Podcasts about international classification

Have you or do you feel stress? What is stress and how can we deal with it? Our guest this time is Rachelle Stone who discusses those very questions with us. Rachelle grew up in a very small town in Massachusetts. After attending community college, she had an opportunity to study and work at Disney World in Florida and has never looked back.   Rachelle loved her Disney work and entered the hospitality industry spending much of 27 years working for or running her own destination management company. She will describe how one day after a successful career, at the age of 48, she suffered what today we know as burnout. She didn't know how to describe her feelings at the time, but she will tell us how she eventually discovered what was going on with her.   She began to explore and then study the profession of coaching. Rachelle will tell us about coaches and clients and how what coaches do can help change lives in so many ways.   This episode is full of the kind of thoughts and ideas we all experience as well as insights on how we can move forward when our mindsets are keeping us from moving forward. Rachelle has a down-to-Earth way of explaining what she wants to say that we all can appreciate.       About the Guest:   “As your leadership consultant, I will help you hone your leadership, so you are ready for your next career move. As your executive coach, I will partner with you to overcome challenges and obstacles so you can execute your goals.”     Hi, I'm Rachelle. I spent over 25 years as an entrepreneur and leader in the Special Event industry in Miami, building, flipping, and selling Destination Management Companies (DMCs).  While I loved and thrived in the excitement and chaos of the industry, I still managed to hit a level of burnout that was wholly unexpected and unacceptable to me, resulting in early retirement at 48.   Now, as a trained Leadership Consultant and Executive Coach, I've made it my mission to combine this hard-won wisdom and experience to crack the code on burnout and balance for others so they can continue to thrive in careers they love. I am Brené Brown Dare to Lead ™ trained, a Certified Positive Intelligence ® Mental Fitness coach, and an accredited Professional Certified Coach by the ICF (International Coaching Federation, the most recognized global accreditation body in the coaching industry).   I continue to grow my expertise and show my commitment to the next generation of coaches by serving on the ICF-Central Florida chapter board of directors. I am serving as President-Elect and Chapter Liaison to the global organization. I also support those new to the coaching industry by mentoring other coaches to obtain advanced coaching credentials.   I maintain my well-being by practicing Pilates & Pvolve ® a few days a week, taking daily walks, loving on my Pug, Max, and making time for beach walks when possible.   Ways to connect Rachel:   www.rstoneconsulting.com https://www.linkedin.com/in/rstoneconsulting/ Instagram: @even_wonderwoman_gets_tired   About the Host:   Michael Hingson is a New York Times best-selling author, international lecturer, and Chief Vision Officer for accessiBe. Michael, blind since birth, survived the 9/11 attacks with the help of his guide dog Roselle. This story is the subject of his best-selling book, Thunder Dog.   Michael gives over 100 presentations around the world each year speaking to influential groups such as Exxon Mobile, AT&T, Federal Express, Scripps College, Rutgers University, Children's Hospital, and the American Red Cross just to name a few. He is Ambassador for the National Braille Literacy Campaign for the National Federation of the Blind and also serves as Ambassador for the American Humane Association's 2012 Hero Dog Awards.   https://michaelhingson.com https://www.facebook.com/michael.hingson.author.speaker/ https://twitter.com/mhingson https://www.youtube.com/user/mhingson https://www.linkedin.com/in/michaelhingson/   accessiBe Links https://accessibe.com/ https://www.youtube.com/c/accessiBe https://www.linkedin.com/company/accessibe/mycompany/   https://www.facebook.com/accessibe/       Thanks for listening!   Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page. Do you have some feedback or questions about this episode? Leave a comment in the section below!   Subscribe to the podcast   If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or Stitcher. You can subscribe in your favorite podcast app. You can also support our podcast through our tip jar https://tips.pinecast.com/jar/unstoppable-mindset .   Leave us an Apple Podcasts review   Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review on Apple Podcasts.       Transcription Notes:   Michael Hingson ** 00:00 Access Cast and accessiBe Initiative presents Unstoppable Mindset. The podcast where inclusion, diversity and the unexpected meet. Hi, I'm Michael Hingson, Chief Vision Officer for accessiBe and the author of the number one New York Times bestselling book, Thunder dog, the story of a blind man, his guide dog and the triumph of trust. Thanks for joining me on my podcast as we explore our own blinding fears of inclusion unacceptance and our resistance to change. We will discover the idea that no matter the situation, or the people we encounter, our own fears, and prejudices often are our strongest barriers to moving forward. The unstoppable mindset podcast is sponsored by accessiBe, that's a c c e s s i capital B e. Visit www.accessibe.com to learn how you can make your website accessible for persons with disabilities. And to help make the internet fully inclusive by the year 2025. Glad you dropped by we're happy to meet you and to have you here with us. Well, hi and welcome to unstoppable mindset where inclusion diversity and the unexpected meet. But you know, the more fun thing about it is the unexpected. Unexpected is always a good thing, and unexpected is really anything that doesn't have anything directly to do with inclusion or diversity, which is most of what we get to deal with in the course of the podcast, including with our guest today, Rachelle Stone, who worked in the hospitality industry in a variety of ways during a lot of her life, and then switched to being a coach and a leadership expert. And I am fascinated to learn about that and what what brought her to that? And we'll get to that at some point in the course of the day. But Rachelle, welcome to unstoppable mindset. We're glad you're here. Thank   Rachelle Stone ** 02:08 you, Michael. I'm honored to be here. Excited to be talking to you today.   Michael Hingson ** 02:12 Well, it's a lot of fun now. You're in Florida. I am. I'm in the Clearwater   Rachelle Stone ** 02:16 Dunedin area. I like to say I live in Dunedin, Florida without the zip code.   Michael Hingson ** 02:22 Yeah. Well, I hear you, you know, then makes it harder to find you that way, right?   Rachelle Stone ** 02:28 Physically. Yeah, right, exactly. Danita, without the zip code, we'll stick with that. Yeah,   Michael Hingson ** 02:33 yeah, that works. Well, I'm really glad you're here. Why don't we start by maybe you talking to us a little bit about the early Rachelle growing up and some of that stuff.   Rachelle Stone ** 02:43 Yeah, I was lucky. I grew up in rural Western Massachusetts, little po doc town called Greenfield, Massachusetts. We were 18 miles from the Vermont border, which was literally a mile and a half from the New Hampshire border. So I grew up in this very interesting area where it was like a tri state area, and our idea of fun growing up, well, it was, we were always outdoors, playing very much outdoors. I had three siblings, and I was the youngest, and it was one of those childhoods where you came home from school, and mom would say, go outside, don't come back in the house until you hear the whistle. And every house on the street, every mother had a whistle. There were only seven houses because there was a Boy Scout camp at the end of the road. So as the sun was setting and the street lights would come on, you would hear different whistles, and different family kids would be going home the stone kids up, that's your mom. Go home, see you next time that was it was great. And you know, as I got older and more adventurous, it was cow tipping and keg parties and behind and all sorts of things that we probably shouldn't have been doing in our later teen years, but it was fun. Behind   Michael Hingson ** 04:04 is it's four wheeling,   Rachelle Stone ** 04:08 going up rough terrain. We had these. It was very, very hilly, where I was lot of lot of small mountains that you could conquer.   Michael Hingson ** 04:17 So in the winter, does that mean you got to do some fun things, like sledding in the snow. Yeah, yeah.   Rachelle Stone ** 04:24 We had a great hill in the back of our yard, so I learned to ski in my own backyard, and we had three acres of woods, so we would go snowshoeing. We were also close to a private school called Northfield Mount Hermon, which had beautiful, beautiful grounds, and in the winter, we would go cross country skiing there. So again, year round, we were, we were outdoors a lot.   Michael Hingson ** 04:52 Well, my time in Massachusetts was three years living in Winthrop so I was basically East Boston. Yeah. Yes and and very much enjoyed it. Loved the environment. I've been all over Massachusetts in one way or another, so I'm familiar with where you were. I am, and I will admit, although the winters were were cold, that wasn't as much a bother as it was when the snow turned to ice or started to melt, and then that night it froze. That got to be pretty slippery,   05:25 very dangerous, very dangerous.   Michael Hingson ** 05:29 I then experienced it again later, when we lived in New Jersey and and I actually our house to take the dogs out. We had no fenced yards, so I had to take them out on leash, and I would go down to our basement and go out and walk out basement onto a small deck or patio, actually, and then I had to go down a hill to take the dogs where they could go do their business. And I remember the last year we were in New Jersey, it snowed in May, and the snow started to melt the next day, and then that night, it froze, and it and it stayed that way for like about a day and a half. And so it was as slick as glass is. Glass could be. So eventually I couldn't I could go down a hill, it was very dangerous, but going back up a hill to come back in the house was not safe. So eventually, I just used a very long flex leash that was like 20 feet long, and I sent the dogs down the hill. I stayed at the top.   Rachelle Stone ** 06:33 Was smart, wow. And they didn't mind. They just wanted to go do their business, and they wanted to get back in the house too. It's cold, yeah?   Michael Hingson ** 06:41 They didn't seem to be always in an incredible hurry to come back into the house. But they had no problem coming up the hill. That's the the advantage of having claws,   Rachelle Stone ** 06:51 yes. Pause, yeah, four of them to boot, right? Yeah, which   Michael Hingson ** 06:54 really helped a great deal. But, you know, I remember it. I love it. I loved it. Then now I live in in a place in California where we're on what's called the high desert, so it doesn't get as cold, and we get hardly any of the precipitation that even some of the surrounding areas do, from Los Angeles and Long Beach and so on to on the one side, up in the mountains where the Snow is for the ski resorts on the other so Los Angeles can have, or parts of La can have three or four inches of rain, and we might get a half inch.   Rachelle Stone ** 07:28 Wow. So it stays relatively dry. Do you? Do you ever have to deal like down here, we have something called black ice, which we get on the road when it rains after it hasn't rained in a long time? Do you get that there in California,   Michael Hingson ** 07:41 there are places, yeah, not here where I live, because it generally doesn't get cold enough. It can. It's already this well, in 2023 late 2023 we got down to 24 degrees one night, and it can get a little bit colder, but generally we're above freezing. So, no, we don't get the black ice here that other places around us can and do. Got it. Got it. So you had I obviously a fun, what you regard as a fun childhood.   Rachelle Stone ** 08:14 Yeah, I remember the first day I walked into I went to a community college, and I it was a very last minute, impulsive, spontaneous decision. Wow, that kind of plays into the rest of my life too. I make very quick decisions, and I decided I wanted to go to college, and it was open enrollment. I went down to the school, and they asked me, What do you want to study? I'm like, I don't know. I just know I want to have fun. So they said, you might want to explore Recreation and Leisure Services. So that's what I wound up going to school for. And I like to say I have a degree in fun and games.   Michael Hingson ** 08:47 There you go. Yeah. Did you go beyond community college or community college enough?   Rachelle Stone ** 08:53 Yeah, that was so I transferred. It took me four years to get a two year degree. And the reason was, I was working full time, I moved out. I just at 17, I wanted to be on my own, and just moved into an apartment with three other people and went to college and worked. It was a fabulous way to live. It was wonderful. But then when I transferred to the University, I felt like I was a bit bored, because I think the other students were, I was dealing with a lot of students coming in for the first time, where I had already been in school for four years, in college for four years, so the experience wasn't what I was looking for. I wanted the education. And I saw a poster, and it was Mickey Mouse on the poster, and it was Walt Disney World College program now accepting applications. So I wrote down the phone number, email, whatever it was, and and I applied. I got an interview again. Remember Michael? I was really bored. I was going to school. It was my first semester in my four year program, and I just anyway. I got a call back and. And I was accepted into the Disney College Program. So, um, they at that time, they only took about 800 students a year. So it was back in 1989 long time ago. And I was thrilled. I left Massachusetts on january 31 1989 in the blizzard of 89 Yeah, and I drove down to Orlando, Florida, and I never left. I'm still here in Florida. That was the beginning of my entire career. Was applying for the Disney College Program.   Michael Hingson ** 10:36 So what was that like, being there at the Disney College, pro nominal, phenomenal. I have to ask one thing, did you have to go through some sort of operation to get rid of your Massachusetts accent? Does   Rachelle Stone ** 10:50 it sound like it worked? No, I didn't have well, it was funny, because I was hoping I would be cast as Minnie Mouse. I'm four foot 10. I have learned that to be Mini or Mickey Mouse, you have to be four, eight or shorter. So I missed many by two inches. My second choice was being a lifeguard, and I wound up what I they offered me was Epcot parking lot, and I loved it, believe it or not, helping to park cars at Epcot Center. I still remember my spiel to the letter that I used to give because there was a live person on the back of the tram speaking and then another one at the front of the tram driving it to get you from the parking lot to the front entrance of the gate. But the whole experience was amazing. It was I attended classes, I earned my Master's degree. I picked up a second and third job because I wanted to get into hotels, and so I worked one day a week at the Disney Inn, which is now their military resorts. And then I took that third job, was as a contractor for a recreation management company. So I was working in the field that I had my associates in. I was working at a hotel one day a week, just because I wanted to learn about hotels. I thought that was the industry I wanted to go into. And I was I was driving the tram and spieling on the back of the tram five days a week. I loved it was phenomenal.   Michael Hingson ** 12:20 I have a friend who is blind who just retired from, I don't know, 20 or 25 years at Disneyland, working a lot in the reservation centers and and so on. And speaks very highly of, of course, all the experiences of being involved with Disney.   Rachelle Stone ** 12:38 Yeah, it's really, I'm It was a wonderful experience. I think it gave me a great foundation for the work in hospitality that I did following. It was a great i i think it made me a better leader, better hospitality person for it well,   Michael Hingson ** 12:57 and there is an art to doing it. It isn't just something where you can arbitrarily decide, I'm going to be a successful and great hospitality person, and then do it if you don't learn how to relate to people, if you don't learn how to talk to people, and if you're not having fun doing it   Rachelle Stone ** 13:14 exactly. Yes, Fun. Fun is everything. It's   Michael Hingson ** 13:18 sort of like this podcast I love to tell people now that the only hard and fast rule about the podcast is we both have to have fun, or it's not worth doing.   Rachelle Stone ** 13:25 That's right. I'm right there with you. Gotta Have fun,   Michael Hingson ** 13:30 yeah? Well, so you So, how long were you with Disney? What made you switched? Oh, so   Rachelle Stone ** 13:36 Disney College Program. It was, at that time, it was called the Magic Kingdom college program, MK, CP, and it's grown quite significantly. I think they have five or 7000 students from around the world now, but at that time it was just a one semester program. I think for international students, it's a one year program. So when my three and a half months were up. My semester, I could either go back. I was supposed to go back to school back in Massachusetts, but the recreation management company I was working for offered me a full time position, so I wound up staying. I stayed in Orlando for almost three and a half years, and ultimately I wound up moving to South Florida and getting a role, a new role, with a different sort of company called a destination management company. And that was that was really the onset destination management was my career for 27 years. 26   Michael Hingson ** 14:38 years. So what is a destination management company. So   Rachelle Stone ** 14:41 a destination management company is, they are the company that receives a group into a destination, meetings, conventions, events. So for instance, let's say, let's say Fathom note taker. Wants to have an in person meeting, and they're going to hold it at the Lowe's Miami Beach, and they're bringing in 400 of their top clients, and and and sales people and operations people. They need someone on the receiving end to pick everybody up at the airport, to put together the theme parties, provide the private tours and excursions. Do the exciting restaurant, Dine Around the entertainment, the amenities. So I did all the fun. And again, sticking with the fun theme here, yeah, I did all of the auxiliary meeting fun add ons in the destination that what you would do. And I would say I did about 175 to 225, meetings a year.   Michael Hingson ** 15:44 So you didn't actually book the meetings, or go out and solicit to book the meetings. You were the person who took over. Once a meeting was arranged,   Rachelle Stone ** 15:53 once a meeting was booked in the destination, right? If they needed a company like mine, then it would be then I would work with them. If I would be the company. There were several companies I did what I do, especially in Miami, because Miami was a top tier destination, so a client may book the lows Miami Beach and then reach out to two to three different DMCs to learn how can they partner with them to make the meeting the most successful. So it was always a competitive situation. And it was always, you know, needing to do our best and give our best and be creative and out of the box. And, yeah, it was, it was an exciting industry. So what makes   Michael Hingson ** 16:41 the best destination management company, or what makes you very successful? Why would people view you as successful at at what you do, and why they would want to choose you to be the company to work with? Because obviously, as you said, it's competitive.   Rachelle Stone ** 16:59 Everybody well, and there's choice. Everybody has choice. I always believed there was enough business to go around for everybody. Very good friends with some of my my hardiest competitors. Interestingly, you know, although we're competing, it's a very friendly industry. We all network together. We all dance in the same network. You know, if we're going to an industry network, we're all together. What? Why would somebody choose me over somebody else? Was really always a decision. It was sometimes it was creativity. Sometimes it was just a feeling for them. They felt the relationship just felt more authentic. Other times it was they they just really needed a cut and dry service. It just every client was always different. There were never two programs the same. I might have somebody just wanting to book a flamenco guitarist for three hours, and that's all they need. And another group may need. The transportation, the tours, the entertainment, the theme parties, the amenities, the whole ball of Fox, every group was different, which is, I think, what made it so exciting, it's that relationship building, I think, more than anything. Because these companies are doing meetings all over the country, sometimes some of them all over the world. So relationships were really, really important to them to be able to go into a destination and say to their partner in that destination, hey, I'm going to be there next May. This is what I need. Are you available? Can you help? So I think on the initial front end, it is, when it's a competitive bid, you're starting from scratch to build a relationship. Once that's relationship is established, it is easier to build on that relationship when things go wrong. Let's talk about what worked, what didn't, and how we can do better next time, instead of throwing the entire relationship out with the bathwater and starting from scratch again. So it was a great industry. I loved it, and   Michael Hingson ** 19:00 obviously you must have been pretty successful at it.   Rachelle Stone ** 19:04 I was, I was lucky. Well, luck and skill, I have to give myself credit there too. I worked for other DMCs. I worked for event companies that wanted to expand into the DMC industry. And I helped, I helped them build that corporate division, or that DMC division. I owned my own agency for, I think, 14 years, still alive and thriving. And then I worked for angel investors, helping them flip and underperforming. It was actually a franchise. It was an office franchise of a global DMC at the time. So I've had success in different areas of Destination Management, and I was lucky in that I believe in accreditation and certification. That's important to me. Credibility matters. And so I. Involved in the association called the association of Destination Management executives international admei I know it's a mouthful, but I wound up serving on their board of directors and their certification and accreditation board for 14 years, throughout my career, and on the cab their certification accreditation board, my company was one of the first companies in the country to become a certified company, admc certified. I was so proud of that, and I had all of my staff. I paid for all of them to earn their certification, which was a destination management Certified Professional. That's the designation. I loved, that we could be a part of it. And I helped write a course, a university level course, and it was only nine weeks, so half a semester in teaching students what destination management is that took me three years. It was a passion project with a couple of other board members on the cab that we put together, and really glad to be a part of that and contributing to writing the book best practices in destination management, first and second edition. So I feel lucky that I was in this field at a time where it was really growing deeper roots. It had been transport the industry. When I went into it was maybe 20 years young, and when I left it, it been around for 40 plus years. So it's kind of exciting. So you so you   Michael Hingson ** 21:41 said that you started a company and you were with it for 4014 years, or you ran it for 14 years, and you said, it's still around. Are you involved with it at all? Now, I   Rachelle Stone ** 21:51 am not. I did a buyout with the I had two partners at the time. And without going into too much detail, there were some things going on that I felt were I could not align with. I felt it was unethical. I felt it was immoral, and I struggled for a year to make the decision. I spoke to a therapist, and I ultimately consulted an attorney, and I did a buyout, and I walked away from my this was my legacy. This was my baby. I built it from scratch. I was the face of the company. So to give that up my legacy, it was a really tough decision, but it really did come full circle, because late last year, something happened which brought me back to that decision, and I can, with 100% certainty, say it was a values driven decision for me, and I'm so happy I made that decision. So I am today. Yeah,   Michael Hingson ** 22:57 and, and let's, let's get to that a little bit so you at some point, you said that you had burnout and you left the industry. Why did you do that?   Rachelle Stone ** 23:08 So after I did, sold my my business, I worked for angel investors for about three and a half years. They brought me in. This was an underperforming office that the franchisee, because they had owned it for 10 years, had done a buyout themselves and sold it back to the angel investors or the private equity so they brought me in to run the office and bring it from surviving to thriving again. And it took me about 18 months, and I brought it from under a million to over 5.3 million in 18 months. So it's quite successful. And I had said to the owners, as they're thanking me and rewarding me, and it was a great first two years, I had said to them, please don't expect this again. This was a fluke. People were following me. There was a lot of curiosity in the industry, because this was a really big move for me to sell my company and then go work for this one. It was big news. So it was a great time. But the expectation for me to repeat, rinse and repeat, that kind of productivity was not realistic. It just wasn't realistic. And about a year and a half later, I just, I was driving from the Lowe's Miami Beach. It's funny, because I used that as an example before, to the breakers in Palm Beach. And if you know South Florida at all, it's, it's, you're taking your life in your hands every time you get on 95 it's a nightmare. Anyway, so I'm driving from the lows to the breakers, and I just left a kind of a rough meeting. I don't even remember what it was anymore, because that was back in 2014 and I'm driving to another meeting at the breakers, and I hang up the phone with somebody my. Son calls about something, Mom, this is going on for graduation. Can you be there? And I'm realizing I'm going to be out of town yet again for work, and I'm driving to the breakers, and I'm having this I just had this vision of myself in the middle of 95 slamming the brakes on in my car, coming to a full stop in the middle of the highway. I did not do this this, and I don't recommend you do this. And I opened up my car door, and I literally just walked away from my car. That was the image in my mind. And in that moment, I knew it was time for me to leave. I had gone as high as I could go. I'd done as much as I could do. I'd served on boards, contributed to books, spoken on panels. I wanted to go back to being an entrepreneur. I didn't want to work for angel investors anymore. I wanted to work for myself. I wanted to build something new, and I didn't want to do it in the DMC world. So I went home that night thinking I was going to just resign. Instead, I wrote a letter of retirement, and I retired from the industry, I walked away two and a half weeks later, and I said I was never going to return.   Michael Hingson ** 26:09 And so I burnt out, though at the time, what? What eventually made you realize that it was all burnt out, or a lot of it was burnt out. So I   Rachelle Stone ** 26:17 didn't know anything about burnout at that time. I just knew I was incredibly frustrated. I was bored. I was over in competence, and I just wanted out. Was just done. I had done well enough in my industry that I could take a little time. I had a lot of people asking me to take on consulting projects. So I did. I started doing some consulting in hospitality. And while I was doing that, I was kind of peeling away the layers of the onion, saying, What do I want to do next? I did not want to do DMC. That's all I knew. So I started this exploration, and what came out of it was an interest in exploring the field of coaching. So I did some research. I went to the coachingfederation.org which is the ICF International coaching Federation, is the leading accreditation body for coaches in the world. And through them, I researched Who were some of the accredited schools. I narrowed it down. I finally settled on one, and I said, I'm going to sign up for one course. I just want to see what this coaching is all about. So I signed up for a foundations course with the with the school out of Pennsylvania, and probably about three weeks into the course, the professor said something which was like a light bulb moment for me, and that I realized like, oh my   Speaker 1 ** 27:40 god, I burnt out. And I was literally, at this   Rachelle Stone ** 27:46 time, we're in school, we're on the phone. It was not zoom. We didn't have all this yet. It was you were on the phone, and then you were pulling up documents on your computer so the teacher couldn't see me crying. I was just sobbing, knowing that this is i i was so I was I was stunned. I didn't say anything. I sat on this for a while. In fact, I sat on it. I started researching it, but I didn't tell anybody for two years. It took me two years before I finally admitted to somebody that I had burnt out. I was so ashamed, embarrassed, humiliated, I was this successful, high over achiever. How could I have possibly burnt out?   Michael Hingson ** 28:34 What? What did the teacher say   Rachelle Stone ** 28:37 it was? I don't even remember what it was, but I remember that shock of realization of wellness, of it was, you know what it was that question, is this all? There is a lot of times when we were they were talking about, I believe, what they were talking about, midlife crisis and what really brings them on. And it is that pivotal question, is this really all there is, is this what I'm meant to be doing? And then in their conversation, I don't even remember the full conversation, it was that recognition of that's what's happened to me. And as I started researching it, this isn't now. This is in 2015 as I'm researching it and learning there's not a lot on it. I mean, there's some, mostly people's experiences that are being shared. Then in 2019 the World Health Organization officially, officially recognizes burnout as a phenomenon, an occupational phenomenon.   Michael Hingson ** 29:38 And how would you define burnout? Burnout is,   Rachelle Stone ** 29:43 is generally defined in three areas. It is. It's the the, oh, I always struggle with it. It's that disconnect, the disconnect, or disassociation from. Um, wanting to succeed, from your commitment to the work. It is the knowing, the belief that no one can do it well or right. It is there. There's that. It's an emotional disconnect from from from caring about what you're doing and how you're showing up, and it shows up in your personal life too, which is the horrible thing, because it your it impacts your family so negatively, it's horrible.   Michael Hingson ** 30:39 And it it, it does take a toll. And it takes, did it take any kind of a physical toll on you?   Rachelle Stone ** 30:45 Well, what I didn't realize when I when I took this time, I was about 25 pounds overweight. I was on about 18 different medications, including all my vitamins. I was taking a lot of vitamins at that time too. Um, I chronic sciatica, insomnia. I was self medicating. I was also going out, eating rich dinners and drinking, um, because you're because of the work I was doing. I had to entertain. That was part of that was part of of my job. So as I was looking at myself, Yes, physically, it turns out that this weight gain, the insomnia, the self medication, are also taught signs of of risk of burnout. It's how we manage our stress, and that's really what it comes down to, that we didn't even know. We don't even know. People don't no one teaches us how to process our stress, and that that's really probably one of the biggest things that I've through, everything that I've studied, and then the pandemic hitting it. No one teaches us how to manage our stress. No one tells us that if we process stress, then the tough stuff isn't as hard anymore. It's more manageable. No one teaches us about how to shift our mindsets so we can look at changing our perspective at things, or only seeing things through our lizard brain instead of our curious brain. These are all things that I had no idea were keeping me I didn't know how to do, and that were part of contributing to my burnout. Right?   Michael Hingson ** 32:43 Is stress more self created, or is it? Is it an actual thing? In other words, when, when there is stress in the world? Is it something that, really, you create out of a fear or cause to happen in some way, and in reality, there are ways to not necessarily be stressful, and maybe that's what you're talking about, as far as learning to control it and process it, well,   Rachelle Stone ** 33:09 there's actually there's stresses. Stressors are external. Stress is internal. So a stressor could be the nagging boss. It could be your kid has a fever and you're going to be late for work, or you're going to miss a meeting because you have to take them to the doctor. That's an external stressor, right? So that external stressor goes away, you know, the traffic breaks up, or your your husband takes the kid to the doctor so you can get to your meeting. Whatever that external stress, or is gone, you still have to deal with the stress that's in your body. Your that stress, that stress builds up. It's it's cortisol, and that's what starts with the physical impact. So those physical symptoms that I was telling you about, that I had, that I didn't know, were part of my burnout. It was unprocessed stress. Now at that time, I couldn't even touch my toes. I wasn't doing any sort of exercise for my body. I wasn't and that is one of the best ways you can process stress. Stress actually has to cycle out of your body. No one tells us that. No one teaches us that. So how do you learn how to do that?   Michael Hingson ** 34:21 Well, of course, that's Go ahead. Go ahead. Well, I was gonna   Rachelle Stone ** 34:24 say it's learning. It's being willing to look internally, what's going on in your body. How are you really getting in touch with your emotions and feelings and and processing them well?   Michael Hingson ** 34:37 And you talk about stressors being external, but you have control. You may not have control directly over the stressor happening, but don't you have control over how you decide to deal with the external stress? Creator,   Rachelle Stone ** 34:55 yes, and that external stress will always. Go away. The deadline will come and go. The sun will still rise tomorrow in set tomorrow night. Stressors always go away, but they're also constantly there. So you've got, for instance, the nagging boss is always going to bring you stress. It's how you process the stress inside. You can choose to ignore the stressor, but then you're setting yourself up for maybe not following through on your job, or doing   Michael Hingson ** 35:29 right. And I wouldn't suggest ignoring the stressor, but you it's processing that   Rachelle Stone ** 35:34 stress in your body. It's not so let's say, at the end of the rough day, the stressors gone. You still, whether you choose to go for a walk or you choose to go home and say, Honey, I just need a really like I need a 62nd full on contact, bear hug from you, because I'm holding a lot of stress in my body right now, and I've got to let it out So that physical contact will move stress through your body. This isn't this is they that? You can see this in MRI studies. You see the decrease in the stress. Neuroscience now shows this to be true. You've got to move it through your body. Now before I wanted to kind of give you the formal definition of burnout, it is, it is they call it a occupational phenomenal, okay, it by that they're not calling it a disease. It is not classified as a disease, but it is noted in the International Classification of Diseases, and it has a code now it is they do tie it directly to chronic workplace stress, and this is where I have a problem with the World Health Organization, because when they added this to the International Classification of diseases in 2019 they didn't have COVID. 19 hybrid or work from home environments in mind, and it is totally changed. Stress and burnout are following people around. It's very difficult for them to escape. So besides that, that disconnect that I was talking about, it's really complete exhaustion, depletion of your energy just drained from all of the stressors. And again, it's that reduced efficiency in your work that you're producing because you don't care as much. It's that disconnect so and then the physical symptoms do build up. And burnout isn't like this. It's not an overnight thing. It's a build up, just like gaining 25 pounds, just like getting sick enough that I need a little bit more medication for different issues, that stuff builds up on you and when you when you're recovering from burnout, you didn't get there overnight. You're not going to get out of it overnight either. It's I worked with a personal trainer until I could touch my toes, and then she's pushed me out to go join a gym. But again, it's step by step, and learning to eat healthy, and then ultimately, the third piece that really changed the game for me was learning about the muscles in my brain and getting mentally fit. That was really the third leg of getting my health back.   Michael Hingson ** 38:33 So how does all of that help you deal with stress and the potential of burnout today? Yeah,   Rachelle Stone ** 38:43 more than anything, I know how to prevent it. That is my, my the number one thing I know when I'm sensing a stressor that is impacting me, I can quickly get rid of it. Now, for instance, I'll give you a good example. I was on my the board of directors for my Homeowners Association, and that's always   Michael Hingson ** 39:03 stressful. I've been there, right? Well, I   Rachelle Stone ** 39:06 was up for an hour and a half one night ruminating, and I I realized, because I coach a lot of people around burnout and symptoms, so when I was ruminating, I recognized, oh my gosh, that HOA does not deserve that much oxygen in my brain. And what did I do the next day? I resigned. Resigned, yeah, so removing the stressors so I can process the stress. I process my stress. I always make sure I schedule a beach walk for low tide. I will block my calendar for that so I can make sure I'm there, because that fills my tank. That's self care for me. I make sure I'm exercising, I'm eating good food. I actually worked with a health coach last year because I felt like my eating was getting a little off kilter again. So I just hired a coach for a few months to help me get back on track. Of getting support where I need it. That support circle is really important to maintain and process your stress and prevent burnout.   Michael Hingson ** 40:10 So we've talked a lot about stress and dealing with it and so on. And like to get back to the idea of you went, you explored working with the international coaching Federation, and you went to a school. So what did you then do? What really made you attracted to the idea of coaching, and what do you get out of it?   Rachelle Stone ** 40:35 Oh, great question. Thanks for that. So for me, once I I was in this foundations course, I recognized or realized what had happened to me. I i again, kept my mouth shut, and I just continued with the course. By the end of the course, I really, really enjoyed it, and I saw I decided I wanted to continue on to become a coach. So I just continued in my training. By the end of 2015 early 2016 I was a coach. I went and joined the international coaching Federation, and they offer accreditation. So I wanted to get accredited, because, as I said, from my first industry, a big proponent for credit accreditation. I think it's very important, especially in an unregulated industry like coaching. So we're not bound by HIPAA laws. We are not doctors, we are coaches. It's very different lane, and we do self regulate. So getting accredited is important to me. And I thought my ACC, which my associate a certified coach in 2016 when I moved to the area I'm living in now, in 2017 and I joined the local chapter here, I just continued on. I continued with education. I knew my lane is, is, is burnout. I started to own it. I started to bring it forward a little bit and talk about my experiences with with other coaches and clients to help them through the years and and it felt natural. So with the ICF, I wanted to make sure I stayed in a path that would allow me to hang my shingle proudly, and everything I did in the destination management world I'm now doing in the coaching world. I wound up on the board of directors for our local chapter as a programming director, which was so perfect for me because I'm coming from meetings and events, so as a perfect person to do their programming, and now I am their chapter liaison, and I am President Elect, so I'm taking the same sort of leadership I had in destination management and wrapping my arms around it in the coaching industry,   Michael Hingson ** 42:56 you talk about People honing their leadership skills to help prepare them for a career move or their next career. It isn't always that way, though, right? It isn't always necessarily that they're going to be going to a different career. Yep,   Rachelle Stone ** 43:11 correct. Yeah. I mean, not everybody's looking for trans transition. Some people are looking for that to break through the glass ceiling. I have other clients that are just wanting to maybe move laterally. Others are just trying to figure it out every client is different. While I specialize in hospitality and burnout, I probably have more clients in the leadership lane, Senior VP level, that are trying to figure out their next step, if they want to go higher, or if they're content where they are, and a lot of that comes from that ability to find the right balance for you in between your career and your personal life. I think there comes a point when we're in our younger careers, we are fully identified by what we do. I don't think that's true for upcoming generations, but for our generation, and maybe Jen, maybe some millennials, very identified by what they do, there comes a point in your career, and I'm going to say somewhere between 35 and 50, where you recognize that those two Things need to be separate,   Michael Hingson ** 44:20 and the two things being   Rachelle Stone ** 44:23 your identity, who you are from what you do, got it two different things. And a lot of leaders on their journey get so wrapped up in what they do, they lose who they are.   Michael Hingson ** 44:39 What really makes a good leader,   Rachelle Stone ** 44:42 authenticity. I'm a big proponent of heart based leadership. Brene Brown, I'm Brene Brown trained. I am not a facilitator, but I love her work, and I introduce all my clients to it, especially my newer leaders. I think it's that. Authenticity that you know the command and control leadership no longer works. And I can tell you, I do work with some leaders that are trying to improve their human skills, and by that I mean their emotional intelligence, their social skills, their ability to interact on a human level with others, because when they have that high command and control directive type of leadership, they're not connecting with their people. And we now have five generations in the workforce that all need to be interacted with differently. So command and control is a tough kind of leadership style that I actually unless they're willing to unless they're open to exploring other ways of leading, I won't work with them. Yeah,   Michael Hingson ** 45:44 and the reality is, I'm not sure command and control as such ever really worked. Yeah, maybe you control people. But did it really get you and the other person and the company? What what you needed.   Rachelle Stone ** 46:01 Generally, that's what we now call a toxic environment. Yes, yes. But that, you know, this has been, we've been on a path of, you know, this work ethic was supposed to, was supposed to become a leisure ethic in the 70s, you know, we went to 40 hour work weeks. Where are we now? We're back up to 6070, hour work week. Yeah, we're trying to lower the age that so kids can start working this is not a leisure ethic that we were headed towards. And now with AI, okay, let's change this conversation. Yeah, toxic environments are not going to work. Moving forward that command and control leadership. There's not a lot of it left, but there's, it's lingering, and some of the old guard, you know, there it's, it's slowly changing.   Michael Hingson ** 46:49 It is, I think, high time that we learn a lot more about the whole concept of teamwork and true, real team building. And there's a lot to be said for there's no I in team, that's right, and it's an extremely important thing to learn. And I think there are way to, still, way too many people who don't recognize that, but it is something that I agree with you. Over time, it's it's starting to evolve to a different world, and the pandemic actually was one, and is one of the things that helps it, because we introduced the hybrid environment, for example, and people are starting to realize that they can still get things done, and they don't necessarily have to do it the way they did before, and they're better off for it.   Rachelle Stone ** 47:38 That's right. Innovation is beautiful. I actually, I mean, as horrible as the pandemic was it, there was a lot of good that came out of it, to your point. And it's interesting, because I've watched this in coaching people. I remember early in the pandemic, I had a new client, and they came to the they came to their first call on Zoom, really slumped down in the chair like I could barely see their nose and up and, you know, as we're kind of talking, getting to know each other. One of the things they said to me, because they were working from home, they were working like 1011, hours a day. Had two kids, a husband, and they also had yet they're, they're, they're like, I one of the things they said to me, which blew my mind, was, I don't have time to put on a load of laundry. They're working from home. Yeah? It's that mindset that you own my time because you're paying me, yeah, versus I'm productive and I'm doing good work for you. Is why you're paying for paying me? Yeah? So it's that perception and trying to shift one person at a time, shifting that perspective   Michael Hingson ** 48:54 you talked before about you're a coach, you're not a doctor, which I absolutely appreciate and understand and in studying coaching and so on, one of the things that I read a great deal about is the whole concept of coaches are not therapists. A therapist provides a decision or a position or a decision, and they are more the one that provides a lot of the answers, because they have the expertise. And a coach is a guide who, if they're doing their job right, leads you to you figuring out the answer. That's   Rachelle Stone ** 49:34 a great way to put it, and it's pretty clear. That's, that's, that's pretty, pretty close the I like to say therapy is a doctor patient relationship. It's hierarchy so and the doctor is diagnosing, it's about repair and recovery, and it's rooted in the past, diagnosing, prescribing, and then the patient following orders and recovering. Hmm, in coaching, it's a peer to peer relationship. So it's, we're co creators, and we're equal. And it's, it's based on future goals only. It's only based on behavior change and future goals. So when I have clients and they dabble backwards, I will that's crossing the line. I can't support you there. I will refer clients to therapy. And actually, what I'm doing right now, I'm taking a mental health literacy course through Harvard Medical Center and McLean University. And the reason I'm doing this is because so many of my clients, I would say 80% of my clients are also in therapy, and it's very common. We have a lot of mental health issues in the world right now as a result of the pandemic, and we have a lot of awareness coming forward. So I want to make sure I'm doing the best for my clients in recognizing when they're at need or at risk and being able to properly refer them.   Michael Hingson ** 51:04 Do you think, though, that even in a doctor patient relationship, that more doctors are recognizing that they accomplish more when they create more of a teaming environment? Yes,   51:18 oh, I'm so glad you   Rachelle Stone ** 51:20 brought that up, okay, go ahead. Go ahead. Love that. I have clients who are in therapy, and I ask them to ask their therapist so that if they're comfortable with this trio. And it works beautifully. Yes,   Michael Hingson ** 51:36 it is. It just seems to me that, again, there's so much more to be said for the whole concept of teaming and teamwork, and patients do better when doctors or therapists and so on explain and bring them into the process, which almost makes them not a coach as you are, but an adjunct to what you do, which is what I think it's all about. Or are we the adjunct to what they do? Or use the adjunct to what they do? Yeah, it's a team, which is what it should be.   52:11 Yeah, it's, I always it's like the Oreo cookie, right?   Michael Hingson ** 52:16 Yeah, and the frosting is in the middle, yeah, crying   Rachelle Stone ** 52:19 in the middle. But it's true, like a therapist can work both in the past and in the future, but that partnership and that team mentality and supporting a client, it helps them move faster and further in their in their desired goals. Yeah,   Michael Hingson ** 52:37 it's beautiful, yeah, yeah. And I think it's extremely important, tell me about this whole idea of mental fitness. I know you're studying that. Tell me more about that. Is it real? Is it okay? Or what? You know, a lot of people talk about it and they say it's who cares. They all roll   Rachelle Stone ** 52:56 their eyes mental fitness. What are you talking about? Yeah, um, I like to say mental fitness is the third leg of our is what keeps us healthy. I like to look at humans as a three legged stool, and that mental fitness, that mental wellness, is that third piece. So you have your spiritual and community wellness, you have your physical wellness, and then you have your mental wellness. And that mental wellness encompasses your mental health, your mental fitness. Now, mental fitness, by definition, is your ability to respond to life's challenges from a positive rather than a negative mindset. And there's a new science out there called positive it was actually not a new science. It's based on four sciences, Positive Intelligence, it's a cognitive behavioral science, or psychology, positive psychology, performance psychology, and drawing a bank anyway, four sciences and this body of work determined that there's actually a tipping point we live in our amygdala, mostly, and there's a reason, when we were cavemen, we needed to know what was coming that outside stressor was going to eat us, or if we could eat it. Yeah, but we have language now. We don't need that, not as much as we did, not in the same way, not in the same way, exactly. We do need to be aware of threats, but not every piece of information that comes into the brain. When that information comes in our brains, amplify it by a factor of three to one. So with that amplification, it makes that little, little tiny Ember into a burning, raging fire in our brain. And then we get stuck in stress. So it's recognizing, and there's actually you are building. If you do yoga, meditation, tai chi, gratitude journaling, any sort of those practices, you're flexing that muscle. You talk to somebody who does gratitude journaling who just started a month in, they're going to tell. You, they're happier. They're going to tell you they're not having as many ruminating thoughts, and they're going to say, I'm I'm smiling more. I started a new journal this year, and I said, I'm singing more. I'm singing songs that I haven't thought of in years. Yeah, out of the blue, popping into my head. Yeah. And I'm happier. So the the concept of mental fitness is really practicing flexing this muscle every day. We take care of our bodies by eating good food, we exercise or walk. We do that to take care of our physical body. We do nothing to take care of our brain other than scroll social media and get anxiety because everybody's life looks so perfect,   Michael Hingson ** 55:38 yeah, and all we're doing is using social media as a stressor.   Rachelle Stone ** 55:42 That's right, I'm actually not on social media on LinkedIn. That's it.   Michael Hingson ** 55:48 I have accounts, but I don't go to it exactly. My excuse is it takes way too long with a screen reader, and I don't have the time to do it. I don't mind posting occasionally, but I just don't see the need to be on social media for hours every day.   Rachelle Stone ** 56:05 No, no, I do, like, like a lot of businesses, especially local small businesses, are they advertise. They only have they don't have websites. They're only on Facebook. So I do need to go to social media for things like that. But the most part, no, I'm not there. Not at all. It's   Michael Hingson ** 56:20 it's way too much work. I am amazed sometimes when I'll post something, and I'm amazed at how quickly sometimes people respond. And I'm wondering to myself, how do you have the time to just be there to see this? It can't all be coincidence. You've got to be constantly on active social media to see it. Yeah,   Rachelle Stone ** 56:39 yeah, yeah. Which is and this, this whole concept of mental fitness is really about building a practice, a habit. It's a new habit, just like going to the gym, and it's so important for all of us. We are our behaviors are based on how we interpret these messages as they come in, yeah, so learning to reframe or recognize the message and give a different answer is imperative in order to have better communication, to be more productive and and less chaos. How   Michael Hingson ** 57:12 do we teach people to recognize that they have a whole lot more control over fear than they think they do, and that that really fear can be a very positive guide in our lives. And I say that because I talked about not being afraid of escaping from the World Trade Center over a 22 year period, what I realized I never did was to teach people how to do that. And so now I wrote a book that will be out later in the year. It's called Live like a guide dog, stories of from a blind man and his dogs, about being brave, overcoming adversity and walking in faith. And the point of it is to say that you can control your fear. I'm not saying don't be afraid, but you have control over how you let that fear affect you and what you deal with and how you deal it's all choice. It is all choice. But how do we teach people to to deal with that better, rather than just letting fear build up   Rachelle Stone ** 58:12 it? Michael, I think these conversations are so important. Number one is that learner's mind, that willingness, that openness to be interested in finding a better way to live. I always say that's a really hard way to live when you're living in fear. Yeah, so step number one is an openness, or a willingness or a curiosity about wanting to live life better,   Michael Hingson ** 58:40 and we have to instill that in people and get them to realize that they all that we all have the ability to be more curious if we choose to do it.   Rachelle Stone ** 58:49 But again, choice and that, that's the big thing so many and then there's also, you know, Michael, I can't wait to read your book. I'm looking forward to this. I'm also know that you speak. I can't wait to see you speak. The thing is, when we speak or write and share this information, we give them insight. It's what they do with it that matters, which is why, when I with the whole with the mental fitness training that I do, it's seven weeks, yeah, I want them to start to build that habit, and I give them three extra months so they can continue to work on that habit, because it's that important for them to start. It's foundational your spirit. When you talk about your experience in the World Trade Center, and you say you weren't fearful, your spiritual practice is such a big part of that, and that's part of mental fitness too. That's on that layers on top of your ability to flex those mental muscles and lean into your spirituality and not be afraid.   Michael Hingson ** 59:55 Well, I'd love to come down and speak. If you know anybody that needs a speaker down there. I. I'm always looking for speaking opportunities, so love your help, and   1:00:03 my ears open for sure and live like   Michael Hingson ** 1:00:06 a guide dog. Will be out later this year. It's, it's, I've already gotten a couple of Google Alerts. The the publisher has been putting out some things, which is great. So we're really excited about it.   Rachelle Stone ** 1:00:16 Wonderful. I can't wait to see it. So what's   Michael Hingson ** 1:00:19 up for you in 2024   Rachelle Stone ** 1:00:22 so I actually have a couple of things coming up this year that are pretty big. I have a partner. Her name's vimari Roman. She's down in Miami, and I'm up here in the Dunedin Clearwater area. But we're both hospitality professionals that went into coaching, and we're both professional certified coaches, and we're both certified mental fitness coaches. When the pandemic hit, she's also a Career Strategist. She went she started coaching at conferences because the hospitality industry was hit so hard, she reached out to me and brought me in too. So in 2024 we've been coaching at so many conferences, we can't do it. We can't do it. It's just too much, but we also know that we can provide a great service. So we've started a new company. It's called coaches for conferences, and it's going to be like a I'll call it a clearing house for securing pro bono coaches for your conferences. So that means, let's say you're having a conference in in LA and they'd like to offer coaching, pro bono coaching to their attendees as an added value. I'll we'll make the arrangements for the coaches, local in your area to to come coach. You just have to provide them with a room and food and beverage and a place to coach on your conference floor and a breakout. So we're excited for that that's getting ready to launch. And I think 2024 is going to be the year for me to dip my toe in start writing my own story. I think it's time   Michael Hingson ** 1:02:02 writing a book. You can say it. I'm gonna do it.   Rachelle Stone ** 1:02:05 I'm gonna write a book Good. I've said it out loud. I've started to pull together some thoughts around I mean, I've been thinking about it for years. But yeah, if the timing feels right,   Michael Hingson ** 1:02:21 then it probably is, yep, which makes sense. Well, this has been fun. It's been wonderful. Can you believe we've already been at this for more than an hour? So clearly we   1:02:33 this went so fast. Clearly we   Michael Hingson ** 1:02:35 did have fun. We followed the rule, this was fun. Yeah, absolutely. Well, I want to thank you for being here, and I want to thank you all for listening and for watching, if you're on YouTube watching, and all I can ask is that, wherever you are, please give us a five star rating for the podcast. We appreciate it. And anything that you want to say, we would love it. And I would appreciate you feeling free to email me and let me know your thoughts. You can reach me at Michael H, I m, I C, H, A, E, L, H i at accessibe, A, C, C, E, S, S, I, B, e.com, would love to hear from you. You can also go to our podcast page, www, dot Michael hingson.com/podcast, and it's m, I C, H, A, E, L, H, I N, G, s, O, N, and as I said to Rochelle just a minute ago, if any of you need a speaker, we'd love to talk with you about that. You can also email me at speaker@michaelhingson.com love to hear from you and love to talk about speaking. So however you you reach out and for whatever reason, love to hear from you, and for all of you and Rochelle, you, if you know anyone else who ought to be a guest on unstoppable mindset, let us know we're always looking for people who want to come on the podcast. Doesn't cost anything other than your time and putting up with me for a while, but we appreciate it, and hope that you'll decide to to introduce us to other people. So with that, I again want to say, Rochelle, thank you to you. We really appreciate you being here and taking the time to chat with us today.   Rachelle Stone ** 1:04:13 It's been the fastest hour of my life. I'm gonna have to watch the replay. Thank you so much for having me. It's been my pleasure to join you.   **Michael Hingson ** 1:04:24 You have been listening to the Unstoppable Mindset podcast. Thanks for dropping by. I hope that you'll join us again next week, and in future weeks for upcoming episodes. To subscribe to our podcast and to learn about upcoming episodes, please visit www dot Michael hingson.com slash podcast. Michael Hingson is spelled m i c h a e l h i n g s o n. While you're on the site., please use the form there to recommend people who we ought to interview in upcoming editions of the show. And also, we ask you and urge you to invite your friends to join us in the future. If you know of any one or any organization needing a speaker for an event, please email me at speaker at Michael hingson.com. I appreciate it very much. To learn more about the concept of blinded by fear, please visit www dot Michael hingson.com forward slash blinded by fear and while you're there, feel free to pick up a copy of my free eBook entitled blinded by fear. The unstoppable mindset podcast is provided by access cast an initiative of accessiBe and is sponsored by accessiBe. Please visit www.accessibe.com . AccessiBe is spelled a c c e s s i b e. There you can learn all about how you can make your website inclusive for all persons with disabilities and how you can help make the internet fully inclusive by 2025. Thanks again for Listening. Please come back and visit us again next week.

Dr. Tesha Monteith talks with Dr. Peter Goadsby about advances in headache science and classification.  Read the fourth edition of the International Classification of Headache Disorders. Disclosures can be found at Neurology.org. 

Experiences of participation in daily life of adolescents and young adults with cerebral palsy: A scoping reviewStacey L Cleary, Prue E Morgan, Margaret Wallen, Ingrid Honan, Nora Shields, Freya E Munzel, James R Plummer, Cassandra Assaad, Petra Karlsson, Evelyn Culnane, Jacqueline Y Ding, Carlee Holmes, Iain M Dutia, Dinah S Reddihough, Christine ImmsPMID: 39673293DOI: 10.1111/dmcn.16196AbstractAim: To synthesize the experiences of 15- to 34-year-olds with cerebral palsy (CP) as they participate in key life situations of young adulthood.Method: A mixed-methods scoping review was undertaken and six electronic databases searched (January 2001 to August 2023). Participation foci and thematic outcomes were mapped to the International Classification of Functioning, Disability and Health. Results were integrated using a convergent integrated analysis framework, and data analysis completed through thematic synthesis. Themes were mapped to the family of Participation-Related Constructs.Results: Thirty-eight publications (32 studies; 2759 participants) were included. More participants were male (n = 1435), walked independently (n = 1319), and lived with their families (n = 1171). 'Claiming my adulthood and "doing" life' was the unifying descriptor of participation, conveying the effortful work young people felt necessary to take their places in the adult world. The physical accessibility of the environment was a significant barrier to participation, as were people's negative attitudes or misconceptions about disability. A close-knit 'circle of support', typically family members, formed a supportive foundation during this period.Interpretation: Young people with CP aim to participate fully in adult life, alongside their peers. Improved community accessibility, inclusion, and more supportive health environments would ensure they could live the lives they choose.

Welcome to Real Food Recovery, a podcast created by two lifelong processed food addicts with over 100 years of addiction (and recovery) between them. Paige Alexander and Jamie Morgan Reno use their Real Food Recovery podcast and social media channels to share their struggles, lessons learned, tools, tips, and resources that freed them from decades of food addiction, obsession, and loss. Join us as we interview Clarissa Kennedy. Clarissa is a distinguished Clinical Social Worker and founder of Reinvent Your Bliss Point, co-founder of Sweet Sobriety, and co-host of the Food Junkies Podcast. With over 15 years of experience across residential treatment, outpatient services, and private practice, Clarissa is a leader in the field of food addiction and eating disorders. She holds a specialized diploma in Professional Addiction Studies and is currently part of the team advocating for Ultra-processed Food Addiction to be recognized in the International Classification of Disease with the World Health Organization.   In every Real Food Recovery episode, Paige and Jamie take time to answer viewer questions about processed food addiction, obsession, and recovery, be sure to submit yours on their YouTube Channel or Facebook Page. You can also follow Real Food Recovery on Instagram (@realfoodrecovery4u), TikTok (@realfoodrecovery) or at www.realfoodrecovery4u.com.  

Jung und Freudlos ist zurück! Nach langer Schaffenspause melden sich Ismene, Christa und Sebastian wieder, erklären die lange Pause und was als nächstes kommen soll. Moritz grüßt aus der Pfalz, ehe es wieder inhaltlich wird und wir uns mit den International Classification of diseases beschäftigen. Die wurde nämlich erneuert und die sogenannte ICD-11 gilt nun auch in Deutschland.

The INFACT School (https://infactschool.com/) is the only school in the world that teaches students about the science of food addiction and how to treat it.  Graduates receive a Certified Food Addiction Professional (CFAP) which is recognized in Europe and the U.S.  This seven-month virtual training program involves speakers and many top professionals who study the disease of food addiction. Students are taught screening, assessments and intake technique processes involving looking at behaviors and addiction genealogy. They are trained in counseling and treatment for abstinence and the reversal of personality changes that happen as a person becomes addicted to a substance.  The guest is the podcast owner and highly respected pioneer and school's founder, Esther Helga Gudmundsdottir, a recovered food addict who released 130 lbs. to achieve a healthy weight through abstinence and working a 12-step food addiction recovery program.  She then knew what her life's mission would be: help other food addicts by opening a treatment center in Iceland and beginning the INFACT School.  Over 130 students have graduated from the school, with new classes offered in March and September each year.   We discuss the science behind food addiction, which is just like the addiction to alcohol and drugs: a dopamine response, and over time, experiencing higher tolerance, using more of the substance despite negative consequences. Late-stage food addicts are often obese with obesity-related health issues and cannot stop on their own from eating the offending foods, and once they start, they have difficulty stopping.   37 clinicians, researchers, and academics throughout the world have reached an agreement that food addiction, specifically ultra-processed food addiction, is a substance use disorder.  The International Food Addiction Consensus (IFAC) (https://heyzine.com/flip-book/a00ee3aa6c.html) met in London, U.K. in May 2024, and a conference is planned in Mexico City in September 2025 as the application is being submitted to the World Health Organization (WHO) to be placed in the International Classification of Disease, (ICD) to place ultra-processed food addiction as a substance use disorder, in the ICD. Esther believes in complete abstinence from sugar and addictive foods, along with treatment and recovery programs to recover from food addiction. Her work and that of the school have been impactful and revolutionary.  Listen to this wonderful interview with Esther Helga Gudmundsdottir. Yale Food Addiction Scale https://infactschool.com/yale-food-addiction-survey/

Orofacial pain comprises many disorders with different etiologies and pathophysiologies. A multidisciplinary approach combining medication, physical therapy, and procedural and psychological strategies is essential in treating patients with orofacial pain. In this episode, Teshamae Monteith, MD, FAAN, speaks with Meredith Barad, MD; Marcela Romero-Reyes, DDS, PhD, authors of the article “Orofacial Pain,” in the Continuum® October 2024 Pain Management in Neurology issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Barad is a clinical associate professor of anesthesiology, perioperative and pain medicine, and neurology and neurological sciences and codirector of the Stanford Facial Pain Program at Stanford Medicine in Stanford, California. Dr. Romero-Reyes is a clinical professor and director of the Brotman Facial Pain Clinic and Department of Neural and Pain Sciences at the University of Maryland in Baltimore, Maryland. Additional Resources Read the article: Orofacial Pain Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media @ContinuumAAN Host: @headacheMD Guest: @meredith_barad facebook.com/continuumcme Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum 's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. Today I'm interviewing Drs Meredith Barad and Marcela Romero-Reyes about their article on oralfacial pain, which appears in the October 2024 Continuum issue on pain management and neurology. Welcome to the podcast, ladies. How are you?  Dr Barad: Excellent.  Dr Romero-Reyes: Fine, happy to be here.  Dr Monteith: I am so happy to see you. I mean, I think both of you I've known for like ten years. Dr Romero-Reyes: Yeah.  Dr Barad: Yes.  Dr Monteith: So why don't you introduce yourselves? While I know you, our audience, some of them, may not know you.  Dr Romero-Reyes: I'm Dr Marcella Romero Reyes. I am a neuropathial pain specialist, clinical professor, and director of the Provident Special Pain Clinic here in the University of Maryland School of Dentist. Dr Monteith: Excellent.  Dr Barad: My name is Meredith Barad. I'm a clinical associate professor at Stanford and I work- I'm the codirector of our headache and facial pain clinic in the Stanford pain management clinic. Dr Monteith: Well, first of all, thank you for writing this article. It is extremely detailed and up-to-date and very informative. And in neurology, I think we don't get enough pain management. I'm interested in both of your backgrounds and, you know, what led you even to become an expert in this area? And both of you have complementary areas. I think we can see in the quality of this article. But why don't we start with you, Dr Romero-Reyes? Dr Romero-Reyes: Well, for me to get interested in orofacial pain, I will say more than an interest was like a calling that I wanted to take care of this patient population. So, as you know, my background is dentistry and at that time I was very interested in patients with complex medical issues. And was the time I was- I started to be interested in temporomandibular disorders. But what really picked completely my attention was the first time I saw a patient with trigeminal neuralgia. This was my last year in dental school. This patient already had, like, almost a full upper quadrant of teeth extracted where pain was not resolved. So when the patient came to us and I did my exam and, you know, and I triggered the pain, the sharp shoot electrical pain, that really broke my heart. And I took an x-ray and I didn't find anything that will explain it was something wrong until I talked to my professor and he said, no, this is medical. There's nothing wrong with it, with that tooth and needs to be, you know, followed with proper management and medication. And for me, that was like, wow, what a proper diagnosis and proper management can take care of these of these patients. And when the patient got better, that really said, oh, you know, I want to do this.  Dr Monteith: That's a crazy story. It's always that last patient of the day.  Dr Romero-Reyes: And you know, think about it, at least in dentistry at that time, I learned about trigeminal neuralgia from a book, right, my classes. But when you see the patient, this is it. That completely, you know, made me say yes, I want to study this.  Dr Monteith: Yeah. And unfortunately, that's not an uncommon scenario where patients with trigeminal neuralgia get, you know, their extractions and pain can sometimes be more complicated. What about you, Dr Barad? Dr Barad: Well, I guess I'm sort of like the opposite. So as a neurologist and a trained pain physician, I saw a lot of patients with neuralgic pain and headache pain, but I also saw many patients who would say, I have TMJ. And as, as Dr Romero has educated us, that's like saying I have shoulder or I have knee. But I quickly realized that I needed to work with a multidisciplinary team to really understand more about orofacial pain. It's not just neuralgic. There are other ideologies. And so that's how we started working together and that's how we practice in our clinic at Stanford. Dr Monteith: So, why don't you tell us about the objectives of this article? Dr Barad: I think our objectives were to help the neurologist broaden the differential diagnosis on facial pain to encompass below the nose, the oral cavity, the temporal mandibular joint. And to just think more broadly about facial pain and to understand some of the more recent diagnostic criteria that have been developed for facial pain and to- how to diagnose properly and how to begin treatment for some of the other conditions that are non-neurologic.  Dr Romero-Reyes: And I think I will ask about what Dr Barad say that also to bring awareness to the neurologist about the vast classification of oral facial pain disorder, craniofacial and orofacial. I think that was also a key thing too. And also, to show how well we can work together, you know, the multi-disciplinary management that is indicated for these cases. Dr Monteith: Cool. And you mentioned some of the new diagnostic criteria. I want to talk just briefly about the new international classification of orofacial pain, ICOP. When did that come out and what was the process there in really fine-tuning the diagnosis of orofacial pain disorders? Dr Romero-Reyes: So, in 2019 the orofacial head pain especially interest group of the International Association for the Study of Pain, the International Network for Orofacial Pain and Related Disorders methodology and the American Academy of Orofacial Pain and the International Headache Society. They partnered together to develop to develop this international classification of orofacial pain. And these, I think- it's such a great effort, you know, all the main people doing pain about this area, and goes very well together with the international classification of headache disorders. So, for example, you know, some disorders that International Classification of Headache Disorders doesn't present such as and the ICOP, International Classification of Orofacial Pain, presents, like the persistent idiopathic dental Viola pain. You have it in the ICOP. It's not, you know, mentioned in the in the International Classification of Headache Disorders, as well as, also we have the- I think it's item number five, the orofacial representations headache disorder or primary headache disorder. The ICOP gives you a nice, clean diagnostic criteria.  Dr Monteith: So, I guess I would ask Dr Barad with this classification in mind, how useful is it in neurology practice? And I know obviously you see patients with pain, but how useful even in managing patients with headache? Dr Barad: I think it's great because I've had a lot of dentists and ENT doctors who have started referring patients to me because they've realized that they've increased their awareness about orofacial pain and realized that pain in the sinuses, for example, accompanied by light sensitivity and sound sensitivity and rhinorrhea, may not be a recurrent monthly sinus infection. And so that kind of broadens our awareness of these of these disorders. And it's been, it's brought new patients into my clinic that we can help and treat. So that's been exciting.  Dr Monteith: And what about in the world of dentistry? Obviously, I think people in orofacial pain worlds are highly attuned to this, but I would hope this would hopefully have been disseminated into dentists and regular practice at C patients with trigeminal neuralgia. Dr Romero-Reyes: Going back for the, what you were discussing about the ICOP. So, it's what we're trying now as a new specialty. Well that we have been for the last four years, but finally in 2020 we have been recognized by the American Mental Association to disseminate this knowledge. But also, you know, can you imagine in in the realm in orofacial pain or dentistry have a patient with this recurrent pain, phonophobia, photophobia, throbbing dental pain is throbbing, but it's nothing wrong with your tooth. And that did they tell you that actually you have an orofacial or facial migraine or a neurovascular or facial pain. How crazy, right? And that is managed with migraines therapy. So it really, you know, to make you think like that. Wow, so these weird tooth things that used to come every week or these with facial pain, it's nothing to deal with, you know, with my teeth or any structure, you know, inside my mouth. Dr Barad: It sounds to me like what you're saying is that we've, this has encouraged patient education as well, not only interdisciplinary education, but really helping provide an explanation for the patient about what is going on with them. So rather than just getting sent away to another tertiary specialist, the patient is getting a more robust understanding of what's going on.  Dr Romero-Reyes: And going back to what you were saying about trigeminal neuralgia, you know, at least in dentistry also we're teaching now a new awareness like for two things, right? What about from the neurology setting? The patient has captured electrical pain. The trigger is intraoral. If it's pain inside your mouth, the first practitioner you're going to see who will be maybe the dentist that the dentist knows that could be a possibility of a disorder that doesn't deal with teeth, but also, it's important and we discussed that in our paper. What about that actually that weird trigger actually, it's not a general. What about if it's a cracked tooth has that singing sensation too. So, you see, it's two ways; one, to teach dentist to learn about this disorder and you know, we have learned, but you know, it's much more awareness now that this is great that, you know, these disorders you're not going to treat with dental procedures. Right? It's medical and vice versa, that the neurologist also has the awareness that oh, central trigger. Have you gone to the to the dentist? Have you checked that out? Dr Monteith: So what should neurologist know about dental sources of pain? Dr Barad: Well, maybe they should read the paper?  Dr Romero-Reyes: Yeah. Yeah, you need to read the paper. Yeah.  Dr Monteith: Top three, don't treat this with gabapentin.  Dr Romero-Reyes: Like well, dental pain is not going to be resolved with gabapentin. That would need to make a diagnosis if and you know it's that examination that come comes with a radiographic evidence that shows that maybe could be a cavity or could be a problem. You know in the in the practical tissues of the tooth that is given a symptomatology. Not only dental could be a lot of different disorders inside there now that can produce pain that also the readers can check our paper and learn about and see the wonderful interesting pictures that we have added there. Dr Monteith: Yeah. And so why don't we talk a little bit about TMD disorders and what is the new thinking around these conditions? Dr Romero-Reyes: Well, I will say for the last decade, maybe a little bit more has been a change in the evidence. They evidence based understanding of the theologia pathophysiologist and for mandibular disorders. Imagine that what's the shift in the in the paradigm that in dentistry prevails for a long, long time. That is that really focus and I will call it the pathological mechanistic point of view. What I mean by that I was focusing your bite, your occlusion, how the relation between in your maxilla mandible. That was the only issues that would create in temporomandibular disorders. So now we know that temporomandibular disorders are complex, are multifactorial and you need to understand them and see them within a biopsychosocial framework. And this dictate the main way to management for the primary way that we start will be conservative, reversible and basing evidence that the best evidence available that we have. Dr Monteith: And what about for trigeminal neuralgia? Is there newer kind of classification around trigeminal neuralgia? and what are some key points that we should consider when diagnosing these patients and treating these patients, Dr Barad?  Dr Barad: There haven't been any new diagnostic criteria, but I would say that there's been an increased awareness that classical trigeminal neuralgia is more likely than not related to neurovascular compression or we should say, maybe I should say neurovascular contact or compression. There is a developing grading system of that. That's an evolution as we speak. I think it's an exciting time for facial neuralgia because it's opened the door for us to look at other neuralgia also as vascular compressions and to think about how we can treat them with decompression or possibly with peripheral nerve stimulation or medicine or Botox. Or who knows what's the future is going to hold? But it is I think a change in the way we are thinking about the definition of neuralgia of, of trigeminal neuralgia in that is caused by a compression which is different than other neuralgia in other parts of the body. I should, I just want to classify there's about maybe ten twelve percent of people who present with classical trigeminal neuralgia who there is not evidence on imaging of a vascular contact or compression. But the majority of cases do seem to have some somewhere in the spectrum from contact to compression.  Dr Monteith: Even contact I find to be a bit vague sometimes say, well, thanks for letting me know that they're touching. But and then some of the neurosurgeons have different perspective when you open the patient up. So, I didn't know about the grading.  Dr Barad: Yeah, I think you've hit on it exactly like that is a big problem in the field right now. How do we understand what patients will be the best patients for surgery? And it used to be that you have the classical trigeminal neurologist symptomology plus some imaging that shows something versus nothing. And now we're getting into parsing out the imaging and trying to understand who's the best candidate for that with the imaging.  Dr Monteith: Dr Romero, anything to add?  Dr Romero-Reyes: No, that I agree about that, you know, and I think now maybe for the patients that I have seen with that, because under partial pain settings, sometimes we're the ones that, oh, actually what you have is trigeminal neuralgia idea, you know, so we start to have our small disciplinary management, but you know, when they come out, I already have an MRI doctor, but, and they say that these are compression, but what degree? And some patients that they don't have symptoms can have a compression. And I'm thinking maybe right that later on when we have more time and maybe nicer imaging, we're going to really find out or if it's the development angle is the measurement has some other characteristics, who knows. So, I think for trigeminal neuralgia, the things is still evolving, right? For our understanding. I have to help us to make a more- I will not say definitive diagnosis, but maybe some parameters will change in the future. Dr Monteith: So now we have a lot of people listening, international folks listening, and they always want some treatment, a tip, some clinical tips. So, can you give us a little bit of clinical insight to how to treat patients with trigeminal neuralgia and when you're seeing patients for second and third opinions, what might you see that may explain why their pain is not well controlled? We all get into interdisciplinary care, but in terms of pharmacology? Dr Barad: I think people are a little reluctant to use some of these medications that neuromodulating medications because, in general, it's an older population and they're rightly worried about falls and dizziness and confusion and low sodium. And so, I think they hesitate to go to the doses that are needed to help with pain control. So, a lot of our, my initial management is gingerly and gently titrating that to try to get to see if we can get control of the pain. Dr Monteith: Dr Romero?  Dr Romero-Reyes: I could add, for example, one thing that I in the realm of facial pain addition to pharmacology. Let's say that we have a patient with that intraoral trigger and we were able to localize that intraoral trigger. Sometimes we can even also use topical medication. And in the topical medication we can use, for example, an anticonvulsant, let's say gabapentin, oxcarbazepine for example, to add in the cream. And we use, we call it a neurosensory stent in my looks like a Nygard, but it's not a Nygard that can cover that area. So, the patient can add that cream very delimited in that area. And that helps, you know, can help with the pain sometimes. What we can find is that, at least in my, in my experience, and that when we add a topical, maybe we don't need to increase as much. The systemic medication, of course, depends from case to case.  Dr Monteith: So those are two great tips. Not being afraid to push those doses up in a safe manner and maybe with monitoring as well as of maybe utilizing more topicals. And I think we could probably hear a lot more from you on topicals at some other point. But thank you also for the table. I think it's, it's really nice the way all the treatments are laid out. So what other cranial neuralgia advances have there been? Dr Barad: I would say the main advancements have been in applying the knowledge that neurosurgeons have learned from microvascular decompression of the trigeminal nerve, to the glossopharyngeal nerve, to the geniculate nerve, and really trying to optimize imaging and optimize neurosurgical techniques to try to treat these neuralgias. If the patient has failed medicine, if the patient is a good candidate for surgery and if the patient desires that. Dr Monteith: Great. So now let's talk about multidisciplinary approaches. I know both of you are big fans of that, and you may do things a little bit differently at your institution, especially with your background. So maybe Dr Romero, do you want to tell us about your experience? And then we'll have Dr Brad. Dr Romero-Reyes: But in my experience from study management, let's say depend, of course, also the started we're talking about. But let's say for example about temporomandibular disorders, you know that for TMD is one of these overlapping pain conditions and we know that TMD is common with primary headache disorders, especially migraine. So, if we're able to utilize, you know, the expertise of neurologist specializing headache. With me, for example, or a facial pain person that is that is helping you manage a patient with this comorbidity. This is super effective because we know the presence of TMD in a migraineur can help the disorder to, to progress some more chronic form. So, you see, this is super important and effective to provide, you know, optimal care for the patient. For example, in the patients that I do see with neuralgias, like in addition to trigeminal neuralgia, let's say nervous intermediates neuralgia, that sometimes they can come to me like, oh, the pain is in my ear and my EMT or, or I think maybe it's my TMJ and for the pain is charged shooting inside the ear doesn't follow the for the diagnosis of temporomandibular disorders. And I can maybe help the patient to get a proper imaging or already penalize it with a neurologist to make sure. And maybe at least my way will be maybe I'm the one that can catch those disorders and help, you know, the patient to go for the next step. Dr Barad: I think Marcella, Dr Romero-Reyes, hit on a nice point that maybe this group is not as familiar with and that is that temporal mandibular dysfunction TMD is a, is one of the disorders that we call chronic overlapping pain conditions or COCPs. And those include headache. it's not, it's not specified fibromyalgia, irritable bowel syndrome, chronic pelvic pain and several other chronic pain syndromes. And they suggest a central sensitization to one's pain. And the way that we treat centrally sensitized pain is not just through medications, it's in a biopsychosocial framework because we see much higher rates of depression and anxiety in this group. And so, using a pain psychologist to help the patient develop coping strategies to help them manage their pain, using a physical therapist to help them learn this, the stretching exercises and using medications to help with not only with their pain syndrome, but also sometimes with their psych comorbidities. And then additionally, procedures sometimes play a role in the process to help usually turn down the pain. Interestingly, when we look at trigeminal neuralgia, we see much less overlapping pain disorders. It's much rarer to see somebody with TN who has other COCPs or the kind of chronic levels of depression and anxiety that we see in these patients. So, the approach is very different, and I think it requires the use of a multidisciplinary team to help guide the treatment pathways for these patients. Dr Monteith: Today, I've been interviewing Drs Meredith Barad and Marcelo Romero-Reyes, whose article on orofacial pain appears in the most recent issue of Continuum on pain management and neurology. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.

Istnieją różne przyczyny dysforii płciowej i transpłciowości. Omawiam je w nowym odcinku podkastu To Tylko Teoria. Odcinek powstał we współpracy z Esprit, wydawcą książki autobiograficznej Oliego Londona o zmianie płci i wycofaniu się z niej. Patronite: https://patronite.pl/totylkoteoria Źródła: Alexander Korte i wsp. Deutsches Ärzteblatt International (2008). Annalisa Anzani i wsp. International Journal of Environmental Research and Public Pealth (2020). Anne A. Lawrence. Sexual Dysfunction (2011). Atefeh G. Jolfaei i wsp. Journal of family medicine and primary care (2022). 11 International Classification of Diseases. World Health Organisation. Caroline Lowbridge. BBC (2021). Charles W. Davenport. Archives of Sexual behavior (1986). Christian J. Bachmann i wsp. Deutsches Ärzteblatt International (2024). Daria J. Kuss i wsp. Psychology of Popular Media (2020). David Ludden. Psychology Today (2023). 10 International Classification of Diseases. World Health Organisation. Devita Singh i wsp. Frontiers in Psychiatry (2021). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association. Dragana Duišin i wsp. The Scientific World Journal 2014 (2014). Emilie Kao i wsp. Newsweek (2024). Hannah Barnes. The Guardian (2024). Jennifer Katz i wsp. The American Journal of Family Therapy (2009). Jiska Ristori i wsp. „Gender dysphoria in childhood”. International Review of Psychiatry (2016). John Bowlby. Wydawnictwo Naukowe PWN (2020). John Money i wsp. Journal of Pediatric Psychology (1979). Jonathon W. Wanta i wsp. Transgender health (2019). Kaltiala-Heino, Riittakerttu i wsp. Child and Adolescent Psychiatry and Mental Health (2015). Kelley D. Drummond i wsp. Developmental psychology (2008). Kenneth Zucker. Archives of Sexual Behavior (2019). Kristin Valentino i wsp. Journal of Family Psychology (2012). Lauren Smith. Spiked (2024). Lisa Littman i wsp. Archives of Sexual Behavior (2024). Lisa Littman. Archives of Sexual Behavior (2021). Lisa Littman. PLOS One (2019). Madeleine S. C. Wallien i wsp. Journal of the American Academy of Child & Adolescent Psychiatry (2008). Melissa Midgen i wsp. Archives of Sexual Behavior (2019). Michael Bailey i wsp. Archives of Sexual Behavior (2023). Michael Shellenberger. Uherd (2024). Phil S. Lebovitz. American Journal of Psychiatry (1972). Susan Bewley i wsp. Healthcare (2022). Theodore Millon. Polskie Towarzystwo Psychologiczne. Warszawa (2012). Thomas D. Steensma i wsp. Journal of the American Academy of Child & Adolescent Psychiatry (2013). Varun Warrier i wsp. Nature communications (2020). Zbigniew Lew-Starowicz i wsp. Wydawnictwo Lekarskie PZWL (2020). Okładka: Beasternchen/Pixabay z późn. zm.

The Centers for Medicare & Medicaid Services (CMS) has released the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code updates for the 2025 fiscal year (FY).The FY 2025 ICD-10-CM updates introduce more than 300 code changes, including 252 new codes, 13 deletions, and 36 revisions, reflecting ongoing advancements in clinical documentation and disease specificity. These code changes will go into effect for discharges on Oct. 1, 2024.During the next live broadcast of the popular Talk Ten Tuesdays Internet broadcast, produced by ICD10monitor, AGS Health Vice President of Coding Services Leigh Poland will return to share 11 key takeaways. These updates reflect the continuous evolution of medical coding to match advancements in medical practice, patient care, and research.Also during the broadcast, these instantly recognizable panelists will report more news during their segments:• The Coding Report: Pamela Scott, Vice President of Coding Support and Compliance Services with First Class Solutions, will report on the latest coding news.• Social Determinants of Health: Tiffany Ferguson, CEO for Phoenix Medical Management, Inc., will report on the news that is happening at the intersection of medical record auditing and the SDoH.• News Desk: Timothy Powell, ICD10monitor national correspondent and regulatory expert, will anchor the Talk Ten Tuesdays News Desk.• TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc., and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.Cozen O'Connor Public Strategies - The Beltway BriefingListen for of-the-moment insider insights, framed by the rapidly changing social and...Listen on: Apple Podcasts Spotify

Validating the International Classification of Functioning, Disability and Health Core Sets for Autism in a Sample of Australian School-Aged Children on the Spectrum.Assessing functioning of children on the autism spectrum is necessary to determine the level of support they require to participate in everyday activities across contexts. The International Classification of Functioning, Disability and Health (ICF) is a comprehensive biopsychosocial framework recommended for classifying health-related functioning in a holistic manner, across the components of body functions, activities and participation, and environmental factors. The ICF Core Sets (ICF-CSs) are sub-sets of relevant codes from the broader framework that provide a basis for developing condition-specific measures. This study combined the ICF-CSs for autism, attention deficit hyperactivity disorder (ADHD) and cerebral palsy (CP) to validate the ICF-CSs for autism in an Australian sample of school-aged children. This cross-sectional study involved caregivers of school-aged children on the spectrum (n = 70) completing an online survey and being visited in their homes by an occupational therapist to complete the proxy-report measure based on the ICF-CSs for autism, ADHD and CP. Absolute and relative frequencies of ratings for each of the codes included in the measure were calculated and reported, along with the number of participants who required clarification to understand the terminology used. Findings indicate that the body functions and activities and participation represented in the ICF-CSs for autism were the most applicable for the sample. However, findings relating to environmental factors were less conclusive. Some codes not currently included in the ICF-CSs for autism may warrant further investigation, and the language used in measures based on the ICF-CSs should be revised to ensure clarity.https://pubmed.ncbi.nlm.nih.gov/38400895/

In dieser Episode spricht Johannes Gronover über die Herausforderungen und Risiken des Homeoffice, insbesondere in handwerklichen und beratenden Unternehmen. Während das Homeoffice oft als flexible und bequeme Lösung gepriesen wird, zeigt Johannes auf, welche negativen Auswirkungen es haben kann, wenn Mitarbeiter dauerhaft von zu Hause aus arbeiten. Er argumentiert, dass Isolation zu einem Verlust an Kreativität und Teamgeist führen kann, was letztlich auch die Produktivität und Zufriedenheit im Job gefährdet. Studien renommierter Institutionen wie der Harvard Business School und der WHO untermauern seine Thesen. Johannes teilt zudem seine eigenen Erfahrungen und erklärt, warum er in seinem Unternehmen auf die Präsenz vor Ort setzt. Eine spannende Folge für alle, die sich mit den Vor- und Nachteilen des Homeoffice auseinandersetzen möchten.Soziale Verbindungen und ZufriedenheitStudie: The Harvard Study of Adult DevelopmentQuelle: Robert Waldinger et al., Harvard Medical SchoolLink: Harvard Study of Adult DevelopmentStress und Burnout im HomeofficeStudie: World Health Organization: Burn-out an "occupational phenomenon": International Classification of DiseasesQuelle: World Health Organization (WHO)Link: WHO on BurnoutProduktivität und Kreativität im BüroStudie: The MIT Human Dynamics Laboratory Study on Collective IntelligenceQuelle: Massachusetts Institute of Technology (MIT)Link: MIT Human Dynamics LaboratoryVertrauen und Oxytocin in sozialen InteraktionenStudie: The Role of Oxytocin in Interpersonal Trust: Human Behavior and Evolution SocietyQuelle: Paul J. Zak, Claremont Graduate UniversityLink: Oxytocin and Trust StudySozialkompetenz als SchlüsselqualifikationStudie: The Future of Jobs Report 2020Quelle: World Economic Forum (WEF)Link: Future of Jobs ReportJobunsicherheit und OutsourcingStudie: The Global Risks Report 2021Quelle: World Economic Forum (WEF)Link: Global Risks ReportVertrauen und Führungskräfte im BüroStudie: Gallup State of the American Workplace ReportQuelle: GallupLink: Gallup Report

In dieser Episode spricht Johannes Gronover über die Herausforderungen und Risiken des Homeoffice, insbesondere in handwerklichen und beratenden Unternehmen. Während das Homeoffice oft als flexible und bequeme Lösung gepriesen wird, zeigt Johannes auf, welche negativen Auswirkungen es haben kann, wenn Mitarbeiter dauerhaft von zu Hause aus arbeiten. Er argumentiert, dass Isolation zu einem Verlust an Kreativität und Teamgeist führen kann, was letztlich auch die Produktivität und Zufriedenheit im Job gefährdet. Studien renommierter Institutionen wie der Harvard Business School und der WHO untermauern seine Thesen. Johannes teilt zudem seine eigenen Erfahrungen und erklärt, warum er in seinem Unternehmen auf die Präsenz vor Ort setzt. Eine spannende Folge für alle, die sich mit den Vor- und Nachteilen des Homeoffice auseinandersetzen möchten.Soziale Verbindungen und ZufriedenheitStudie: The Harvard Study of Adult DevelopmentQuelle: Robert Waldinger et al., Harvard Medical SchoolLink: Harvard Study of Adult DevelopmentStress und Burnout im HomeofficeStudie: World Health Organization: Burn-out an "occupational phenomenon": International Classification of DiseasesQuelle: World Health Organization (WHO)Link: WHO on BurnoutProduktivität und Kreativität im BüroStudie: The MIT Human Dynamics Laboratory Study on Collective IntelligenceQuelle: Massachusetts Institute of Technology (MIT)Link: MIT Human Dynamics LaboratoryVertrauen und Oxytocin in sozialen InteraktionenStudie: The Role of Oxytocin in Interpersonal Trust: Human Behavior and Evolution SocietyQuelle: Paul J. Zak, Claremont Graduate UniversityLink: Oxytocin and Trust StudySozialkompetenz als SchlüsselqualifikationStudie: The Future of Jobs Report 2020Quelle: World Economic Forum (WEF)Link: Future of Jobs ReportJobunsicherheit und OutsourcingStudie: The Global Risks Report 2021Quelle: World Economic Forum (WEF)Link: Global Risks ReportVertrauen und Führungskräfte im BüroStudie: Gallup State of the American Workplace ReportQuelle: GallupLink: Gallup Report

Indomethacin-responsive headache disorders are rare conditions whose hallmark is an absolute response to the medicine and include paroxysmal hemicrania and hemicrania continua. In this episode, Gordon Smith, MD, FAAN, speaks with Peter Goadsby, MD, PhD, FRS, author of the article “Indomethacin-Responsive Headache Disorders,” in the Continuum® April 2024 Headache issue. Dr. Smith is a Continuum® Audio interviewer and professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Goadsby is a professor of neurology at King's College London in London, United Kingdom and professor emeritus of neurology at the University of California, Los Angeles in Los Angeles, California. Additional Resources Read the article: Indomethacin-Responsive Headache Disorders Subscribe to Continuum: continpub.com/Spring2024 Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Guest: @petergoadsby Transcript Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the Show Notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the Show Notes. AAN members: Stay tuned after the episode to hear how you can get CME for listening. Dr Smith: This is Dr Gordon Smith. Today, I've got the great pleasure of interviewing Dr Peter Goadsby on indomethacin-responsive headache disorders, which is part of the April 2024 Continuum issue on headache. Dr. Goadsby is a Professor of Neurology at King's College London, in London, United Kingdom and a Professor Emeritus of Neurology at the University of California, Los Angeles, which is located in Los Angeles, California. Dr Goadsby, welcome to the podcast. Well Peter, I'm super excited to have the opportunity to talk to you. And I think, before we begin, we probably ought to expand on your introduction. I think there may be three or four neurologists who don't know who you are, and I think they should know who you are because you've got a really amazing story. These are exciting times in headache, right? And a lot of that's because of your work and you've been widely acknowledged for that; you received the appropriately named “Brain Prize,” which (if I'm correct) is the largest neuroscience award in the world; got to meet Danish royalty; you're - more recently, the ABF Scientific Breakthrough Award, which is super excited. So, particularly interested in hearing about your Continuum article. But before we get there, I think it would be really great to hear your story. How did you get into this in the beginning, and what's inspired you along the way to the many achievements you've had? Dr Goadsby: Why, it's a very kind introduction. People have been nice to me. It has to be said, Danish royalty were very nice, I have to say, and the very jolly chap, the Prince of Denmark. I got into neurology - I guess it's all about mentoring for me. I got into neurology because I got into medical school pretty much by accident. I really wasn't that interested and heard a lecture by James Lance, who was Professor of Neurology, University of New South Wales, at the time. He was talking about a nondominant parietal lobe. I'd seen the case as a medical student; it sort of just seemed weird to me and I wasn't that interested. But he set out this way of thinking about things to try and understand why a clinical presentation is what it is - what he described as a physiological approach to clinical neurology. He described a number of things, but he described that in this lecture and then gave a reference to some work that Mountcastle did on nondominant parietal recordings from awake behaving monkeys in the Journal of Neurophysiology. And I thought to myself, “Wow, this is really interesting - you could really get to the bottom of something,” and had that sort of “puzzle-y” thing going on. And I thought Lance was just wonderful, so I became interested in that. And then eventually I asked him about research - actually, I asked him about research after a lecture he gave on migraine, and the explanation of the time was some circulating substance - probably just as silly now. I went up to him afterwards and said to him, I thought the explanation he was giving was wrong. Like, here was a global person - he described Lance-Adams syndrome; this was someone who trained at Mass General, trained at Queen Square; was the first professor of neurology in Australia. I was just – like, it was a stupid thing to do. But I couldn't resist myself - I told him I thought it was wrong. And he's very polite, and he said, “Well, perhaps you could come and help us by doing some research.” And I thought, “Okay, that's a very nice response.” Interestingly, his daughter described him as unfailingly polite at his funeral. Of the many things you'd say about him, he was a kind person. Whether it's science or just the way you practice - that word (kind) - you can know as much about a subject as you like, but if you're not kind to patients, you're probably in the wrong game. He taught me to be curious about a problem and got me interested in headache, and to be kind in clinical practice - just kind – and I think they were very important lessons. So, I got into it because of excellent mentoring, and I'd like to think I've helped some others along the way. Dr Smith: Well, you certainly have helped a lot of people, Peter, and what a great story. I'm reflecting - I think the first vignette in The Man Who Mistook His Wife for a Hat was a right parietal syndrome - wasn't it? You've read that book? Dr Goadsby: Yes, I have. And I've met Sacks. When Sacks came to Australia, he wanted to see Lance, and Lance said, “Fine, but you have to meet me between the morning round and the afternoon clinical meeting.” And he got him to come and have lunch with him in the hospital cafeteria at the Prince Henry Hospital and invited me to this lunch. And I sat there and watched them chat. But it was a measure of Lance and how people were interested in him that Oliver Sacks had to get in a taxi and come out to a hospital cafeteria to have lunch if you wanted to have a chat. Because it was - it was a privilege to train with the person. You know, I've done okay, but I only do okay if you've got – you know, you can work with patients, you've got great collaborators, and you've got someone you can get advice from (a great mentor). Dr Smith: Yeah, that's actually really great words of wisdom for the residents and fellows and junior faculty listening to this. Maybe we should actually talk about your article, which was really great. Your article was on indomethacin-responsive headaches - and we can maybe talk about some specific questions - but what's the main take-home point? If our listeners needed to take or were to take home one point from your article, what would it be, other than it's indomethacin-responsive (that's in the title)? Dr Goadsby: Yeah, it's what it says on the jar. Well, I think the one thing to take home is that there are forms of headache that seem relatively pedestrian, like one-sided headache that feels like it ought to be migraine that's strictly one-sided, and a small percentage of them respond almost like switching a light off to indomethacin. So, I think you have to have a high index of suspicion. And I'm sure I give indomethacin to ten, twenty times as many people - or thirty - who end up (or even more, probably) who end up having a response. But we do it for a short period of time. For those who get the response - I can tell you, when they come back, they're crying, their partners crying, or the other day I saw one, their child's crying, because all of a sudden, you've basically fixed the problem up. So, the message would be, if you've heard about something and it feels a bit “maybe, could be” - you've heard this indomethacin thing - just do it for a couple of weeks. The worst thing that can happen is nothing (nothing happens). For a couple of weeks, they're not going to have a problem with the tummy (and I'm not advocating taking people with a active gastric ulcer, trying to bump them off). But you cover them properly, you give them a short trial, and occasionally in your practice, you will be so rewarded by that - you will dance home. Dr Smith: Well, this is going to be my next question. There are very specific criteria, right, for defining cluster, SUNCT, SUNA (and there was a really great Continuum Audio conversation I had with Mark Burish I'll refer our listeners to about cluster, SUNCT, and SUNA), but the indomethacin-responsive headaches - and even migraine - that sounds to me, as someone who's not a headache person, like, that could be challenging to sort out. If you see someone who has consistent, unilateral headache, do you just do an indomethacin trial, or do you select based on other criteria from the classification system? Dr Goadsby: I'd like to think I was aware of the criteria, and I am. But the longer I practice, the more I'm inclined simply to give the indomethacin and get the question off the table because I don't think there's a sine qua non; there's nothing that will - apart from the indomethacin effect - there's nothing that will convince me 100% to be able to not do it. I've seen enough people who haven't clearly read the classification in detail (patients, I mean) and took indomethacin, and got a response where you wouldn't have predicted it, and they're very happy and the story ends well. So, I would advise people not to worry too much about whether it ought to or not respond, but find out if it does. Dr Smith: So, the obvious next question is, how does this work? It's pretty unusual in medicine, certainly in neurology, to have something that's so dramatically effective. What's the mechanism? Dr Goadsby: Well, that's the easiest question - we don't understand it. It is particular to indomethacin - it's weird. Some patients will say, “We'll give you a little bit of a hint by telling you (maybe) that ibuprofen was useful,” but most don't give you that much of a hint (some will even say aspirin is useful). But we haven't really gotten to the bottom of it. What are the current thoughts? It must be something that's not simply cyclo-oxygenase because other cyclo-oxygenase inhibitors don't do that – so, that's helpful. The other broad things people think about are whether there's a nitrergic aspect to it. We've got some basic science work that can show that nitrergically induced changes in experimental animal model of these trigeminal autonomic cephalalgias can be modified by indomethacin in one part of the model, where naproxen (for example) can't. So, we think there may be a nitrergic component to it. The other thing is the structure of the molecule makes you think about melatonin, if you put the two up – it's a work in progress. Of the things I would like to do in my life, I'd really like to get to the bottom of it, I have to tell you, because if we could work out what it is that's great about indomethacin and then get rid of the GI thing . . . Then, if you talk about cure - because when people get a response to this (you know, the oldest reported case with a response took it for thirty-seven years; they died of something else) - and continue to respond. It's one of the sort of upsides and downsides when you diagnose it - you can tell a person that they're going to continue to respond (take a breath) until they die basically, because unfortunately, the problem doesn't tend to settle down - at least the treatment stays consistent. If we could get rid of the tummy problem, that would be real progress. Dr Smith: So, what do you do with the patient who has the tummy problem? Is there another approach? Dr Goadsby: Well, there's a range of things you try and do; you use PPIs (proton pump inhibitors) and H2 blockers pretty liberally; you try to get the lowest dose, and that's usually best done by the patient. I give them the ordinary-release indomethacin; it's an impression that I have, over the years, that the slow-release indomethacin is not as efficient (just as a recommendation). I let patients - they take it three times a day, or twice - I let them work out what the littlest amount is that they need, having given them a regime to iron it out, because they can work it out for themselves. It's a partnership. It'll be very individual. If someone wants to take two in the morning and one at night and feels happy, have at it. If they want to take one three times a day, if they want to take one at lunchtime - whatever they - let them work out the minimal amount. And the other thing that we found useful - small percentage (maybe one in five) will find the coxibs useful (like celecoxib), but that's not universal at all; it generally takes the edge off. A palpable percentage will find adding melatonin in can be indomethacin sparing. Then the other (probably most important) thing is that the noninvasive vagal nerve stimulator can be very useful in reducing indomethacin dosing or even getting patients entirely off indomethacin dosing. How that works, of course, is as mysterious in the sense of these problems as is indomethacin. But that's something really worth thinking about - can be very, very useful in getting the doses down. Dr Smith: You've been doing this for a while, right? And you've seen a lot of – Dr Goadsby: Let's not emphasize that “for a while” side, right, okay? Dr Smith: For a while – just a little while, Peter. Dr Goadsby: A little while. Dr Smith: I'm just thinking - and I'm a neuromuscular guy, so give me a little latitude - but when I was a resident, our concept of headache was pretty simple; it was migraine, classic or common, and we knew a little bit about cluster. And no one talked about SUNCT or SUNA or all these other things, and wow, what an amazing several decades it's been. What's the future look like? And - maybe think big – so, is a cure for migraine in the foreseeable future? What's coming next? Dr Goadsby: If you think really big (and I'll think really big), if “cure” means that we could control it sufficiently that you wouldn't notice it, I think that's very much - it's almost here, for some. Now, I think of it like cholesterol - someone's got high cholesterol; they take a statin, and if they don't get any problems, the cholesterol normalizes. I'm simplifying things (I'm not a cardiologist), but you take your cholesterol tablet - you take it once a day; everything's fine and dandy. You never get “cured,” as such, but the effect is an effective cure from manifestations of the problem - and I am simplifying things a little bit. If I look at it like that, then I think we're getting to a place where some patients, we can treat them so well, and the problem is so suppressed, and they have so few problems with side effects (and some have none), that we're really getting there. We saw a study of the promontory phase of migraine using a gepant (ubrogepant), and we saw the ability (if you recognize the attack early enough) to treat and never have pain. Never have pain. Well, that's pretty close. It might sound crazy to think about it as a cure because someone will say, “Well, they've still got their genes,” and so on. Fine. But migraine is about disability, and if you can stop the disability and give a person full function in their life, well, you're pretty much there. And we're getting there, as we understand the disease. Dr Smith: Really amazing. I have another question that I've actually been really dying to ask you. I'm a peripheral nerve guy, and you may not be aware of this, but those of us who are interested in therapeutic development in peripheral neuropathy, or advocacy, or recognition of neuropathy as a substantive, meaningful entity, are inspired by the work of you and your colleagues in headache. Examples might be advocacy for federal funding or having CDMRP funding - things like this. But an area where - I'm just curious - we spent a lot of effort (and it seems like it's been really transformational for you guys) is having taxonomy, which isn't a particularly sexy topic. But maybe you can talk about the power of having a taxonomic classification and getting towards a cure. Because looking through this Continuum issue - it's really remarkable – it's just all sorts of things that I never would have thought of twenty years ago, and each of them is treated a bit differently. Dr Goadsby: Yes. As with all things in medicine, if you don't get the diagnosis, you can't get to the base - you've got to be able to get a diagnosis. And our taxonomy, the International Classification of Headache Disorders, has gone through three editions. We're working on the fourth. I have the privilege of being the chairman for the fourth edition (the first three were chaired by Jes Olesen). I do think it's one of the absolute achievements of our field (and Olesen needs to be really feted for doing this) that we have a definition system - it's operational; it's reasonably straightforward; it's been translated into, like, forty languages; that every government on the planet that I know of - and I'm talking about (I think I'd better mention no governments) but every big government you can think of, without exception, has adopted (‘cause I'll just get in trouble with the ones I've mentioned) have all adopted this classification; all the health technology assessments (the FDA, for example; the European Medicine, for another example), the Chinese government (People's Republic), Taiwan. Just, all over the world, people use one thing. So, if we do a randomized control trial - there's one recently came out; it doesn't really matter which gepant it is - but you look at the results in North America, and then you look at the results that were done by the Chinese and the South Koreans in a study, and the placebo rates and the active rates are more or less identical. Because what we've been able to do is homogenize who gets into clinical trials and understand what's happening. So, if I get up and talk about whatever we're going to talk about now, like, in rural India, people will know what we're talking about; all the neurologists will be on the same page and so we can make progress. And when we make progress, it's global progress because we sing from the same hymn sheets. I think the taxonomy has been really important for this. And, of course, if you get the diagnosis right, then you can start to begin to get the treatments right and you can bring all the knowledge from randomized controlled trials. There's no point having a whole lot of data if you can't apply it, and what's great about our taxonomy is we can apply it everywhere in the world. Dr Smith: Wow, what a cool answer. So, I have a follow up question for you, Peter, which has to do with reproducibility. This is a huge issue, right? In reproducibility and clinical trial evidence and in many fields, this has been a big issue - in psychiatry and other areas of neurology, where trials are nonreproducible. To what extent do you think this problem in other fields is a taxonomic problem, or a internal validity problem, in terms of the populations being recruited? I'm really impressed to hear that you don't have that problem in headache. Dr Goadsby: I do think one of the advantages that the International Classification of Headache Disorders has given us (International Headache Society being the proponent of that) is that there's clinical homogeneity, relatively speaking, in our clinical trial populations. This comes back to the clinic; good clinical trials are as much about the clinicians who are involved and the care they take in recruiting patients, and so on. Which is not to say that psychiatrists are not careful - not at all. But I do think that if you want to just test a question, everyone in the laboratory will tell you that you need to have - say you're doing work with rodents, for example; you want about the same weight, you want the same strain, they're eating about the same, they're up and down at night - everything is about the same. If you want to do good clinical trial work, you have to tidy up as much as you can so the only thing that's really impacting upon the question is the medicine, or the placebo, or whatever that you're testing. So, I think you're right. I think sometimes the pain people struggle with this because, as you say, a painful neuropathy can come from a lot of places. Well, if you just take all of those etiologies, you throw them into one study, and you test it against something, it doesn't surprise me that that's not so useful, compared to taking an individual thing that's really well defined - where you've understood the clinical side, you've understood the pathophysiology as much as you could - and just test that, one at a time. I think that's been a good lesson for us. And that's why there's nothing that's ever failed in a migraine clinical trial (a properly designed one) that ever was useful, and nothing that was ever successful that didn't continue to be successful. Now, some things were successful, and they produced, like, liver enzyme problems - so, that's “no win-no foul” situation. But the homogeneity's been quite important, I think. And it comes back to good clinical practice. Dr Smith: Well, thank you for the roadmap - that's really, really interesting. I'd like to finish up with another shift in gears, and to talk about workforce. Obviously, we have a national shortage of neurologists in the United States. We're never going to be able to train enough headache neurologists to take care of all headache patients, and we need to think about systems of care, which I guess we could talk about. But my question for you is, what would you say - a lot of residents listen to Continuum Audio, and hopefully, more medical students in the future and now - what do you say to them about a career in headache? Listening to this, I kind of feel like I want to go do a headache fellowship - it's pretty exciting. What's your pitch to them? Dr Goadsby: I'll tell you one small thing first before I say that; I did do twelve months in clinical neurophysiology, doing nerve conduction, muscle biopsies, evoked potentials. I actually did over ninety muscle biopsies (needle muscle biopsies) when I was training, so I understand your feeling. But I just got the feeling many years earlier than you've had it. What do I say to residents? Well, headache is an area where you can make a diagnosis, you can manage the patient, and you can make them better. I'd say to the resident, “Ask - just look in the mirror and ask yourself, why did you get into medicine?” You got into medicine to help people, and headache is an area where you can really help them. Plus, there's tens of millions of people with the problem, so you will always be in demand. And one of the great things about headache (I think it's probably true of neuromuscular) is it's also a very good lifestyle choice because our problems are generally with primary headache disorders - are not emergent (people don't tend to ring you up at night), and it's not really an on-call issue. You can have a proper balanced existence (work-life balance), and you can do it in a way that's really enjoyable. And then there's an extra bonus: there's all the wonderful neuroscience and neuropharmacology that's going on in headache. I just think if a resident looks in the mirror and says, “Why am I doing this?” most of them are going to look back at themselves and say, “Because I want to do good.” And they also want to do good in a way that they can have a proper life themselves. And if they're the two answers you got back when you look in the mirror (“I want to do good” and “I want to have some life myself”) - headache - that's the place to go, because there's plenty of room and you can do both. Dr Smith: Well Peter, that's great - sign me up. And I think people know where to find you to call for a recommendation. What a great conversation and a really great article. And again, I'll refer our listeners to Mark Burish's article on cluster, which is a really great companion to your article ‘cause it gives you the full spectrum of trigeminal autonomic cephalgias (which is pretty cool), and the rest of the issue is equally amazing. Peter, you don't disappoint. The next time you see the Danish Crown Prince, say “Hi” from me (I love Denmark - it's a lovely place to be). And thanks again for doing this. Dr Goadsby: Well, thank you, and thanks for the Academy for organizing. And the other thing about residents - if you want to stay in touch with neurology, stay in touch with the Academy; they're a pretty good bunch. Dr Smith: Couldn't agree more, couldn't agree more. Again, today we've been interviewing Dr. Peter Goadsby. His article on indomethacin-responsive headache disorders appears in the most recent issue of Continuum, on headache. Be sure to check out our Continuum Audio podcasts from this and other issues. And listeners, thank you very much for joining us today.   Dr. Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practice. Right now, during our Spring Special, all subscriptions are 15% off. Go to Continpub.com/Spring2024, or use the link in the episode notes to learn more and take advantage of this great discount. This offer ends June 30, 2024. AAN members: go to the link in the episode notes and complete the evaluation to get CME. Thank you for listening to Continuum Audio.

New daily persistent headache is a syndrome characterized by the acute onset of a continuous headache in the absence of any alternative cause. Triggers are commonly reported by patients at headache onset and include an infection or stressful life event. In this episode, Aaron Berkowitz, MD, PhD, FAAN, speaks with Matthew Robbins, MD, FAAN, FAHS, author of the article “New Daily Persistent Headache,” in the Continuum® April 2024 Headache issue. Dr. Berkowitz is a Continuum® Audio interviewer and professor of neurology at the University of California San Francisco, Department of Neurology and a neurohospitalist, general neurologist, and a clinician educator at the San Francisco VA Medical Center and San Francisco General Hospital in San Francisco, California. Dr. Robbins is an associate professor of neurology and director of the Neurology Residency Program at New York-Presbyterian/Weill Cornell Medical Center in New York, New York. Additional Resources Read the article: New Daily Persistent Headache Subscribe to Continuum: continpub.com/Spring2024 Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @https://twitter.com/AaronLBerkowitz Guest: @ @mrobbinsmd Full Transcript Available: Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the Show Notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the Show Notes. AAN members: stay tuned after the episode to hear how you can get CME for listening.   Dr Berkowitz: This is Dr Aaron Berkowitz, and today I'm interviewing Dr Matthew Robbins about his article on new daily persistent headache, from the April 2024 Continuum issue on headache. Dr Robbins is an Associate Professor of Neurology and Director of the Neurology Residency Program at New York-Presbyterian/Weill Cornell Medical Center, in New York. Welcome to the podcast. Dr Robbins: It's great to be with you, Dr Berkowitz. Dr Berkowitz: Well, thanks so much for joining us this morning. To start, what is new daily persistent headache? I think it's an entity maybe that might be new to some of our listeners. Dr Robbins: Yeah - it's an entity that also struck me when I was in training. I didn't hear much of it as a neurology trainee until I did a fellowship in headache, where, all of a sudden, we were seeing patients with this syndrome (and labeled as such) all the time. And that actually inspired me to begin a research project to better characterize it - a clinical project that ended up helping to broaden the diagnostic criteria. New daily persistent headache really is just defined by what it says - it's new; it's every day; it persists; it's a headache. It can't be from some other identifiable cause, which includes both secondary disorders (you know, something that, where headache is a symptom of) or a primary headache disorder; distinguishes itself from, say, migraine or tension-type headache because there's no real headache history and there's an abrupt onset of a daily and continuous headache that has to last for at least three months since onset. And the onset is typically remembered - it's usually acute or abrupt; there may or may not be some circumstances that surrounded the onset that might have some diagnostic or causal or associated implications that we can explore. Dr Berkowitz: Okay. So, I always find it challenging in headache medicine and some other areas where we don't have a biomarker, per se - an imaging finding, a lab finding; we have an eloquent and detailed clinical description - to know how comfortable to be making a diagnosis like this. In this case, particularly, right - you said it has to be going on for three months. What if I see a patient one month into something I think could be this, but I can't technically say, per the criteria, right (it's three months)? When do you start thinking about this diagnosis in patients, and what are some of the main considerations in confirming the diagnosis, and what needs to be ruled out or excluded for making the diagnosis?   Dr Robbins: I think traditionally, in headache, the term “chronic” has that three-month time period. The reasons are twofold: one is that, typically, if there's some secondary disorder that might have some distinguishing feature (something that really evokes the headache or some other neurological accompaniment that develops in addition to headache), it would pretty much be likely to declare itself by the three-month mark. Or if it was something that was very self-limited, it would probably go away before three months have elapsed. Or if it resolved after some days or weeks but then declared itself as a more episodic disorder, then we might say someone who begins with continuous headache that might, for example, resemble migraine (maybe it presented a status migrainosis but then it devolved into a more episodic disorder that might just be migraine overall). So, I think that's pretty much why the three-month mark has been so prevalent in the International Classification of Headache Disorders, including how new daily persistent headache is diagnosed. But at the same time, there's lots of disorders that might mimic (or might be misdiagnosed as) new daily persistent headache, and they really are a secondary disorder. Probably the most common one that we think about is a disorder of intracranial pressure or volume, mainly because routine MRI features could be normal or could be easily missed if they had subtle abnormalities. The defining symptom of those disorders are also continuous headache, often from onset, with an abrupt and remembered nature. So, that's often the main category of secondary headache that might be misdiagnosed as primary headache. I think, probably, idiopathic intracranial hypertension as the prototypical disorder of high pressure often declares itself with visual symptoms, pulsatile tinnitus, and other abnormalities. And nowadays, there's much more increasing recognition for MRI abnormalities or even MRV abnormalities with such patients. But spontaneous intracranial hypotension (despite increasing recognition of CSF leaks in the spine that lead to intracranial hypotension or hypovolemia) really remains an underdiagnosed entity. I think that's one disorder where - for example, if I'm seeing a patient with new daily persistent headache and there's no orthostatic or positional nature to their headache - I will still do an MRI, with and without contrast, to be sure. But that the chances of them having a spontaneous CSF leak are low if that scan is unremarkable. Dr Berkowitz: That's very helpful. Yeah. It's interesting; when you talked about the criteria for this condition - that it has an acute onset, which is a red flag, right, and it is persistent for months, which for a new headache would also be a red flag. So, this is a condition - correct me if I'm wrong – that, if you're considering it, there's no way that you're going to make this diagnosis without neuroimaging because there are two red flags, in a way, embedded in the criteria before we get to the other diagnoses being excluded. Is that right? So, this would only be a diagnosis made clinically but after neuroimaging is obtained, given that two red flags are part of the criteria – isn't that right? Dr Robbins That's absolutely right. So, I can't imagine there's anyone who has new daily persistent headache who hasn't had appropriate neuroimaging, and that typically should include an MRI, with and without contrast, unless there's some compelling reason to avoid that. There's some other workup that could be done that's not universal but - for example, in clinic-based studies of patients who have new daily persistent headache versus those who may have, say, chronic migraine or chronic tension-type headache, you may find more abnormalities. The biggest and more compelling example of that is hypothyroidism, which presumably would be somewhat subclinical if it hadn't been brought to someone's medical attention earlier. It doesn't mean that hypothyroidism is the cause of new daily persistent headache, but it could be some type of triggering or priming factor that leads to headache perpetuation in some patients. Sometimes, if that hasn't been done already, that would be a blood test I might think about sending. And, of course, the context of onset; if someone lived in a place where tick-borne illnesses are endemic, if there are other neurological symptoms, that might prompt looking for serological evidence of Lyme disease, as one example. Dr Berkowitz: We see a lot of headache. I'm a general neurologist; I know you're a headache specialist; we all see a lot of patients with headache. You and I both work closely with residents. Often, residents will come to present a headache patient to me and they'll say, “The patient seems to have a new daily persistent headache. They haven't been imaged yet. They have a completely normal exam. The history fits.” And I always ask them, “Okay, we have to get neuroimaging, right? There's at least one red flag of the chronicity, maybe the red flag of something beginning relatively abruptly. Even though you're looking at the patients - I'm pretty sure that imaging is going to be normal, but we've got to do it.” But I always encourage residents, “Try to predict - do you think the imaging is going to be normal (this is a rule out) or do you think you're going to see something (this is a rule in)? - just to sort of work on calibrating your clinical judgment.” I'd love to ask you - as a headache specialist, when you're looking at the patient and say, “I know I need to get neuroimaging here to fully make this diagnosis of exclusion,” or you've heard something that sounds like a red flag; you know you're obligated to image, but your clinical suspicion of finding anything more than something incidental is pretty low. How often are you surprised in practice in a sort of enriched tertiary headache population? Dr Robbins: That's a great way to frame such a presentation on how a resident would present to you the case and whether it's a rule in or rule out. I totally agree with your approach. I think much of it depends on the clinical story. I think if it was just a spontaneous onset of headache that kind of resembles migraine that just continued, then likely the MRI is being done to just be sure we're not missing anything else. However, if the headache started – really, say someone coughed vigorously or bent over and the headache started, and there was some clear change that you could perceive in - that was, say, the Valsalva or a transiently raised intracranial pressure, or some other maneuver; then you might really say, “Well, this really could be a spontaneous CSF leak,” for example. Even if the MRI of the brain, with and without contrast, is totally normal, I'm not really sure I'm convinced - that you might even take it further. For example, you might do an MRI of the total spine, with a CSF-leak-type protocol, to see if there's some sign of a spontaneous CSF leak or an extradural collection. So, I think in the cases where the preclinical suspicion is higher for a secondary headache, it might not stop at an MRI of the brain (with and without contrast) that's normal. Patients with spontaneous CSF leaks - about eighty percent of them have abnormal brain MRIs, but twenty percent don't. We found, from some observational studies, that a newer cause of intracranial hypotension, such as a CSF venous fistula in the spine, is more likely to present than other causes of CSF leak - with say, Valsalva-associated headache or cough-associated headache. That might prompt us to really take a workup more deeply into that territory, rather than someone where it really just sounds like chronic migraine that switched on. And maybe in those patients, when you dig around, they were carsick as a kid, or they were colicky babies, or they used to get stomachaches and missed school as a teenager here and there, and you think migraine biology is at play. Dr Berkowitz: So, if you're thinking of this diagnosis before you can make it, these patients are going to get an MRI, with and without contrast. And it sounds like the main things you're looking to make sure you're not missing are idiopathic intracranial hypertension or intracranial hypotension from some type of leak. Any other secondary headaches you worry about potentially missing in these patients or want to rule out with any particular testing? Dr Robbins: Yeah - I think sometimes we think of other vascular disorders, especially - when these patients come to medical attention, it's often a total change from what they're used to experiencing. They may present to the emergency room. So, it depends on the circumstance. You might need to rule out cerebral venous thrombosis. Or if there was a very abrupt onset or a relapsing nature of abrupt-onset headaches with sort of interictal persistent headache, we might think of other arteriopathies, such as reversible cerebral vasoconstriction syndrome. There's the more common things to rule out - or commonly identified conditions to rule out - like neoplasm and maybe a Chiari malformation in certain circumstances; those usually would declare themselves pretty easily and obviously on scan or even on clinical exam. Dr Berkowitz: Another question I'd love to ask you as a headache specialist, in your population - sometimes we see this type of new daily persistent headache presentation in older patients, and the teaching is always to rule out giant cell arteritis with an ESR and CRP, in the sense that older patients can present with just headache. Again, my clinical experience as a general neurologist - I wanted to ask you as a headache specialist – is, for the countless times I've done this (older patient has gotten their neuroimaging; we've gotten ESR and CRP), I've never made a diagnosis of giant cell arteritis based on a headache alone, without jaw claudication, scalp tenderness, visual symptoms or signs. Have you picked this up just based on a new headache, older person, ESR, CRP? I'm going to keep doing it either way, but just curious - your experience. Dr. Robbins: Yeah. We're taught in the textbooks (I'm sure we're taught by past Continuum issues and maybe even in this very issue) about that dictum that's classically in neurology teaching. But I agree - I've never really seen pure daily headache from onset, without any other accompaniments, to end up being giant cell arteritis. Then again, someone like that might walk in tomorrow, and the epidemiology of giant cell arteritis supports doing that in people over the age of fifty. But almost always, it's not the answer; I totally agree with you. Dr Berkowitz: Good to compare notes on that one. Okay - so let's say you're considering this diagnosis. You've gotten your neuroimaging, you've gotten (if the patient is over fifty) your ESR and CRP, and you ruled out any dangerous secondary causes here. You have a nice discussion in your article about the primary headache differential diagnosis here. So, now we're sort of really getting into pure clinical reasoning, right, where we're looking at descriptions (colleagues like yourself and your colleagues have come up with these descriptions in the International Classification of Headache Disorders). Here again, we're in a “biomarker-free zone,” right? We're really going on the history alone. What are some of the other primary headache disorders that would be management changing here, were you to make a diagnosis of a separate primary headache disorder, as compared to new daily persistent headache? Dr Robbins: I think the two main disorders really are chronic migraine and chronic tension-type headache. Now, what we're taught about chronic migraine and chronic tension-type headache is that they are disorders that begin in their episodic counterparts (episodic migraine, episodic tension-type headache) and then they evolve, over time, to reach or culminate in this daily and continuous headache pattern, typically in the presence of risk factors for that epidemiologic shift we know to exist but that may happen on the individual level, which does include things that we can't modify, like increasing age, women more than men, some social determinants of health (like low socioeconomic status), a head injury (even if it didn't cause a concussion or clear TBI), a stressful life event, medication overuse, having comorbid psychiatric or pain disorders in addition to the headache problem, having sleep apnea that's untreated, and so on. New daily persistent headache - by definition, it should really be kind of “switched on.” Many years ago, Dr Bill Young and Dr. Jerry Swanson wrote an editorial where they labeled new daily persistent headache as the “switched-on headache.” Then, we're taught in headache pathophysiology that this chronification process happens over time because of, perhaps, markers of central sensitization that might clinically express itself as allodynia in trigeminal or extratrigeminal distributions. So, we're not comfortable with this new daily persistent headache, where we think the biology is like chronic migraine that gets switched on abruptly, but in so many patients, it seems to be so - it behaves like chronic migraine otherwise; the comorbidities might be the same; the treatments might still work similarly for both disorders in parallel. So, I think those are the two that we think about. Obviously, if there's unilateral headache, we might think of a trigeminal autonomic cephalalgia that's continuous, even if it doesn't have associated autonomic signs like ptosis or rhinorrhea (which is hemicrania continua) - and in those patients, we would think about a trial of indomethacin. But otherwise, I think chronic migraine and chronic tension-type headache are the two that phenotypically can look like new daily persistent headache. In patients with new daily persistent headache, about half have migraine-type features and about half have tension-type features. When I was a fellow, the International Headache Society and the classification only allowed for those who have more tension-type features to be diagnosed as new daily persistent headache. But we (and many other groups) have found that migraine-type features are very common in people who fulfill rigorously the criteria for new daily persistent headache otherwise. And then the latest iteration of the classification has allowed for us to apply that diagnosis to those with migraine features. Dr Berkowitz: That's very helpful. So, we've ruled out secondary causes and now you're really trying to get into the nuances of the history to determine, did this truly have its abrupt onset or did it evolve from an episodic migraine or tension-type headache? But it could be described by the patient as migrainous, be described by the patient as having tension features The key characteristics (as you mentioned a few times) should be abrupt onset and a continuous nature. Let's say, now you (by history) zeroed in on this diagnosis of new daily persistent headache. You've ruled out potential secondary causes. You're pretty convinced, based on the history, that this is the appropriate primary headache designation. How do you treat these patients? Dr Robbins: Well, that's a great question, Dr Berkowitz, because there's this notoriety to the syndrome that suggests that patients just don't respond to treatments at all. In clinical practice, I can't dispute that to a degree. I think, in general, people who have this syndrome seem to not respond as well, to those who have clear established primary headache disorders. Part of that might be the biology of the disorder; maybe the disorder is turned on by mechanisms that are different to migraine (even though it resembles chronic migraine) and therefore, the medications we know to work for migraine may not be as effective. In some, it could be other factors. There's just a resistance to appreciating that you have this headache disorder that - one day you were normal, the next day you're afflicted by headache that's continuous. And there's almost this nihilism that, “Nothing will work for me, because it's not fair - there's this injustice that I have this continuous headache problem.” And often people with new daily persistent headache may be resistant to, say, behavioral therapies that often are really helpful for migraine or tension-type headache because of this sort of difficult with adjustment to it. But at least there's observational studies that suggest that most of the treatments that work for migraine work for new daily persistent headache. There's been studies that show that people can respond to triptans. In my clinical experience, CGRP antagonists that work for the acute treatment of migraine may work. There is evidence that many of the traditional, older medicines (like tricyclic antidepressants, topiramate, valproate, beta-blockers, probably candesartan) and others that we use for migraine may work. There's observational studies specifically for new daily persistent headache that show that anti-CGRP therapies in the form of monoclonal antibodies and botulinum toxin can work for the disorder. Are there anything specific for some of the new daily persistent headache that might work? Not that we really know. There's been some attempts to say, “Well, if you get these people in the hospital early and try to reduce the risk of headache persistence by giving them DHE, or dexamethasone, or lidocaine, or ketamine, will you reduce the chances of headache persistence at that three-month mark or longer?” We don't really know (there's some people who believe that, though). Maybe there's good reason to do some type of elective hospitalization for aggressive treatment because we know that, notoriously, the treatment response is very mixed. There's been specific treatments that people have looked at. There's been some anecdotes about doxycycline as a broad anti-inflammatory type of treatment that might be used in a variety of neurological disorders, but there's really nothing in the peer-reviewed literature that suggests that is effective or safe, necessarily. And I think a lot of people in new daily persistent headache do develop a profile that resembles chronic migraine (they can develop medication overuse very easily). Often, goal setting is really important in the counseling of such patients. You really have to suggest that the goal for them might be difficult to have them pain-free at zero and cured, but we want this to be treated so the peaks of severity flatten out a bit, and then the baseline level of pain diminishes so that it devolves into a much more episodic disorder over time that looks like regular migraine or regular tension-type headache. Dr Berkowitz: I see. So, in addition to starting a migraine-type prophylactic agent based on the patient's comorbidities and potential benefits of the medication (the same way we would choose a migraine prophylactic), do you do anything, typically, to try to, quote, “break the cycle” - a quick pulse of steroids as an outpatient or a triptan in the office - and see how they do, or do you typically start a prophylactic agent and go from there? Dr Robbins: I think, like all things, it kind of depends on the distress of the patient and how they are functioning. If it's someone who's just out of work, cannot function - and someone like that might be very amenable to an elective hospitalization or some parenteral therapy, or maybe an earlier threshold to use a preventative treatment than we would be doing otherwise in someone with migraine overall - I think that it really depends on that type of a disability that's apparent early. I think it's compelling that, with new daily persistent headache, about a third of people report some antecedent infection that was around at the time. When new daily persistent headache was first described by this Canadian neurologist, Dr Vanast, in the 1980s, it was described in the context of Epstein-Barr virus infection, or at least a higher rate of serologies that are positive for, perhaps, recent Epstein-Barr exposure. And we know that Epstein-Barr is obviously implicated in lots of neurological diseases, like multiple sclerosis. And I mean, I think about these things all the time, and especially with COVID now. So, it's compelling - as a postinfectious disorder, do we, as neurologists (who are so comfortable with using pulse-dose steroids, IVIG) - do we use these things for a new daily persistent headache? But there's no great evidence that enduring inflammation in the dura that would spill into CSF analyses is really present in such patients. There was one study that looked at markers, such as TNF-alpha, in the CSF, but the rates of seeing that were the same in new daily persistent headache and chronic migraine, so there isn't really a specificity to that. Many people we see with new persistent headaches since 2020 may have it as part of a long COVID syndrome (or postacute COVID syndrome), and in those cases, often it's more like “new daily persistent headache-plus.” They might have something that resembles POTS (postural orthostatic tachycardia syndrome); they might have something that resembles fibromyalgia, chronic fatigue. Often in those patients, it takes management of the whole collection of neurological syndromes to get them better, not just the headache alone. Dr Berkowitz: Well, this sounds like such a challenging condition to treat. How do you counsel patients when you've made this diagnosis - what to expect, what the goals are, what this condition is, and how you developed your certainty? It's often challenging (isn't it?) sometimes with patients with headache disorders, when we're not relying on an MRI or lab test to say, “This is the diagnosis”; telling them, it's just our opinion, based on their collection of symptoms and signs. So, how do you give the diagnosis and how do you counsel patients on what it means to them? Dr Robbins: Yeah, it's a great question because it's high stakes, because people will read online, or on social media, or on support groups that this is a dreadful condition - that no one gets better, that they're going to be afflicted with this forever, and the doctors don't know what they're doing, and, “Just don't bother seeing them.” And the truth is not that; there's so many people who can get substantially better. I tell people that it's common; in some epidemiologic studies, one in one thousand people in any given year develop new daily persistent headache, and most of those people get better (they don't seek medical care eventually, or they do, just in the beginning, and then they don't have follow-up because they got all better) - and I think that really happens. I think the people who we see in, say, a headache clinic (or even in general neurology practice) are typically the ones who are the worst of the worst. But even amongst those, we see so many stories of people who get better. So, I really try to reset expectations - like we mentioned before about assessing for treatment response and understanding that improvement will not just mean one day it switches off like it switched on (which seems unfair), but that the spikes will flatten out of pain (first), that the baseline level of intensity will then improve (second); that we turn it into a more manageable day-to-day disorder that really will have less of an impact on someone's quality of life. Sometimes people embrace that and sometimes people have a hard time. But it does require, like many conditions in neurology, incremental care to get people better. Dr Berkowitz: Fantastic. Well, Dr Robbins, thanks so much for taking the time to speak with us today. I've learned so much from your expertise in talking to you and getting to pick your brain about this and some broader concepts and challenges in headache medicine. And I encourage all our listeners to seek out your article on this condition that has even more clinical pearls on how to diagnose and treat patients with this disorder. Dr Robbins: Thanks Dr. Berkowitz - great to be with you. Dr Berkowitz: Again, for our listeners today, I've been interviewing Dr Matthew Robbins, whose article on new daily persistent headache appears in the most recent issue of Continuum, on headache. Be sure to check out other Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr. Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practice. Right now, during our Spring Special, all subscriptions are 15% off. Go to Continpub.com/Spring2024 or use the link in the episode notes to learn more and take advantage of this great discount. This offer ends June 30, 2024. AAN members: go to the link in the episode notes and complete the evaluation to get CME. Thank you for listening to Continuum Audio.

Posttraumatic headache is an increasingly recognized secondary headache disorder. Posttraumatic headaches begin within 7 days of the causative injury and their characteristics most commonly resemble those of migraine or tension-type headache. In this episode, Aaron Berkowitz, MD, PhD, FAAN, speaks with Todd Schwedt, MD, FAAN, author of the article “Posttraumatic Headache,” in the Continuum April 2024 Headache issue. Dr. Berkowitz is a Continuum® Audio interviewer and professor of neurology at the University of California San Francisco, Department of Neurology and a neurohospitalist, general neurologist, and a clinician educator at the San Francisco VA Medical Center and San Francisco General Hospital in San Francisco, California. Dr. Schwedt is a professor of neurology at Mayo Clinic in Phoenix, Arizona. Additional Resources Read the article: Posttraumatic Headache Subscribe to Continuum: continpub.com/Spring2024 Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz Guest: @schwedtt Transcript Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the show notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the show notes. AAN members: stay tuned after the episode to hear how you can get CME for listening.      Dr Berkowitz: This is Dr Aaron Berkowitz, and today, I'm interviewing Dr. Todd Schwedt about his article on post-traumatic headache from the April 2024 Continuum issue on headache. Dr. Schwedt is a Professor of Neurology at Mayo Clinic in Phoenix, Arizona. Welcome to the podcast today, Dr. Schwedt.    Dr Schwedt: Well, thanks so much. It's a real pleasure to be here.    Dr Berkowitz: Thanks. We're very happy to have you. So, head trauma is common, and headache following head trauma is also very common. Let's say you're seeing an otherwise healthy young patient in your clinic who had a minor car accident a few weeks ago with some head strike and whiplash, presenting now for evaluation of headache again a few weeks out from the accident. Walk us through your approach to the history and exam here when you're seeing one of these patients. Dr Schwedt: Yeah, absolutely. I'd be happy to do so. I'll start by saying, as you mentioned, this is such a common problem - patients that are coming in with post-traumatic headache). Of course, like almost everything in neurology, it's super important to get a detailed history to start with (so, doing the appropriate interview), and I usually like to start by getting some information about the injury itself - the mechanism of the injury, and the severity, and, of course, the symptoms that went along with the potential traumatic brain injury – so things we all know about. Then, of course, it's very important to understand how the patient felt prior to the injury because we know that, amongst people presenting with post-traumatic headache, oftentimes they might have had headaches even prior to their injury, and that's because having preinjury headaches is a risk factor for developing post-traumatic headache, as well as the persistence of that post-traumatic headache. If someone had headaches prior to their injury, then of course we want to know if that actually changed or not - is there a difference in the severity, or the frequency, or in the characteristics of the headaches they've been experiencing since their injury? Then, of course, you're going to ask about exactly what the symptoms are they're having now and what's concerning them the most, realizing that for a diagnosis of post-traumatic headache, it's very important to understand the timing of the onset of these headaches in relation to the injury. By definition, post-traumatic headache should have onset within seven days of the inciting traumatic brain injury - so the diagnosis of PTH, I mean, really is dependent upon that timing -  so, using ICHD (which is International Classification of Headache Disorders) criteria, it's got to start (or be reported to have started) within seven days. It's important to realize there are no specific headache characteristics that help to actually rule in or rule out post-traumatic headaches; the criteria themselves just say “any headache,” as long as it was within that seven-day period. Having said that, though, the vast majority of people who come into the clinic for evaluation - their post-traumatic headache is going to be very similar to migraine. So, like, in other words, if they didn't tell you and you didn't ask about when the headache started and you just asked about symptoms, it would seem a lot like migraines – so, very common for the headache to be moderate and severe in intensity, be associated with light sensitivity and sound sensitivity and nausea, be worse with physical and mental exertion (very much the migraine-type characteristics). As far as diagnosis, it's also, of course, important to think about other sequelae of traumatic brain injury that could be causing the headache. For example, if you're under the impression it's a mild traumatic brain injury, but in fact, there's an intracranial hemorrhage - it wouldn't necessarily be mild any longer, but of course, that could cause headaches. We should be thinking about whether there could have been injuries to the cervical spine or the musculature of the neck that could be causing more of a muscular, cervicogenic-type headache. Think about rare possibilities, like if there was a cervical artery dissection, or if there's actually a spinal fluid leak, or, again, other things that after an injury could be causing headache. Most of the time, that's not going to be the case and you would move forward with your diagnosis of post-traumatic headache.  Dr Berkowitz: Fantastic. That's very helpful to hear your approach. You just mentioned, as you said, most patients who've had minor head trauma and are presenting with headache, fortunately, have not suffered a cervical artery dissection or CSF leak or have an evolving subdural. But when you're in this early stage (just a few weeks after the initial injury) and there is headache, what features of the history or exam would clue you into thinking that this patient does need neuroimaging to look for some of these less common, but obviously very serious, sequelae of head trauma?  Dr Schwedt: So, it's things that, as neurologists, we all know about, right? But certainly, if you're concerned about a spinal fluid leak, then really someone who has a prominent orthostatic component to their headache (so, you know, much worse when they sit up or stand up, compared to lying down) could be concerning. With a cervical artery dissection, almost always you're going to have focal neurologic deficits in addition to the headaches. With intracranial hemorrhage - again, usually it's going to be fairly obvious, in that the symptoms that someone's presenting with are much more diffuse and more severe, and maybe they're actually having progression of symptoms over time rather than stability or even early improvement. Then, as we would always say, the exam is essential, right? I mean, certainly someone who's had a mild traumatic brain injury might have very subtle deficits in things like their cognition and memory of events around the injury itself - and perhaps some ocular motor deficits and some vestibular dysfunction - but they should be relatively minor compared to somebody who has one of these other etiologies for a postinjury headache. We'll point out, of course, not everyone requires imaging, again, as there's all these decision rules out there about who needs CT, for example, after an injury (and certainly not everyone does). But, you know, if people have red flags, then of course it makes sense to initially get a CT of the head, and then if symptoms persist, perhaps an MRI. Dr Berkowitz: So, once you're confident that this is a primary headache disorder - and presuming again (as in the example I gave to start us off here) that we're just a few weeks out from the initial trauma - and the patient's presenting to you for evaluation of their headache, how do you approach treatment in these patients? Dr Schwedt: Yeah, so the specificity of your question, I think, is actually quite important - so considering the timing of when you're seeing that patient really is essential. So, if we're a couple weeks out or a few weeks out and the person is still having symptoms, that tells us something to start. The majority of people who have postconcussion symptoms are going to have resolution within a few days, or a week or two, so if someone's still having symptoms at, let's say, two weeks, three weeks, four weeks, well, then that's an indicator that, unfortunately, they're likely to continue to have symptoms for some time - when we want to be a little more aggressive, if you will, with the diagnostics and management of that patient. So, like, very early on - let's say within the first few days, or even the first week or two - some patients won't require any treatment. So, if they're having mild headaches, and maybe they take something over the counter every once in a while as it gets a little more severe, that's oftentimes fine, actually. If someone's having much more severe problems with headache (even in that very acute setting), then maybe we would give them a prescription medicine just to take for their more severe headaches. But then as symptoms progress and persist, then we should of course be thinking about other ways to - in more of a preventive approach of how to - help the patient, because, unfortunately, we don't have high-quality evidence for how to treat both acute and persistent post-traumatic headaches. The recommendation for many years (and it continues to be) is that you determine the other headache type that the PTH most resembles and you treat it like that. For example, if someone has PTH and a lot of migraine symptoms, well, then you would treat it like migraine. That might mean actually giving people specific acute migraine medications. It might mean, perhaps, putting them on migraine-preventive medications. Certainly, using other forms of therapy besides medications - maybe physical therapy is needed if someone has a lot of muscular involvement of the neck. And if they're having vestibular dysfunction from the injury, maybe they need vestibular rehab. Cognitive behavioral therapies - there's some evidence, at least, to suggest that can be helpful after an injury - so, kind of the multimodal approach. We need to make sure that people are getting good sleep, or doing what we can for that to occur (we know that sleep problems, including insomnia, are quite common after a concussion, for example), and really making sure that we're treating the whole patient. The person who is still having headaches at multiple weeks after their injury - likely they're still having other symptoms, too (some of which I just named, but other symptoms as well), like symptoms of autonomic dysfunction are quite common (like orthostatic problems; autonomic type of orthostatic problems) after an injury, cognitive problems, emotional issues - people probably are anxious and not feeling well. A lot of these folks are quite healthy prior to their injury, and all of a sudden, they have, really, a significant problem, and maybe they're missing work and missing school, and so we really have to treat the patient as a whole, of course. Dr Berkowitz: Along those same lines, I was wondering - at this early stage - the patient has had still relatively recent head trauma (they are a few weeks out from this initial injury) but still having symptoms which, as you importantly highlighted, can go well beyond headache and a number of other neurologic symptoms they might have. Very common for the patient to ask, “How long is this going to last? How long am I going to feel like this?” How do you counsel patients? Obviously, the outcomes are very variable. How do you counsel patients as an expert here,  based on seeing so many of these patients a few weeks out - as you said, an otherwise healthy patient, minor head trauma, having headache, and potentially even other concussion symptoms as you mentioned - how do you counsel them on what to expect?  Dr Schwedt: I'll start by saying that this is an area of really high interest to me and my research team, as well as my clinical team - so we're not good enough yet in being able to actually predict recovery and the timing of that recovery - but this is an absolutely essential point, and for multiple reasons. The main reason is based on the question you just asked. Of course, our patients want to know, “When am I going to get better? How long is it going to take? When can I get back to my normal life (whether that be work, or playing sports, or military, or other scenarios)?” – so, that's the most important reason. And it's important as well, because from the clinician's standpoint, if you know (or if you think you know) based on prediction that someone's highly likely to continue to have symptoms – well, again, that might help you make the decision about how (you know, I'll use the word aggressive) to be with their treatment and how closely to have them follow up, and this type of thing. It's also important for research. I already mentioned that, unfortunately, there really isn't decent quality evidence (for example, for what treatments to use for post-traumatic headache), and part of that reason for that is that there have been attempts at large clinical trials, and they've failed in a sense, and I think part of the reason for that is because there is, fortunately, such a high rate of natural resolution of symptoms that if you end up enrolling those patients into these prospective clinical trials, it makes it difficult to actually study any difference you might see between a treatment and your placebo. So, if we can have and develop good, clinically useful predictive models, that would really help in each of those domains. So what do I do now? I mean, basically, it's a little bit of a cop-out answer, but what I do is, I try to look at the trajectory that the patient has had thus far (and so, you know, this is all just logical and obvious), but if a patient is already having some degree of improvement - even if they still have symptoms, but they're having some improvement over those first three weeks - well, you would more or less consider the slope of that recovery to persist more or less at the same level. On the flip side, though, if someone's there and it's been multiple weeks - and they've just had absolutely no recovery and maybe they're even feeling worse - then I'm more concerned that this might be a longer-term issue. Dr Berkowitz: That's helpful to understand both your approach and the challenges in making a firm statement on counseling our patients and using (as has been a theme in many of your helpful responses today) just, sort of, the clinical trajectory and what information that patient's giving you to try to help with the prognosis (however ambiguous it may be) and just needing time to see how the patient does. Dr Schwedt: I might just add as well, though, that there are studies that have suggested there are certain risk factors for prolonged recovery from post-traumatic headache (and there's some limitations to these studies, so, really, validation is needed), but for post-traumatic headaches specifically, I mean, probably the biggest risk factor for persistence of the post-traumatic headache is having headaches prior to the injury. So, for example, people who have migraine before TBI that then are having an exacerbation or a new headache after the injury - unfortunately, they're less likely to have resolution during the acute phase. Other factors include the severity of the injury itself - so there are certain features of the injury that if, you know, it is seemingly more severe, maybe their likelihood for resolution in the acute phase is lower. And then there are multiple other factors that have been suggested as well, including the patient's own expectations for recovery, which I find to be quite an interesting one.  Dr Berkowitz: Yeah - very important points. So, let's say that, unfortunately, the patient does continue to have headache now several months out after the trauma; how do you approach these patients with respect to treatment? Dr Schwedt: Yeah. Once someone's gotten to that point, they probably really are going to need more in the way of preventive measures (and, you know, I did mention some of these). So, if someone's having migraine-like PTH, well, then I'm probably going to end up putting them on medicines that I would use for prevention of migraine. You know, you do have to be especially careful, though, in these individuals who have had TBIs, because you want to make sure that the treatments you're starting aren't going to actually exacerbate their other symptoms, right? So, of course we know some of our migraine preventives can cause things like hypotension, or, you know, cause things like insomnia or cognitive problems, as side effects, and if people are already having those issues from their TBI, then we could actually make them overall feel worse even if we make some progress for their headaches. So, you know of course, we're always careful when thinking about side effects from these medications, but especially so, perhaps, in the patient with a concussion who's having some of these symptoms anyway. And then again - just to highlight, it's not all about medication - that's one small aspect here (one important, but perhaps small, aspect here). So, really, trying to get at lifestyle measures that can be helpful - so, again, sleep, and trying to help people to moderate their stress levels, and making sure that they have an environment that's going to facilitate the recovery (meaning, if they're having a lot of light sensitivity and sound sensitivity and these types of things, you know, doing what we can to help these individuals to be in environments that will allow them to recover). Dr Berkowitz: Yeah, all very important points - medication being just one part of treatment for these patients, as you said. But to just ask another question about medication so our listeners can learn from your expertise - I'm a general neurologist, and my experience with patients with post-traumatic headache and migraine and otherwise is that it's hard to predict who will respond to which medication (and some patients who failed many pharmaceutical medications will have an amazing response to riboflavin and vice versa) - in your experience (acknowledging that we are very limited in terms of data here), are there any migraine prophylactic agents that you feel, anecdotally, have been particularly helpful in patients with post-traumatic headaches or similar to the general migraine/tension headache population? It's very hard to predict, and it's trial and error and picking the right medication and finding the right dose (just depends on the patient). It requires the patient's patience - and our patience as well - as we sort of go through some trial and error. Dr Schwedt: Yeah, I guess. You can hardly even imagine how much I want to answer this question by saying, "Yes, with my experience, I've found that it's these two classes of medications that really work the best for folks with acute or persistent post-traumatic headache,” - but that would be disingenuous. It's so much like it is in migraine, where there is some trial and error, and, you know, again, as you say, it's so difficult to predict exactly which one is going to be the right pharmacologic agent for which patient. If access was no issue, I would go to medications that have the least side effects (which tend to be some of the newer medicines that we have for migraine), but we all know the realities of practice, and oftentimes, that's not a possibility due to access issues. Almost all of our patients that have significant postconcussion symptoms are also being managed by our neuropsychologists - and so, again, they're getting things like cognitive behavioral therapy and getting things like cognitive rehab, and they also are very helpful when it comes to workplace or school-place recommendations and accommodations. Many of our patients are being seen by our vestibular audiologists, as well, to work on their vestibular dysfunction, and vestibular rehab with physical therapy and occupational therapy. And so, you know, as you say, once you get out to multiple months, this is really a multidisciplinary, comprehensive type of treatment approach.  Dr Berkowitz: Let's say the patient has now gone one to two years out from their initial injury and you had started them on a prophylactic agent (or found the one that works for them maybe after a few trials), and they're doing great (no headaches for several months; otherwise young, healthy person), and they ask you, “Well, do you think I can just go ahead and try coming off these medications now? My injury is a long time ago. While those first few months were awful - thank you for helping me to get these headaches under control - do you think if I go off this medicine, that my headaches will come back, or am I sort of in the clear now?” How do you think about tapering patients off of preventive medications when they've had a good response at a year or so out? Dr Schwedt: That's so important, right? I mean, I think we all see patients that we inherit that end up kind of being left on medications that perhaps aren't even needed anymore, and it's certainly a mistake we wouldn't want to make. Post-traumatic headache - unlike primary headaches like migraine that tend to be present for decades - they can go away; they can resolve, and they usually do. I mean, we can't lose sight of that, right? Usually, it's going to go away on its own (as I mentioned, you know, within the first few days or weeks), and even after it's become persistent, if you can get a good treatment response, then, absolutely, after several months of that good treatment response, we should be tapering people off. Just like with any headache patient who's on a preventive, I would recommend tapering off of the effective treatment slowly, so if that's a medication, I'm usually very slowly just reducing the dose over several weeks or months (depends on how long they've been on it), usually not because I'm concerned about side effects of withdrawing the medication, but you're just testing it to make sure that the headaches aren't starting to creep back as you reduce the dose of that medication. So, it's a test, and if headaches do start to come back as you're lowering the dose, well, then, presumably you can more quickly get control of it again by elevating the dose back to where it was previously effective. For medications and treatments that don't really have dosing, the other way of doing it - so, you know, some of our medicines, of course, are given at one dose but given at intervals (like, let's say, each month or every three months) where you can't really reduce the dose - you can increase the interval between treatments. So, if you're supposed to have a treatment every month, well, if someone's doing really well, then maybe you say, “You know what? Give it an extra week.” Maybe do it in five weeks instead of four or six weeks. In that same way, you're kind of testing whether or not the medication is still really needed. Dr Berkowitz: Yeah, that makes sense as an approach here. In addition to your clinical expertise, Dr Schwedt, you're also a researcher in this area. Tell us, what's on the horizon for the future of diagnosis and treatment of patients with post-traumatic headache?  Dr Schwedt: There's a lot of exciting things on the horizon. It's really encouraging that despite, for example, the lack of evidence currently that we have for treatment, and perhaps not as much preclinical and clinical research into post-traumatic headache as we need, the exciting part is that there's a lot going on. Fortunately, the funding environment for such research has been decent over the past so many years, and so, again, there's almost certainly going to be meaningful breakthroughs here in the near future. Some of our own work - for example, we do a lot of neuroimaging research of post-traumatic headache. One of the main areas of controversy in the headache field is whether or not post-traumatic headache and migraine are really the same thing or are they truly distinct headache disorders? And so, like, a lot of our work has gone towards addressing that - both through neuroimaging, as well as just examining outcomes and symptoms and whatnot - to see where there are similarities and differences. And I'm absolutely biased when it comes to addressing this, but I feel strongly that they really are distinct headache disorders. And that's important, because that means that we need to continue to study them as distinct disorders and we can't just fall back to the idea of saying, “Well, PTH of a migraine phenotype is migraine, and we already have migraine therapy, so let's just use those,” because I think all of us that see patients with PTH in clinical practice realize that our migraine treatments don't work as well for PTH as they do for migraine. So, we really need to continue down the path of understanding the mechanisms underlying PTH, the mechanisms of what makes PTH persist (you know, why it persists in some people and not others), and then what we can do to intervene. I think a major topic, I believe, in determining best treatment approaches is also kind of related to the way you were asking me these questions - it's related to the timing of the intervention. Much of what's been done in studying treatment of PTH is done after it's already persistent, and so in some of these studies, including ours (I mean, it's not a criticism; including ours) - sometimes, these people have had post-traumatic headache for five years or ten years at the time that you enroll them into a study. And, you know, at that point, that's probably a very different population as far as mechanisms and who might respond to which treatments (compared to if you were studying those folks, let's say, in the first few weeks or in the first couple months). There's preclinical evidence (from rodent models of mild traumatic brain injury and post-traumatic headache) that the earlier you intervene, the more effective that intervention is going to be in treating that headache and preventing its persistence, and I would think we could logically presume that's probably the case in people as well. But, of course, we don't want to expose everybody early on to treatments if they don't need it (I mean, if they're going to have natural resolution, then that would actually be inappropriate [to expose them to treatments]). And that's where the prediction comes in. If we had good predictive models of - oh, you know, even though they're only a week into their headache, based on their pre-TBI factors and other characteristics, that they're very likely to have persistence - well, maybe that's the patient where they should have an earlier intervention, and, you know, in another patient, maybe not.  Dr Berkowitz: It's great to hear about your work and the work of others to help us understand this very, very common condition (and that's been a theme in many of our questions), one in which we do our best, but are often limited by, our scientific understanding and the data on how to best manage these patients' headaches. I've learned a lot from our discussion - both clinically, and I'm excited to have learned more about your work and what's on the horizon to help us take care of these patients. Thank you very much, Dr Schwedt, for joining me on Continuum Audio today. Again, for our listeners, I've been interviewing Dr Todd Schwedt, whose article on posttraumatic headache appears in the most recent issue of Continuum on headache. Be sure to check out other Continuum Audio podcasts from this and other issues. Thank you so much to our listeners for joining today.    Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practice. And right now, during our Spring Special, all subscriptions are 15% off. Go to Continpub.com/Spring2024, or use the link in the episode notes, to learn more and take advantage of this great discount. This offer ends June 30, 2024. AAN members: go to the link in the episode notes and complete the evaluation to get CME. Thank you for listening to Continuum Audio.    

Do you think your child was exposed to alcohol or drugs during pregnancy? If so, a diagnosis can help your child access services and support. Check out this show with Dr. Yasmin Senturias, a developmental-behavioral pediatric specialist with 28 years of experience in developmental pediatrics and prenatal substance exposure. She worked with the American Academy of Pediatrics on developing their FASD Toolkit.In this episode, we cover:Prenatal Drug ExposureDo the impacts differ depending on what drug the child was exposed to? What's the difference between Neonatal Abstinence Syndrome (NAS) or Neonatal Opioid Withdrawal Syndrome (NOWS). Short-term impacts? Is the impact less severe for legal drugs, such as nicotine and marijuana?Is the impact less severe for legal medications used to treat substance abuse disorders in pregnant women? What are the medical disorders in the Diagnostic and Statistical Manual (DSM) or International Classification of Diseases (ICD) for prenatal drug exposure? Do these diagnoses have to be made at birth?What diagnosis is available if the child was exposed to drugs in utero but was not born dependent and didn't go through withdrawal, and therefore did not have a diagnosis of NAS or NOWS in their medical record?Do these diagnoses help the child and youth receive more services?What type of doctor can make this diagnosis? FASD:It is estimated that 1% to 5% of children in the United States may have an FASD. How common is drinking in pregnancy? (Centers for Disease Control and Prevention data indicate that approximately 12% of pregnancies may have alcohol exposure.)Is the severity of the impact on the child, youth, or adult directly correlated to the amount of alcohol the mother consumed when pregnant?What are the actual diagnoses that exist on this spectrum of FASDs?Explain the differences in these disorders.Is one diagnosis better than another in terms of getting services and support for the child in childhood, adolescence, and adulthood?Are these different disorders linear on the spectrum from lesser to greater life impacts?Why is it important to get a diagnosis? Is it possible to get a diagnosis without mom admitting to using alcohol or drugs during her pregnancy? What to do if the child's record doesn't reflect that the mom drank during pregnancy?If you suspect or know that your child or youth was exposed to alcohol in utero, how can you get a diagnosis?What are some common misdiagnoses that kids and adolescents with prenatal alcohol exposure may get?What type of doctor can diagnose? Do you need a referral from your pediatrician to get an appointment with a specialist?Dual Exposure to Alcohol and DrugsHow common is the dual use of alcohol and drugs?How can drugs and alcohol together affect the child both in infancy and throughout life?Impact of TraumaHow does trauma interplay with prenatal substance exposure?Resources:American Academy of Pediatric Fetal Alcohol Spectrum Disorders The American Academy of Pediatrics FASD Toolkit was developed in coordination with the CDC to raise awareness, promote surveillance and screening, and ensure that all children who possibly have FASDs receive appropriate and timely interventions. Focused primarily on proviSupport the showPlease leave us a rating or review RateThisPodcast.com/creatingafamily

In this week's episode, SPA's Jane Delaney speaks with Jane McCormack, Associate Professor at ACU, and Heather Tancredi, PhD candidate at QUT, about speech pathologists' role in the education sector. They discuss the International Classification of Functioning, the social model of disability, inclusive education, and multi-tiered systems of support. Speech pathologists can learn more about these in the newly published SPA guidelines and learning modules for Speech Pathology in Education. Speech Pathology Australia acknowledge the Traditional Custodians of lands, seas and waters throughout Australia, and pay respect to Elders past, present and future. We recognise that the health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples are grounded in continued connection to culture, country, language and community and acknowledge that sovereignty was never ceded. Resources: Speech Pathology in Education Page (SPA member access only) https://www.speechpathologyaustralia.org.au/Members/Members/Professional-practice/Practice-areas/Speech-pathology-in-education.aspx?hkey=6cebac7f-a00e-4d42-8d46-ef5678e8cc46 Speech Pathology in Education (Public access) https://www.speechpathologyaustralia.org.au/Public/Public/services/About-speech-pathologists/Speech-pathology-in-Education.aspx?hkey=015030b4-b906-431d-8bdf-40ce8d4cb6ee Speech Pathology in Education Learning Modules (SPA Members log in for discount) https://learninghub.speechpathologyaustralia.org.au/topclass/expand.do?template=News&viaTC=1&newsId=402071&from=UserWelcome Consulting students with disability: A practice guide for educators and other professionals https://research.qut.edu.au/c4ie/wp-content/uploads/sites/281/2020/08/Practice-Guide-Student-Consultation.pdf International Classification of Functioning, Disability and Health: Children & Youth (ICF-CY) https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health Transcripts for this and other episodes are available at no cost on SPA's Learning Hub. 1. Go to: https://www.speechpathologyaustralia.org.au/Public/Shared_Content/Events/On-Demand-Learning.aspx?hkey=940859e8-0efc-4ba2-83be-11f49e616542 2. Filter – Format – Podcast – Search 3. Select the podcast of your choice 4. Enrol (you will need to sign in or create an account) 5. Add to cart – Proceed to checkout – Submit 6. You will receive an email Order Confirmation with a link back to the Learning Hub 7. The Podcast and transcript will be available in your Learning Centre You may also email to request a free transcript at learninghub@speechpathologyaustralia.org.au

In today's episode I talk about facial pain. 1/3 of non-dental facial pain is idiopathic, meaning without a specific cause. During this episode l discuss the 6 major classifications of facial pain along with the psycho social impacts of facial pain sufferers. I round off the episode by discussing what I'm currently doing in clinic with people struggling with facial pain. Do you suffer from facial pain. If so, what has helped you along the way? Comment below! Episode Resources  *(No authors listed). International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia. 2020;40(2):129-221. doi:10.1177/0333102419893823. *Ziegeler C, Beikler T, Gosau M & May A. Idiopathic Facial Pain Syndromes - An Overview and Clinical Implications. Dtsch Arztebl Int. 2021;118(6):81-87. doi:10.3238/arztebl.m2021.0006.  --- Send in a voice message: https://podcasters.spotify.com/pod/show/concast/message

In the last version of the Diagnostic and Statistical Manual, the different subtypes of autism were folded into one label: autism spectrum disorder. A similar revision is being made around the International Classification of Diseases, the system the WHO uses across the world to describe autism and provide appropriate reimbursements for services and supports. In … Continue reading "Are new ICD-11 criteria for an autism diagnosis too vague?"

In 1998 the phrase “internet addiction” was first used to describe problematic prolonged internet use, and encompassed a wide range of online activities including reading news, connecting in chat rooms, viewing pornography, and gambling. Since then, particular focus has been placed on internet gaming, and in 2022 the World Health Organization's International Classification of Diseases (11th edition) classified Gaming Disorder as a "mental disorder due to addictive behaviors." But as Dr. Veli-Matti Karhulahti and Dr. Yaewon Jin explain, there is far from universal consensus on what “gaming disorder” exactly is. They share their insights as researchers of the ORE (Ontological Reconstruction of Gaming Disorder), a five-year interdisciplinary project funded by the European Research Council, and discuss the difficulties not only in identifying “gaming disorder” but in categorizing the various kinds of games that are considered. They share their own experiences with computer gaming, from early 1990s Finnish schools to South Korea's PC bangs (internet cafés). They leave us to contemplate culturally and historically dependent perspectives not only on what constitutes a so-called disorder, but why individuals play games. This episode is supported by the Otto A. Malm Foundation. Dr. Veli-Matti Karhulahti is the ORE project's principle investigator and is an interdisciplinary senior researcher of play, games, and the philosophy of science at the University of Jyväskylä. Dr. Yaewon Jin is a post-doctoral researcher at Jyvaskyla, and focuses on South Korea as part of the project. She is also currently a visiting professor at Yonsei University and principal researcher at the Game-n-Science institute. The Nordic Asia Podcast is a collaboration sharing expertise on Asia across the Nordic region, brought to you by the following academic partners: Asia Centre, University of Tartu (Estonia), Asian studies, University of Helsinki (Finland), Centre for Asian Studies, Vytautas Magnus University (Lithuania), Centre for East Asian Studies, University of Turku (Finland) and Centre for East and South-East Asian Studies, Lund University (Sweden) and Norwegian Network for Asian Studies. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

In 1998 the phrase “internet addiction” was first used to describe problematic prolonged internet use, and encompassed a wide range of online activities including reading news, connecting in chat rooms, viewing pornography, and gambling. Since then, particular focus has been placed on internet gaming, and in 2022 the World Health Organization's International Classification of Diseases (11th edition) classified Gaming Disorder as a "mental disorder due to addictive behaviors." But as Dr. Veli-Matti Karhulahti and Dr. Yaewon Jin explain, there is far from universal consensus on what “gaming disorder” exactly is. They share their insights as researchers of the ORE (Ontological Reconstruction of Gaming Disorder), a five-year interdisciplinary project funded by the European Research Council, and discuss the difficulties not only in identifying “gaming disorder” but in categorizing the various kinds of games that are considered. They share their own experiences with computer gaming, from early 1990s Finnish schools to South Korea's PC bangs (internet cafés). They leave us to contemplate culturally and historically dependent perspectives not only on what constitutes a so-called disorder, but why individuals play games. This episode is supported by the Otto A. Malm Foundation. Dr. Veli-Matti Karhulahti is the ORE project's principle investigator and is an interdisciplinary senior researcher of play, games, and the philosophy of science at the University of Jyväskylä. Dr. Yaewon Jin is a post-doctoral researcher at Jyvaskyla, and focuses on South Korea as part of the project. She is also currently a visiting professor at Yonsei University and principal researcher at the Game-n-Science institute. The Nordic Asia Podcast is a collaboration sharing expertise on Asia across the Nordic region, brought to you by the following academic partners: Asia Centre, University of Tartu (Estonia), Asian studies, University of Helsinki (Finland), Centre for Asian Studies, Vytautas Magnus University (Lithuania), Centre for East Asian Studies, University of Turku (Finland) and Centre for East and South-East Asian Studies, Lund University (Sweden) and Norwegian Network for Asian Studies. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/psychology

In 1998 the phrase “internet addiction” was first used to describe problematic prolonged internet use, and encompassed a wide range of online activities including reading news, connecting in chat rooms, viewing pornography, and gambling. Since then, particular focus has been placed on internet gaming, and in 2022 the World Health Organization's International Classification of Diseases (11th edition) classified Gaming Disorder as a "mental disorder due to addictive behaviors." But as Dr. Veli-Matti Karhulahti and Dr. Yaewon Jin explain, there is far from universal consensus on what “gaming disorder” exactly is. They share their insights as researchers of the ORE (Ontological Reconstruction of Gaming Disorder), a five-year interdisciplinary project funded by the European Research Council, and discuss the difficulties not only in identifying “gaming disorder” but in categorizing the various kinds of games that are considered. They share their own experiences with computer gaming, from early 1990s Finnish schools to South Korea's PC bangs (internet cafés). They leave us to contemplate culturally and historically dependent perspectives not only on what constitutes a so-called disorder, but why individuals play games. This episode is supported by the Otto A. Malm Foundation. Dr. Veli-Matti Karhulahti is the ORE project's principle investigator and is an interdisciplinary senior researcher of play, games, and the philosophy of science at the University of Jyväskylä. Dr. Yaewon Jin is a post-doctoral researcher at Jyvaskyla, and focuses on South Korea as part of the project. She is also currently a visiting professor at Yonsei University and principal researcher at the Game-n-Science institute. The Nordic Asia Podcast is a collaboration sharing expertise on Asia across the Nordic region, brought to you by the following academic partners: Asia Centre, University of Tartu (Estonia), Asian studies, University of Helsinki (Finland), Centre for Asian Studies, Vytautas Magnus University (Lithuania), Centre for East Asian Studies, University of Turku (Finland) and Centre for East and South-East Asian Studies, Lund University (Sweden) and Norwegian Network for Asian Studies.

In 1998 the phrase “internet addiction” was first used to describe problematic prolonged internet use, and encompassed a wide range of online activities including reading news, connecting in chat rooms, viewing pornography, and gambling. Since then, particular focus has been placed on internet gaming, and in 2022 the World Health Organization's International Classification of Diseases (11th edition) classified Gaming Disorder as a "mental disorder due to addictive behaviors." But as Dr. Veli-Matti Karhulahti and Dr. Yaewon Jin explain, there is far from universal consensus on what “gaming disorder” exactly is. They share their insights as researchers of the ORE (Ontological Reconstruction of Gaming Disorder), a five-year interdisciplinary project funded by the European Research Council, and discuss the difficulties not only in identifying “gaming disorder” but in categorizing the various kinds of games that are considered. They share their own experiences with computer gaming, from early 1990s Finnish schools to South Korea's PC bangs (internet cafés). They leave us to contemplate culturally and historically dependent perspectives not only on what constitutes a so-called disorder, but why individuals play games. This episode is supported by the Otto A. Malm Foundation. Dr. Veli-Matti Karhulahti is the ORE project's principle investigator and is an interdisciplinary senior researcher of play, games, and the philosophy of science at the University of Jyväskylä. Dr. Yaewon Jin is a post-doctoral researcher at Jyvaskyla, and focuses on South Korea as part of the project. She is also currently a visiting professor at Yonsei University and principal researcher at the Game-n-Science institute. The Nordic Asia Podcast is a collaboration sharing expertise on Asia across the Nordic region, brought to you by the following academic partners: Asia Centre, University of Tartu (Estonia), Asian studies, University of Helsinki (Finland), Centre for Asian Studies, Vytautas Magnus University (Lithuania), Centre for East Asian Studies, University of Turku (Finland) and Centre for East and South-East Asian Studies, Lund University (Sweden) and Norwegian Network for Asian Studies. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/science-technology-and-society

Hello and welcome to our new mini series designed to help prepare internal medicine residents get ready for the neurology section of their board exams! While it is aimed at IM residents it is a good review for anyone feeling a little rusty on headache. In our first session we talk about diagnosing different headache disorders, red flag symptoms, and some treatment considerations for the more commonly tested disorders. After listening to the episode give our quiz a try (link below)!https://forms.gle/G2QQisD55wtNXEhE6Learn more about headaches from the International Classification of Headache Disorders website: https://ichd-3.org/ Check out our website at www.theneurotransmitters.com to sign up for emails, classes, and quizzes! Would you like to be a guest or suggest a topic? Email us at contact@theneurotransmitters.com Follow our podcast channel for The Neurotransmitters @neuro_podcast for future news! Find me on Twitter @DrKentris (https://twitter.com/DrKentris) https://linktr.ee/DrKentris The views expressed do not necessarily represent those of any associated organizations. The information in this podcast is for educational and informational purposes only and does not represent specific medical/health advice. Please consult with an appropriate health care professional for any medical/health advice.

Liekom na vyhorenú spoločnosť plnú sebazahľadeným narcisov je viac kreatívnej negativity. To aspoň odporúča Byung-Chul Han, nemecký filozof juhokórejského pôvodu, a dnes budeme pokračovať v rozmýšľaní v jeho spoločnosti. Čo presne myslí pod kreatívnou negativitou a ako s tým súvisia rituály, konšpiračné teórie a potreba byť idiot?----more----   Súvisiace dávky: PD#299: Byung-Chul Han a konzumný narcizmus, http://bit.ly/davka299 PD#275: Simone Weil a pandémia nepozornosti, http://bit.ly/davka275 PD#156: Frankfurtská škola a reforma Marxa, http://bit.ly/davka156 PD#154: Štrukturalizmus ako filozofická revolúcia, http://bit.ly/davka154 PD#144: Postmodernizmus a dekonštrukcia, http://bit.ly/davka144   Použitá alebo odporúčaná literatúra: Byung-Chul Han, Vyhořelá společnost (Rybka Publishers, 2016) “Byung-Chul Han, the philosopher who lives life backwards” (interview, EL PAÍS, 2023) “All That Is Solid Melts Into Information”(interview, NOĒMA, 2022) “Byung-Chul Han: ‘I Practise Philosophy as Art'” (interview, ArtReview, 2021) Byung-Chul Han in Budapest (Goethe-Institut Ungarn, youtube, 2022) Philosophize This! (podcast), Episode #188 Achievement Society and the rise of narcissism depression and anxiety Overthink Podcast, “Byung-Chul Han, The Burnout Society“ (youtube) WHO, Burn-out an "occupational phenomenon": International Classification of Diseases   ***   Baví ťa s nami rozmýšľať? Podpor našu tvorbu priamo na SK1283605207004206791985 alebo cez Patreon (https://bit.ly/PDtreon), kde Ťa odmeníme aj my.

Byung-Chul Han je nemecký filozof juhokórejského pôvodu, o ktorom ste asi rovnako ako ja donedávna nepočuli. Niekto by mohol povedať, že je filozofom post-postmoderny a jeho kreatívna kritika Michela Foucaulta a nadväznosť na Gillesa Deleuzea a Felixa Gauttariho by tomu viac ako nasvedčovali.----more---- Čo je to moc a ako sa prejavuje vo svete? Sme si naozaj istí, že sme slobodní? Ako vieme, že nie sme len dokonale manipulovaní? Alebo, ak by som mal ešte pritvrdiť, ako viem, že nezotročujem sám seba a to ešte v mene vlastnej slobody, autonómie a autenticity?   Súvisiace dávky: PD#275: Simone Weil a pandémia nepozornosti, http://bit.ly/davka275 PD#156: Frankfurtská škola a reforma Marxa, http://bit.ly/davka156 PD#154: Štrukturalizmus ako filozofická revolúcia, http://bit.ly/davka154 PD#144: Postmodernizmus a dekonštrukcia, http://bit.ly/davka144   Použitá alebo odporúčaná literatúra: Byung-Chul Han, Vyhořelá společnost (Rybka Publishers, 2016) “Byung-Chul Han, the philosopher who lives life backwards” (interview, EL PAÍS, 2023) “All That Is Solid Melts Into Information” (interview, NOĒMA, 2022) “Byung-Chul Han: ‘I Practise Philosophy as Art'” (interview, ArtReview, 2021) Byung-Chul Han in Budapest (Goethe-Institut Ungarn, youtube, 2022) Philosophize This! (podcast), Episode #188 Achievement Society and the rise of narcissism depression and anxiety Overthink Podcast, “Byung-Chul Han, The Burnout Society“ (youtube) WHO, Burn-out an "occupational phenomenon": International Classification of Diseases *** Baví ťa s nami rozmýšľať? Podpor našu tvorbu priamo na SK1283605207004206791985 alebo cez Patreon (https://bit.ly/PDtreon), kde Ťa odmeníme aj my.

Today, we present a segment from an interview with Dr. Robert Damstra, a Dutch dermatologist and specialist in lymphovascular medicine, which took place during the 2016 Lipedema Worldwide Summit.Dr. Damstra explains that the treatment guidelines for lipedema in the Netherlands incorporate the International Classification of Function and the Chronic Disease Model as a framework to steer the management of lipedema.

Is Video Game Addiction Real? It's great to do things you enjoy. But can you go too far with a hobby? And at what point does it become an addiction? That's the question experts are trying to answer about playing video games.Continuing our Best Of series, we share some of our listener favorites. The episode originally aired on March 21, 2022, as Ep #93.The World Health Organization added “gaming disorder” to the 2018 version of its medical reference book, International Classification of Diseases. But the American Psychiatry Association's manual, the DSM-5, didn't. (So far, gambling is the only “activity” listed as a possible addiction.)Signs to Watch ForThe DSM-5 does include a section to help people and doctors know the warning signs of problem video gaming. These problems can happen whether you play online or offline.Here's what to look for in yourself or someone close to you -- your partner, a child, or a friend. You need to have five or more of these signs in 1 year to have a problem, according to criteria that were proposed in the DSM-5:Thinking about gaming all or a lot of the timeFeeling bad when you can't playNeeding to spend more and more time playing to feel goodNot being able to quit or even play lessNot wanting to do other things that you used to likeHaving problems at work, school, or home because of your gamingPlaying despite these problemsLying to people close to you about how much time you spend playingUsing gaming to ease bad moods and feelingsFrom WebMD_____If you or anyone you know is struggling with addiction, depression, trauma, sexual abuse or feeling overwhelmed, we've compiled a list of resources at secretlifepodcast.com.______To share your secret and be a guest on the show email secretlifepodcast@icloud.com_____SECRET LIFE'S TOPICS INCLUDE addiction recovery, mental health, alcoholism, drug addiction, sex addiction, love addiction, OCD, ADHD, dyslexia, eating disorders, debt & money issues, anorexia, depression, shoplifting,  molestation, sexual assault, trauma, relationships, self-love, friendships, community, secrets, self-care, courage, freedom, and happiness._____Comedian Paul Gilmartin hosts a weekly, hour-long audio podcast, The Mental Illness Happy Hour, consisting of interviews with artists, friends, and the occasional doctor.Podcast: The Mental Illness Happy Hour Podcast | Website | Instagram | TwitterCheck it out wherever you podcast Apple | Google | Amazon | Instagram______Brianne's novel: SECRET LIFE OF A HOLLYWOOD SEX & LOVE ADDICT Check out the website: Secret Life Novel or buy on Amazon______HOW CAN I SUPPORT THE SHOW?Tell Your Friends & Share Online!Follow, Rate & Review: Apple Podcasts | SpotifyFollow & Listen iHeart | Stitcher | Google Podcasts | Amazon | PandoraSpread the word via social mediaInstagramTwitterFacebook#SecretLifePodcastDonate - You can also support the show with a one-time or monthly donation via PayPal (make payment to secretlifepodcast@icloud.com) or at our WEBSITE.Connect with Brianne Davis-Gantt (@thebriannedavis)Official WebsiteInstagramFacebookTwitterConnect with Mark Gantt (@markgantt)Main WebsiteDirecting WebsiteInstagramFacebookTwitterAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

F-words and early intervention ingredients for non-ambulant children with cerebral palsy: A scoping reviewAna Carolina De Campos, Álvaro Hidalgo-Robles, Egmar Longo, Claire Shrader, Ginny PalegAbstractAim: To explore the ingredients of early interventions provided to young children with cerebral palsy (CP) who are classified in Gross Motor Function Classification System (GMFCS) levels IV and V, and to identify the 'F-words' addressed by the interventions.Method: Searches were completed in four electronic databases. Inclusion criteria were the original experimental studies that fitted the following PCC components: population, young children (aged 0-5 years, at least 30% of the sample) with CP and significant motor impairment (GMFCS levels IV or V, at least 30% of the sample); concept, non-surgical and non-pharmacological early intervention services measuring outcomes from any of the International Classification of Functioning, Disability and Health domains; and context, studies published from 2001 to 2021, from all settings and not limited to any specific geographical location.Results: Eighty-seven papers were included for review, with qualitative (n = 3), mixed-methods (n = 4), quantitative descriptive (n = 22), quantitative non-randomized (n = 39), and quantitative randomized (n = 19) designs. Fitness (n = 59), family (n = 46), and functioning (n = 33) ingredients were addressed by most experimental studies, whereas studies on fun (n = 6), friends (n = 5), and future (n = 14) were scarce. Several other factors (n = 55) related to the environment, for example, service provision, professional training, therapy dose, and environmental modifications, were also relevant.Interpretation: Many studies positively supported formal parent training and use of assistive technology to promote several F-words. A menu of intervention ingredients was provided, with suggestions for future research, to incorporate them into a real context within the family and clinical practice.

Dr. Jared Keeley explains the International Classification of Disease's history, purpose, and structure, including key differences between the ICD-10, ICD-11 and DSM-5-TR. Interview with Elizabeth Irias, LMFT

Are you one of those people that offers to do EVERYTHING? Not just at work, maybe you're the part planner amongst your mates, or the group gift organiser amongst your siblings? It's not only winter when we get worn down and we're going to teach you how to keep your party flame lit without burning yourself to a crisp LINKS  Read ‘4 therapist-approved ways to beat summer burnout' from Stylist.co.uk Read ‘Burn-out an "occupational phenomenon": International Classification of Diseases' from World Health Organisation Read ‘Recognizing and Curing Superhero Syndrome' from DZone Agile Follow @thespace_podcast on Instagram    Watch @thespace_podcast on TikTok   Follow @novapodcastsofficial on Instagram    CREDITS Host: Casey Donovan @caseydonovan88 Writer: Amy Molloy @amymolloy Executive Producer: Anna HenvestEditor: Adrian Walton  Listen to more great podcasts at novapodcasts.com.au   See omnystudio.com/listener for privacy information.

Burnout: It's real and it can affect all of us. In this episode, Dave invites a panel of experts to tackle this important and potentially damaging syndrome as it affects attorneys who volunteer their time in a pro bono setting. The demands never seem to end, but volunteering is meant to “fill your cup,” not overflow it.   A Bloomberg survey found burnout is a major problem, and it's getting worse among attorneys. For the first time the survey found reports of attorney burnout exceeded 50%. Reports of wellbeing and job satisfaction are in decline too. But it's not just in corporate practice, burnout affects those who want to volunteer. With so much need it's easy to forget you're only one person, and you can't do it all.  How can we get involved in pro bono work without burning out? It can start with being aware of the syndrome, adjusting our workflow to the right level, adopting “virtual” programs to balance time, sharing the load, and focusing on areas of passion.  Learn to recognize the signs of burnout in the pro bono space and how you can help yourself, and others, deal with stress and feeling overwhelmed. And for all who volunteer their services to help others: Thank you. Mentioned in this Episode: Bloomberg Law, “How to Rethink and Encourage Attorney Well-Being in Firms” World Health Organization, “Burn-out an occupational phenomenon: International Classification of Diseases” American Bar Association American Bar Association Litigation Section Anne Geraghty Helms previous appearance on Litigation Radio, “The Need For Pro Bono” Children's Law Center Of Massachusetts American Bar Association Children's Rights Litigation Committee

Burnout: It's real and it can affect all of us. In this episode, Dave invites a panel of experts to tackle this important and potentially damaging syndrome as it affects attorneys who volunteer their time in a pro bono setting. The demands never seem to end, but volunteering is meant to “fill your cup,” not overflow it.   A Bloomberg survey found burnout is a major problem, and it's getting worse among attorneys. For the first time the survey found reports of attorney burnout exceeded 50%. Reports of wellbeing and job satisfaction are in decline too. But it's not just in corporate practice, burnout affects those who want to volunteer. With so much need it's easy to forget you're only one person, and you can't do it all.  How can we get involved in pro bono work without burning out? It can start with being aware of the syndrome, adjusting our workflow to the right level, adopting “virtual” programs to balance time, sharing the load, and focusing on areas of passion.  Learn to recognize the signs of burnout in the pro bono space and how you can help yourself, and others, deal with stress and feeling overwhelmed. And for all who volunteer their services to help others: Thank you. Mentioned in this Episode: Bloomberg Law, “How to Rethink and Encourage Attorney Well-Being in Firms” World Health Organization, “Burn-out an occupational phenomenon: International Classification of Diseases” American Bar Association American Bar Association Litigation Section Anne Geraghty Helms previous appearance on Litigation Radio, “The Need For Pro Bono” Children's Law Center Of Massachusetts American Bar Association Children's Rights Litigation Committee

A few years ago, the World Health Organization added “burn-out” to the International Classification of Diseases. Here's how they define it: Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. Quite a while ago, we learned from the Centers for Disease Control that your immediate supervisor is more important to your health than your primary care doctor. If burn-out results from chronic workplace stress, we're seeing that to be true. And it makes sense. 74% of people say the workplace is the leading cause of stress. On Monday mornings, there's a 20% increase in heart attacks. On this podcast, you'll hear an edited version of a webinar featuring Barry-Wehmiller CEO Bob Chapman and Dr. Jeffrey Pfeffer, author of Dying for a Paycheck, called, “The Next Leading Cause of Death: The Workplace?” They'll talk about this crisis and what leaders need to do to solve the issue. 

The International Classification of Sleep Disorders, 3rd ed, lists the criteria needed for a diagnosis idiopathic hypersomnia.For a diagnosis of idiopathic hypersomnia, the following must be met:o excessive daytime sleepiness daily for at least 3 monthso cataplexy is not presento multiple sleep latency test (MSLT) shows 90%)o Long, unrefreshing naps (>1 hour)This episode is produced by Sleep Review. It is episode 2 of a 5-part series sponsored by Jazz Pharmaceuticals. Visit Jazzpharma.com and SleepCountsHCP.com for more information.In episode 2, listen as Sleep Review's Sree Roy and neurologist-sleep specialist Margaret S. Blattner, MD, PhD discuss:o What are some barriers to diagnosing idiopathic hypersomnia?o Objective sleep testing is needed to diagnosis idiopathic hypersomnia. What polysomnography and multiple sleep latency test findings support a diagnosis of idiopathic hypersomnia?o What are some best practices for conducting a PSG and MSLT for a patient with suspected idiopathic hypersomnia?o What are some of the additional commonly seen supportive features of idiopathic hypersomnia?

What if there was a tool that could transform the way we deliver healthcare? That's the question we explore with Dr. Harry Feliciano and Rhonda Oaks in this riveting discussion about the International Classification of Functioning, Disability and Health (ICF). Dr. Feliciano, a seasoned geriatrician and former senior medical director, brings a rich history of experience in public health and preventive medicine to the table. He shares invaluable insights from his time on the front line of healthcare, as well as his personal journey as a family caregiver. On the other hand, Rhonda, a certified hospice and palliative care nurse, divulges her expertise on classification systems in healthcare. She illustrates how the ICF can be instrumental in stratifying dementia patients, tracking health outcomes, and considering the impact of social determinants and family care on a patient's prognosis. We also venture into some forward-thinking ideas about the integration of artificial intelligence and digital media with the ICF to capture classes of information. Listen in, it's not every day you get to peek into the future of healthcare delivery.Guest:Dr Harry FelicianoFormer Senior Medical Director for Palmetto GBA Rhonda OakesCertified Hospice and Palliative Nurse serving as Community Clinical Liaison at Four Seasons Host:Chris Comeaux, President / CEO of TCNTeleios Collaborative Network / https://www.teleioscn.org/tcntalkspodcast

Dr Deepak Ravindran, a NHS consultant in pain medicine, reveals how we need to completely rethink our views about pain. Pain, particularly long term intractable chronic pain, can be one of the most difficult medical conditions to live with, making normal work or life almost impossible. Globally around 20% of people suffer from the condition. And getting the help they need can be incredibly difficult. Ravindran explains how many of us totally misunderstand pain. The problem can be someone with chronic pain can have a battery of tests that all come back clear, which may lead some medical professionals to suggest that there is not actually anything wrong with these patients. But that is not the case. For the first time in 2022, the World Health Organisation updated the International Classification of Diseases to include chronic pain as a separate medical condition. And as Ravindran reveals, the biological mechanism of chronic pain, which can lead to an over-sensitised immune and nervous system is not the same as acute pain. That means a very different treatment is required, using not just drugs, but taking a whole body approach which includes diet, exercise, sleep and cognitive techniques. It's a technique that has had life-changing consequences for patients, who have often suffered for years with crippling chronic pain. In the podcast, Ravindran discusses the importance of being cautious about every drug that is given for pain management and recommends the following website: https://thennt.com/ The Pain-Free Mindset: 7 Steps to Taking Control and Overcoming Chronic Pain by Dr Deepak Ravindran is published by Vermilion The host of the podcast, Liz Tucker is an award winning medical journalist and former BBC producer and director.  You can follow Liz on Twitter at https://twitter.com/lizctucker and read her Substack newsletter about the podcast at https://liztucker.substack.com If you would like to support this podcast you can do so at patreon.com/whatyourgpdoesnttellyou or via PayPal at https://www.patreon.com/WhatYourGPDoesntTellYou What Your GP Doesn't Tell You has been selected by Feedspot as one of the top 20 UK Medical Podcasts https://blog.feedspot.com/uk_medical_podcasts/

Despite the cases involving breast implant illness, there is still a lack of research studies, clinical studies, and other resources regarding this matter. Recognizing the concerns raised, surgeons, medical practitioners, and other organizations have called for further investigation into breast implant safety and potential health risks associated with them, particularly regarding breast implant illness. That is why it's important for us to discuss breast implant illness considering the fact that it's been hard to characterize such a condition. We have to continue raising awareness to provide timely intervention and appropriate medical management, if necessary. Your body and breast implants play a role but it's not the only factor. Back in 2019-2020, when I was the president of the Education Research Foundation for the Aesthetic Society, we were able to fund studies on the psychological and basic scientific aspects of breast implant illness. We were able to learn more about the condition as we conducted a randomized prospective trial about surgery, identification of heavy metals, and more. Initially, we thought of it as just an inflammation but it became more significant to the point that the patient can no longer manage the inflammation. Moreover, it affects the patient's mental health and this issue cannot be solely linked to their bodies or breast implants. There are other factors causing the symptoms of anxiety, depression, brain fog, muscle, and joint pains, and the list goes on. And from a provider's standpoint, it's complicated and challenging to recognize all the patterns because the condition of breast implant illness is not yet well acknowledged and understood. Breast Implant Illness is still not part of the provided classification systems. It should be noted that for something to be categorized as a medical diagnosis, it has to be implemented in the International Classification of Diseases (ICD). At present, breast implant illness is still not part of the provided classification systems. Therefore, it is not yet a recognized medical diagnosis, although there are groups and organizations working towards that. It's going to take some time before it gets to be recognized as a medical diagnosis officially but since I've spent years studying the condition, we were able to make a program to further help patients and even surgeons. As much as we can, we provide the best care for our clients. Putting a great deal into different factors that may contribute to inflammation and breast implant illness Due to the lack of studies regarding this matter, many practitioners find it difficult to recognize the symptoms and patterns of breast implant illness. Personally, I've seen a lot of patients dealing with environmental toxicity which is why I put a great deal into everybody's personal genetics as well as the toxicity levels, food sensitivities, and hormone imbalances. Other factors, like the environment, should also be taken into consideration in correlation with personal genetics, especially when we speak of inflammation. A good example of this would be some of my clients who are realtors constantly exposed to environmental toxins as they go into different homes and renovations. Some of these toxins can cause brain fog, anxiety, and gut problems. Pattern recognition is really important and because I have done thousands of consultations, heard different stories throughout my years of being in this field, and seen the outcomes of different tests, it's been easier for me to guide patience throughout their journey. The importance of addressing other issues before surgery It's vital for us to address all the health issues a patient may have because otherwise, the patient will still experience symptoms. Our assessments should be done with a holistic approach to be able to treat everything properly. Taking a holistic approach to assessment and treatment allows providers to consider the broader context of a patient's health and well-being for more effective solutions or treatments. Before surgery, conducting a comprehensive evaluation helps identify any underlying health conditions or factors that may affect the surgery's outcome or recovery. Addressing these issues beforehand can optimize the patient's overall health and reduce the risk of complications during or after surgery. Links and Resources Dr. Robert Whitfield's Website (https://drrobssolutions.com/)

Recently, the Phelan-McDermid Syndrome Foundation was successful in applying for and receiving a specific ICD code (International Classification of Diseases code) for Phelan-McDermid syndrome from the Centers for Disease Control (CDC). Kate sits down with Annie Kennedy of the EveryLife Foundation, who has longstanding expertise in what a specific code can mean for progress for rare diseases. Kate asks - what exactly is an ICD code? What does this mean for progress in Phelan-McDermid syndrome research? Why didn't we have one already? Can it be used internationally? What was the process in getting one? What are some examples of progress after getting a code? What is the code not helpful for? Annie Kennedy is the Chief of Policy, Advocacy, and Patient Engagement at the EveryLife Foundation. She also previously served within the Parent Project Muscular Dystrophy and the Muscular Dystrophy Association. Her work includes building strong partnerships with policy makers, federal agencies, industry partners, and alliances to advance research and access in rare disease. She has developed an ICD code roadmap with the EveryLife Foundation, has conducted economic burden studies in rare disease, led efforts for newborn screening, led access efforts after the first therapies were approved by the FDA for Duchenne muscular dystrophy, and much more.

Besides choosing a qualified plastic surgeon, there are those who also take into consideration the costs of breast explant surgery. In fact, one of the questions we frequently get is whether breast explant surgery is covered by insurance. Insurance coverage influences the decision-making process. Knowing whether or not such a surgery is covered by insurance helps individuals evaluate the costs and benefits before deciding if they are willing to proceed with the operation. In today's episode, we'll be talking about such insurance coverage and financial preparation. Is breast explant surgery covered by insurance? At present, it's hard to get breast implant illness or breast explant surgery covered by insurance since there is still no International Classification of Disease 10th Revision (ICD-10) coding for such a procedure. As an alternative, what we use for the ICD-10 Code is breast pain considering that it is still indicative of breast implant illness. Many patients suffering from breast implant illness have experienced breast pain, which is why we tend to associate breast pain with breast implant illness. In line with this, patients also suffer from capsular contracture or pain associated with the implant, which may be nerve pain or breast pain in general. Everything is very costly! The patient has to pay for the facilities to be used and also for the surgeon, which is why many patients ask if these can be covered by insurance. The answer is yes; however, breast explant surgery can only be covered by insurance upon showing medical necessity. We used to provide basic letters of medical necessity. However, it became sort of a problem for us because insurers would come back to us to really inquire about many things, which really complicated everything. That is why we gradually shifted to implementing a purely cash-based practice. And although it is rare, I had people who had self- administered plans able to get reimbursement from insurance. How to prepare for the cost of the procedure? We have pointed out how costly it is for patients to get breast implants and to undergo breast explant surgery. Surely, some of you may have started wondering how to prepare for the expenses. We use PatientFi and Ally routinely, which are great companies that work with our patients to provide options for financing. We can also work and consult with your tax strategist and advisors if it is possible to have these written off of your taxes as medical expenses. Another recommendation is to get support and counselling from a financial advisor or other patient groups advocating for explants. You can also check out our Holistic Accelerated Recovery Program (HARP) to get started. We offer supplements and services that would help you to learn more about breast implant illness and help prepare you for financial investments. Links and Resources Dr. Robert Whitfield's Website (https://drrobssolutions.com/)

From starkly arid lands to lush, cosmopolitan foreign capitals, a wide-ranging mix of peoples – some old, some new – were the focus of attention as the World Health Organization (WHO), with characteristic dignity, celebrated 75 years of improving the health of mankind.ICD10monitor (so named for the WHO's International Classification of Diseases, Version 10) and Talk Ten Tuesdays will mark the occasion with the conclusion of a two-part series recognizing the accomplishments of the WHO, which has been working overtime to alleviate deadly diseases, protect people from pandemics, and promote world peace.During the next live edition of Talk Ten Tuesdays, Lorraine Fernandes, immediate past president and communications chair of the International Health Information Management Association (IHIMA), will be the special guest and will report on activities that took place during World Health Day.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the latest coding news.RegWatch: Stanley Nachimson, founder of Nachimson Advisors, LLC, will report on the latest news regulatory news coming out of Washington, DC.SDoH Report: Tiffany Ferguson, a subject-matter expert on the social determinants of health (SDoH), will report on the news that's happening at the intersection of coding and the SDoH.News Desk: Timothy Powell, CPA, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

  The Friday Five for February 10, 2023: COVID-19 Public Health Emergency End Date CMS 2024 MA and Part D Advance Notice CMS & The Universal Foundation Bard, ChatGPT, and JEF from The Rez Instagram Founders Unveil New App Artifact   Register for your FREE RitterIM.com account   Follow Us on Social!   Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim Twitter, https://twitter.com/RitterIM and Youtube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ and Instagram, https://www.instagram.com/thesarahjrueppel/ Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/   Resources:   5 Ways to Build Your Confidence: https://agentsurvivalguide.podbean.com/e/5-ways-to-build-your-confidence-the-friday-five/ Creating Margin & Taking Back Control of Your Time: https://agentsurvivalguide.podbean.com/e/creating-margin-taking-back-control-of-your-time-monday-motivation/ How Much Can Insurance Agents Make Selling Medicare?: https://agentsurvivalguide.podbean.com/e/how-much-can-insurance-agents-make-selling-medicare-2023/ How to Get Health and Life Insurance Continuing Education Credits As An Agent: https://agentsurvivalguide.podbean.com/e/how-to-get-health-and-life-insurance-continuing-education-credits-as-an-agent/ Understanding Medicare Coverage for Mental Health & Substance Use Disorder: https://agentsurvivalguide.podbean.com/e/understanding-medicare-coverage-for-mental-health-substance-use-disorder/   References:   2023 Medicare Advantage and Part D Advance Notice Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/2023-medicare-advantage-and-part-d-advance-notice-fact-sheet 2024 Medicare Advantage and Part D Advance Notice Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-advance-notice-fact-sheet A deep dive into the end of the COVID PHE: https://www.advisory.com/daily-briefing/2023/02/03/covid-phe-aftermath Advance Notice of Methodological Changes for Calendar Year (CY) 2024 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies: https://www.cms.gov/files/document/2024-advance-notice.pdf Aligning Quality Measures across CMS — The Universal Foundation: https://www.nejm.org/doi/full/10.1056/NEJMp2215539 CMS Releases 2024 Advance Notice with Proposed Payment Updates for the Medicare Advantage and Part D Prescription Drug Programs: https://www.cms.gov/newsroom/press-releases/cms-releases-2024-advance-notice-proposed-payment-updates-medicare-advantage-and-part-d-prescription CMS seeks to make quality measures more 'universal' in rollout of new program: https://www.fiercehealthcare.com/payers/cms-seeks-make-quality-measures-more-universal-rollout-new-program Google's AI chatbot Bard makes factual error in first demo: https://www.theverge.com/2023/2/8/23590864/google-ai-chatbot-bard-mistake-error-exoplanet-demo Hands-on with Bing's new ChatGPT-like features: https://techcrunch.com/2023/02/08/hands-on-with-the-new-bing/ International Classification of Diseases, (ICD-10-CM/PCS) Transition - Background: https://www.cdc.gov/nchs/icd/icd10cm_pcs_background.htm Instagram's co-founders are back with Artifact, a kind of TikTok for text: https://www.theverge.com/2023/1/31/23579552/artifact-instagram-cofounders-kevin-systrom-mike-krieger-news-app Instagram's co-founders introduce a new social app…for news reading: https://techcrunch.com/2023/01/31/instagrams-co-founders-introduce-a-new-social-app-for-news-reading/ The 6 Major Differences Between ICD-9 And ICD-10 Codes: https://www.coronishealth.com/blog/the-6-major-differences-between-icd-9-and-icd-10-codes/ What the End of the Covid Public Health Emergency Could Mean for You: https://www.nytimes.com/2023/02/01/well/live/covid-public-health-emergency.html What The End Of The Covid-19 Public Health Emergency Will Mean For Older Adults: https://www.forbes.com/sites/howardgleckman/2023/02/01/what-the-end-of-the-covid-19-public-health-emergency-will-mean-for-older-adults/?sh=671854adb922

What happens when identical twins born in Vietnam are separated by adoption, with one adopted by a US family and one adopted by a Vietnamese family? Join us to talk with Erika Hayasaki, a journalist and author of Somewhere Sisters: A Story of Adoption, Identity and the Meaning of Family.In this episode, we cover:The story.Twin studies.Adoption studies.The similarities of the twins in your story and in twin studies.The differences between the twins in your story and in twin studies.ReunitingHow did the twins' reunion affect them, their family in Vietnam, and their adopted family in the US?Complications that the disparate degrees of wealth caused.Adoptive parents' role in reunion.Twin studies referenced:Polderman, T., Benyamin, B., de Leeuw, C. et al. Meta-analysis of the heritability of human traits based on fifty years of twin studies. Nat Genet 47, 702–709 (2015). https://doi.org/10.1038/ng.3285Website based on the research cited above: MaTCH. This website provides a resource for the heritability of all human traits that have been investigated with the classical twin design. The traits have been classified into 28 broad trait domains, as well as according to the standard classification schemes of the International Classification of Functioning, Disability, and Health (ICF) or the International Classification of Diseases and Related Health Problems (ICD-10). Currently, the database includes information from 2748 papers, published between 1958 and 2012, reporting on 17804 traits on a total of 14,558,903 twin pairs. https://match.ctglab.nl/#/homeThis podcast is produced  by www.CreatingaFamily.org. We are a national non-profit with the mission to strengthen and inspire adoptive, foster & kinship parents and the professionals who support them. Creating a Family brings you the following trauma-informed, expert-based content:Weekly podcastsWeekly articles/blog postsResource pages on all aspects of family buildingPlease leave us a rating or review RateThisPodcast.com/creatingafamilySupport the showPlease leave us a rating or review RateThisPodcast.com/creatingafamily

In this episode, I invite Ashley Ritter for a conversation addressing workplace burnout. She shares great insight on some of the nuances and complexities of how we may view and understand workplace burnout.  Highlights of our conversation include:Defining workplace burnoutUnderstanding your relationship with chronic stressAddressing the system of stressors at an organizational levelEmotional safety at workIndicators of a toxic workplaceUnderstanding emotions at workAbout AshleyAshley K. Ritter is the Practice Director and Career and Leadership Coach at Chicago Career Consulting where they empower individuals and teams to design meaningful lives and careers. She believes the world of work can exist with more creativity, human compassion, and equity. She specializes in issues related to burnout, toxic workplace recovery, and emotional safety at work.  Connect with Ashleyhttps://www.linkedin.com/in/ashleykritter/https://www.chicagocareerconsulting.com/https://www.chicagocareerconsulting.com/podcastResources/ArticlesBurn-out an "occupational phenomenon": International Classification of DiseasesWhat You're Getting Wrong About BurnoutConnect with me!LinkedIn: https://www.linkedin.com/in/lizherrera1/Instagram:  https://www.instagram.com/lizcareercoaching/Website:  https://www.lizcareercoaching.net/Twitter: https://twitter.com/HerreraLiz27Email: lizcareercoaching@gmail.comMusic: https://www.purple-planet.comArtwork: Joseph Valenzuela DesignSupport the show

Once your idea has been implemented, you probably think you're done with this whole Get Sh*t Done Wheel thing — but there's one more step, Learn. On this episode of the Radical Candor Podcast, Kim, Jason and Amy talk about how creating a culture of learning can make it safe for people to fail, help mitigate future mistakes and ensure everyone knows how to repeat success. Sounds simple, right? Not so fast. There are two things that can get in the way of learning. Listen to find out what they are! Radical Candor Podcast Episode At a Glance Kim, Jason and Amy discuss why it's important to learn from mistakes and successes alike to keep improving. And why denial is actually the more common reaction to imperfect implementation than learning. Let's face it — no one wants to admit they have an ugly baby, but not admitting it doesn't mean it's not true. There are two main barriers to learning: 1. The Pressure to Be Consistent You obviously can't change course like this lightly, and if you do, you need to be able to explain clearly and convincingly why things have changed. Revisit the listen, clarify, debate, and decide steps with an inner circle. When it was time to persuade the broader team again after you've reached a new conclusion, it is important to take a deep breath and share, patiently and repeatedly, how you got there, and to call out the change in direction explicitly. 2. Burnout Sometimes we're overwhelmed by our work and personal lives, and these are the moments when it is hardest to learn from our results and to start the whole cycle over again. In 2019 — before the pandemic even began — burnout was officially recognized as a work-related phenomenon by the World Health Organization and characterized by 3 dimensions: feelings of energy depletion or exhaustion; increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy.   Kim says, “The essence of leadership is not getting overwhelmed by circumstances.” How do people walk this line, and how can managers set expectations for their teams to help them avoid burning out? Listen to the episode to learn more! Radical Candor Podcast Checklist Sometimes you have to say whoops-a-daisy. Don't let the pressure to be consistent keep you from acknowledging when things could have gone better. If you have to change course, you need to be able to explain clearly and convincingly why things have changed. This often means revisiting the listen, clarify, debate, and decide steps of the Get Shit Done Wheel. Make it safe for everyone to fail and create a culture that fosters a positive relationship between learning from failure and self-development. You can only accomplish this if you've built a trusting relationship with each person reporting to you, and there can only be real trust when people feel free at work and everyone has a safety net. Show up for yourself. Put the things you need to do for yourself on your calendar, just as you would an important meeting. Don't blow off those meetings with yourself or let others schedule over them any more than you would a meeting with your boss. Make workflows and learning visible using tools like Kanban boards and by “walking around” the office. If you're virtual, you can check in using a collaboration tool like Joyous. Quantify the benefits of what you've learned. This allows you to celebrate failure along with success and it also destigmatizes failure.   Radical Candor Podcast Resources Radical Candor Podcast: How To Use The Get Sh*t Done Wheel 2 Reasons We Stop Learning In Our Careers | Radical Candor Don't Be Afraid to Fail Because You Can Learn From It! How Intrinsic Motivation Leads to Enhanced Self-Development and Benevolent Leadership as a Boundary Condition - PMC Burnout may be changing your brain. Here's what to do How to Beat Burnout — Without Quitting Your Job - The New York Times Burn-out an "occupational phenomenon": International Classification of Diseases The Backlash Against Quiet Quitting Is Getting Loud - WSJ 6 Tips for Navigating a Work Martyr Culture The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth: Edmondson, Amy C.: 9781119477242

Ladies, have you been feeling like you're constantly overwhelmed and drained by your tasks? Are you having a hard time keeping up or just straight-up tired of everything on a daily basis?If so, you're probably dealing with a burnout and you may not even be aware of it.According to the 11th Revision of the International Classification of Diseases (ICD-11), burnout is an occupational phenomenon. Burnout stems from chronic stress (commonly in the workplace), that has not been managed. It has three dimensions:Exhaustion or energy depletionDepersonalization or negative feelings about your jobReduced professional efficacy/feelings of lack of accomplishment“Burn-out refers specifically to phenomena in the occupational context and even though it should not be applied to describe experiences in other areas of life,” I feel that it can and does spill over and affect other areas of our lives.In today's episode we are going to look at 10 signs and symptoms of burnout and then look at some strategies to help with it.If you would like to avoid burnout and work on ways to prevent it I encourage you to take a look at my “Your Wellness Journey Program” and book a 20 minute free call.Go to www.wellwomennetwork.com/work-with-meSend me a DM on the gram @wellwomennetworkAre you subscribed to my podcast? If you're not, I want to encourage you to do that today. I don't want you to miss an episode. I'm adding a bunch of bonus episodes to the mix and if you're not subscribed there's a good chance you'll miss out on those. Click here to subscribe in iTunes!Now if you're feeling the extra love, I would be really grateful if you left me a review over on iTunes, too. Just click here to review , select "Ratings and Reviews" and "Write a Review" and let me know what your favorite part of the podcast is.Also, join us on Facebook at our Facebook group here! See acast.com/privacy for privacy and opt-out information.

This week we're starting a new series all about burnout. The Lord put this topic on my heart to process in these Talk Therapy sessions for a few reasons. First, both my husband and I have experienced it at different seasons and it almost took us off track of our callings. Second, because I counsel so many people who suffer from it. Third, I am tired of the enemy taking territory in an area that could be avoided. Let's start by bringing some facts about burnout into the light: The term “burnout” originated in the 1970s by psychoanalyst Dr. Herbert Freudenberger. While supervising counselors who work with people dealing with addiction, he noticed symptoms of emotional and physical fatigue that were imparting their work. World Health Organization (WHO) included “burn-out” in the eleventh edition of the International Classification of Diseases (ICD-11) in 2019. This means burnout is serious! Symptoms of burnout mirror depression. But Dr. O'Hana says that burnout's bottom line is disconnection from everything that is important to you, including your very heart and soul. “When we are disconnected, we begin to equate our identity with achievement and performance rather than accepting and loving ourselves as the people God created us to be.” “Self-care is not a luxury; it is an ethical priority.” Now, let's pause to process: How is your heart? On a scale of 1-10, with 1 being “I'm great” to 10 meaning “I'm already burnt out”, where do you fall? Be honest. If anything above a 5, please get help. Tell a friend, family member, or counselor. God, what are you saying to me today? Resource mentioned: Beyond Burnout: What to Do When Your Work Isn't Working for You Connect with Rachael: website | Instagram | Facebook

Is Video Game Addiction Real? It's great to do things you enjoy. But can you go too far with a hobby? And at what point does it become an addiction? That's the question experts are trying to answer about playing video games.The World Health Organization added “gaming disorder” to the 2018 version of its medical reference book, International Classification of Diseases. But the American Psychiatry Association's manual, the DSM-5, didn't. (So far, gambling is the only “activity” listed as a possible addiction.)Signs to Watch ForThe DSM-5 does include a section to help people and doctors know the warning signs of problem video gaming. These problems can happen whether you play online or offline.Here's what to look for in yourself or someone close to you -- your partner, a child, or a friend. You need to have five or more of these signs in 1 year to have a problem, according to criteria that were proposed in the DSM-5:Thinking about gaming all or a lot of the timeFeeling bad when you can't playNeeding to spend more and more time playing to feel goodNot being able to quit or even play lessNot wanting to do other things that you used to likeHaving problems at work, school, or home because of your gamingPlaying despite these problemsLying to people close to you about how much time you spend playingUsing gaming to ease bad moods and feelingsFrom WebMD_____If you or anyone you know is struggling with addiction, depression, trauma, sexual abuse or feeling overwhelmed, we've compiled a list of resources at secretlifepodcast.com.______To share your secret and be a guest on the show email secretlifepodcast@icloud.com_____SECRET LIFE'S TOPICS INCLUDE addiction recovery, mental health, alcoholism, drug addiction, sex addiction, love addiction, OCD, ADHD, dyslexia, eating disorders, debt & money issues, anorexia, depression, shoplifting,  molestation, sexual assault, trauma, relationships, self-love, friendships, community, secrets, self-care, courage, freedom, and happiness._____Comedian Paul Gilmartin hosts a weekly, hour-long audio podcast, The Mental Illness Happy Hour, consisting of interviews with artists, friends, and the occasional doctor.Podcast: The Mental Illness Happy Hour Podcast | Website | Instagram | TwitterCheck it out wherever you podcast Apple | Google | Amazon | Instagram______Brianne's novel: SECRET LIFE OF A HOLLYWOOD SEX & LOVE ADDICT Check out the website: Secret Life Novel or buy on Amazon______HOW CAN I SUPPORT THE SHOW?Tell Your Friends & Share Online!Follow, Rate & Review: Apple Podcasts | SpotifyFollow & Listen iHeart | Stitcher | Google Podcasts | Amazon | PandoraSpread the word via social mediaInstagramTwitterFacebook#SecretLifePodcastDonate - You can also support the show with a one-time or monthly donation via PayPal (make payment to secretlifepodcast@icloud.com) or at our WEBSITE.Connect with Brianne Davis-Gantt (@thebriannedavis)Official WebsiteInstagramFacebookTwitterConnect with Mark Gantt (@markgantt)Main WebsiteDirecting WebsiteInstagramFacebookTwitterAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy