Podcasts about Interventions

In which stage of lymphedema will elevation of an extremity MOST particularly help reduce swelling? Find it all out in the podcast!  Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.  #Npte #PT #ptboards #crushtheNPTE #study #studygram #spt #ptstudent #ptlife #sptprobs #physicaltherapystudent #physicaltherapy #physio #physiotherapist #ptlife #ptstudentstudy

We catch up with Professor Petrus De Vries!Coaching of PWLE in LMIC with behavioral interventions: What are the key components of effective coaching programs for people with lived experience in low- and middle-income countries, particularly those focusing on behavioral interventions?Another brilliant interview with researchers from EACD / IAACD 2025 at Heidelberg Germany!

Dr Jo Morrissey joins Paul to discuss her research into wellbeing challenges faced by forensic practitioners worldwide. As Workforce Strategy Lead at the Forensic Capability Network, Dr Morrissey is conducting a comprehensive study examining mental health impacts across all forensic disciplines - from digital forensics to crime scene investigation, DNA analysis, and fingerprint examination. They explore the unique psychological pressures forensic practitioners face, including exposure to traumatic material, working in isolation, and the barriers that prevent many from seeking help. Dr Morrissey discusses how stigma around help-seeking behavior and fears about career prospects continue to affect practitioners, and why evidence-based national guidelines are urgently needed. Take part in the research: Dr Morrissey is seeking responses from current and former forensic practitioners worldwide across all disciplines and sectors. The survey examines well-being challenges, available interventions, and their effectiveness. Your participation could help shape future well-being support for the forensic community. Survey closes Friday 4th July 2025. Survey link: https://forms.office.com/e/GXPMwnpyMi #ForensicScience #MentalHealth #Wellbeing #DigitalForensics 00:00 Introduction to Dr. Jo Morrissey 01:31 Overview of the Wellbeing Study 03:34 Challenges Faced by Forensic Practitioners 08:25 Survey Specifics and Goals 14:57 Barriers and Stigma in Wellbeing 18:49 Ethical Considerations and Future Research 20:09 Open Access to Research Report 20:38 National Guidelines for Wellbeing 22:00 Challenges in Implementing Guidelines 25:07 Importance of Survey Participation 27:02 Potential for Funding and Further Research 28:06 Exploring Differences in Wellbeing 30:51 Impact of Experience and Culture on Wellbeing 33:39 Resilience and Adverse Childhood Experiences 37:05 Closing Remarks and Future Research

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Join pioneering LGBTQ+ activist Daniel C. Tsang for a special conversation reflecting on his 50 years of activism, including his groundbreaking 1975 article Gay Awareness in Bridge Magazine, one of the first to address LGBTQ+ issues in the Asian American community. Tsang will discuss the evolution of LGBTQ+ rights, his personal journey, and the ongoing challenges facing the community. Moderated by the Museum of Chinese in America's Chief Curator Herb Tam, the event will conclude with a Q and A session for audience engagement.

On Legal Docket, Supreme Court rules on treatment for gender transition; on Moneybeat, the Middle East risk; and on History Book, the start of the Korean War. Plus, the Monday morning newsSupport The World and Everything in It today at wng.org/donateAdditional support comes from WatersEdge Kingdom Investments — personal investments that build churches. 5.05% APY on a three-month term. WatersEdge.com/investWatersEdge Kingdom Investments - WatersEdge securities are subject to certain risk factors as described in our Offering Circular and are not FDIC or SIPC insured. This is not an offer to sell or solicit securities. WatersEdge offers and sells securities only where authorized; this offering is made solely by our Offering Circular.

Flex Diet Certification Enrollment Deadline  (click here) & Optimal Weight Loss StrategiesIn this episode of the Flex Diet Podcast, Dr. Mike Nelson discusses the closing of the Flex Diet Certification enrollment, emphasizing its comprehensive program for improving body composition, muscle gain, and performance through nutrition and recovery. Dr. Nelson provides a key tip for weight loss. Listen in for more.00:24 Flex Diet Certification Enrollment01:50 Expert Interviews and Course Content03:41 Tip of the Week05:01 Prioritizing 2 Interventions 07:03 Exercise and Caloric Deficit11:04 Cardio and Activity Recommendations14:40 Upcoming Events

This lecture discusses key ideas from the 20th Century American science-fiction short story writer and novelist, Philip K. Dick's novel Ubik It focuses specifically on the many points in the novel, after the surprise attack on Glen Runciter, Joe Chip, and the entire team of the inertials, where a seemingly dead and in cold-pac Runciter breaks through into the "reality" of those who think themselves survivors. At first this happens through strange written interventions, like a matchbook cover, graffiti, and notes, and through Runciter appearing on currency. As time goes on, the manifestations extend to video and even a meeting between Joe Chip and Glen Runciter. To support my ongoing work, go to my Patreon site - www.patreon.com/sadler If you'd like to make a direct contribution, you can do so here - www.paypal.me/ReasonIO - or at BuyMeACoffee - www.buymeacoffee.com/A4quYdWoM You can find over 3000 philosophy videos in my main YouTube channel - www.youtube.com/user/gbisadler You can get a copy of Ubik here - https://amzn.to/4k8i348

Dr. Halley Alexander and Dr. Serena Yin discuss the effectiveness of an electronic medical record best practice alert in preventing iatrogenic interventions for patients with a diagnosis of PNES. Show references:  https://www.neurology.org/doi/10.1212/CPJ.0000000000200457 

Send us a textAdd this episode to your Helpful file. Have you been in rooms like David uncomfortably endured in a recent Great Clips  experience? His skilled hair-stylist lacked read-the-room-awareness or a voice that didn't make his skin crawl. Intervention was needed. So we unpacked it. And we probed how new grandpa David's son gently corrected his clumsy baby-holding skills. Intervention well done.

Dr. Josh Mitteldorf summarizes his #research perspective #published in Volume 17, Issue 5 of Aging (Aging-US), titled “Methylation clocks for evaluation of anti-aging interventions.” DOI - https://doi.org/10.18632/aging.206245 Corresponding author - Josh Mitteldorf - aging.advice@gmail.com Author interview - https://www.youtube.com/watch?v=efgNvr5ezTk Video short - https://www.youtube.com/watch?v=YjUvpqMzCGc Abstract Methylation clocks have found their way into the community of aging research as a way to test anti-aging interventions without having to wait for mortality statistics. But methylation is a primary means of epigenetic control, and presumably has evolved under strong selection. Hence, if methylation patterns change consistently at late ages it must mean one of two things. Either (1) the body is evolved to destroy itself (with inflammation, autoimmunity, etc.), and the observed methylation changes are a means to this end; or (2) the body detects accumulated damage, and is ramping up repair mechanisms in a campaign to rescue itself. My thesis herein is that both Type 1 and Type 2 changes are occurring, but that only Type 1 changes are useful in constructing methylation clocks to evaluate anti-aging interventions. This is because a therapy that sets back Type 1 changes to an earlier age state has stopped the body from destroying itself; but a therapy that sets back Type 2 changes has stopped the body from repairing itself. Thus, a major challenge before the community of epigenetic clock developers is to distinguish Type 2 from Type 1. The existence of Type 1 epigenetic changes is in conflict with conventional Darwinian thinking, and this has prompted some researchers to explore the possibility that Type 1 changes might be a form of stochastic epigenetic drift. I argue herein that what seems like directed epigenetic change really is directed epigenetic change. Of five recent articles on “stochastic methylation clocks,” only one (from the Conboy lab) is based on truly stochastic changes. Using the Conboy methodology and a methylation database, I construct a measure of true methylation drift, and show that its correlation with age is too low to be useful. Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.206245 Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Keywords - aging, methylation, stochastic, entropy, programmed aging, aging clock, epigenetic clock To learn more about the journal, please visit our website at https://www.Aging-US.com​​ and connect with us on social media at: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Bluesky - https://bsky.app/profile/aging-us.bsky.social Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

CutTheClutter: Iraq,Libya to Afghanistan:What regime changes & US interventions say about Israel ‘end goal' in Iran

In this episode of the Autism Little Learners Podcast, I sit down with Alex Lamoreaux—a mom of three, including two autistic boys—to talk about her personal and powerful journey with autism. From receiving a late diagnosis herself to navigating complex medical advice, Alex shares how she shifted from fear to confidence in parenting.  We dive into what it really means to trust your gut as a parent and honor the unique needs of each child. This heartfelt conversation explores the emotional ups and downs of advocating for autistic kids and highlights the power of intuition, self-advocacy, and community. You won't want to miss Alex's inspiring and relatable story. Bio Alex Lamoreaux is a late-diagnosed neurodivergent mom of three young boys and a Licensed Clinical Social Worker with a background in addiction recovery and trauma treatment. After two of her sons were diagnosed with autism, she dove into learning—and unlearning—what it really means to support autistic children. Now in the thick of parenting and advocacy, Alex shares practical, real-life insights with honesty and heart, hoping to spark connection and offer support to fellow parents on similar journeys. Alex's TikTok Account https://www.tiktok.com/@alex.lamx?_t=ZT-8xBXQBH46la&_r=1 Takeaways Late diagnosis can provide clarity and reduce shame over past differences. Parents often feel overwhelmed by the amount of information available. Shifting from panic to empowerment is crucial in parenting. Each autistic child is unique and requires different interventions. There is no one-size-fits-all approach to autism. Trusting parental instincts is essential for effective parenting. You do not have to fill your child's day with therapy. Trust your gut feelings about your child's needs. Parents often know their children best, despite professional opinions. Medical professionals may not always have the latest information on autism. Advocating for your child can be challenging, but it is essential. Bringing a list to meetings can help parents stay focused. Cognitive dissonance is common when navigating medical advice. Parents should feel empowered to change providers if necessary. Finding clarity amidst overwhelming information is crucial for parents. You may also be interested in these supports Visual Support Starter Set  Visual Supports Facebook Group Autism Little Learners on Instagram Autism Little Learners on Facebook  

Step inside the evolving world of fetal therapy where precision, teamwork, and full-spectrum care matter most. In this episode of the BackTable OBGYN Podcast, Dr. Anthony Shanks, Vice Chair of Education in the OB department at Indiana University School of Medicine, interviews Dr. Hiba Mustafa, a distinguished maternal-fetal medicine specialist and fetal interventionalist at Riley Children's Hospital. They discuss Dr. Mustafa's expertise in fetal diagnosis and therapy, her training journey through various fellowships, and her role in directing multiple fetal medicine programs. --- SYNPOSIS Dr. Mustafa elaborates on the intricacies of fetal interventions, including procedures for complications in monochorionic twins, spina bifida repair, and new emerging therapies. They also touch on research methodologies like the Delphi consensus technique and summarize key findings from recent studies on conditions such as hemolytic disease, gastroschisis, lower urinary tract obstructions, and preterm birth in twin pregnancies. Dr. Mustafa shares insights on how to stay sharp in the field, the importance of teamwork in surgical procedures, and advice for those aspiring to enter the field of fetal therapy. --- TIMESTAMPS 00:00 - Introduction02:45 - The Role of a Fetal Interventionalist04:00 - Dr. Mustafa's Training Journey07:42 - Fetal Surgery Fellowships16:43 - Conditions Treated by Fetal Interventionalists21:17 - Monitoring and Referrals for Monochorionic Twins30:04 - Understanding Percutaneous Procedures31:10 - Navigating the Equator in Fetal Surgery32:31 - Laser Surgery Techniques and Outcomes33:18 - The Importance of Placenta Delivery33:47 - In Utero Spina Bifida Repair36:19 - Minimally Invasive Techniques for Spina Bifida38:28 - Maintaining Skills in Fetal Interventions42:11 - Delphi Consensus Technique in Medical Research46:19 - Key Takeaways from Recent Research51:55 - Future of Fetal Therapy and Personal Insights

Dr. Halley Alexander talks with Dr. Serena Yin about the effectiveness of an electronic medical record best practice alert in preventing iatrogenic interventions for patients with a diagnosis of psychogenic nonepileptic seizures. Read the related article in Neurology® Clinical Practice.  Disclosures can be found at Neurology.org. 

durée : 00:58:03 - Le 13/14 - par : Bruno Duvic - Maxime Prud'homme 23 ans et Tangui Mosin 22 ans étaient pompiers volontaires. Ils sont morts lundi dernier en combattant un incendie dans le centre-ville de Laon. Un drame qui interroge sur les risques que prennent les pompiers lors de ces interventions, au cœur des centres villes vétustes.

More than 3 million young people aged 15-24 in South Africa are not in employment, education, or training (NEET). They have fallen through the cracks, shut out of learning and earning prospects because they haven’t completed matric, or don’t have post-school qualifications or general work experience. This lack of opportunity has a devastating effect: continued unemployment leads to financial hardship, worsening mental health, exposure to crime and violence and social isolation, both in their community and wider society. Views and News with Clarence Ford is the mid-morning show on CapeTalk. This 3-hour long programme shares and reflects a broad array of perspectives. It is inspirational, passionate and positive. Host Clarence Ford’s gentle curiosity and dapper demeanour leave listeners feeling motivated and empowered. Known for his love of jazz and golf, Clarrie covers a range of themes including relationships, heritage and philosophy. Popular segments include Barbs’ Wire at 9:30am (Mon-Thurs) and The Naked Scientist at 9:30 on Fridays. Thank you for listening to a podcast from Views & News with Clarence Ford Listen live on Primedia+ weekdays between 09:00 and 12:00 (SA Time) to Views and News with Clarence Ford broadcast on CapeTalk https://buff.ly/NnFM3Nk For more from the show go to https://buff.ly/erjiQj2 or find all the catch-up podcasts here https://buff.ly/BdpaXRn Subscribe to the CapeTalk Daily and Weekly Newsletters https://buff.ly/sbvVZD5 Follow us on social media: CapeTalk on Facebook: https://www.facebook.com/CapeTalk CapeTalk on TikTok: https://www.tiktok.com/@capetalk CapeTalk on Instagram: https://www.instagram.com/ CapeTalk on X: https://x.com/CapeTalk CapeTalk on YouTube: https://www.youtube.com/@CapeTalk567 See omnystudio.com/listener for privacy information.

In this episode of Copeland's Corner, Brian welcomes Tony Camin, Cathy Ladman & Mike Larsen as they check in from the SoCal area to discuss the current situation in the U.S. regarding the militarization and federal response to protests, specifically anti-ICE demonstrations. The group reflects on media portrayal differences, the implications of sending Marines for crowd control, and the historical context of federal government intervention in state matters. They also touch on the role of Gavin Newsom as a figure of resistance, the use of military force against American citizens, and the political landscape under Trump. Additionally, they discuss the potential ramifications on freedom of speech, particularly in the stand-up comedy community, in light of recent incidents in Brazil and historical examples from the U.S. Furthermore, they delve into themes regarding authoritarianism, the influence of the Trump administration on different sectors, including higher education and the arts, and the broader social implications of current policies.--Connect with our Guests...Tony Camin - Website: TonyCamin.com  and on Instagram @Tony.CaminCathy Ladman- Website  and @CathyLadman1 on Instagram  Mike Larsen - @WriteMikeLarsen on Instagram --For more from Brian...Visit his website: www.BrianCopeland.comFollow on Social Media: Instagram - @CopelandsCorner & @BrianCopieEmail: BrianCopelandShow@Gmail.com --Copeland's Corner is Created, Hosted, & Executive Produced by Brian Copeland. This Show is Recorded & Mixed by Charlene Goto with Go-To Productions. Visit Go-To Productions for all your Podcast & Media needs.Our Booking Producer is Tom Sawyer. For any show inquiries, please email CopelandsCornerPodcast@gmail.com

On this episode of Big Rich, TD, and Fletch, the glam gauntlet is thrown down in Top of the Rock — who ruled harder: Motley Crue or Poison? Then the guys get real about grade school bullying and the moments that still sting (or make us laugh) decades later. Plus, Big Rich shares his no-BS tips for breaking up with your phone and reclaiming your time from the social media vortex.

Developmental relationship-based interventions have been around for many years, but have not received the level of attention that intervention approaches based on applied behavior analysis have received. Drs. Josh Feder and Andrea Davis, along with a number of colleagues, including Barry, are currently involved in collaborative efforts to bring greater awareness and funding to DRBI interventions. They discuss the justification and research basis for the work currently being undertaken to provide families with greater options for supporting their children's development.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Emmanuel Amiesen is lead author of “Circuit Tracing: Revealing Computational Graphs in Language Models” (https://transformer-circuits.pub/2025/attribution-graphs/methods.html ), which is part of a duo of MechInterp papers that Anthropic published in March (alongside https://transformer-circuits.pub/2025/attribution-graphs/biology.html ). We recorded the initial conversation a month ago, but then held off publishing until the open source tooling for the graph generation discussed in this work was released last week: https://www.anthropic.com/research/open-source-circuit-tracing This is a 2 part episode - an intro covering the open source release, then a deeper dive into the paper — with guest host Vibhu Sapra (https://x.com/vibhuuuus ) and Mochi the MechInterp Pomsky (https://x.com/mochipomsky ). Thanks to Vibhu for making this episode happen! While the original blogpost contained some fantastic guided visualizations (which we discuss at the end of this pod!), with the notebook and Neuronpedia visualization (https://www.neuronpedia.org/gemma-2-2b/graph ) released this week, you can now explore on your own with Neuronpedia, as we show you in the video version of this pod. Chapters 00:00 Intro & Guest Introductions 01:00 Anthropic's Circuit Tracing Release 06:11 Exploring Circuit Tracing Tools & Demos 13:01 Model Behaviors and User Experiments 17:02 Behind the Research: Team and Community 24:19 Main Episode Start: Mech Interp Backgrounds 25:56 Getting Into Mech Interp Research 31:52 History and Foundations of Mech Interp 37:05 Core Concepts: Superposition & Features 39:54 Applications & Interventions in Models 45:59 Challenges & Open Questions in Interpretability 57:15 Understanding Model Mechanisms: Circuits & Reasoning 01:04:24 Model Planning, Reasoning, and Attribution Graphs 01:30:52 Faithfulness, Deception, and Parallel Circuits 01:40:16 Publishing Risks, Open Research, and Visualization 01:49:33 Barriers, Vision, and Call to Action

In this episode of the PFC Podcast, host Dennis engages with Andy Fisher to discuss the controversial topic of needle decompression in Individual First Aid Kits (IFACs). They explore the historical context of IFAC contents, the effectiveness of needle decompression, and the challenges in identifying tension pneumothorax in the pre-hospital setting. The conversation also delves into the training and decision-making processes in combat medicine, assessment techniques for pneumothorax, and potential alternatives to needle decompression. In this conversation, the speakers delve into the evolving perspectives on thoracostomy and its application in pre-hospital settings, particularly in combat medicine. They discuss the implications of tension physiology in hemothorax and the prevalence of massive hemothorax in recent years. The conversation also revisits treatment protocols for chest injuries, emphasizing the need for a shift towards simple thoracostomy over needle decompression. Finally, they evaluate the use of pigtail catheters versus traditional chest tubes, weighing the pros and cons of each in emergency situations.TakeawaysNeedle decompression is debated in the context of IFACs.Historical context shows that needle decompression was not originally included in official DOD lists.Hemorrhage is the leading cause of mortality in trauma cases.Tension pneumothorax is rare, occurring in only 1.1% of cases.Identifying tension pneumothorax in pre-hospital settings is challenging.Medics should rely on objective data for decision-making.Training often prioritizes speed over thorough assessment.Prophylactic interventions for tension pneumothorax may not be effective.Chest tubes are not always life-saving interventions.Exploring alternatives like finger thoracostomy may be beneficial. Evolving views on thoracostomy emphasize its selective use.Needle decompression may be overused in practice.Tension physiology can occur with blood accumulation in the chest.Massive hemothorax is increasingly recognized in trauma cases.Up to 49% of combat casualties require chest tubes.Simple thoracostomy should be prioritized over needle decompression.Patient monitoring is crucial in pre-hospital settings.Pigtail catheters may not be suitable for pre-hospital use.Chest tubes are preferred for their reliability in emergencies.Comfort for the patient is important but should not compromise urgent care.Chapters00:00 Introduction to the Podcast and Guest01:01 Debate on Needle Decompression in IFACs03:20 Historical Context of IFAC Contents06:40 Effectiveness of Needle Decompression09:09 Challenges in Identifying Tension Pneumothorax12:00 Training and Decision-Making in Combat Medicine16:21 Assessment Techniques for Pneumothorax21:29 Interventions for Tension Pneumothorax25:19 Exploring Alternatives to Needle Decompression25:50 Evolving Perspectives on Thoracostomy31:38 Understanding Tension Physiology in Hemothorax36:41 Revisiting Treatment Protocols for Chest Injuries43:12 Evaluating Pigtail Catheters vs. Chest TubesThank you to Delta Development Team for in part, sponsoring this podcast.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠

This episode of Kiwi Birth Tales is proudly brought to you by Eve Wellness - supplements that become your body's new best friend. In this episode of Kiwi Birth Tales, I speak to Beatrice. Some of the topics we cover:Trying to conceive for 2 yearsFertility Therapist Spontaneous pregnancy Midwifery CareNIPTYour Birth Project and Antenatal ClassesWaters broke at home, labour didn't startMisoprostol inductionGood hospital midwives EpiduralInterventions after long pushing stageIssues with cord preventing baby coming downBirth CareLactation Consultant Nipple Shield Pelvic Floor PhysioYour Birth Project Online Hypnobirthing Coursehttps://www.fertilityassociates.co.nz/book-a-free-nurse-consultPlease seek support for any mental health concerns, some helpful links are below:Mental Health in PregnancyPerinatal Depression and Anxiety Aotearoa Plunket - Dads Mental HealthLittle Shadow - Private Counselling NZFind me @kiwibirthtales and @yourbirthproject Hosted on Acast. See acast.com/privacy for more information.

Brent Minchew is Co-Founder, Executive Director, and Chief Scientist at Arête Glacier Initiative, a new nonprofit launched to close the gap between frontier glaciology research and actionable sea-level forecasts—and to probe whether “brake-tapping” inside Antarctic glaciers can slow their slide into the sea. Brent explains why current models still span 1–6 feet of rise by 2100—even if Paris targets are met—and how melting glaciers, especially Antarctica's so-called “Doomsday Glacier,” drive that uncertainty. He details why glaciology remains drastically underfunded, how sea-level changes already threaten coastal economies via insurance markets, and where Arête's first $5 million in philanthropic capital is going. He also walks through early-stage solutions—from thermo-siphons that passively refreeze ice to pumping sub-glacial water—that could “hit the brakes” on glacier flow and buy humanity time for deep decarbonization.In this episode, we cover: [03:45] Launching Arête to bridge glacier science and solutions[05:38] Inside the “doomsday glacier” and its global risk[07:18] Why Thwaites may collapse even if we hit climate goals[09:51] Sea level rise: Millions displaced per inch[12:41] The silent crisis of glacial melt[13:28] Economic ripple effects of rising seas[15:53] What Larsen B's collapse taught us[20:04] Arête's model: Philanthropy + global research[22:51] Advancing glacier tech through TRL stages[25:45] How Antarctica is governed[35:28] Refreezing glaciers with thermo-siphons[45:00] Drilling costs vs. seawalls: Where's the value?Episode recorded on May 14, 2025 (Published on June 2, 2025) Enjoyed this episode? Please leave us a review! Share feedback or suggest future topics and guests at info@mcj.vc.Connect with MCJ:Cody Simms on LinkedInVisit mcj.vcSubscribe to the MCJ Newsletter*Editing and post-production work for this episode was provided by The Podcast Consultant

This episode features a conversation with Diya Deb, executive director of Mindworks. It was recorded in April 2025.Growing up as an activist in India, Diya has in-depth experience of working in harsh political and social realities. With a variety of leadership roles under her belt from Amnesty and Greenpeace India, and a background in campaigning and program management too, she holds a deep belief in the need to decolonise knowledge and drive systemic change in Global Majority countries. At the helm of Mindworks, Diya works to apply cognitive and social science insights to support organisations and changemakers, particularly in Asia, Africa and Latin America, to campaign innovatively to address climate and other systemic issues.Amongst other things, Diya and I discussed the ways that mindsets in places like India and Indonesia demand new strategies and emphasis from climate communicators, the fresh ways that denial emerges in such contexts, and the desperate need for more listening in developing interventions and engagement that resonates.Additional links: Visit the Mindworks websiteDig in to the Anger & Agency MonitorCheck out the Time to Talk insights and toolkit

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research and interview Steve Cook from the University of Michigan USA about the importance of correctly interpreting and assessing the available data. Associate Professor Jamie Hartmann-Boyce and Associate Professor Nicola Lindson discuss the new evidence in e-cigarette research and interview Dr Steven Cook from the Department of Epidemiology, School of Public Health University of Michigan and the Centre for Assessment of Tobacco Regulations, University of Michigan. In the May podcast Steve Cook discusses the methodological problems of cross-sectional data on the health effects of e-cigarette use a topic he addressed at the May 2025 EC Summit, Washington DC. Steve Cook underlines why all cross-sectional health effects studies should be interpreted with extreme caution unless they examine dose-response relationships and account for temporality and cigarette smoking confounding. Dr Cook emphasises the importance of other information such as smoking histories and health histories and the importance of developing a best practice to ensure that we minimize the risks associated with spurious association and maximise predictive accuracy. Steven Cook receives National Institute for Health (NIH) and Food and Drug Administration's (FDA) Center for Tobacco Products (CTP) funding. This is not deemed a conflict of interest. EC Summit, Washington DC: https://www.e-cigarette-summit.com/program-2025/ Recent paper: 10.1016/j.isci.2025.111985 This podcast is a companion to the electronic cigarettes Cochrane living systematic review and Interventions for quitting vaping review and shares the evidence from the monthly searches. Our search for the EC for smoking cessation review carried out on 1st May 2025 found 1 ongoing (NCT06922617) and 1 linked study (DOI: 10.1101/2025.02.17.25322409). Our search for our interventions for quitting vaping review up to 1st May 2025 found 1 new (DOI 10.1001/jama.2025.3810) and 4 ongoing studies (DOI 10.2196/71961, KCT0010346, NCT06909500, NCT06929520). For further details see our webpage under 'Monthly search findings': https://www.cebm.ox.ac.uk/research/electronic-cigarettes-for-smoking-cessation-cochrane-living-systematic-review-1 For more information on the full Cochrane review of E-cigarettes for smoking cessation updated in January 2025 see: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub9/full For more information on the full Cochrane review of Interventions for quitting vaping published in January 2025 see: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD016058.pub2/full This podcast is supported by Cancer Research UK.

In this episode of the Pacey Performance Podcast, Tyler Lesher, head athletic trainer for UCLA men's basketball, discusses the current state of athletic training in the US, the importance of gut health in recovery, and the challenges faced by athletic trainers. He emphasizes the need for a balance between research and clinical practice, the gut-brain connection, and practical interventions for improving gut health. Tyler also shares insights on assessing gut health and the significance of testing for athletes. Main talking points: • Athletic training jobs are declining due to various factors. • Gut health is crucial for overall recovery and performance. • Research can often be biased and not applicable to real-world scenarios. • Chronic inflammation can hinder recovery processes. • Fasting and cold water immersion can improve gut health. • The gut-brain axis significantly affects mental health. • Personalized testing is essential for understanding individual gut health. • Athletes should keep a food and symptom journal to identify triggers. • Interventions for gut health should be tailored to the individual. • Communication with athletes about nutrition is vital for their performance.

Today, I am delighted to connect with James Kimmel Jr., a Yale psychiatry lecturer, a lawyer, and the founder and co-director of the Yale Collaborative for Motive Control Studies.  In our conversation, we explore the science of revenge, examining how it affects the brain and identifying risk factors that could contribute to extremes in revenge activity. James shares his journey from childhood to law and academia and offers his perspective on the intersection of justice, neuroscience, and human behavior. We talk about forgiveness, exploring how it reshapes the brain, counteracts revenge addiction, and serves as a tool for healing. We also cover specific interventions, including the non-justice system and the warning signs for extremes in addictive behaviors. This invaluable and insightful conversation with James Kimmel Jr. is an incredible resource for moms everywhere. IN THIS EPISODE YOU WILL LEARN: How revenge impacts the brain How psychological harm can lead to revenge cravings The link between addiction and revenge-seeking Why some individuals are more at risk for revenge-seeking than others Some common forms of revenge-driven behavior What does a revenge attack look like? James shares how revenge motivated his choice to become a lawyer and how he came to do the work he does now The benefits of forgiveness as an antidote to revenge cravings How social media platforms exploit the addictive process of revenge-seeking Interventions and support systems for managing revenge addiction Connect with Cynthia Thurlow   Follow on ⁠X⁠ ⁠Instagram⁠ ⁠LinkedIn⁠ Check out Cynthia's ⁠website⁠ Submit your questions to ⁠support@cynthiathurlow.com⁠ Connect with James Kimmel Jr. On his⁠ website⁠ Buy a copy of James' latest book,⁠ The Science of Revenge⁠ ⁠SavingCain.org⁠: Preventing Murd

Dr. Barbara Moscicki discusses the critical role of HPV in women's health, particularly its association with various cancers, including cervical cancer. She explains the dual nature of HPV as both a commensal organism and a pathogen, emphasizing the importance of understanding its oncogenic potential. The conversation also covers the significance of screening methods, such as Pap smears, in detecting precancerous changes and the complexities surrounding the treatment of different cervical intraepithelial neoplasia (CIN) stages. This conversation delves into the complexities of cancer screening methods, particularly focusing on cervical and anal cancer. Dr. Barbara Moscicki discusses the importance of understanding various screening guidelines, the role of HPV vaccination in preventing cancers, and the need for clear communication between clinicians and patients regarding these topics. The discussion highlights the evolving nature of cancer screening practices and the importance of patient education in navigating these changes.About Our Guest:Dr. Moscicki is a Pediatrician, Board Certified in Adolescent Medicine. She is the current Division Chief of Adolescent and Young Adult Medicine with clinical expertise in reproductive health care for menstrual irregularities, sexual health, and sexually transmitted diseases. Dr. Moscicki has expertise in HPV -related disease including diagnosis of cervical dysplasia and treatment. She also offers medical care for women with eating disorders.Resources & Links:This episode was supported by the Patient Centered Outcomes Research Institute (PCORI) and features the PCORI research study here: https://pubmed.ncbi.nlm.nih.gov/33632649/ ‘Effect of 2 Interventions on Cervical Cancer Screening Guideline Adherence'Chapter Codes00:00 Introduction to HPV and Women's Health03:00 Understanding HPV's Role in Cancer06:01 The Dual Nature of HPV: Commensal vs Pathogenic08:57 Oncogenes and Their Impact on Cellular Regulation12:09 The Intersection of HPV and Screening Methods14:58 Cervical Cancer Screening and Pap Smears20:30 Understanding Cancer Screening Methods23:17 Guidelines for Cervical and Anal Cancer Screening31:02 The Importance of HPV Vaccination39:35 Key Messages for Clinicians and PatientsTakeaways- Dr. Moscicki specializes in adolescent and young adult medicine.- HPV is linked to multiple cancers beyond cervical cancer.- The understanding of HPV's role in cancer has evolved significantly.- E6 and E7 proteins from HPV disrupt normal cell regulation.- CIN3 is considered a true pre-cancer that requires treatment.- Liquid cytology has improved the accuracy of Pap smears.- CIN1 is often self-resolving and does not require treatment.- CIN2 presents a diagnostic dilemma due to variability in interpretation.- Women have options regarding the management of CIN2 lesions.Connect with Us:Enjoyed this episode? Make sure to subscribe, rate, and review! Follow us on Instagram, Facebook, or Linkedin @mantacares and visit our website at mantacares.com for more episodes and updates.Listen Elsewhere: Website: https://mantacares.com/pages/podcast?srsltid=AfmBOopEP5GJ-Wd2nL-HYAInrw YouTube: https://www.youtube.com/@mantacares Spotify: https://open.spotify.com/episode/3TR1lFLtf6em5YyKtlWy2L?si=6ma-9g_w Apple: https://podcasts.apple.com/us/podcast/navigating-cervical-cancer-screening-surger Disclaimer:All content and information provided in connection with Manta Cares is solely intended for informational and educational purposes only. This content and information is not intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.This episode was supported by an award from the Patient-Centered Outcomes Research Institute.

A patient with ascites is most likely to develop which of the following complications? Find it all out in the podcast!  Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.  #Npte #PT #ptboards #crushtheNPTE #study #studygram #spt #ptstudent #ptlife #sptprobs #physicaltherapystudent #physicaltherapy #physio #physiotherapist #ptlife #ptstudentstudy

Episode 54 concludes a four-episode arc, within the Unit Supervision Pathway, that presents the 10 techniques that make up the Hierarchy of Interventions.  This episode focuses on how to implement these interventions in a way that goes beyond surface behavior management to supporting the development of self-regulation in children and youth.   This episode particularly focuses on the Forced-Choice and related Weighted-Choice techniques.  These interventions leverage a program's consequence system to help child-clients make choices that determine whether or not they receive a consequence for any misbehaviors.  That, in turn, supports the development of self-regulation over their own impluses and emotional-reasoning.  These techniques are also a very effective way to help kids who struggle with taking responsibility for their own feelings, thoughts, and especially behaviors to mature.  They are also excellent techniques for ending pointless control-battles between a staff person and a client.   Centering Breaks are similar to Time Outs, however, they add structures to the time that move the intervention beyond simply removing a client from an over-stimulating or triggering situation.  These structures are individualized to the needs and abilities of individual kids, but are strategically intended to help each child or youth become emotionally, cognitively, behaviorally, and physiologically centered.   The Support Center structure and intervention is used by many multi-unit residential programs and schools to completely separate misbehaving kids from their peers.  Typically, separate counselors staff the Support Center, providing a change of face as well as a Change-of-Environment.  Ideally, Support Center counselors also Process the incidents that resulted in a child or youth being separated from the group.  A structured approach to Processing is presented in prior podcast episodes. Physical Interventions, including physical restraint, are techniques used in residential treatment programs to safely de-escalate or contain extreme behaviors.  Processing afterwards is key for moving these interventions beyond behavior management to supporting the development of self-regulation in kids.  

In this episode of The Luke Coutinho Show, I am thrilled to welcome back Dr. Sonali Kohli, an Integrative Aesthetic Dermatologist, and Hair Transplant Surgeon after two incredible episodes on skin health!Tune in to discover:The shift in skincare trends among children: Exploring the dangers of early skincare product use, role of parents in setting boundaries, makeup dependencyImpact of pollution on skin: How pollutants triggers immune responses, damages mitochondria, disrupts gut microbiome, and accelerates agingLiver function as a skin health anchor: Importance of liver-skin axis, liver detoxification pathways and herbs, and regulation of insulin and estrogen metabolismSkincare across ages: From teens to seniors, learn about protecting fragile senior skin with barrier repair or managing teenage acne through early interventionEarly testing in children, nutritional deficiencies, and PCOS/PCOD management: How to uncover nutritional deficiencies, hormonal imbalances, and conditions like PCOS with targeted testingThe key to longevity: Interventions like gentle fasting and adaptogens, combined with avoiding harmful biohacks, can prevent early hormonal issues, supporting longevityAnd much more…

This episode includes extended Q&A sessions that address your unanswered questions from the following presentations delivered at the 2025 Spring Congress in Philadelphia, Pennsylvania:  (00:20) All the Tea on ADHD: Guidance for Developing Effective Treatment Strategies for Patients With ADHD by Andrew Cutler, MD   (20:20) You and I and an LAI: Benefits, Early Adoption, and Options for Patients With Serious Mental Illness Desiree Matthews, MSN, PMHNP-BC and Jonathan Meyer, MD (Q&A with Desiree Matthews)   (38:53) A Practical Guide to Ordering and Interpreting Kidney Function Tests by Rajnish Mago, MD   (59:13) Preventing the Progression From Casual to Casualty: An Update on Interventions for Substance Use Disorders by Hara Oyedeji, APRN, PMHNP-BC, MSN, MSEd and Andrew Cutler, MD (Q&A with Hara Oyedeji)    Never miss an episode!

As BCBAs, each day we walk a fine line between keeping children safe while ensuring our interventions are compassionate, ethical, and effective. Prioritizing safety in behavior management is a non-negotiable and it doesn't have to come at the expense of empathy. Here, we discuss the best ways to balance safety and compassion in our interventions and how to ensure that the individuals we serve are not only protected but also respected and empowered. When developing interventions, it's important to use the least intrusive, most effective strategies. We discuss how to build a foundation of trust and antecedent-based intervention as proactive strategies. We also cover the importance of regulation for both ourselves and our learners, how to determine whether corrective behavior is essential, and how to hold appropriate boundaries.Dr. Hanley's Universal Protocol is a great guideline to have when balancing safety and compassion. Remind yourself of some best practices by downloading our Applying Universal Protocol Cheat Sheet below! What's Inside:How to balance safety and compassion in our interventionsThe importance of building a foundation of trustHow to determine if corrective behavior is essentialMentioned In This Episode:HowToABA.com/joinHow to ABA on YouTubeFind us on FacebookFollow us on Instagram Free Applying Universal Protocol Cheat Sheet Episode 113: How to Maintain Client Dignity in ABA 

On this episode, we discuss chronic coronary syndrome (CCS) and describe its clinical presentation, underlying pathophysiology, and progression. We review current guidelines and evidence-based treatment strategies for managing CCS, including both pharmacological and non-pharmacological interventions. Our primary pharmacotherapy focus was on comparing and contrasting antianginal therapies, but we also touch on antiplatelet agents, and risk factor modification strategies. Cole and I are happy to share that our listeners can claim ACPE-accredited continuing education for listening to this podcast episode! We have continued to partner with freeCE.com to provide listeners with the opportunity to claim 1-hour of continuing education credit for select episodes. For existing Unlimited (Gold) freeCE members, this CE option is included in your membership benefits at no additional cost! A password, which will be given at some point during this episode, is required to access the post-activity test. To earn credit for this episode, visit the following link below to go to freeCE's website: https://www.freece.com/ If you're not currently a freeCE member, we definitely suggest you explore all the benefits of their Unlimited Membership on their website and earn CE for listening to this podcast. Thanks for listening! If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable PowerPoint slides for each lecture. If you purchase an annual membership, you'll also get a free digital copy of High-Powered Medicine 3rd edition by Dr. Alex Poppen, PharmD. HPM is a book/website database of summaries for over 150 landmark clinical trials.You can visit our Patreon page at the website below:  www.patreon.com/corconsultrx We want to give a big thanks to Dr. Alex Poppen, PharmD and High-Powered Medicine for sponsoring the podcast..  You can get a copy of HPM at the links below:  Purchase a subscription or PDF copy - https://highpoweredmedicine.com/ Purchase the paperback and hardcover - Barnes and Noble website We want to say thank you to our sponsor, Pyrls. Try out their drug information app today. Visit the website below for a free trial: www.pyrls.com/corconsultrx We also want to thank our sponsor Freed AI. Freed is an AI scribe that listens, prepares your SOAP notes, and writes patient instructions. Charting is done before your patient walks out of the room. You can try 10 notes for free and after that it only costs $99/month. Visit the website below for more information: https://www.getfreed.ai/  If you have any questions for Cole or me, reach out to us via e-mail: Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com

In this episode, Karen sits down with Rachael Austin, RN, IBCLC—an internationally recognized midwife and head educator for the Thompson Method of Breastfeeding—to unravel some of the most misunderstood parts of the birth-to-breastfeeding journey. Whether you're preparing for your first baby or recovering from a rough start, this episode will open your eyes and give you confidence to trust your body—and your baby.   Timestamps: 03:29 – How Birth Interventions Affect Breastfeeding 05:08 – Nipple Pain & Outdated Breastfeeding Techniques 06:05 – How Pitocin & Epidurals Disrupt Oral Function 09:02 – Alternatives When Breastfeeding Isn't Working 10:19 – Bottle Design & Breastfeeding Confusion 13:13 – Colic, Reflux & Overfeeding Explained 15:31 – Can You Overfeed a Breastfed Baby? 23:30 – Retraining Baby to Breastfeed After NICU/Interventions 24:07 – Proper Latch vs. Common Mistakes 30:17 – The Truth About Newborn Weight Loss & IV Fluids 33:29 – Mastitis, Oversupply & Nipple Trauma 46:35 – Tongue Ties, Lip Ties & Misdiagnosis 51:09 – The Tongue Tie Surgery Boom (900% Increase?) 57:11 – Postpartum Mental Health & Maternal Burnout   Get 50% OFF the Thompson Method Birth & Breastfeeding Course:https://thompsonmethod.com/painfree   CONNECT WITH KAREN: Youtube - https://www.youtube.com/@painfreebirthwithkarenwelton  Facebook - https://www.facebook.com/painfreebirth  Instagram - https://www.instagram.com/painfreebirth/  Spotify Podcast - https://open.spotify.com/show/5zEiKMIHFewZeVdzfBSEMS  Apple Podcast - https://podcasts.apple.com/ca/podcast/pain-free-birth/id1696179731 Website - https://painfreebirth.com/  Email List https://pain-free-birth.mykajabi.com/website-opt-in  

Robin rambles about Mother's Day, the spirit world, book endorsements, coaster etiquette, playoff hockey, and shares some musical tracks from last week's guests, Jonathan S. Rose, and Chelsea Rose Odhner.When You're Not in My Life - Clear Shining After Rain (2016)https://music.apple.com/us/album/clear-shining-after-rain/1114082508May the Bones - Confident Hope (2019)https://music.apple.com/ng/album/confident-hope/1487333177Opening the Inner World Spiritual Healing, Internal Family Systems, and Emanuel Swedenborghttps://bitl.to/4SvmTreatment Plans and Interventions in Couple Therapy A Cognitive-Behavioral Approachhttps://bitl.to/4W7m--Become a supporter on Patreon: https://www.patreon.com/therobinsmithshowGet in touch: robinsmithshow@gmail.comCall the hotline: +1 (301) 458-0883Got a question? We'd love to hear from you!

Dr. Michael Artigues is president of the American College of Pediatricians. Dr. Artigues received his undergraduate degree in Biomedical Engineering from Tulane University in 1988 and medical degree from the University of Mississippi Medical School in 1992 where he also completed his pediatric residency in 1995. He practices general pediatrics in McComb, Mississippi. He has served as a board member and president of the local crisis pregnancy and child advocacy centers and has been a member of the American College of Pediatricians Board since 2014.Children across America have been identifying as transgender in what some have called, "epidemic proportions." In fact, it's almost become a status symbol to be viewed as transgender. Earlier this month, the Department of Health and Human Services released a ground-breaking report which confirms the lack of evidence supporting both the safety and efficacy of transgender interventions both in children and adolescents. This goes against the mantra that's been coming out from many public school systems, as well as the practices of Planned Parenthood and what we've been seeing from Hollywood. This is a many faceted issue that involves aspects such as gender dysphoria, gender affirming care, preferred pronouns, puberty blockers, emotional instability, the suicide factor and more. Review this broadcast and you'll hear these things discussed while listeners called with their opinions both pro and con.

Dr. Michael Artigues is president of the American College of Pediatricians. Dr. Artigues received his undergraduate degree in Biomedical Engineering from Tulane University in 1988 and medical degree from the University of Mississippi Medical School in 1992 where he also completed his pediatric residency in 1995. He practices general pediatrics in McComb, Mississippi. He has served as a board member and president of the local crisis pregnancy and child advocacy centers and has been a member of the American College of Pediatricians Board since 2014.Children across America have been identifying as transgender in what some have called, "epidemic proportions." In fact, it's almost become a status symbol to be viewed as transgender. Earlier this month, the Department of Health and Human Services released a ground-breaking report which confirms the lack of evidence supporting both the safety and efficacy of transgender interventions both in children and adolescents. This goes against the mantra that's been coming out from many public school systems, as well as the practices of Planned Parenthood and what we've been seeing from Hollywood. This is a many faceted issue that involves aspects such as gender dysphoria, gender affirming care, preferred pronouns, puberty blockers, emotional instability, the suicide factor and more. Review this broadcast and you'll hear these things discussed while listeners called with their opinions both pro and con.

Dr. Shannon McLaughlin-David discusses the complexities of cervical cancer, HPV, and the role of gynecologic oncology. The dialogue explores the emotional and clinical challenges faced by both patients and clinicians, emphasizing the importance of effective communication and empathy in patient care. The discussion also highlights the various types of gynecologic cancers, surgical interventions, and the difficult decisions patients must make regarding their treatment options. This conversation delves into the complexities of patient autonomy, the emotional challenges faced by oncologists, and the systemic incentives within healthcare that can impact patient care. The discussion also covers the evolution of cervical cancer screening guidelines, the role of HPV in cervical cancer, and the importance of patient advocacy and education regarding vaccination.Resources & Links:This episode was supported by the Patient Centered Outcomes Research Institute (PCORI) and features the PCORI research study here: https://www.google.com/url?q=https://pubmed.ncbi.nlm.nih.gov/33632649/&sa=D&source=editors&ust=1746483503903350&usg=AOvVaw0SNo_jk-rzoVp85P5E3s6F ‘Effect of 2 Interventions on Cervical Cancer Screening Guideline Adherence'Chapter Codes00:00 Introduction to Cervical Cancer and HPV02:49 The Journey to Gynecologic Oncology05:57 Understanding Gynecologic Cancers09:05 Surgical Interventions in Gynecologic Oncology11:59 The Complexity of Patient Decisions15:07 Patient-Clinician Communication Challenges17:45 The Role of Empathy in Oncology21:05 Navigating Hormonal Treatments and Patient Reactions27:30 Navigating Patient Autonomy and Medical Ethics29:47 The Emotional Toll of Oncology33:00 Understanding the Healthcare System's Incentives35:58 The Role of Patient Advocacy39:05 The Evolution of Cervical Cancer Screening Guidelines51:46 HPV and Its Impact on Cervical Cancer54:48 Current Screening Protocols and HPV VaccinationConnect with Us:Enjoyed this episode? Make sure to subscribe, rate, and review! Follow us on Instagram, Facebook, or Linkedin @mantacares and visit our website at mantacares.com for more episodes and updates.Listen Elsewhere: Website: https://mantacares.com/pages/podcast?srsltid=AfmBOopEP5GJ-Wd2nL-HYAInrwerIVhyJw67salKT-r9Qb_gadBvbHie YouTube: https://www.youtube.com/@mantacares/videosSpotify: https://open.spotify.com/episode/0rSG16JUXGnRmOPfpJSplS?si=ayogPMUMT4eHJclXn6_5xA Apple: https://podcasts.apple.com/us/podcast/the-microbiomes-impact-on-colorectal-cancer/id1622669098?i=1000705538270 Tags & Keywords:cervical cancer, HPV, gynecologic oncology, patient communication, surgical interventions, women's health, cancer treatment, patient empathy, decision making, hormonal therapy, patient autonomy, medical ethics, oncology, healthcare system, patient advocacy, cervical cancer, HPV, screening guidelines, emotional toll, healthcare incentives#Storytelling #Identity #Representation #Authenticity #Podcast #Culture #CancerAwareness #MedicalPodcast #CancerSurvivor #Oncology #Healthcare #CancerSupport #PatientStories #CancerResearch #HealthPodcast #CancerCommunity #SurvivorStories #MentalHealth #Wellness #HealthcareInnovationDisclaimer:All content and information provided in connection with Manta Cares is solely intended for informational and educational purposes only. This content and information is not intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.This episode was supported by an award from the Patient-Centered Outcomes Research Institute.

Chapters 00:00 Introduction to Luke Nelson 02:55 Running Journey and Injuries 06:02 Understanding Hamstring Tendinopathy 08:47 Overuse vs. Overload in Tendon Injuries 12:08 Differential Diagnosis of Hamstring Pain 15:05 Role of Imaging in Diagnosis 18:03 The Understudied Area of Hamstring Tendinopathy 20:50 Managing Daily Activities and Pain 23:52 Rehabilitation Strategies for Hamstring Tendinopathy 31:56 Understanding Hamstring Tendon Rehabilitation 36:17 Strength Training for Runners 41:06 Assessing Muscle Atrophy in Injuries 44:29 Managing Running Frequency and Intensity 47:23 Incorporating Plyometrics in Rehab 49:05 Long-Term Recovery Expectations for Tendinopathy 53:24 Function vs. Pain in Rehabilitation 59:32 Targeting Muscle and Tendon Adaptations 01:00:35 Running Technique and Proximal Hamstring Assessment 01:05:25 Rehabilitation Strategies for Running Technique 01:10:03 Interventions for Proximal Hamstring Tendinopathy 01:15:44 Field Sports vs. Distance Running Rehabilitation 01:17:27 Distal Hamstring Tendinopathy Insights 01:20:24 Metabolic Tendinopathy Considerations 01:23:11 Reflections on Knowledge and Experience Takeaways Luke Nelson is a sports and exercise chiropractor with 20 years of experience. He has run 10 marathons, with his latest being his fastest. Luke has experienced various running injuries, including hamstring tendinopathy. Hamstring tendinopathy can significantly impact daily life, not just athletic performance. The distinction between overuse and overload injuries is crucial in rehabilitation. Imaging is not always necessary for diagnosing tendinopathy. Hamstring tendinopathy is often under-researched compared to other tendon injuries. Daily activities, such as sitting, can exacerbate hamstring pain. A multifaceted approach is essential for effective rehabilitation. Strengthening exercises, particularly hamstring curls, are vital in recovery. Early hamstring rehabilitation focuses on building capacity and strength. Runners often lack strength training, impacting their recovery. Incorporating heavy lifting and compound movements is crucial. Plyometrics can enhance performance and aid in rehabilitation. Managing running frequency is essential for tendon recovery. Pain levels may not correlate directly with functional improvements. Capacity testing is vital for assessing recovery progress. Long-term recovery from tendinopathy can take over 12 months. Flare-ups during rehab are common and should be managed. Muscle and tendon adaptations should be targeted separately.  Running technique significantly impacts proximal hamstring load. Trunk position and over-stride are critical factors in assessment. Flexibility in runners may not always correlate with performance. Rehabilitation strategies should focus on individual needs. Shockwave therapy has mixed results for tendinopathy treatment. Field sports present unique challenges in managing injuries. Distal hamstring tendinopathy is less common but still relevant. Metabolic conditions can trigger various tendinopathies. Continuous learning and adaptation are essential in rehabilitation. AI may play a future role in predicting running injuries. Luke on Instagram: https://www.instagram.com/sportschiroluke/?hl=en Luke on Twitter: https://x.com/SportsChiroLuke Website: https://www.healthhp.com.au Notes: https://jackedathlete.com/podcast-146-proximal-hamstring-tendinopathy-with-luke-nelson/

Liara presents with relapsing-remitting multiple sclerosis with complaints of fatigue and difficulty walking. She reports worsening symptoms in the afternoon but denies any new relapses. Examination reveals mild spasticity in the lower limbs, decreased endurance, and poor postural control. The patient works as a teacher and finds it challenging to maintain energy throughout the day. Which intervention is MOST appropriate to improve the patient's functional mobility and address her symptoms?A) Aerobic training at moderate intensity with frequent rest breaksB) Strength training with resistance bands targeting lower extremity musclesC) Cooling strategies during physical activity to improve enduranceD) Balance training on a foam surface to reduce fall riskJoin the FREE Facebook Group: www.nptegroup.com

If your kid refuses therapy, what other options are there?Or maybe they don't refuse therapy, but you'd still like to increase the therapeutic support for your child and family.Here are 20 different non-therapy therapeutic supports based on Dr. Perry's work of ‘moments of healing' and experiences that are rhythmic, repetitive, relational, and somatosensoryOver on my website, you can download a handout that lists them all out (and was generated with the help of AI) so you don't have to take notes!Resources mentioned in this podcast:Moments of Healing PodcastHow the Brainstem Heals {EP 49}Equine-Assisted Trauma-Informed Psychotherapy {EP 51}Read the full transcript at: URL goes hereFollow Me On:FacebookInstagramOver on my website you can find:Webinar and eBook on Focus on the Nervous System to Change Behavior (FREE)eBook on The Brilliance of Attachment (FREE)LOTS & LOTS of FREE ResourcesOngoing support, connection, and co-regulation for struggling parents: The ClubYear-Long Immersive & Holistic Training Program for Parenting Professionals: Being WithMaking Sense of Baffling Behaviors: A FREE audio-only training for professionals who work with the families of kids with big, baffling behaviors!Yes! FREE! You'll listen on your own time, right in your podcast app.RobynGobbel.com/BafflingBehaviors for all the details and to sign up!It starts May 5 and will be available to listen to until May 12. But don't wait to sign up! Check Out All Robyn's Free Resources!You can download all sorts of free resources, including webinars, eBook, and infographics about topics such as lying, boundaries, and co-regulation!RobynGobbel.com/FreeResources :::The All-About-Me workbook will help your child grow their owl brain and develop ways to calm their watchdog and possum brain. 24 page, full-color, instant download at RobynGobbel.com/store :::Buy Raising Kids with Big, Baffling Behaviors at RobynGobbel.com/BafflingBookJoin The Club (or get on the waiting list!) over at RobynGobbel.com/TheClubHop on the waiting list for Being With- an immersive professional training program exploring the neurobiology of big, baffling behaviors at RobynGobbel.com/BeingWith

Fri, 25 Apr 2025 19:00:00 GMT http://relay.fm/rd/259 http://relay.fm/rd/259 Cascade of Interventions 259 Merlin Mann and John Siracusa Stop blaming the dog. Stop blaming the dog. clean 5939 Subtitle: Consider the Banana.Stop blaming the dog. This episode of Reconcilable Differences is sponsored by: Yawn Email: Tame your inbox with intelligent daily summaries. Start your 14-day free trial today. Grist: A modern, open source spreadsheet that goes beyond the grid. Try it for free today. Links and Show Notes: Things kick off with a second episode in which John has to force a context transition, then Merlin commiserates about how bad apps and institutions can be. In Follow-Up, Merlin introduces both new data and new methodologies to Things It Took Me Too Long to Realize, and John shares yet another instance of erroneously blaming an animal for something bad happening. Topic one seems like it'll be a topic about how an aging gentleman grooms, but then it ends up being about follicle madness, acceptance, and retaining the sort of friends who'll tell you when your fly is down. Finally, John has a really good music topic that ends up going into feelings and the sublime subtleties of ardent fandom. (Recorded on Tuesday, April 15, 2025) Credits Audio Editor: Jim Metzendorf Admin Assistance: Kerry Provenzano Music: Merlin Mann The Suits: Stephen Hackett, Myke Hurley Get an ad-free version of the show, plus a monthly extended episode. The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease and Other Dementias Kirk Cameron and Ray Comfort on "The Atheist's Nightmare": a banana Don't blame the penguin 10 Ways to Tell Someone Their Fly Is Unzipped - Reddit What to Say When Someone's Fly Is Down Fortress: The London Symphony Orchestra Performs the Music of Sting - Amazon Fortress: The London Symphony Orchestra Performs the Music of Sting - YouTube True Love Waits - Christopher O'Riley Plays Radiohead I Was Born for This (Soundtrack version) I Was Born for This - Live with the Swedish Radio Symphony Orchestra D.H.T.'s cover of Listen To Your Heart - YouTube Threes video game soundtrack - YouTube Doctor Who, The End of Time: Part 2: This song is ending, but the story never ends - YouTube L

On this episode of Technically Leadership, Chris Leonard joins to talk about the costs of intervention in a team discussion, whether that's to bring a team back to a topic or to make a decision that needs to be made. We discuss hero culture (both in the team and as the leader), imposter syndrome, and... Read more »

Lorren sustained burns to his right forearm and hand while working with hot oil. The burn area is red with blistering, and the patient reports significant pain. On examination, capillary refill is intact, and the wound blanches with pressure. The patient is referred to physical therapy to prevent complications during the early phase of healing. Which intervention is MOST appropriate during the initial phase of rehabilitation?A) Daily aggressive stretching to maintain range of motionB) Moisturizing and scar massage to prevent contracture formationC) Gentle range of motion exercises to prevent joint stiffnessD) Compression wrapping to reduce hypertrophic scarringDOWNLOAD THIS EPISODES CHEATSHEET:www.nptecheatsheet.com/burns25