Burnout Podcast and the Flow State Membership. When she started her career as a Registered Nurse working in the ICU she noticed that the majority of the reasons people found themselves in the ICU were because of illnesses and diseases that could be linked to chronic stress. She decided to get out of the reactive side of medicine and now helps highly sensitive high achievers prevent burnout and reverse the negative health effects of stress.  After experiencing a significant change of health and severe burnout in 2018, Avery had to learn to redefine her identity and grieve the loss of who she used to be. Now she shares her story openly to help others realize that they are not alone in their struggles and talk about the strategies that helped her heal along the way. I sit down with Avery to reflect on the dichotomous way of living, the importance of compassion in her own healing, how she came to terms with the sick and hurt side of her personality and turned her health around. In This Episode (05:55) – Reflecting on the dichotomous way of living. (08:35) – The red flag of a toxic ICU. (12:09) – How Avery started to numb out.   (15:06) – My experiences with burning out. (21:40) – Going through the five stages of grief in two years. (23:39) – Coming to terms and working out stuff with the sick Avery. (27:32) – On changing her name and telling her family. (35:31) – Asking yourself: What do I actually need? (37:13) – Measuring achievement in terms of impact and creating. (42:25) – Discussing labels and satisfying an underlying need. (44:49) – Bringing awareness around differing values. (48:51) – Returning to the wholeness and fullness of who we are. (52:07) – The role of compassion in Avery's journey. (57:47) – What makes suffering so challenging? Notable Quotes “This is still a part of me and all of me deserves compassion. And then I wrote to this part of me that is sick. This part of me that is disabled, this part of me that is keeping me from who I used to be, who I identified as. And I said, I love you. Let's figure this out. You are along for the ride. I'm going to work with you rather than against you. And it was at that moment that I realized that I needed to somehow create a fresh start.” – Avery (24:32) “Compassion and authenticity aren't an end goal. They're not an outcome. They are a path themselves that's creating. When we create with the same energy that we want in the outcome, that's how we actually get the outcome. Both Gandhi and Martin Luther King Jr spoke about how the means and the ends must be one and the same in a sense, and to quote Gandhi specifically, means are ends in the making.” – Luke (37:59) Resources & Links On This Walk https://www.facebook.com/dlukeiorio https://www.linkedin.com/in/lukeiorio/ https://instagram.com/dlukeiorio https://instagram.com/onthiswalkshow Avery Thatcher https://becomingavery.com/ https://instagram.com/becomingavery

The River Ridge girls basketball team got its revenge on the ultimate stage, winning the Class AAAAAA state championship 68-50 over Lovejoy on Friday night at the Macon Coliseum. It is the first team state championship for River Ridge in any sport, and the Knights are the first girls basketball champion from Cherokee County since Etowah in 2005. River Ridge played with a chip on its shoulders, going up against a Lovejoy team that knocked the Knights out in the quarterfinals last year. This was the matchup the Knights wanted, and they pulled away late for the history-making 18-point win. Mataya Gayle took over in her final opportunity at River Ridge, scoring a game-high 25 points, surpassing 2,000 points for her career, while picking up nine rebounds and five assists. Behind Gayle, two sophomores had major contributions. Kayla Cleaveland scored 15 points despite fouling out in the fourth quarter, while Sophia Pearl finished with 11 points and five steals. River Ridge limited Lovejoy's talented guard duo of Bryanna Preston and La'nya Foster to 29 combined points. Foster's 16 points led the way, while Preston was forced to the bench after picking up her fourth foul with 2:30 left in the first half. Cherokee's run came to an end Saturday night, with the Warriors falling 78-58 to Wheeler in the Class AAAAAAA state championship game in Macon. It was nothing like the last time these two teams met. Cherokee was within striking distance for much of the game and trailed by just nine points in the third quarter. Wheeler's size and athleticism ultimately helped it pull away late, but the Warriors were anything but an easy out. Saturday marked the Warriors' first trip to the state title game since 1982, behind the late Tony Ingle, the future coach at Kennesaw State and a Cherokee County Sports Hall of Fame honoree. Wheeler's win gave the program its ninth state championship all-time and third in the last four seasons. It was the fourth time Cherokee had seen Wheeler during the 2022-23 season, and after falling 94-41 in the Region 5AAAAAAA championship, the Warriors played like they had something to prove. Saturday marked the end of just Coach Joe Veihman's second season at Cherokee since taking over for longtime coach Roger Kvam. He led the Warriors to a 41-17 record, and now, a Class AAAAAAA runner-up trophy. A former Holly Springs educator has been sentenced to eight years in prison after pleading guilty to child sexual abuse during his time as a teacher at a private school. Robert Vandel, 65, of Canton was sentenced Thursday to eight years in prison followed by 12 years on probation after pleading guilty to child sexual abuse crimes while he was teaching science at Lyndon Academy in Holly Springs. This sentence will run concurrently with a 10-year prison sentence Vandel is serving in Fulton County. Vandel pled guilty to his Fulton County charges in May 2022, admitting to rape, aggravated child molestation, false imprisonment, and child molestation while he was a science teacher at Fulton Academy of Science and Technology Charter School in Roswell. He was sentenced to 10 years to serve in prison followed by life on probation with sex offender special conditions. In September 2021, Vandel was arrested at Lyndon Academy by Roswell Police on charges that he sexually assaulted one of his students at Fulton Academy of Science and Technology Charter School. He was charged in Roswell with rape, aggravated assault with intent to rape a child under 14, aggravated child molestation, sexual assault by persons in supervisory authority, enticing a child for indecent purposes, and false imprisonment of a child under 14. After his arrest, Vandel was terminated from his teaching position. Since he was teaching in Holly Springs, Holly Springs Police Department initiated a separate investigation. A forensic interview showed that Vandel had been showing the child favoritism and giving her answers to test questions, before engaging in criminal acts, prosecutors said. In a negotiated guilty plea, Vandel admitted to intentionally making physical contact with intimate parts of the child's body, including pressing the front of his body against the child and smacking her buttocks with a ruler, prosecutors reported. In an impact statement, the victim said she has had sleepless nights, and they have felt betrayed and afraid, waiting for justice, prosecutors said. Lyndon Academy Headmaster Linda Murdock declined to comment on the civil case Friday due to the case being open. Records on the Georgia Professional Standards Commission website show that Vandel's teaching certification was revoked in October 2020. The commission had suspended his license in 2006. Last year, Murdock told WSB-TV that when Lyndon Academy hired Vandel two years earlier, the alleged sexual assault in Roswell had not yet been reported to authorities, and he passed a background check that included the Georgia Bureau of Investigation, social media checks, references, and recommendations. A 37-year-old woman from Woodstock has been arrested after authorities say she had a sexual relationship with a minor starting when he was 15 years old. Brittany Stetson is charged with child molestation, aggravated child molestion, sexual assault by teacher, according to her arrest warrant filed by Holly Springs Police Department. In the warrant, police say that in February 2021 Stetson initiated a sexual relationship with a boy who was 15 at the time, which continued for over a year. The woman is a former substitute teacher at Cherokee County schools, including the high school the teen attended. A representative of the Cherokee County School District said that the alleged sexual misconduct was not connected to Stetson's work as a substitute teacher, and she is no longer employed by the district. Stetson was arrested March 7 and booked into the Cherokee County jail. As of March 10, she remained there without bond, according to the Cherokee Sheriff's Office. A team of students from Etowah High School recently won first place in a statewide career skills competition for their public service announcement on mental health awareness. Juniors Samantha Durst, Temilola Oloruntoba, Katie Shay and Hannah Stack won the state HOSA Future Health Professionals competition for their video, the Cherokee County School District announced. They are part of their school's HOSA chapter, advised by Career Pathway healthcare science teachers Megan King and Amber Thayer. The PSA is currently available on You Tube. The team will compete nationally this summer at the HOSA International Leadership Conference in Dallas, Texas. The Cherokee County school board and superintendent will recognize the team at an upcoming school board meeting. Cherokee County Fire and Emergency Services brought home four awards from the 2023 Northwest Georgia - Region 1 EMS Awards Banquet in Rome Thursday night. CCFES was recognized as the EMS Service of the Year. This award is presented to an agency that has not only maintained a high-performance level and spotless record but has also made improvements or contributions which benefit the citizens it serves and has contributed significantly to emergency services at the community, regional and state level. Fire Apparatus Operator and Paramedic Connor Bourn received the Tommy Gayler Medical Call of the Year Award. He was recognized for the outstanding work he and his crew performed on a cardiac arrest patient that resulted in the patient being discharged to home after receiving care in the ICU. Capt. Krisi Wigington received the Mike Miller EMS Educator of the Year Award. She was recognized for her prestigious career in fire and emergency services which has resulted in her serving as the driving force in the accredited Cherokee Fire Paramedic Program. Dr. Jill Mabley, retired medical director for Cherokee County Fire and Emergency Services, received the Dr. Paul Nassour Lifetime Achievement Award. She was recognized for her lifetime of exemplary dedication to fire and emergency services at the local, state and national level. #CherokeeCounty #Georgia #LocalNews           -          -          -          -          -          -          The Cherokee Tribune Ledger Podcast is local news for Woodstock, Canton, and all of Cherokee County. Register Here for your essential digital news.             This podcast was produced and published for the Cherokee Tribune-Ledger and TribuneLedgerNews.com by BG Ad Group     For more information be sure to visit https://www.bgpodcastnetwork.com/    https://cuofga.org/   https://www.drakerealty.com/   https://www.esogrepair.com/         See omnystudio.com/listener for privacy information.

Caleigh has had it both ways in the ICU. She has been sedated and immobilized which led to battling delirium and ICU acquired weakness. She has also been awake and mobile while intubated and walked out the doors. Listen to Caleigh share her insights and what meant to her to be communicative, connected, and autonomous during her fights for her life. Www.daytonicuconsulting.com --- Support this podcast: https://anchor.fm/restoringlife/support

Michael Ackerman is currently the director of the Master in Healthcare Innovation Program and Professor of Clinical Nursing and the director of the Center for Healthcare Innovation and Leadership at the Ohio State University College of Nursing. He also maintains a clinical practice as an acute care nurse practitioner at St. Joseph's Neighborhood Hospital in Rochester, New York. Today, we talk about nursing, healthcare innovation, and opportunities for designers in the healthcare industry. Listen to learn about: The role of nurses in nursing/healthcare innovation The unique challenges of innovation in healthcare Improving the healthcare innovation cycle OSU's Center for Healthcare Innovation and Leadership Our Guest Michael Ackerman is currently the Director of the Master in Healthcare Innovation Program and Professor of Clinical Nursing, and the Director of the Center for Healthcare Innovation and Leadership at the Ohio State University College of Nursing. He also maintains a clinical practice as an acute care nurse practitioner at St Joseph's Neighborhood in Rochester, NY.  He is also the Owner of Ackerman Consultants. Dr. Ackerman has held just about every position a nurse could hold in academia and clinical practice from candy striper to senior director. His entire career has been dedicated to critical care with numerous publications as well as invitations to speak nationally and internationally. His research and writing has focused on a variety of clinical topics including sepsis, airway management, hemodynamics, innovation and leadership. His innovation work has led to many disruptions in clinical practice and health system change. He has been recognized for his various contributions with various fellowships including; Fellow in Critical Care Medicine, Fellow in the National Academy of Practice, and Fellow in American Academy of Nurse Practitioners. Dr. Ackerman completed his BSN from Niagara University, his MSN and DNS from The State University of New York at Buffalo, a post-masters certificate as an Acute Care Nurse Practitioner from the University of Rochester and is currently enrolled in a Design Thinking certificate program at Rochester Institute of Technology.   Show Highlights [01:18] Michael talks about his love of nursing, and starting his career in the ICU. [01:46] Finding his way into the healthcare innovation space. [03:27] What people, and especially designers, should understand about bedside nursing. [04:33] The three “P's” of nursing and design. [07:22] Co-creating with nurses via the Center for Healthcare. [09:52] Nurses are moving into the innovation space. [11:59] Michael's wishlist of things designers should do when working in the healthcare innovation space. [12:37] The healthcare industry is risk-averse. [14:46] A look at the different viewpoints of healthcare executives. [16:41] Michael talks about one project – a new feeding tube device. [19:07] The healthcare innovation cycle is often slow. [20:20} How the COVID-19 pandemic sped up the innovation cycle. [22:18] How designers and healthcare leadership can help improve the healthcare innovation cycle. [23:27] Democratizing innovation and inviting healthcare staff to the table. [26:00] Ohio State's innovation studios for healthcare and nursing. [27:42] Working with the architecture school on creating healthier work environments. [28:48] OSU's Masters in Healthcare Innovation program. [30:12] OSU's Center for Healthcare Innovation and Leadership. [32:42] The importance of creativity, and logic-brain versus creative-brain. [34:21] Designers need to help people find ways to turn off their logic-brain to allow their creative-brain to turn on. [35:43] Giving people permission to experiment and create. [38:37] The patient harm threshold for rapid healthcare innovation. [39:49] The need for innovation leadership roles in hospitals and healthcare. [43:01] All leaders would benefit from being familiar with design thinking and being able to lead teams using a design mindset and methods. [44:51] A culture of innovation and creativity starts at the top. [47:22] Hospitals and healthcare are complex adaptive systems. [49:59] Michael's and Dawan's advice for innovators.   Links Michael on LinkedIn Michael on Twitter Ackerman Consulting Michael on ResearchGate The Handoff: Nurse Burnout with Michael Ackerman Google Scholar list of articles where Michael is an author/co-author The #HCBIZ Show: The Novation Dynamic: 3 Pillars for Healthcare Innovation Success with Michael Ackerman SONSEIL   Other Design Thinking 101 Episodes You Might Like Healthcare Design Teams + Wellness + ScienceXDesign with Chris McCarthy — DT101 E24 Nursing + Service Design + Healthcare Innovation with Brittany Merkle — DT101 E38 Seeing, Reframing, and Pursuing Problems with Thomas Wedell-Wedellsborg — DT101 E86

My guest today is Evan Mestman this will be the second time I chat with him on the Coaching Call podcast. Even was known as Heavy Evy and that's what started him on the journey to change his life. Evan started his career in nutrition with a passion for knowledge and motivation to help those who struggle with being their best mentally, physically, and spiritually. As an adolescent, Evan was challenged with his own need to lose weight, become healthy and stay fit. When he took his first nutrition class in college, it resonated to the point of becoming his pivotal moment and his career path was set. After receiving his master's and becoming a Registered Dietician, he worked in hospital ICU's with the most critical of patients. He saw their fears and vulnerabilities and realized that having the right attitude was half the battle. He started studying the psychology of behavior and change which led to the development of his first nutrition program Appetite and Attitudes. He became a diabetes educator, and an adjunct professor teaching Nutrition and Disease as well as Nutrition and Performance for over 10 years. Facebook https://www.facebook.com/B3ProAttitudes/ Facebook Group: ProAttitudes-Helping you live healthy-lifestyle habits that really work! https://www.facebook.com/groups/proattitudesforprofessionals Instagram https://www.instagram.com/B3ProAttitudes/ LinkedIn https://www.linkedin.com/in/evan-mestman/ A link to my Jumpstart program: --- Send in a voice message: https://anchor.fm/coachingcall/message

Out of PA, this awake woman has been doing a spiritual podcast for eight years (!), has had many amazing people on her show and SHE is soooo interesting. Here she tells her story about her son Kyle and his passing which is incredible, hard, wonderful, mind-blowing. A little hint... imagine him on life support while she simultaneously lies in a hospital bed "on watch" in the corresponding  ICU. As a person who understands spirit and has faith, she openly discusses her struggles and how she came out on the other side. As a parent, she has truly let him go which, in the end, only brings both souls closer together. She also talks about another parent group that does not focus on "grief." Beyond that, we get into Black Lives Matter, diversity, Oneness and, of course, the Great Awakening.Just Be Practice is a song from Caroline.Reference:Helping Parents Heal: https://www.helpingparentsheal.org/providers Contact Caroline:Website: https://www.awake2onenessradio.org YouTube: https://www.youtube.com/@Awake2OnenessRadio Bitchute: https://www.bitchute.com/channel/2xfAIRnSf8Pv Rumble: https://rumble.com/c/c-1979232 Facebook: https://www.facebook.com/awake2onenessradioContributing Journalist at American Media Periscope:  https://americanmediaperiscope.comContact info for host Eden Koz / Just Be®, LLC:Insta, FB, LinkedIn, Bitchute, Rumble, YouTube, Odysee, TruthSocialWebsite: EdenJustBe.comEmail: eden@edenjustbe.comMY UPCOMING CLASS (date/time changed):"Meditation Simplified" Zoom class Thurs, April 13, 20 & 27 from 1-2pm EST. Sign-up eden@edenjustbe.com. Only $55.Products I endorse to help through this Great Awakening:• Purium Health: For vaccine healing, regret or issues – 4 products here. 25% discount through me or $50 off. 1-time usage. $180 plus ship (normally $240). All products non-GMO, organic, vegan, dairy free. For the heavy metal/toxin tincture removal only go here. $40 + ship (normally $90)• Mint ...

Hey lovely folk! So on today's show we have a disappearing bearded man, a demon in the ICU and a big old chat with Bekah about all things Heaven & Hell, as well as a review of Insidious 3, what more could you ask for? (Loads probably!) Don't forget, by signing up to Patreon you not only support the show, but you also get access to over 200+ hours of additional Patreon only content! Simply head over to: www.patreon.com/weneedtotalkaboutghosts And send your stories to: contact@talkabobutghosts.com

Show notes at pharmacyjoe.com/episode799. In this episode, I’ll discuss whether the Tisdale Risk Score can be used to identify ICU patients at risk of QTc prolongation. The post 799: Can the Tisdale Risk Score be used to identify ICU patients at risk of QTc prolongation? appeared first on Pharmacy Joe.

Find out more about Patrick, Nicolle and ONTPD and this episode at: www.the-incubator.org/116/____________________________________________________________________As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. enjoy!This podcast is proudly sponsored by Chiesi.

In his weekly clinical update Dr. Griffin discusses confronting the evolution and expansion of anti-vaccine activism in the USA in the COVID-19 era, the effectiveness of maternal Influenza vaccination in Peru, characteristics and predictors of persistent symptoms post-COVID-19 in children and young people, parental nonadherence to health policy recommendations for prevention of COVID-19 transmission among children, community-onset bacterial coinfection in children critically ill with SARS-CoV-2 infection, bivalent booster effectiveness against severe COVID-19 outcomes in Finland, viral kinetics of sequential SARS-CoV-2 infections, risk of COVID-19 associated pulmonary aspergillosis based on corticosteroid duration in intensive care patients, immunomodulators for severe COVID19 in transplant patients: do they increase the risk of secondary infection, long-term cardiovascular outcomes in COVID-19 survivors among non-vaccinated population, cardiac abnormalities in Long COVID 1-year post-SARS-CoV-2 infection, one-year adverse outcomes among us adults with Post–COVID-19 condition vs those without COVID-19 in a large commercial insurance database, and long-term gastrointestinal outcomes of COVID-19. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Confronting the evolution and expansion of anti-vaccine activism (The Lancet)  Effectiveness of maternal influenza vaccination in Peru (OFID) Characteristics and predictors of persistent symptoms post-COVID-19 (BMJ) Parental nonadherence to health policy recommendations for prevention of COVID-19 (JAMA) Community-onset bacterial coinfection in children ill with SARS-CoV-2 infection (OFID) Bivalent booster effectiveness against severe COVID-19 outcomes (medRxiv)  Viral kinetics of sequential SARS-CoV-2 infections (medRxiv) Risk of COVID-19 associated pulmonary aspergillosis based on corticosteroid duration in ICU patients (OFID) Immunomodulators for severe COVID-19 in transplant patients (TID) Long-term cardiovascular outcomes in COVID-19 survivors among non-vaccinated population (eClinicalMedicine)  Cardiac abnormalities in Long COVID 1-year post-SARS-CoV-2 infection (BMJ) One year adverse outcomes among US adults with post COVID-19 condition vs those without COVID-19 (JAMA) Long-term gastrointestinal outcomes of COVID-19 (Nature) Contribute to our ASTMH fundraiser at PWB Dr. Griffin's treatment guide (pdf) Letters read on TWiV 990 Don't crush Paxlovid (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

A near-death experience in the ICU forced this renowned public interest lawyer to sort out his priorities. He talks to Howie Severino about why he needed to go public with his prostate cancer, which very few men want to talk about. Then they tackle some of those issues that he thinks about the most: how climate change is causing typhoons in the Philippines to jump around; why the government needs to heavily subsidize public transport, including the much lamented jeepneys; and why he thinks the day of reckoning is coming for those responsible for killings during the drug war, despite the government's refusal to cooperate with the International Criminal Court. Finally, he offers a mission statement to young people who are considering a law career. "Lawyers are needed for even basic things in the countryside. But it's also about making a difference for society. Make use of your gifts to do things where you are needed. Work for big causes because small causes like yourself and your family alone will not make you happy. Happiness comes from making a difference in a big way to the extent that you can wherever your world is." Here are some links to Atty. Tony La Viña's columns and ideas: https://tonylavina.com/ https://tonylavina.com/2023/01/07/new-year-new-life/ https://opinion.inquirer.net/byline/tony-la-vina https://manilastandard.net/category/opinion/columns/eagle-eyes-by-tony-la-vina -- Produced by Aubrey Delos Reyes and Sanafe Marcelo Edited by Jayr Magtoto

Join 6AMRun.com Ambassador and Host, Marc Paisant, as we welcome cancer survivor and public speaker, Matt Ode.  From Cancer to Coma, at the age of 24 Matt Ode was diagnosed with stage 3C Testicular cancer. After chemotherapy and a very complicated surgery to remove the remaining cancer from his body, Matt encountered various complications. He was under the watch and care of the ICU for over 40 days and in the Cleveland Clinic for 53 days where he was met with a number of near-death experiences including 5 major surgeries causing a large open wound on his stomach. For two weeks, he laid non-responsive in a coma, met with complete kidney and liver failure, and went into cardiac arrest where nurses performed 8 minutes of CPR to bring him back to life. Doctors didn't know if and when he would awake, informing his family and girlfriend he would likely be on dialysis the rest of his life having to relearn everyday tasks like eating and walking again. Prior to the diagnosis and subsequent treatment, Matt was a healthy personal trainer weighing in at 185 lb. But this disease wreaked havoc on his body and in a matter of 8 months he dwindled down to a mere 110 lbs. Matt has now taken this near-death experience to motivate others to live their best lives every day.  Please visit: https://mattodespeaks.com/ to learn more. To be a guest, or share your story with the 6AM Run Community apply at: https://forms.gle/hBHCKpYKT6R9tH6m7 6AM Run believes in improving everyone's physical ability to not only have motion, but STAY IN MOTION. All this while creating an amazing supportive, surrounding community. Run Faster, Farther, & Recover For More Runs! 6amrun.com #6amrunSee omnystudio.com/listener for privacy information.

I can't stand Frenchmen,* but Pierre Kory is a gentleman and an exceptional animal among his irritating breed. *Apologies to my close friend RM. What annoys me most about you is you always were a better climber than I was. This interview, from Paul Thomas' With the Wind podcast, showcases two courageous medical freedom movement physicians. They put their patients first and paid a high price. I recorded this at 1.5 speed to help you develop rapid listening skills. If you want to listen at regular speed, HERE is the original interview.In case you missed it, HERE is my recent interview with Dr. Paul. You can listen to more of his interviews and his trademark optimism at Children's Health Defense. Or, search your podcast app for With the Wind. Dr. Kory was a top academic intensive care unit (ICU) geek at the pinnacle of his skills and specialty. When COVID and the attendant lies were spread through the world, he collaborated with an international team of like-minded doctors to innovate successful treatments that flew in the face of fraudulent drugs and protocols. When his institution resisted and defamed him, he quit his prestigious job and volunteered at a training hospital in New York. They initially allowed him to continue his research and treat his patients properly. His innovations included the use of steroids and blood thinners. He and his partner Paul Marik, MD, (the most published ICU doctor who is still in practice) founded the Front Line Critical Care COVID-19 Alliance (FLCCC). They now have an outpatient practice and see patients virtually. They use the skills they developed over the past several years to treat syndromes such as vaccine damage, which is often falsely called the "COVID long hauler's" syndrome. A friend has a problem like this after a blood transfusion, presumably due to spike protein transfer. Kory has treated her, and she loves him. See DrPierreKory.com.Dr. Kory wrote a book about ivermectin (Amazon link HERE) that should be available soon.He says this drug is the most effective COVID and vax damage treatment. It is non-toxic and is used together with nutraceuticals such as zinc and vitamin D. Although traditional pharmacies suppress ivermectin, Dr. Kory prescribes it using US compounders. I explained what compounding pharmacies do in Hormone Secrets and included that chapter as a bonus section at the end of this post.Here is an open secret that Kory alluded to but sidestepped: veterinary ivermectin is widely used for people because the pharmacies and the regulators have made the human version expensive and unavailable. You can buy the vet version over the counter from any feed store, and your local Tractor Supply is just around the corner. It is available as either a paste or an injectable. Both can be taken orally and need to be measured carefully. HERE is a video about figuring out the exact dose of paste. The horses I've spoken to say they like its apple flavor.The injectable form has to be extracted from the vial with a syringe and then squirted into the animal's mouth. The mammals I've interviewed say it tastes terrible. I apologize for these bad jokes--they are not funny, but neither is standard medical care. Who would have predicted our companies and governments would have gone rogue and start slaughtering us? Support the show

In this episode, we welcome Marie-Josée Forget. Marie-Josée is a bilingual Pelvic Health Physiotherapist, educator, and mentor with 18 years of clinical experience. She operates a private physiotherapy practice focused on treating pelvic floor dysfunction and teaches courses related to pelvic anatomy and health at Pelvic Health Solutions. Marie-Josée Forget speaks with us about women's health. We learn about perimenopausal, and menopausal women and their pelvic health. How your pelvic health affects your lifestyle and sexual health, Kegel exercises, navigating perimenopause, menopause, and more!SPONSORBETTERHELPBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to a licensed therapist. BetterHelp makes professional counseling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use discount code “solvinghealthcare"Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.TRANSCRIPT KK: We are on the brink of a mental health crisis, and this is why I am so appreciative of the folks over at BetterHelp. It provides the largest online counseling platform worldwide to change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to licensed therapists that are helped make professional counseling available anytime, anywhere through a computer, tablet, or smartphone. Sign up today. Go to betterhelp.com And use a promo code ‘solvinghealthcare' and get 10% off signup fees. SP: COVID has affected us all and with all the negativity surrounding it, it's often hard to find the positive. One of the blessings that is given us is the opportunity to build an avenue for creating change. Starting right here in our community discussing topics that affect us most such as racism and health care, maintaining a positive mindset, creating change, the importance of advocacy, and the many lessons we have all learned from COVID. If you or your organization are interested in speaking engagements, send a message to kwadcast@gmail.com, reach out on Facebook at Kwadcast or online at drkwadwo.caKK: Welcome solving healthcare. I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physician here in Ottawa and the founder of ‘Resource Optimization Network' We are on a mission to transform healthcare in Canada. I'm going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better health care system that's more cost effective, dignified, and just for everyone involved.KK: Kwadcast nation welcome back. We have a tremendous episode with MJ Forget. She is a pelvic floor specialist in physiotherapy and sees a lot of perimenopausal women and was really knowledgeable in terms of the issues that she sees firsthand. Many people can benefit from a pelvic floor physio, for example, if they're having incontinence, pain or with sexual health, this is such an important aspect of things. Then she dives into how holistic the approach must be how the physio can actually make some significant strides. How lifestyle changes can impact things. Honestly, I learned so much in this episode. So, we'll jump on it right away here. But first, I want to give a quick plug to our latest newsletter on substack kwadcast.substack.com. Where you can stay up to date with all our releases, our blogs, or blogs or guest appearances, courses all are on one site and it's all point. Check out kwadcast.substack.com and jump on the train. So, without further ado MJ Forget. KK: Welcome to the show. We we've been talking more about women's health, specifically, perimenopausal and menopausal women. One of the areas that I must say it was a bit foreign to me and I didn't realize it was such a big issue was pelvic health. So MJ you've been at this for a while, like when you started? You said over 20 Maybe 25 years? MJ: 25 years? Yeah. KK: What lured you to pelvic health and like how big of an issue has is pelvic health ben for people?MJ: When we graduate from university, you know, and the medical fields we get to find areas of interest when we graduate and that's kind of all that we do. And you know physio, some of them want to do orthopedics and work with sports teams. When I graduated, I went to the hospital system, which is a lot of what physios do, and I worked in ICU and I worked on the floors, I did orthopedics, post knee posts, hips, and it really wasn't where my passion lied by any means. But it was a really great introduction to all thing's physios working in a hospital setting. So, when I thought about where do I want to go? And what do I want to do? I always had an interest at the time what we call more women's health. Now we call it pelvic health because again, all genders have pelvic health issues. I had classmates who did their thesis on incontinence. I remember thinking at the time oh my gosh “That's something that we can do?”. It really wasn't anything we were taught in university, nobody really talked about, again pelvic health, women's health, women's health issues, menopause, that was never covered in our degree. So, I took my first course and Alberta back in 1997 and I never looked back. I had no idea how much pelvic health issues was a problem. Remember 25 years ago, nobody talked about any of that. Nobody talked about bladder control issues or bowel control issues. Certainly, nobody talked about menopause, and nobody talked about sexual health, which is a lot of what we do in pelvic health. So, I started my career, like I said, I was in my early 20s and that's all I've been doing now, for 25 years. This is where I'm at. KK: Wow. You alluded to, you didn't realize how big of a problem it was, like how big of a problem truly is it? MJ: If we talk just about incontinence in Canada, if we just talk about general stats in Canada, 3.3 million Canadians have bladder issues in Canada. When we think about gender differences, one in four women, one of one to nine men, so it's significant. It actually gets a little worse as we age. That's an issue with menopause. So, if we think about the female population, there's about a 20% to 30% incidence of incontinence in our young adulthood. Think of like your 20s and 30s. Then that spikes up to almost 40%. By the time we get into middle age, which is kind of the perimenopausal menopausal age. Then it goes up as high as 50% in our elderly, which is a really big concern. One of the main reasons that our clients get admitted into nursing homes is because of bladder issues, and fecal incontinence rate, loss of bladder and bowel control is usually kind of an event where families then have a hard time maybe coping with taking care of their of their loved ones, and that will increase admissions to nursing homes. So, we're not talking about small numbers. It's a significant number and we have an aging population in Canada. We have a lot of people going through perimenopause and menopause. One of the biggest risk factors of incontinence is actually menopause. We have a lot of people right now who are entering kind of that phase, you know, and I think in Canada, the stats are that there's 10 million of us in this age group in perimenopause, heading into menopause in Canada. That's a big number.KK: It's massive. And I think this is what's motivated us to cover some of this content because these are years of productivity, have high needs, like moms that are in that perimenopausal age where you're active with your family, your career paths, like a lot of people this is where they're starting to peak in their careers, a lot of demands just to be to be on the workforce, like when I think of health care workers. So, anything we could do to make them more functional and thrive. I think we need to really look at. I don't know if I realized that, like this is kind of like the peak or one of the main concerns during the perimenopausal perimenopausal menopausal timeline. What can you do? What do you do to help? MJ: There's so much we can talk about this for hours, but we'll try to kind of keep in to keep our timeline because I can get started. I mean, if we're just going to focus on, we'll talk the impact of perimenopause and menopause. Like you said, it's such a difficult time. You know, people going through perimenopause and menopause, like you said, are working. They are often parents, with children that still require a lot of our attention. Plus, sometimes we're taking care of our parents as well. We're kind of like in that middle group where we're busy with our careers. We may or may not have children, but we also may have parents that we help and it's a really stressful time, and quality of life really starts to take an impact. So typically, when people come to see a pelvic health physiotherapist, or a physiotherapist who's done postgraduate studies in pelvic health, what we do is we are often seeing people that come for problems of bladder control and bowel control. So that would say that's kind of when I started that was the most of what I've seen, but we also help our patients with sexual function and the ability to have pain free sexual intercourse, which is a big issue again in perimenopause and it can actually worsen and menopause as well. We help with conditions called pelvic pain, pelvic pain can be anything like you know, our patients telling me I have vaginal pain or rectal pain, and when I treat my population of men it could be prostate related type of pains. Pain in the pelvis. A lot of pain in the pelvis affects sexual function and has an impact on your bladder and bowel function. So, it's all related together. When you come and see a pelvic health physio, what's important to know is we take what they call a biopsychosocial approach to care. So that means when you come and see us, we're looking at you as a whole person. What's really great about our profession is we have the luxury of time, because when you come and see us, we have an hour on assessment with you. Follow up treatments can be half an hour, 45 minutes or even an hour. So, we have the luxury of time, and we have the luxury of talking. S o the main thing that we always want to do is let people tell us their story, you know, why are you here? What's bothering you? And how much is this bothering you? Because again, when it comes to menopause, or bladder issues, or sexual function, these are not subjects that people want to talk about easily, right? There's a lot of taboo, a lot of embarrassment. A lot of my clients think they're the only ones who cant have intercourse anymore than the only ones who are losing bladder control and can't, you know, run a marathon. Everybody thinks they're the only ones but there are in fact, not, the stats are actually quite high in terms of impact of blood, bladder, health and sexual health on our patients. So, we talk and then we address all things incontinence, bladder, bowel, sexual function, and things like constipation and pain in the pelvic area. So, we do all of that. It's quite a bit and it spans quite a lot of topics. We also talk about lifestyle because lifestyle is important. On the on, on maybe my first visit or second visit, I'm going to talk to you about are you sleeping well? Are you managing your stress well? Are you having any issues with your mental health? depression, stress, anxiety that you're not managing? Well, how are you feeling hormonally? Because part of what we do and what I've noticed during COVID a lot as well is we've kind of become a little bit of the gatekeepers, I want to see we really had to help our patients navigate the healthcare system, and a time that it was really difficult to navigate the health care system. I always tell my clients, I'm here to help build your team around you who do you need to help you navigate perimenopause and menopause so you can live your best life, because as physios, we have to stay in our scope of practice, we can't do everything. So, if I talk about nutrition, I can talk about why nutrition is important, but I'm not allowed to give you advice on nutrition because it's not in my scope. But I'll send you to the people who do that. And the biggest challenge and menopause is that for a long time, there was nobody to send people to. Right? If you think about, you know, how many menopause clinics do you know, that exist out there? Right. There's one at Mount Sinai. There's just not a lot of menopause clinics that are run by a gynecologist and maybe have a nutritionist and a psychologist all working together and maybe with a pelvic health physio, that'd be great. That could look at that whole biopsychosocial approach to care to really help our patients navigate menopause. I think that's now starting to change. I think now, you know, the tagline right now is menopause is having a moment while menopause is having a moment. I think partly because there's a lot more of us in our field talking about it on social media, there's definitely some gynecologist now that are much more vocal on social media, talking about hormones, talking about safety of hormones. When I started 25 years ago, hormones were a no go, there was so much fear around all things hormonal replacement therapy, and it was really difficult because as a physio, I could see how devastating some of the symptoms of menopause were and there wasn't really a lot of options for my patients at the time as to what to do about it. Because everybody has such a fear of hormone, whether it's topical hormones or hormonal replacement therapy, and I think that that's shifting as well. So, we talk about all of these things with our clients when they come in. Then we help navigate and say, Okay, if you're struggling with nutrition, who could we send you to? If you're really struggling with your hormones, who are the hormone, menopause, hormonal experts out there to send you to? If your mental health is an issue, who do we send you to for that so that you can kind of work on your anxiety and your depression and your stress? There's been a lot of stress, you know, in the last few years, and then as physios, we take care of more that kind of the physical kind of component of incontinence, pelvic pain, bowel health, constipation and sexual health.KK: You know, what I'm really appreciating is you're saying MJ is how holistic the approach is, it's not so just the physical aspects and the rehabilitation, you need to know how it's affecting your life, how you're doing from a lifestyle perspective, stress level, sleep, how well you're eating, and just approaching it that way. That's what I'm finding really encouraging about this is that you know, you're just not soloing the approach, it really comes down to how the person is doing as a whole. In my opinion when it comes to so many issues in medicine, this is the only way like, you need to really address so many of the needs outside the actual physical concern. Another thought just came to mind too, is just hearing all the, the symptoms that so many perimenopausal and menopausal women have to go through it, it just, it really is sad that so many people have had to go through without it go through all this without attention. You put it together, the hot flashes, the mental health concerns, weight issues,MJ: the insomnia, the anxiety KK: Then you add the pelvic pain, the incontinence on top of that MJ: It's significant, and it's all today can be a very overwhelming time and our client's life, because, again, they're so busy, they're under a lot of stress, they have a lot of obligations. Then they're dealing with, you know, ‘I can't have intercourse with my partner, it hurts too much. I'm leaking urine, I can't exercise. Now I'm gaining more weight. I am going through perimenopause, I got insomnia, I can't sleep'. That has huge repercussions on the human body. It's important that we all talk about those things. And it's important that we recognize the lane that we're in as, as health professionals and find the right people, for our clients so that they get better. I think you know, again, it's the tides, I think are changing that we're taking a little bit more of this kind of like sort of biopsychosocial approach, looking at the whole person. Also giving permission to our clients to talk to us about these things that it's okay to talk to me about your bladder issues and your sexual health concerns and, and your stressors in your life and how maybe you're having really hard time balancing work life balance and seeing how we can help with that. We can all help with that, in our own way. KK: Absolutely. Give us a sense, MJ when someone walks into the office what some of the stuff you're assessing? what do you do as a physio to help patients that's within your scope? the exercises? help me understand the potential and the things that you do to help address these issues.MJ: So, once we've listened to everybody's story, and they tell us what their main concerns are, and what their goals are, in terms of what would they like to achieve with our time together. We do a lot of education, and education can be like I said, lifestyle, sleep, how are they functioning with nutrition? Are they exercising? are they happy? Are they stressed? then we really go into the function of the pelvic floor. So, if we talk about the main concerns most of our clients are coming in with often it will be bladder issues, bowel issues, it will be sexual health issues, and maybe constipation issues, like some bowel issues, that all tends to act up in perimenopause. That's when we take out our props. I have lots of props to explain to people about the pelvis. Because again, we are not taught anything about the pelvis as human beings. And if we think about our education in our primary schools, in our high schools about pelvic health, there's none of that. So, we often don't really know about the pelvis, right? And where the pelvic what's happening to our pelvis. If we look at this wonderful pelvis has been with me for 25 years, so it's falling apart. KK: People listening, you might have to be extra descriptive, extra descriptiveMJ: Okay, so when we look at the pelvis, if I take the muscles out of the way, this is the front of your pelvis. So that's your pubic bone. By turning the pelvis around, that's your kind of your spinal column and your tailbone would be right here. And if we look at the bottom, while the bottom is all muscular, it's just muscles down there, and you have layers of muscles, and we call it because we're not very clever. We're calling it the pelvic floor muscles. There's a lot of fancy terms in anatomy, so we won't go through that but for the sake of purpose, the pelvic floor and there's layers. The first layer, which is the most superficial, so meaning that you can touch it from the outside. These muscles here go from your pubic bone to your tailbone here at the bottom, they wrap around your clitoris, and your vaginal opening, and then they also wrap around the anal opening. All of these muscles here, the main function of these little muscles are that the vaginal opening or for sexual function, which is why sometimes we can have difficulties with maybe having an orgasm, libido, desire orgasms, and maybe we have pain with intercourse. These muscles which are under voluntary control, so we can learn to use them, they must contract, but they must relax. When things go in the vagina, all these muscles must have the capacity to stretch into expand, and that should never cause us pain. So that's this first little group. We'll maybe dive into kind of sexual function a little later. But that's the first little group. Then deeper inside your pelvis, you have another group of muscles that are deeper inside your body. These muscles, they're quite big, quite large, they wrap around your vaginal opening and your anal opening all the way from your tailbone at the back to your pubic bone at the front, those are your bladder and bowel control muscles. So if I take that muscle out, just to show you how big it is, the big muscle, front to back. When you laugh, when you cough, when you sneeze, when you lift things that are heavy, these muscles tighten around your urethra, or tighten around your anal opening so that you don't lose bladder control, you should be able to hold on to those muscles to get to the bathroom on time. Then when you sit to go to the bathroom, they relax this stretch the expand to allow us to go to the bathroom. So, when people come to see us for bladder issues, bowel issues, or sexual health issues and sexual pains, what we're trying to determine is what's happening to that little group of muscles, what's happening to that pelvic floor. I always tell my clients, there's two groups of you. There's a group that come that comes to pelvic health physio, where when we evaluate the function of their pelvic floor, they just lost a lot of strength and endurance. We see that in perimenopause and menopause because this is my hormones are important. When you go through perimenopause, your hormones are starting to dip down. They're not gone yet. But your estrogens are dipping your testosterone and your DHEA, which are your androgenic hormones are decreasing. We need estrogen for muscle strength, and protein synthesis and collagen. When we have a loss of estrogen, we start to lose muscle strength, we start to have what we call sarcopenia. Right. And that starts to increase as we age if we're not moving and exercising. So, estrogen is really important for muscle function to testosterone, which we have, we don't maybe have as much as our male counterparts. We do have some in it, it is important because it helps with muscle strength and muscle tone. That impacts the pelvic floor. So, I may have someone who has never had babies never, never could not have children or decide not to have children who come to see me, and perimenopause and menopause and they'll say, Why am I having incontinence, I never got pregnant. Well, that's because even if you have not had children, you're gonna go through menopause, you're gonna have those hormonal fluctuations. You can still have some symptoms of menopause and one of them could be incontinence. And the other thing what these pelvic floor muscles do, which is really great when they're working well, and you're able to use them properly, they help decrease the sense of urgency and frequency, right. So, some people say I go to the bathroom all the time I'm peeing every half an hour, I'm getting up three, four times a night to go to the bathroom. When we help regain function of these pelvic floor muscles to reduce incontinence can also reduce urgency and frequency and the need to get up at night. So, group number one may have a lot of weakness and loss of strength in their pelvic floor. Again, that happens in menopause with the loss of our hormones. A lot of the symptoms tend to worsen about seven to 10 years after you're done having your menstrual cycles remember that you are menopausal if you've gone 12 months without your menstrual cycle, usually symptoms of menopausal peak a kind of that seven to 10 years. I's about honestly, they're saying about 50 to 65% of the population may have actually some symptoms, you know, at those seven years, post menopause. Second group of people that often come in is when we evaluate their pelvic floor, they have all the same symptoms will have bladder issues or going to the bathroom a lot. But then they tell us they have pain, they have pain with sexual activity. Then when we look at their pelvic floor, they actually have too much tension. Okay, and that's a problem because if you look at this little layer of your pelvic floor, these muscles that wrap around the vaginal opening and your clitoris, so these are your clitoral muscles. So important to have orgasms if you have too much tension in these muscles like this when things going in the vagina start to hurt. Again, that can start to be a problem in perimenopause and into menopause, again because of hormonal changes. What happens is, you're going through perimenopause, or menopause, or maybe you're in menopause, your estrogen levels have dipped down. Estrogen is like the fountain of youth, estrogen plumps up our tissues, it increases blood flow to the area, it provides elasticity to all of our tissues, and that's your labia, and at the vaginal opening. This area is really, really rich in what we call estrogen receptors. And of course, when we go through perimenopause and menopause, that's a decreasing, and so things get a little thinner, things get a little drier, and things lose the elasticity. What often can happen is, my clients will have intercourse, and it hurts, and maybe they bleed a little bit, because again, you know, when estrogen goes low, everything gets a little drier and more sensitive, and they've been prone to maybe even some tearing, well, then that pelvic floor is actually very clever, these muscles here, they're there to protect us as well. So, if you have pain, then the next time you think about engaging in sexual activity, your brain is going to say, You know what, that really hurt last time and right away, we start to tense up our pelvic floor. And then we get caught in this vicious cycle, where we have that episode of pain because of hormonal changes, then it hurts and then our pelvic floor tenses up. Then we keep trying to have intercourse, but then we keep irritating that area, then the pelvic floor just increases in tension and increases in tension. That can lead to more pain, with sexual activity as well. So, I always tell my clients that we need to figure out which of the two groups do you belong to? Do you have a pelvic floor that just needs strengthening? Or do you have a pelvic floor that maybe requires a little bit more stretching and relaxation, to help you regain proper sexual function? You know, having sexual function without pain? In everything that we do, you know, we always take that step back and go, Okay, well, you know, what are the stressors in your life that also increases muscle tension, right? So, stress and anxiety, and lack of sleep, all increase our fight or flight response. And that's why sleeping is so important to kind of really get you restorative health, you know, and to make sure that we're refreshed in the morning, managing our stress is really important, because when you're under stress through the day, and you're in that fight or flight responses, all your muscles tense up, including your pelvic floor, right? So, then what we do is we do a physical exam. This is kind of where, you know, doing a really good explanation of the pelvic floor is really important. So, I have these really great models that I've designed over the years. And what I do is I show all of the muscles, so you've got muscles at the vaginal opening, that can be the reason you have pain with sexual activity, you've got deep muscles inside that your bladder and bowel function muscles. So, when we do a pelvic exam, we do not use speculums. We don't have you in stirrups, it's not like kind of a pap, we're going in manually with one finger and we start on the outside and we just have a look at all these muscles to see are they causing you any discomfort that could actually explain some of your pain with sexual activity. If we're able to do that, then we can go in. We can look at all of these bands, all of these muscles that you see here that's colored, these are all your pelvic floor muscles. We can evaluate all these bands of muscles right side left side to determine Are any of these muscles causing you any pain, because pain with sexual activity can be pain at the opening? or some people will tell me you know, it's deep inside. ‘It's like I can't like we have to stop it hurts so much deep inside'. Then we evaluate these muscles I say, ‘Okay, if I said to you try to contract, try to squeeze those muscles, especially with people that have incontinence, bladder or bowel, I'll say try to contract your pelvic floor'. That's where we're assessing strength and endurance, okay, how strong are your muscles? You know, how much endurance and power does your muscles generate? And if that's lacking, we're gonna work on that. So that's kind of the physical exam and the physical exam is as per our client's comfort levels. So, some people on day one will say, I'm not comfortable with a pelvic exam, maybe they need a visit or two to get comfortable with the idea. You know, some people are not aware that that's what a pelvic health physio is trained to do. We are trained to do pelvic exams for the purpose of evaluating what's happening to all these layers of pelvic floor muscles. So, you can regain bladder control bowel control, and sexual function. The other thing that this pelvic floor does, it's like a shelf, it holds up our organs and so a lot of our clients will say, ‘I feel like feel like something's falling out of my vagina'. They get diagnosed with something called the ‘prolapse', which is everything kind of softening up and estrogen is important for that because estrogen is what we need to have strong ligaments and strong tendons. A lot of times heading into perimenopause or menopause, somebody may have had a prolapse when they had their, two, three children in their early 20s, and did absolutely fine. But now they're starting to have symptoms because their estrogen levels are decreasing. That's really altering kind of the function of what we call the collagen fibers in their tendons and in their ligaments. We have a lot of ligaments that hold up our organs, and everything just kind of soften. So obviously, nothing's ever going to fall out of your body. It's never going to happen but everything softens a little bit and part of what we have to do is strengthen that pelvic floor if needed to kind of create that supportive system from the bottom. It really is all about exercise. It's about exercise. KK: That was going to be my next question, maybe with that first option of picking up someone that is having issues with incontinence, assuming you're addressing the lifestyle issues, and so on. But what's an example MJ of exercises or type of exercises that they will be using to try and rectify the problem? MJ: Everybody's heard about those famous Kegels right? Everybody's heard about Kegels KK: I'm doing them right now MJ: Kegel, he was a physician; he was a gynecologist back in the 50s. Dr. Kegel and who's who had done kind of a lot of research on the field of the pelvic floor. We call them pelvic floor exercises. So yeah, we teach our clients how to properly contract their pelvic floor. What's important to know is that you can read online on how to do cables, and how to engage your pelvic floor, but they're not easy to do. It's important to see a pelvic floor physio, because a lot of people think they're doing them properly. Then they come and see us and they're confident ‘Oh, no, no, I've been doing my ‘Kegels' fantastic, I think I'm good' and we test them, and they're not doing them properly. We tend to cheat a lot. When we try to engage your pelvic floor, we're holding our breath, maybe we're squeezing your bum, or we're sucking in our belly. Really, you should be able to squeeze your pelvic floor, you can think about I was kind of give the example to my clients, I'm like, imagine a little ping pong at the opening of your vagina and just try to grab and pick up your ping pong and for my patients that have penises, I'll say try to lift up your penis, right. Those are some of the things that we explain. That's how you think about engaging your pelvic floor or think about stopping gas. The reason it's so important for us to do a pelvic exam is from the outside, I can't tell if you're doing a proper pelvic floor exercise. When we do a pelvic exam, it really tells us how well you are using those muscles. If you have pain, then we're at least kind of finding out that there's too much tension and if you have too much tension, I'm not giving you Kegels to do. That makes sense, right? So, if you're coming in just for incontinence, I evaluate your pelvic floor, there's no discomfort, when I'm palpating those muscles and you're good to go. Yeah, then we're going to work on some strengthening. If you're already here, and then you've got pain, with intercourse, maybe it hurts to go to the bathroom, you're not peeing really well. So the muscles are not relaxing, and I evaluate your pelvic floor and there's too much tension, well, I'm not going to give you more Kegels to do. So, in that case, we're doing things to relax the pelvic floor, and this is where we do breath work. And we do yoga-based movements, a lot of pelvic openers and yoga, a lot of breathing, maybe some meditative type of practices to help relax that tension. Once we relaxed that tension, once the pain goes away, then maybe we can do some strengthening, if that's what your body needs at that time. That's why it's so important for us to do an exam because again, I can look at you and I have no idea if you've got a pelvic floor that's too weak or a pelvic floor that has too much tension but when we palpate it we can see and then we can give you the proper exercisesKK: This is good because once again I think there is a lot of women that are struggling with these concerns and with that are maybe at a loss. Are there a lot of pelvic specially physios out there? for example if people want to get access to someone of your caliber and this is not something you could be doing virtually either right? MJ: I did a lot of virtual; I still do. Virtual is really good for is sometimes even just the initial assessment like the first time because we do talk so much and we do a lot of education. So during COVID we did quite a lot of virtual and I continued to do so and sometimes that day one. Maybe you know if you've got COVID You can't come into the clinic well then, I'll just do a virtual with you do all the education and then you come back in to see me for kind of an in person visit when you're feeling better you know when you're not sick, things like that. So there's a lot of us doing virtuals as well. The best place to kind of find a physio in your area that has the qualifications to do a pelvic exam and to do pelvic health, is to look at the website called pelvichealthsolutions.ca and there's a find a physio feature there. You can actually click in your area, look at people's names, it shows all the courses they've done, so then you can kind of look at, oh, this person's done a menopause course, great. This person's done a hormonal health course. That can help you choose a physio in your area. That's a really great feature that we have. pelvichealthsolutions.ca is a great resource. There's a lot because we're, when I started 20 odd years ago, there was four of us in Ontario doing pelvic health. Now we have hundreds of physios who decided to take pelvic health courses as postgraduate training. We are not without pelvic health physios out there to help anybody who has a pelvic floor, anybody who has incontinence, anybody that has any problems with sexual health, anybody with constipation, there's so much we can do. Like I said, we've become resources for our clients to help them find the right people to go see whether it's nutrition, stress management, mental health and whatnot is really part of what we do to help her patients navigate perimenopause and menopause. KK: Wow, MJ, pure gold. In terms of knowledge and resources I must say, this was some of the best explanations of the issues when it comes to pelvic health. This is the stuff as a physician, you hear about these concerns, but the way you just simplified it, using language that all of us can understand, conceptualizing it in ways that we will understand. Putting it into, for example, two frameworks, or two patient populations that you typically see, you're the GOAT. MJ: Thank you! That's why we say to people, if you're not sure at least come in for the first visit. So, you get a chance to chat, you know, and that's a nice thing about doing virtual, you're not sure about it, we'll do a virtual and we can talk through and I think a lot of people then realize, ‘Oh, there is help for me, oh, sexual, sexual dysfunctions and payment sexual activity'. That's not okay. No, it's not okay. It's not okay, that you're not sleeping through the night because of hot flashes, right. Then really talking about the research and the evidence behind what we do. And we have a fairly high level of evidence in what we do in terms of treating incontinence and prolapse and pelvic pain. Having a chance to talk to our potential clients about that is good. Again, to make everybody feel more comfortable with topics that are not comfortable to talk about. I mean, there are still a lot of taboos around bladder and bowel health. There's a lot of taboos around sexual health. There's a lot of taboos about talking about menopause. Because we've been told, while menopause is just part of life and deal with it, suck it up, right, suck it up, you know, don't complain about it, you know. I think, I think our clients are starting to get fed up with feeling so poorly, and so discouraged about their quality of life. Like I said, it's not insignificant, there's over 30 symptoms of menopause. If we can improve any one of them, I think we're doing well, to help navigate, you know, and these challenges that our clients have. We have great research, I was just reading, just to get ready for today, that strength training again, we're physios you know, we're all about exercise motion is lotion. We encourage our clients to even get out like I always tell my clients, even your pelvic floor loves to go for a walk, just walk outside. The thing with walking is that you're outdoors in the fresh air in the sunlight, you're getting your vitamin D, you're setting your circadian rhythm, there's good research to say that if you get outdoors in the morning and bright sunshine for a good walk, you're gonna sleep better at night. Right? But strength training, which we again love to encourage your patients to do reduces hot flashes by 44%. you know, again, this is kind of in the purview of a pelvic physio or any physio is we're all about, you know, strength training to help mitigate the effects of losing estrogen and testosterone, right, strength train to reduce your hot flashes by 44%. Wow, you know, strength training to reduce osteoporosis because that increases when we hit menopause as well, because of all the hormonal changes, strength training to improve your insulin resistance so that you can lose weight and strength train for your pelvic floor because when you're strong, your whole body, everything's strong, even these little muscles here, and so kind of giving permission to your clients to exercise, but it's hard, right? because, you know, it's time, you know, and part of what happens in menopause is that people are overwhelmed with stress, and people are not taking the time to do the things they, you know, that we all get told to do, you know, eat well, sleep well ,exercise. So, it's kind of helping our clients navigate, you know, where could they find time to sneak in a little bit of exercise? What can they cut out? Right? What can they let go? What's not important, you know, and, you know, talking about the importance of strength training, I think, again, it's an eye opener. So that's why the education is so important, because when we educate people go, ‘Oh, okay, well, that's a good reason to act' maybe that's the one thing you needed to hear, to allow you to go and think about strength training, and it doesn't have to be a lot, you know, just a couple of, you know, 10-15 minutes a day can maybe be a good start. Because the impact is so amazing, just like the impact of yoga and osteoporosis and yoga and constipation and it doesn't have to be an hour of yoga, you know, I can help find a video, that's like, 15 minutes, maybe you do that before you go to bed, right to help you sleep and so education is really key, and to, to really help our clients navigate all of these crazy symptoms they have and making sense of it all. Hopefully, get that buy in that motivation that something that speaks to them that says, okay, I am going to try to make a change. When it's hard, you know, you know, one of the things that happens with our clients and menopause is they stopped exercising because they're losing bladder control. KK: Yeah, that was actually one of the things you're mentioning the resistance training. To create the habit, it's not about the result always. You got there, you did your part of the process, even if you get to the gym for that five minutes, and you didn't do all the exercises you were planning to do, but you're getting that that habit developed. So, yeah, as you alluded to, it's hard to do all these things. But to develop the habits, I think is, is where, if you could develop the habits, you'll be moving in the right direction. MJ: Yeah. And I think the more information people have about the benefits, beyond what we already know, right? I mean, we kind of go, weight loss, and I gotta quit smoking, but sometimes you can actually reduce your symptoms of menopause this way or that way, you know, again, that might be enough to persuade someone to say, okay, you know what, then I do need to carve out time in my day, I need to let go of the things that maybe are not that important, and really spend time on myself, and really improved my sleep, and improved my nutrition, and improved my stress management and try to think about exercising, because again, it doesn't take a lot to make a really big change. It doesn't take a lot to go for a walk, I'm happy if you start off with 10 minutes, I'm happy. If we decide Yoga is the best way for you to manage your stress or to help with your IBS or osteoporosis that you're doing even 10 minutes of it. 10-15 minutes of it. We start small, and we build on that. We provide encouragement, because again, we all have bad days where we fall off the rails, and it's okay, we're humans, we're human beings. As long as you just keep at it, you'll start to see some changes. And, and like I said, it's building a team, because our clients need to have the right people helping because MJ can't do everything for everybody like that, you know, if we're only one person, so who are the menopause experts out there who are the nutritionists out there who have a really good interest in menopause and Hormonal Health. Who do you go see if you're having insomnia, right? Because there's CBT there's cognitive behavioral therapy for insomnia. Okay, who are the people for that? Do you want to get hooked up with a personal trainer to kind of motivate you to strength training? Okay, let's find you someone to do that. It's all about building a team and it's all about dialogue, and always talking about these things and giving our patients permission to talk about what's bothering them, and to be open about their frustrations and you know, if they're having frustrations with their weight loss and okay, let's see who's out there who can help you with that.KK: MJ, this has been grand, it's been grand! How do people get a hold of you? I am working right now, I'm in downtown Ottawa. I'm at a clinic called Killens Reid physiotherapy, killensreid.com, we're three pelvic physios at that clinic. There's myself, my lovely colleagues, Natalie and Sophie all of which can help you with menopausal issues. You can look at that pelvic health solution website to find people in your area. It's a great resource. That's the group that I'm one of the teaching instructors for pelvic health. You can see how many great pelvic health physios we have all across Canada. There are also naturopaths, who have taken our courses that are listed. So, if you want to maybe work with a naturopath who has a knowledge of pelvic health, they're listed on there as well. We have some nurse practitioners that have taken our courses, who again have developed an interest in pelvic health. You can find all those people on the pelvichealthsolutions.ca website. Killensreid.com to reach the clinic that I'm at, you can I have a website as well mjforgetpt.ca. I'm on Instagram ‘mjforget'. There's lots of different ways to find us and, and to kind of help you with all your symptoms. KK: I love it. I love it. Thank you, MJ, for the knowledge that you threw down the holistic approach the benefits of seeing the likes of you, I really appreciate you coming on. This is awesome. I appreciate any opportunity to talk about all things pelvic health, and I appreciate all of you've done again, because you've taken quite a holistic approach yourself as someone in medicine right in really thinking about nutrition or sleep or stress or you know, exercise mindfulness and it's always nice to talk to kindred spirits, I say.KK: Thank you so much. Alright, well, I hope you've enjoyed that episode. Please follow us on Instagram YouTube, Facebook, TikTok, Twitter at kwadcast. Please leave any comments kwadcast99@gmail.com. Leave a five-star rating on wherever you listen to podcasts. Leave a review. Check out our newsletter at kwacast.substack.com. Everybody stay beautiful Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

Welsh born, Matt Morgan is an intensive care doctor, researcher and author, currently working in Western Australia. Dr Morgan says we can look to nature to provide valuable lessons and solutions to solve some 21st century medical problems. During the early days of the Covid pandemic, while while working in intensive care, Dr Morgan wrote "A letter from the ICU" which has become one of the most read articles published in the British Medical Journal. His first book, Critical, has been translated into four languages, and his latest book One Medicine delves into how understanding animals can save human lives.

In this episode, Will Duffin is joined by Ffyon Davies, a fellow extreme medic, to discuss her most memorable moments in the field. They delve into her experiences in Mountain Rescue and as an Expedition Medic on Mount Kilimanjaro, which is considered one of the most challenging roles in the field. The conversation covers a range of topics including team dynamics, leadership, casualty management, wilderness fracture management, and more. They also explore how to tackle the unique challenges of expedition medical care such as preventing water from freezing at high altitudes and managing a spread-out group. Other important aspects discussed include understanding one's limits, vulnerability modeling, the significance of having a trusted colleague to confide in, and coping when one is struggling at altitude while others in the group need treatment. The episode is packed with valuable insights and practical advice for anyone interested in extreme medicine. About Ffyon: Ffyon is an ED Registrar based in North Wales. Usually found either outdoors, at work or both, she is currently a clinical fellow in ED, ICU and PHEM (working with EMRTS Air Ambulance) at Ysbyty Glan Clwyd. She is an 'FY5', taking a slightly circuitous route to qualifying in Emergency Medicine via the CESR pathway, taking time out wherever possible to do what she loves undertaking expedition medicine roles which have included working as chief medical officer on worked as chief medical officer on board Tall Ship Pelican of London, sailing from Germany to Tenerife, and as a trail medic supporting ultramarathons in Wales and the Azores islands. When she's not working, she's out playing in the mountains hiking, running, climbing and kayaking, usually accompanied by her trusty welsh collie Foxy. She also volunteers with her local mountain rescue team, North East Wales Search and Rescue. She has completed her Mountain leader training and is also a qualified Elementary Paragliding Pilot.

SEASON 02: WICKED GOOD PREGNANCY | EPISODE 04 Two Lives Forever Changed By Surrogacy with Ashleigh Donahue + Emma Swartz Welcome back listeners! We have covered such a wide variety of topics in our Wicked Good Pregnancy series, and today's show is really special. One of our guests today actually reached out to us asking if we could shine a light on surrogacy, and of course the answer was, "yes!" We are thrilled to learn more about this family building option, and to hear from a surrogate and intended parent: two lives forever changed by surrogacy. About Our Guest  EMMA SWARTZ is a North Shore mom who welcomed a baby boy via surrogacy in October 2022. Emma and her husband lost their first born in June of 2020 when she was 27 weeks pregnant, and she went into cardiac arrest. Her son was born while she was unconscious as medical professionals heroically fought to save her life. Emma never met her son, as she spent months in a coma and on life support. Miraculously she survived and after 100 plus days in the ICU, Emma began her healing journey. It was a long road learning how to walk again, regaining her strength and grieving the loss of her son. A year or so later she began IVF, hopeful that she and her husband could make embryos for a surrogate. After 3 rounds of IVF, Emma and her husband were able to transfer their single embryo to a superhero gestational carrier. Emma is currently a stay at home mom, but makes it her life mission to do what she can to make sure this doesn't happen to others, as well as give hope to those who are going through their own struggles with infertility.   ASHLEIGH DONAHUE is a South Shore mama of two amazing little girls, ages 7 and 4. She works as a virtual Licensed Mental Health Therapist. She has completed two surrogacy journeys through Circle Surrogacy and is a Circle Surrogate Mentor and Ambassador. How to Keep in Touch  Follow Ashleigh on Instagram Follow Emma on TikTok What is the Wicked Good Momcast? WHO | The Wicked Good Momcast is hosted by Shannon Gibson + Meghan Block, two local moms with a heart for community and with an undeniable connection that we hope you'll hear through our voices.  WHAT | In each episode, you'll hear from local + national experts in various spheres relevant to parenting, local moms and business owners who you should know about, and special guests! WHERE | You can listen wherever you listen to other podcasts! Please subscribe so you never miss an update! WHEN | New episodes drop the first and third Tuesdays of the month.  HOW | Are you someone we should interview? Is there a topic you want to be sure we cover? Are you a local brand looking to expand your marketing efforts with Boston Moms? Email shannon@bostonmoms.com to chat or share your thoughts – we would love to hear from you! APPLE PODCASTS | iHeart PODCASTS Links We Mentioned (Or Should Have...)

Episode 121: Having patients awake during mechanical ventilation can require a new skillset and approach to patient care. Let's talk about some of the tips and tricks for improving patient comfort and care. We'll hear it from an RN/podcast listener/ICU survivor and Louise Bezdjian, APRN from the original Awake and Walking ICU. Citations and transcription: www.daytonicuconsulting.com --- Support this podcast: https://anchor.fm/restoringlife/support

Today we interviewed Dawn Gaimaro, a PT of 30 years who has worked in a variety of settings, but has her heart in acute care where she believes the trajectory of recovery is set. She discusses her philosophy on intensity and early mobility as well as how acute care has evolved. If you've ever felt intimidated by working in acute care, Dawn will give you guidance and strategies to lose your fear. Students, new grads, and seasoned professionals alike, let's get out there and help patients have the best start possible and get away from sitting them up in a chair as their acute/ICU therapy program.  

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!_____________________________________________________________________________________Show notes, articles, and CME form can be found on our website: http://www.the-incubator.org/115/

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!_____________________________________________________________________________________Show notes, articles, and CME form can be found on our website: http://www.the-incubator.org/115/

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!_____________________________________________________________________________________Show notes, articles, and CME form can be found on our website: http://www.the-incubator.org/115/

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!_____________________________________________________________________________________Show notes, articles, and CME form can be found on our website: http://www.the-incubator.org/115/

Amy Loughren is a former registered nurse who is known for assisting in the arrest and prosecution of serial murderer Charlie Cullen. Before his apprehension, Cullen and Loughren were friends who both worked the night shift in the ICU at Somerset Medical Center in New Jersey. Loughren was a single mother of two children and hiding her cardiomyopathy from her employers, with some help from Cullen, in whom she confided. In 2003, Loughren was approached by detectives who suspected Cullen of poisoning hospital patients. The patient who triggered law enforcement interest was Florian Gall. After consulting with her 11-year-old daughter, Loughren agreed to assist law enforcement.As part of the investigation into Cullen, Loughren met with him at a diner, wearing a wire. The evidence from the meeting allowed police to then arrest Cullen. After he was arrested, Loughren encouraged him to make a full confession, which then supported his convictions for 29 murders.

After facing a long diagnosis journey that included a misdiagnosis of gallstones despite actually having pancreatic cancer, Jay Buth from CT underwent a Whipple Procedure. While that procedure was initially a success, a dangerous bacterial infection created a huge setback leaving Jay in the ICU for months. Throughout the process of fighting both conditions and losing his mother to colon cancer during his pancreatic cancer battle, Jay found strength from his wife and daughters and the power of seeing a therapist. Listen to this week's episode to learn more about Jay's journey and hear some of his best advice to others who are facing this disease. To learn more about Project Purple, visit https://www.projectpurple.org/ or follow us on social media at these links: https://www.facebook.com/Run4ProjectPurple https://www.instagram.com/projectpurple/ https://twitter.com/Run4Purple https://www.youtube.com/channel/UCgA8nVhUY6_MLj5z3rnDQZQ

Jake chats with stand up comedian and ICU nurse Shaun Patrick Flynn. Watch Shaun's special, Male Nurse on YouTube. Check out Shaun's website https://www.shaunpatrickflynn.com/

Season 4: Turning Pain into Passion begins with my next guest Dr. Stephanie E. Freeman who is one of the nation's most acclaimed ICU physicians. She is a board-certified Critical Care physician, a best-selling author, speaker, and consultant. In addition, she is THE expert in helping doctors discover alternative careers in medicine. Dr. Stephanie consistently meets with physicians individually and in groups to discuss ways they can get “unstuck” in their careers. A compassionate, motivating, energizing, and resourceful physician, it is no wonder why Dr. Stephanie is known among her colleagues as “The Job Doctor”. As Founder and Chief Medical Advisor of DrStephanieICU.com, Dr. Stephanie discusses real-world career strategies to help physicians “think outside the box” regarding their careers. By sharing advice on how to find alternative careers in medicine, Dr. Stephanie helps physicians practice medicine on their own terms. Dr. Stephanie earned her Medical Degree from the University of Alabama School of Medicine. She completed her Internal Medicine Residency at Wake Forest University Baptist Medical Center and her Critical Care Fellowship at the University of Pittsburgh Medical Center. Dr. Stephanie also completed a Geriatrics fellowship at Wake Forest University Baptist Medical Center. She obtained her Master of Business Administration at Auburn University. In this episode, we talk about: ·       Who or what was instrumental in her career and leadership journey? ·       Why representation matters ·       Why she feels being a physician is a calling that is sacred. ·       How she turned pain into purpose after being fired from her job ·       Her life and career as a locums doc ·       Three tips for dealing with adversity and challenges. You can connect with Dr. Stephanie Freeman on IG and TikTok @drstephanieicu and on FB @drstephanie If you're ready to transition into a leadership role and make an impact in healthcare by supporting your colleagues, reducing healthcare disparities, and improving outcomes, schedule a discovery call with me at www.schedulewithdrlisa.com

What is our circadian rhythm and how does it impact our health? What time should we eat, exercise, and sleep? How does caffeine impact our circadian rhythm? What time of day does the brain work best? How does traveling impact our circadian rhythm? How are age and circadian rhythms connected? What are the five tips that can help us improve our circadian rhythm? How does the ICU impact circadian rhythms? Timeline Nutrition — our favorite supplement for cell support and mitochondrial function. Listeners receive 10% off your first order of Mitopure with code AGEIST at TimelineNutrition.com/ageist. LMNT Electrolytes — our favorite electrolytes for optimal hydration. Listeners receive a free 8-serving sample pack with their purchase at DrinkLMNT.com/AGEIST. InsideTracker — the dashboard to your Inner Health. Listeners get 20% off on all products at InsideTracker.com/AGEIST.Dr. Satchin Panda is a professor at The Salk Institute and author of the book The Circadian Code: Lose Weight, Supercharge Your Energy, and Transform Your Health from Morning to Midnight. He joins us to discuss circadian rhythm, what time we should eat, exercise, work, and sleep, how age impacts circadian rhythms, and more. “Circadian rhythm is essentially the master plan that is already written into our DNA in every cell and if we follow this timetable then we can live a few years longer.” “We are designed to eat more carbohydrates in the first half of the day, not in the second half of our day or late into the night.”“Our bodies are programmed with this timetable and we just have to follow it.”  “For people who are trying to control their blood pressure, who are trying to control their blood sugar with exercise, afternoon exercise tends to be more effective in reducing blood pressure and also controlling blood glucose much better than the identical exercise done in the morning.”“Caffeine has a huge impact on sleep.”“As we age, our circadian rhythm dampens; so that means our body actually doesn't have the right timing cue for when to do what.”“Try to go to bed at a habitual, fixed time and then stay in bed for at least 8 hours because when you stay in bed for 8 hours then you get at least 7 hours of restorative sleep.” Listen to the SuperAge podcast wherever you get your pods. Connect with Dr. Satchin Panda:TwitterInstagramBook

In this week's podcast, Neurology Today's editor-in-chief discusses long-term adverse outcomes from pregnancy-associated stroke, a robotic device to assist shoulder movement in ALS, and the promise of neurostimulation for refractory seizures in the ICU.  

I got to interview Nicole Angelique Kerr. Nicole is an award-winning health expert Nicole Kerr is the co-author of Eating the Rainbow: Lifelong Nutritional Wellness—Without Lies, Hype, or Calculus. She has appeared on CNN, PBS, CBS, ABC, the Food Channel, and a host of other TV and radio shows to share her unique perspective on wellness, lifestyle, and nutrition. She is now the author of the best-selling book, You Are Deathless: A Near-death Experience Taught Me How to Live Fully and Not Fear Death. For the past 30 years, Nicole has worked in all sectors of society, including in government (the Centers for Disease Control and Prevention), non-profit (American Cancer Society), military (United States Air Force Medical Operations), academia (University of Hawaii), healthcare institutions/hospitals (Adventist Health Castle and Queens Medical Center), corporate settings (Sea Ties, LLC), and private consultation. Nicole's warm, engaging presentations have earned her a place in front of international audiences ranging from corporate food producers to health and medical associations. Throughout her career, she has focused on supporting people from every walk of life to make realistic, meaningful, happy choices for lifelong health and well-being. When she was a 19-year-old cadet at the United States Air Force Academy, Nicole would be forced to learn how to live and love differently following a terrifying and transformative Near-Death Experience. Her memory of the crash came back 20 years later, and it has taken Nicole almost another two decades to align her soul, spirit, mind, and body, proving healing is certainly a non-linear process. A disabled veteran, Nicole now maintains a private practice primarily using Neuro Emotional Technique (NET) targeting the often overlooked domains of emotional, energy, and spiritual well-being. We spoke about: 7:30 Not ready for the abuse in US Air Force Academy. 9:45 Asking for a ride changed her life. 11:24 Being pronounced dead at the scene. In hospital for 4 months and 7 weeks in ICU. 13:10 Remembering going to the other side. 17:50 Getting rid of the pain. 27:30 Experiencing God on the other side. 32:00 Being honest about death. This episode is sponsored by Nova Zora Digital experts in digital marketing. *Disclaimer: The views and opinions on Roman Prokopchuk's Digital Savage Experience are those of the guest's alone as their own, and the host's alone as his own. Information provided by the guest is fact checked to the best of our abilities. By providing background information to the show, the guest acknowledges that it is as accurate as possible. The show does not endorse, promote, or is in association with the guest's business interests.*

As with everything else, ICU management of sepsis should ideally the evidence based. Evidence based practice combines the best scientific knowledge (evidence) with patient preferences and clinical assessment and judgement.   While the pursuit of specific pharmaceutical agents to treat Sepsis has resulted in the expenditure of billions of dollars without producing a single effective agent, much of what we do in the treatment of patience with Sepsis can be evidence based. Clinicians make literally hundreds of decisions day on the management of an individual patient in the ICU, often these decisions are made routinely without a great deal of thought about the reasoning behind them. Every decision made about the treatment of a critically ill patient should be based on evidence or the belief that the action resulting from that decision will improve a patient centred outcome for that particular patient. A patient centred outcome is an outcome that affects how the patient feels, functions or survives meaning we should question every decision we make to ask whether it is going to improve one of those outcomes.   The best evidence on which to base of such decisions comes from large robust randomised controlled trials conducted by unbiased investigators. The last 20 years has seen the emergence and maturing of regional and national clinical trials groups who conduct such studies and increasingly collaborate with each other. (2) Such collaboration is often essential to perform studies large enough to provide evidence to guide clinical practice such collaboration is often essential to perform studies large enough to provide evidence to guide clinical practice. As someone who designs and contacts clinical trials I am well aware that they provide evidence on a population basis. Each trial result is the net of harm and benefit resulting from the treatment being studied and even when a treatment is proven to have a net benefit there may be some patients who are harmed by the use of that treatment. A graphic example of this is someone who suffers a massive intracranial haemorrhage when treated with thrombolysis. Causing visible harm to a patient may shake a clinician's faith in an effective treatment making it important that we accept such tragic events without changing our practice to deny that effective treatment to future patients.   Research, like clinical practice, has inherent imperfections. Researchers, like clinicians, need to recognise this and be prepared to put their hand up and admit when they have been wrong. Conducting robust studies of appropriate size in an effective collaborative research group is the best way to avoid being wrong too often!   For more head to our podcast page #CodaPodcast

As an ICU registrar you meet septic patients at different points in time: as the first responder, asking ‘could this be sepsis?'; as the second responder, admitting the patient to the ICU; or the third responder, having to consider adjuncts in the deteriorating patient. Each of these presents different challenges and learning experiences, making the reality of managing sepsis more complex than one might first expect. For more head to our podcast page #CodaPodcast

Eleanor Tanno, MD is a Family Physician, Speaker, and Advance Directive Consultant. She completed her medical degree at the U. of Maryland School of Medicine, and her Family Medicine Residency at the Virginia Commonwealth University. She is a full-time primary care family physician and partner in her private practice. She started her side venture, Advance Directive MD, to help people create meaningful advance directives. She does this by providing Workshops, Webinars, Public Speaking Events, and Medical Lectures. This interest developed after meeting many families in the ICU who had never had end-of-life conversations with their family members. And she discovered that most patients who completed advance directives were being shown how to do so by attorneys. However, attorneys and their staffs were not in the best position to explain the options from a medical perspective. So, Dr. Tanno created a business to educate the public about advance directives, and teach individual clients how to properly describe their wishes in these critical documents. You will find links mentioned in the episode at nonclinicalphysicians.com/consulting-business-grew                                                            =============== You can support this podcast by making a small monthly or annual donation. To learn more, go to nonclinicalphysicians.com/donate You can now join the most comprehensive Community for all clinicians looking for a nontraditional career at NewScr!pt. Get an updated edition of the FREE GUIDE to 10 Nonclinical Careers at nonclinicalphysicians.com/freeguide. Get a list of 70 nontraditional jobs at nonclinicalphysicians.com/70jobs. Check out a FREE WEBINAR called Best Options for an Interesting and Secure Nonclinical Job at nonclinicalphysicians.com/freewebinar1

Sepsis causes organ and tissue dysfunction in response to severe infection, resulting in significant physical and cognitive morbidities. For patients diagnosed with severe sepsis, admission to an intensive care unit and use of an artificial airway are often required. The sequalae of severe sepsis necessitating critical care can result in significant changes to a patient's swallowing and communication function. These negative changes and impacts to function can occur during and after a diagnosis of sepsis, and ultimately impact a patient's health and functional status. The nature and long-term recovery of swallowing and communication function is still to be completely understood; however evidence affirms recovery continues well beyond hospital discharge.   This presentation will focus on tasks we do daily – eating, drinking and speaking. Specifically, the nature of swallow impairments will be described, and the impact of this new disability will be explored from the perspective of the patient's body structure, function and activities. Core components of swallowing safety and efficiency will be described, alongside the role of assessment and management within and beyond the ICU. Changes to communication including altered voice, speech and language function will be described. Outcomes of altered communication function over the continuum of care during, and after hospital will be explored. The evidence base and the lived experience of sepsis and patient stories will underpin the content delivered in this presentation.   The final aim of the presentation will be to describe and highlight the role of speech pathology, an allied health profession, in the management of swallowing and communication function. Following the workshop attendees will be able to (1) describe the characteristics of swallowing and communication disorders; (2) have knowledge of the impact of these new disabilities; and (3) will be able to describe the role of speech pathology in the healthcare team for the patient with sepsis.   For more head to our podcast page #CodaPodcast

"They said, 'Deirdre, think of where you were when you signed up for this, and where you are now. And just enjoy this moment.' And so I turned off the music, and I just enjoyed the serenity of running at night, thinking of my dad next to me, thinking of the person I was when I signed up for this, and who I am now. And I crossed that finish line and absolutely fell apart in the best way possible. It's something I'll never, ever forget." You probably remember Deirdre Keane: the pediatric ICU nurse from New York City who was featured on Humans of New York, talking about how losing her dad (an avid runner) to cancer inspired her to become a marathon runner. Today, Deirdre returns to the Ali on the Run Show to talk about her latest, most intense challenge to date: completing the World Marathon Challenge. Earlier this month, Deirdre ran seven marathons in seven days on seven different continents — and was the fastest woman to do so. In this conversation (perfect for your next long run!), she talks about everything this challenge entailed, including how she got involved, how she trained, and how she packed. Then, we break down all the details from each 26.2-mile race on each continent. She ran a marathon in Antarctica in -25 degree temperatures, and ran one in Australia on a 95-degree day. She ran a 32-loop course in Europe, and hit a low point somewhere between Europe and South America. And in true Deirdre form, she did it all for a good cause: to raise money for Vibrant Emotional Health, an organization that addresses mental health needs in New York City and across the nation. SPONSOR: UCAN: Click here to get a FREE Edge sample pack (you'll just pay the cost of shipping), and use code ALI23 for 20% off your next UCAN order. What you'll get on this episode: How Deirdre is feeling, three days post-adventure (3:00) Why Deirdre wanted to complete the World Marathon Challenge (4:45) How Deirdre prepared for this challenge — physically and mentally — and how she packed for the trip (8:30) Deirdre's fueling strategy for each marathon (17:00) The biggest mistake Deirdre made along the way (20:20) All about the bathroom situation for the trip (23:30) Why Deirdre was running to raise money for Vibrant Emotional Health (27:00) What the bond among participants was like (28:15) All about Antarctica (31:00) All about Africa (38:50) All about Australia (48:00) All about Asia (56:20) All about Europe (1:00:50) All about South America (1:07:10) All about the final marathon: North America (1:18:50) What happened once all of the races were complete (1:24:00) Follow Deirdre: Instagram @deirdremkeane Follow Ali: Instagram @aliontherun1 Join the Facebook group Twitter @aliontherun1 Support on Patreon Subscribe to the newsletter Blog Strava SUPPORT the Ali on the Run Show! If you're enjoying the show, please subscribe and leave a rating and review on Apple Podcasts. Spread the run love. And if you liked this episode, share it with your friends!